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anorexia and pregnancy

760 Views 9 Replies 6 Participants Last post by  hippiemom
Hi all,
I am working with a doula client thru my clinic who has a clear case of anorexia nervosa. She is 18 weeks and losing weight, looks malnourished. She is often dizzy, claims not to have enough money for food, though she is hooked up with WIC and food stamps. She just does not want to eat. I tried to counsel her a bit; I gave her a handout that breaks down what the weight gain of pregnancy is (baby, placenta, breasts, blood, fluid, etc), emphasizing that it is not just getting "fat", but I know that anorexia is not really a food issue so much as a control issue... she will be seeing a counselor for eating disorders tomorrow, and has been told by the MW's that she needs to gain 5 lbs by next week or be hospitalized. She had an extreme episode of dizziness in my office, poor girl..

Yes the cheery cases all come to me!

anyone ever work with this? I think it is outside the scope of what many of us do, I will of course offer support but am glad she is seeing a specialized counselor as well. I think trying to have her learn about the baby's growth andhow that works and depends on her will help her focus on the BABY, to let her know she can be in control of her baby's good health through good nutrition, etc... suggestions welcome, merci~
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I've worked with it a bit. One summer i thought I might have inadvertantly gotten a sign that read "have an eating disorder, I'm your midwife"

With one of them, the number of calories daily was an 'assignment' She ended up removing all full length mirrors from her home, and had only small oval mirrors.

We used the FES flower remedy called "Pretty Face" with good results.

I have to go take my chlidren to the pool, so I'll come back and type more later.
Haha, yes I think I wear a sign that only others can see... "Desperate? I'm your doula!"

The MW's are assigning "homework" for her as far as eating/gain. She is not forthcoming about having an eating disorder, but of course we can see it. We are also trying to emphasize how she is the mama now, an adult, in charge of making her own choices, sort of the "empowerment" route where in the past she may have felt out of the driver's seat.. we'll see, thanks for all input. Kids to the pool, yes! Not much time left for that, we go back to school before Labor Day here... then it will be winter (New England)
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Wow... that would be a difficult thing. I have worked with women that have eating disorders - but not in pg. I'll be watching for more information and suggestions here...
I have not experinced a client with an active ED, but I do have anorexia and bulimia myself and my last pregnancy is still fresh to me (youngest is only a year).

I personally found that most tradtional forms of support and help for my ED were not helpful at all, I was even told wanting to eat organic/vegetarian food was all part of my eating disorder and *healthy* eating was eating meat and the processed/refined foods served in treatment.. i was given meds that are dangerous for women with bulimia because my GD was so uneducated.. seeking help (at least for me) was not at all empowering and drove me deeper into a state of despair.

I was forth coming with my midwives and my partner was well aware of the dangers i was facing emotionally and physically, but it was a constant struggle and still is with breastfeeding.

I relied HEAVILY on taking vitamins and i learned which teas i could drink for noutrional benefit as well. I drank a lot of nettle and alfalfa tea and took supplements.
You could also recomend meal replacment supplements- the little milk shake meal replacers- some women with ED find it easier mentally to injest a drink than eat a meal. Or to take a tablespoon a day of flax seed oil for healthy fat intake.

Often the *act* of eating is the problem. your survival instincts can reverse to the point that putting food in your mouth is impossible. Because this disease is so hard to treat and so may medical proffesionals are so very un-schooled about it- a lot of women are pressured or threatened with things like gaining five pounds or else a hospital stay. I should point out the not eating when you have anorexia is NOT a choice. If being hospitalized is what is needed, than giving the girl a torturous week of fighting against a disorder that controls her entire thought process will possibley just hurt her more.

I stopped weighing myslf during pregnancy, and I more put stake in my fundal height mesurements- I made sure i was getting the nourishment i needed but i still did not take in much fat at all. I did not gain much weigth but had a healthy happy homebirthed baby. WIth my third son the entire pregnancy i lost 10 pounds adn he was still anine pound healthy baby..relying on weigth alone to assess the health of an anorexic client will not always paint a picture.. her dizziness and appreance will tell you more as it has thus far. But she could eaily pull her health around and not gain and be filled with fear because so much energy is placed on the actual weight gain.

If she is seeing a GD i suggest getting her blood sugar levels checked and her hemaglobin. If she is not eating she is likely dizzy due to anemia.
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When I did online abuse counseling, I also conversed with many ED women and a few of them were pregannt. I, myself, had a short stint with what I would call a "short lived eating disorder" that I really wanted to kick in the butt before I got pregnant (and I did). What I learned from the women with EDs who were pregannt was that they needed love and support, they needed to ditch mirrors and scales and focus on other ways to know they and their babies were healthy. Making sure they got plenty of water to stay hydrated. Encouragement to drink things like protein drinks or things of that nature. No nagging. They realized they were pregnant and that a baby was growing in there and that their not eating or vomiting or what have you could seriously impact their unborn baby, and themselves, but they didn't want to hear it harped at them. The ones who had good support systems fared the best. The ones who ditched mirrors and scales and spent time feeling their babies move and checking fundal height and being active in their care did the best. I wish I had some really awesome advice and I wish I still had access to those women sop they could help you help your client.

Namaste, Tara
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I've only ever had experience with women who had a history of anorexia, not an active problem (the history is Issue enough!), and you've gotten really good advice already, so I just wanted to offer you a
. Pass in on to your client if she's open to it.
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I found miso soup is really a great way to get protien and electrolytes into moms with ED's because it doesn't 'feel' heavy and it is healthy.

I do have a scale at my office, but almost no one ever steps on it.

The thing is, the women I worked with WANTED healthy pregnancies and were forthcoming about their issues. They were very motivated ladies (as most women with ED's are...sometimes being a control freak is a good thing) and worked very hard to be healthy. Yes, they were obsessive about organic and pure foods, but SO WHAT? I wish more women cared what they put in their bodies. I certainly don't think that is 'part of the problem' ARG.

This lady not aknowledging her issues is a problem. I pray that she will have heard your words in her heart, and will take action to care for her unborn baby.

Originally Posted by midwifetx
This lady not aknowledging her issues is a problem. I pray that she will have heard your words in her heart, and will take action to care for her unborn baby.
I fully understand where you are coming from.. but just from my personal experince. Sometimes when people could not distinguish between my disease and my concious *caring* of my self or my children It only ended up hurting me more.

Not everyone realizes they have a disease- and still even when you do all the love in the universe for your baby will not make the disease go away.

I agree i hope the words penetrate- and do not cause vast guilt on top of her exisiting pain.

i wanted to mention as well, for the doula atteneding her birth- most cases of ED can be traced back to sexual abuse. Not all of course but many! But when it comes to supporting her it might be an issue??
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WOW thank you again all! I admit I was up very late last night thinking about all of this. I printed this whole thread so I could take it to my workplace and just read it over, lots of good advice here. I am putting together herb teas, this might go over well, and she will take supplements and claims to eat chicken and cream of wheat. Hell we can do a lot with that! Fruit/veg juices, miso is a great idea, and how about those tasteless protein shake things that people use when they work out? These are possibilities.

I don't want to pressure her to eat, gain weight, or harp on her about the baby. I just want to try to help her thru this pregnancy, frankly with minimal damage to her body. I think the baby will get what it needs from her stores, and she will suffer.. I will tackle it from the angle of helping her anemia, fatigue, low BP, skin color, etc. And concentrate on fundal height and movoment, great tactic I think. REALLY, it is not a weight thing at all, where her overall weight does not tell us anything about the baby, so that can be taken out of the equation, I agree, thrown out with the mirrors and scales.

I have to consult with the MW's about her, thank you THANK you for your words here, and for the courage to share Hawkfeather, another mama will benefit from what you have taught me.
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