Leila remembers shoving her finger down her throat until her lunch emptied into the toilet. She hoped the baby growing inside her, now six months along, would be okay.
It would be easy to dismiss this scenario as something that never happens. It's hard to understand how any mother would deny her growing baby the nutrients it needs to thrive. In fact, for women like Leila, who have struggled with a history of eating disorders, anxiety or body image, pregnancy is a high-risk time for this mental-health issue to resurface. It can even affect women who have never been diagnosed with an eating disorder.
"The only [people] who knew I had an eating disorder during my pregnancies were my husband and my eating-disorder counsellor," says Leila, who agreed to be interviewed on condition of anonymity. "I felt it was a form of child abuse and I did not want people to judge me. I was scared about what would happen to my babies and how this disorder would affect them. The only way I justified my behaviour was by thinking that some women naturally throw up during pregnancy."
Her eating disorder began at the age of 16, says Leila, now 36, healthy and a mother of two. "I was binging seven times a day. It was like a natural instinct. I would even do it at work, at home and in public. I would drive around, buy fast food and if I didn't have access to a private bathroom, I would throw up in the public washroom. It was horror."
She began to seek treatment with an eating-disorders counsellor before her first pregnancy, and felt in control during the first few months. But by the third trimester, things changed. "I wanted to manage the amount of weight I gained and I found it difficult to see my [body] getting bigger. I was dealing with an inner battle."
The latest statistics from researchers at Toronto's University Health Network and the Centre for Addiction and Mental Health indicate that up to 500,000 people in Canada struggle with an eating disorder. Experts say the condition is under-reported in pregnant woman and difficult to track, but a 2013 study published in European Eating Disorders Review reported that one in 14 pregnant women in the U.K. has an eating disorder.
"It's the secrecy of shame," says Deborah Berlin-Romalis, executive director of Sheena's Place, an eating-disorder support centre in Toronto. "It is such a taboo subject; as taboo as using drugs and alcohol during pregnancy."
The stakes are high: Pregnant women with eating disorders are prone to obstetric complications, and the fetus can experience low birth-weight, growth issues and vitamin deficiencies that can lead to more severe conditions.
Weight gain during pregnancy can be a difficult reality even for those without a history of body-image issues; but for women who have struggled with them, the anxiety caused by the changes to the body can push them over the edge.
Berlin-Romalis believes women face immense social and professional pressure to get back to their prebaby body weight, which, in part, stokes the fire. "We go on Facebook and feel that everyone else looks happier, thinner and more successful," she says. "You hear how quickly models and celebrities shed their baby weight, but what is this saying to women? Being a new mother is an incredibly vulnerable time and if you have any mental-health predisposition, it's a high-risk period for it to resurface."
Experts say reaching out for help and breaking that isolation is the first step toward feeling better. "You need to find a health-care provider or mental-health-care provider experienced in working with these issues," Berlin-Romalis says. "One of the things we find is that many health-care providers do not understand and can unintentionally deepen the harm by saying inappropriate things, such as "Just eat," "It's just a phase" or "You're just having a bad week; get outside."
But even for those who do want to ask for help, the right services can be hard to access due to lack of child care, nearby clinics, or shame.
"Women with eating disorders have high rates of postpartum depression and anxiety, but may not access treatment because they don't want others to know, or because many postpartum-depression programs fail to consider the needs of women who also struggled with eating disorders," says Dr. Simone Vigod, a psychiatrist and lead of the Reproductive Life Stages program at Women's College Hospital in Toronto.
Some programs are beginning to fill the void. In November, 2014, Sheena's Place held its first support meeting for just such a high-risk group. Called Mothers Living with Eating Disorders, it came about after Berlin-Romalis and her colleagues at Mount Sinai Hospital's Perinatal Mental Health Centre realized that more mothers needed help and that there was a gap in support.
"We are a safe space for mothers with eating disorders," Berlin-Romalis says. "We offer insights and strategies and nourish a sense of hope. We help explain that it's not in their control and not their fault.
"These women are so scared of being rejected and judged for putting their child at risk," she adds. "When it affects the life of an unborn child, people don't suspend judgment. It takes a lot of courage to walk through our doors."
Vigod and her team are well aware of that as well. They incorporate a focus on eating disorders and body image into Mother Matters, a 10-week Web-based postpartum mental-health support program run by therapists at Women's College Hospital, where mothers up to a year postpartum can log in anonymously from home and participate at any time that's convenient.
Though the program is currently only offered to Ontarians because of jurisdictional health-care issues, Vigod says the plan is to expand it across Canada, addressing barriers to receiving much-needed care.
Another option is to seek treatment from a private counsellor.
"I went to see my counsellor on a regular basis and I still keep in touch with her," Leila says. "Now I don't think I'm fat or ugly. I love my body for giving me my children."
Friends and loved ones can also help by simply listening, or helping to seek out resources, she says.
"The sufferers I've helped are strong, brave women who feel like they have gotten themselves into a situation where they feel so out of control. It's important for them to know that they are not alone and that they can definitely get better," Simone Finkelstein, a nutritionist and eating disorders specialist, says.
Special to The Globe and Mail