Two for the Price of One: The Impact of Body Image During Pregnancy and After Birth - by Susie Orbach and Holli Rubin


Body image concerns are widespread. The conjunction of body image distress and disturbances in eating have either been seen as rather trivial or as medical psychiatric issues. This has meant that they have rarely been in focus in considering health policies for expectant mothers.

Women’s concerns are anything but trivial. They are making women feel deeply uneasy in their bodies. They are disturbing women’s eating patterns. They are impacting on how women relate to their physical needs in pregnancy and post—partum, interrupting the focus on bonding with baby in the crucial early months when attachment behaviours are being established (Easter et al., 2013.; Orbach, 2005). Keywords: body image, pregnancy, postpartum, eating, bonding Becoming ‘an ordinary devoted mother’ (Winnicott, 1960) is not as natural a process in our times as we might wish.

The first few months of life are critical in establishing the foundations for well-being in the mother—infant couple and for the building of security and resilience in the baby. From Bowlby’s work on Attachment (1969) to neuro~scientific studies showing the effects of brain development, motor development and the uptake of specific hormones as soothers for babies, the picture is clear. Becoming ‘an ordinary devoted mother’ (Winnicott, 1960) is not as natural a process in our times as we might wish. Women’s relationship to their bodies, including their feeding of themselves, combined with the avalanche of often contradictory information telling them how to settle and feed their babies, meets messages from the media which represent pregnancy and post pregnancy as an opportunity to target them about their size as though the most important thing about giving birth is the retrieval of the preipregnant body (Orbach, 2009). Media images that laud celebrity mothers who achieve a state of emaciation six weeks after delivery are switching the focus of the post-partum period away from mother and baby getting to know each other and finding a rhythm together. Instead, there is a cultural insinuation that a mother’s job is to present herself physically as though nothing as life— changing or bodyschanging as having a baby has occurred. This critical moment in which new life and the new mother weave together a delicate and precious bond needs supporting in order to ensure the best possibilities for both.


Pregnancy is a time of hope, joy and promise. Many women enjoy being pregnant. They revel in their growing roundness and feel good both on the outside as well as the inside. Hormonal changes are having a positive effect. For others, discomfort about bodily changes causes worry and creates a background of anxiety about how large they are and whether they will ever get their bodies back. They feel out of control. For still others, the difficulties are far more serious. There is considerable despair about how they look (lemberg 8: Phillips, 1989). They are discontented and focused on feeling fat. They feel exempted from the hype and excitement around being pregnant. The lack of a ‘blooming pregnancy’ contributes to a sense of guilt and confusion. They aren’t able to surrender to their body’s changes. The midwife encounters all of these concerns. If a woman has always managed her body by strict guidelines regarding food and exercise regimes, she is now confronted by a body which seems to have a mind of its own. It is in rebellion. The pregnant body is felt as alien rather than natural and its changing can alarm her. Her diet is disrupted and she becomes anxious. If she has always over—eaten, then she will not necessarily know how to eat appropriately in pregnancy. She may misinterpret bodily signals and ‘over’ eat to quell morning sickness, distancing herself further from her bodily needs. Her emotional need to eat will provide the rationale for eating for more than two (Park et al., 2003).

Holli RubinFulham Osteopaths