According to Skouteris (2012: 664), citing a survey of the American College of Obstetricians and Gynecologists, ‘body image concerns are largely ignored by physicians working with pregnant women’. However, such concerns do attract attention in the public sphere. Docx (2014) quotes Germaine Greer on the Duchess of Cambridge's second pregnancy: ‘The girl is too thin… she is vomiting her guts up and shouldn't have been made to go through all this again so soon.’ Meanwhile, some with an interest in Kim Kardashian's second pregnancy judged the celebrity too fat (King, 2015).
Yet some health professionals seem reluctant to engage with the topic of body dissatisfaction in pregnancy, which Skouteris (2012: 664) states is associated with depression, anxiety, low self-esteem and ‘unhealthy eating and extreme weight loss behaviours, which have serious negative implications for women's health and wellbeing and potentially also for the unborn fetus’.
As the title of a recent UK questionnaire-based study of 128 pregnant women shows, ‘Body image concerns during pregnancy are associated with a shorter breastfeeding duration’ (Brown et al, 2015). Lead author of the study, Associate Professor Dr Amy Brown of Swansea University, told BJM: ‘Mothers who were more worried about their weight and appearance were more likely to see breastfeeding as embarrassing, to not want to breastfeed in public, and to worry about the impact of breastfeeding on their breasts.’
Dr Brown said that wanting to lose weight and go on a diet were often key reasons given for stopping breastfeeding, with new mothers feeling pressure to get back to their ‘pre-pregnant selves’. These social and cultural pressures, she added, ‘have a damaging impact on breastfeeding, pressurising mothers to feel ashamed of themselves… rather than considering the importance of breastfeeding for both infant and maternal health, and ultimately… saving money through reduced NHS costs.’
A recent UK/Israeli study that examined the relationship between self-esteem, restrained eating, body image and body mass index during pregnancy found that mothers who restrained their eating during and after pregnancy were also likely to limit the amount of food given to their infants before the age of 6 months (Shloim et al, 2015). Lead author of the study, Dr Netalie Shloim—a trained psychotherapist and researcher at the University of Leeds—said: ‘Our study findings also indicated that mothers with higher levels of body dissatisfaction during pregnancy had negative body image in the postpartum as well, and this again was positively associated with their feeding behaviours.’
Dr Shloim added: ‘Midwives have a unique opportunity to identify those mothers who are at risk for developing unhealthy eating behaviours, and who are dissatisfied with their body and experience negative wellbeing. By supporting and empowering them, we are likely to identify a more positive mealtime interaction.’
Hopper and Aubrey (2015) cite studies showing an increased focus on pregnant and postpartum celebrity bodies in popular women's magazines in Australia and the UK. Commenting on this trend, Dr Shloim said celebrities who show an unrealistic body size during pregnancy and the early postpartum have a major impact on the negative body experience many women face: ‘Pregnancy is the time when women should focus on their own wellbeing and that of their fetus. They should eat healthily and try and enjoy this unique time. However, being constantly exposed to unrealistic body sizes modelled by celebrities increases the levels of body dissatisfaction, and increases women's attempts to restrain their eating.’
Researchers such as Brown and Shloim attempt to address body-image-related problems by evaluating evidence and applying good sense. By contrast, some authors appear to believe the postpartum female body presents a problem to which cosmetic surgery is the solution. Matarasso and Smith (2015: 245) consider ‘strategies for aesthetic reshaping of the postpartum patient’, noting that ‘the abdomen and breasts are the regions most visibly affected by pregnancy…’ and suggesting that ‘numerous aesthetic units of the trunk and surrounding regions’ attract the concern of those patients keen to pursue ‘postpartum body contouring’.
It seems to me that Matarasso and Smith think that postpartum women are justified in steering away from the notion that our bodies necessarily bear the marks of our passage through life. Their chilling conclusion (2015: 255) is that ‘the demand for postpartum body contouring continues to rise—and the “mommy makeover” population has been “born”—as generations of women who are increasingly concerned with their appearance age after pregnancy.’
Perhaps midwives have a role to play in emphasising the idea that the pregnant and/or postpartum body should be a source not of shame, but of pride.