Eating disorders in pregnancy: practical considerations for the midwife
Women who have eating disorders represent up to 8% of pregnant women today. The risks to both a mother and her baby are significant if an eating disorder is present. It is important that midwives have the knowledge, skills and confidence to enquire about eating disorders with women early in the pregnancy, and are also aware of the clinical signs of eating disorders, in order to recognise these situations. Midwives should use sensitive and compassionate communication skills when caring for women who have eating disorders, who have complex psychological feelings that may affect their behaviour. The symptoms of eating disorders may improve during pregnancy but midwives should be aware of the effects of childbirth. The postnatal phase is an important period for a mother who has an eating disorder, as her symptoms may recur, and midwives should therefore work in partnership with key members of the multidisciplinary team.
It is estimated that 5–8% of women may be experiencing an eating disorder in early pregnancy (Micali et al, 2016; Bye et al, 2018a). Eating disorders fall into four main categories: anorexia nervosa, bulimia nervosa, binge eating disorders and other specified feeding or eating disorders (OSFED). Prevalence rates of each are variable, however, and research indicates that there are similar numbers of women with anorexia nervosa, bulimia nervosa and binge eating disorders, with an increased number of those with OSFED (Bye et al, 2018a). Although eating disorders can develop at any age, midwives should be aware that the risk is highest for young men and women aged between 13–17 years (National Institute for Health and Care Excellence (NICE), 2017), and that it may therefore have an effect across a woman's childbearing years.
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