Five months ago, in my tenth week of pregnancy, I was out shopping with a friend. We noticed a woman much further along standing at the register. “It’s crazy that in a few months, you’ll be as big as her,” my friend said excitedly. I didn’t respond; instead, I felt a twinge of nausea — and not the familiar, first-trimester type I’d grown used to. In pregnancy, a woman sheds the social expectation that she be small, as she now has more important things to do with her body. But still, even after seven months of pregnancy, I can’t pretend I’ve grown accustomed to it.
I was bulimic as a teenager and into my early 20s; I can still tell you the location of every single-stall bathroom on my college campus. After ten years or so of treatment, which included therapy and antidepressants, I recovered and let go of the specific behaviors driving my eating disorder. But I was still at a loss when it came to the arduous task of feeding myself, so I spent two years in my 20s working with a nutritionist on figuring out a game plan. Together, she and I solved the more logistical problems, and my body recovered. I would never go so far as to say I’ve achieved a healthy relationship with food though. I think about food constantly.
For years, I worried I wouldn’t be able to get pregnant because of the toll my eating disorder had taken on my body. I didn’t investigate it much — I just convinced myself it wasn’t something I needed, anyway. It took until my early 30s, when I met my husband, to not only to consider getting pregnant, but to very much want to.
I had all the usual fears about pregnancy — What if my baby doesn’t grow ears? What if the moment she comes out, the doctor says “she’s permanently messed up and it’s because you didn’t give up coffee, unlike the other moms, who are better than you”? — coupled with more serious concerns about my eating habits. Really, I was more afraid of letting my eating disorder control me than anything else. As my husband and I began trying, I started to seek out information on how to navigate pregnancy with an eating disorder, or with any type of unhealthy relationship to food. Common refrains included “listen to your body’s natural hunger cues” and “don’t be afraid to eat.” I am not in touch with “my body’s natural hunger cues.” I feel my body’s natural hunger cues about once every six months, only in extenuating circumstances in which I’ve planned poorly, and the cue is extreme light-headedness. As for “don’t be afraid to eat” — that’s really good advice, why hadn’t I thought of that sooner?
I got pregnant and continued my research, but I still couldn’t find much information. I asked my doctor if she had recommendations for women who’d struggled with eating disorders. She assured me I wasn’t alone — an estimated 5 percent of pregnant people have eating disorders, and research suggests pregnancy may exacerbate or cause them — but her advice was as vague as much of what I’d read online: Eat when you’re hungry, make sure you’re getting enough protein, don’t try to restrict calories. She said she would tell me if anything was wrong with my pregnancy, which I assumed was true regardless.
Even before pregnancy, I found it hard to find information on eating disorders, since they’re often hidden. There are many reasons why: embarrassment, denial, not wanting to trigger others, not wanting to begin treatment. In fact, only about 25 percent of women with eating disorders ever seek treatment. According to Dr. Pernille Yilmam, neuroscientist and founder of Mind Blossom: “EDs are notorious for embedding people’s minds with negative beliefs about themselves, their worth, and their abilities. For many, they only feel safe living with the ED, so asking someone to get treatment is like asking someone to give up their boat in the open sea.”
In pregnancy, that secrecy and shame seemed to compound. I found a few first-person accounts of pregnant people with eating disorders, which I very much appreciated. But perhaps because of the tendency for reticence, the most plentiful source of information was in anonymous Reddit threads. The shame was evident immediately: Many started with “please don’t judge,” or even “I know I’m terrible but …” before confessing to an eating disorder that persisted through pregnancy. I took comfort in the volume of replies. The poster wasn’t alone, they’d say, she wasn’t terrible, and no one is a perfect mother. Others assured her that the constant medical monitoring of pregnant women can pick up on many complications before they become serious, or shared stories of spending their entire pregnancy struggling with food, only to have perfectly healthy babies. Others shared concrete advice liking asking not to be weighed at the doctor, for example. The main benefit of the threads, though, was the reminder that I wasn’t alone. I wasn’t the only one who’d noticed that a lifetime of internalized investigation into what other people think of my body doesn’t just evaporate the moment the test strip turns blue.
I didn’t post myself, but I shared the shame of the women who did. As Allyson Ford, eating disorder and OCD therapist, told me, describing reasons why shame and eating disorders become more entwined in pregnancy: “The most pervasive one I see in clinical practice is the internalization of the ‘perfect mother myth.’ This harmful social construct says that mothers must be nothing but joyful and energized to bring children into the world. No one wants to harm their child, so in order to avoid being perceived as a ‘bad’ mother, many birthing parents with eating disorders suffer in silence.”
She articulated my exact fears, that to admit to problems with eating during pregnancy is to admit to failing at your first task of motherhood: feeding the baby. A mother is expected to sacrifice everything for her child for the rest of that child’s life, so naturally, I felt embarrassed that by week seven in utero, when all that was asked of me was to sleep, eat, and take prenatal vitamins, I was already giving in. Surely, this was the easy part. I should be able to set aside any of my own needs, and even my own mental illnesses, for the sake of the baby.
I’d heard others describe pregnancy as the one time a woman can eat freely, which is not only a very casual way of describing one of the darker aspects of womanhood, but also was nothing like my experience. Any hope I’d had that eating would be “simple” during pregnancy evaporated very early on. Instead, pregnancy doubled my anxiety about food; now I worry about overeating and undereating, when I used to just worry about the former. At first glance, you’d think these concerns might cancel each other out — any time I’m worried about overeating, I can at least assure myself I’m not starving the baby, and vice versa — but no. It didn’t work out that way. And to make matters worse, my nutritional needs changed in a way that required me to put more thought into food, not less. I couldn’t eat anything without asking if it was something I’d feed a baby, which is illogical, as they only drink milk or formula. At one point, I was diagnosed with low iron. I panicked that I hadn’t been eating enough meat. Two days later, after three burgers, I panicked that the processed meat was going to set not just me but also my child up for a lifetime of digestive issues and probably bird flu. Who knows how long bird flu lasts in fetuses?
Clearly, I needed a solution that I wasn’t finding online or at the doctor. So I decided to handle eating during pregnancy the same way I handle eating in general: clinically. I worked backward from a guide of recommended weight gain per week for a woman of my height and weight. Then, I calculated how many calories to add to my diet per day. I factored in a few other concerns — increasing my iron and protein, for example — and I was off. There is nothing less intuitive than my strategy, and also, I can’t really conceive of anything else that would have worked for me. (Also, my French friend told me my “strategy” is very common for pregnant women in her country. Which I suppose is something of a relief.) It also doesn’t work out perfectly; water retention, for example, throws off my plans.
Pregnancy lasts nine months. That’s a long time to go without a reprieve. And I had only one: the growth scans. I was mollified when I learned the doctor could measure the size of the baby directly, as though I could assure myself I was doing okay if my baby was growing at the “correct” rate. And so far, she has, which I’ve found the need to tell everyone, particularly anyone who says I look small for whatever trimester I’m in. “My baby is in the 57% percentile!” I say, “I’m doing enough!” I’ve found the experience of each new growth scan so reassuring, in fact, that I soon began inventing reasons to get extras. Sometimes — like when I slipped on ice, or when I couldn’t feel a kick — the doctor complied. Other times — like when I said the baby just “felt small” — she did not. But there’s a flip-side to my solace: a sense of foreboding that if my baby ever loses ground on a scan, I’ve failed her. Again, there’s no rhyme or reason to this; the scans are estimates anyway and there are a million reasons outside a mother’s control why a baby might be small. I don’t fear having a small baby — I fear causing it.
I worry about how my relationship to food will change post-partum, but I’ll just have to deal with that when I get there. I know treatment is available. According to Dr. Yilmam: “Treatment can help everyone who is struggling with an ED, including people who are pregnant. There are many different types of treatment a pregnant woman might want to seek out, including working with a psychiatrist, a therapist, and dietician, ideally all of whom are specialized in EDs.” She also detailed changes the medical community can make to support pregnant women with eating disorders, including more targeted screening for those who might have trouble sharing them.
For now, though, I’m just trying to get through the next two months. The third trimester has been slightly easier. I’m better at listening to my body, probably because my hunger now would be difficult to ignore. None of the logistics have been quite as confounding as the expectation that it’s supposed to be easy. That as soon as a woman becomes pregnant, she’s supposed to completely flip her perspective on her body. Pregnancy makes loud what was once quiet: changes to a woman’s body. And yet, women who struggle with this are expected not to talk about it. Where’s the logic in that?