Postpartum Body Image and Weight Loss
By Marie Zahorick
and Valeri Webber
Benicia CA USA
From NEW BEGINNINGS, Vol. 17 No. 6, September-October 2000, pp. 156-59, 145
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time
Once the challenges of childbirth are past and a mother has held her new baby and counted fingers and toes, she turns her attention to the dramatic changes pregnancy and childbirth have worked on her body. The first sight of a sagging postpartum tummy can shock even the slimmest, most self-assured woman. For the rest of us, the sight can be absolutely overwhelming.
Adjusting to a post-pregnancy shape may be even more difficult than coping with the changes of pregnancy. Pregnancy represents the biggest change in a woman's body since puberty. As in adolescence, during pregnancy, a woman's body seems to be out of her control and at the whims of a mysterious hormonal tidal wave. Emotions can run high, as in those uncomfortable teenage years. After the baby is born, the stress from sleeplessness and total responsibility for a new human being can intensify the dismay many mothers feel about their physical appearance. This is not the same body they had nine short months ago - or even a few weeks ago. The tight, growing roundness of pregnancy is replaced by loose skin and a "fat" tummy that does not automatically shrink back into place. Most women want to return to their pre-pregnancy body as quickly as possible and end up disappointed and depressed when the extra weight seems not only to linger, but also remains distributed differently.
The Changes Pregnancy Brings
In addition to the baby's weight, a pregnant woman carries about 15 additional pounds from the weight of the placenta, amniotic fluids, the enlarged uterus and breasts, and extra blood, plus about another seven pounds of extra fat stores (Sears 1997). Each of these is essential to the healthy development of the baby and the well being of the mother. When a woman gives birth, she automatically loses some of that weight - the baby, the placenta, and the amniotic fluid. In the next few days, the extra blood and fluids needed to sustain the pregnancy are gradually reabsorbed or excreted from the mother's body. The uterus returns to its size from before pregnancy within six weeks. The fat stored during pregnancy, however, does not automatically disappear.
Women's bodies tend to store up fat in order to nourish babies both during pregnancy and while breastfeeding. Though scientists have long believed that new fat cells were formed only during infancy and puberty, recent research has shown that women actually add new fat cells during the last trimester of pregnancy as well (Mermel 1991). This may explain why so many women have trouble losing weight after pregnancy, even if they didn't have trouble controlling their weight previously. Fat cells don't go away. You can shrink them with diet and exercise, but once they're there, fat cells are always ready and eager to store energy. This is your body's way of protecting you and your baby from famine. Unfortunately, in societies where being thin is more desirable than being well-padded, the fat stored as part of a healthy pregnancy may be unfairly characterized as "baby fat." Women are expected to lose it as quickly as possible.
Perceiving the body's normal attempt to protect off-spring as "baby fat" is only one of many misperceptions that women (and others) may have after childbirth. Despite all the preparations for a new baby, many women do not anticipate all the ways in which having a child will affect their bodies. Breasts are fuller because they are producing milk. Nipples unaccustomed to hungry newborns may be tender for a time. Stitches from cesarean births or episiotomies may be irritating or painful, and this pain sometimes lingers for months. A tight belly that was full of baby is now empty and the abdominal muscles are loose and flabby.
Loss of Control
Many women are surprised to find that their body does not immediately go back to its shape from before pregnancy. In addition to these personal expectations, husbands, family members, friends, and media images add to the pressure, warning that having a baby is no excuse for "letting yourself go." Yet few women are able to regain their pre- pregnancy figures. Childbearing and the passage of time change bodies in irrevocable ways.
Still, mothers try. For some women, losing weight can be one way of regaining control over their drastically changed lives. The reasoning may be, "My life is crazy, I hardly sleep, my baby cries all the time, and I can't seem to finish washing the dishes. But at least I am losing weight." Women who have previously suffered from eating disorders may be especially vulnerable to this kind of thinking, since eating disorders may be linked to a desire for more control over one's life (Korte 1994).
The desire to "get my own body back" can be a very serious concern for some mothers. Many women, especially first-time mothers, are overwhelmed by the intense physical intimacy of caring for a nursing newborn. If her partner is eager to resume a physical relationship, it can add to a woman's feeling of being out of control of her own body.
Loss of Support
The postpartum period is very different from the months in which a woman is pregnant, radiant, and the center of attention. "One reason many women enjoy pregnancy is that they are not expected to look skinny," writes Sheila Kitzinger in her book, The Year after Childbirth. During this nine-month reprieve, women who have struggled with body image and weight loss issues rejoice at not obsessing over every single calorie. After all, pregnant women are expected to eat well and gain weight. One woman remembers, "After a weigh-in at one obstetrician's appointment, the doctor told me to gain more weight. I felt like cheering because I had official medical approval to eat more and not worry about getting fat." Currently, health care providers advise that women gain between 25- 35 pounds during pregnancy, more for a multiple pregnancy.
In contrast, women who had children in the 1960s and 1970s were often advised to gain only 15 pounds. One older woman who had gained 15 pounds during pregnancy said, "Right after I had my first baby, I stepped on the scale and I had lost all the weight I gained." Stories like this coming from the baby's aunts or grandmothers, however well meaning, can undermine a new mother's confidence and feed a subtle sense of competition between her and some of the women who form her support system.
Other aspects of a mother's support system may fall away after her baby's birth, too. When women are pregnant, they receive emotional support and positive attention from family, health care providers, even strangers on the street who encourage them and chat about babies. However, after the birth, new mothers can become isolated and lose that support and attention. With many people, the woman takes a back seat to her new baby. When their attention turns from baby to mother, most people will comment on physical appearances before they comment on emotional concerns, especially if they are not close friends or family. They may say, "You look great, so thin," rather than, "I think it's really great that you're breastfeeding." Everybody likes compliments, so losing weight may be a way of regaining positive attention from others.
Media images of mothers "doing it all" add extra pressure. Each televised entertainment award show seems to feature at least one celebrity who has given birth only weeks before, yet managed to exercise and diet herself into a skin-tight strapless evening gown. Of course, celebrities are financially motivated to maintain a slender physique. However, many mothers unfairly criticize themselves if they aren't able to fit into their non-maternity wardrobe in a matter of weeks. They ignore the fact that they aren't paying others to take care of their house and their baby while they fast and exercise every day with a personal trainer. They also ignore the fact that most of us don't took much like models or movie stars even before we have babies. Rushing one's body back into shape may not be wise. Exercising strenuously in the early postpartum weeks can interfere with the healing of the uterus.
While some women may diet to regain a sense of control over their lives postpartum, others may find themselves eating more than ever. Mothering a newborn can feel overwhelming and eating can become a way to nurture oneself, soothe the blues, pass time, shake off fatigue, and ease the tedium of one's day-to-day routine. With careful, healthy food choices, this may not be a problem, since breastfeeding uses extra calories. But too often "comfort food" means sweets and high-fat snacks. This leads to weight gain rather than weight loss, and in the long run, a mother may feel worse about herself rather than better.
The good news for most women is that breastfeeding is an easy way to burn an extra 500-600 calories a day. While nursing a baby, the mother is doing the best for her baby and also helping herself shed unwanted pounds. The weight may not come off as quickly as a mother may hope, but it will eventually be lost. According to THE BREASTFEEDING ANSWER BOOK, "Breastfeeding mothers tend to lose more weight when their babies are three to six months old than formula-feeding mothers who consume fewer calories. One study of mothers at one month postpartum found that mothers who breastfed (either exclusively or partially) had slimmer hips and weighed less than women whose babies received only formula" (LLLI 1997). Breastfeeding can be an ideal time to lose weight, since lactation seems to mobilize even fat accumulated before pregnancy.
Health care providers advise women not to diet for at least the first six weeks postpartum to allow the body to recover from childbirth and establish a good supply of milk. Rapid weight loss can reduce milk supply. Check with a health care provider before starting any exercise or diet program to rule out any medical conditions that would interfere. Three books that contain practical information on postpartum weight loss and exercise are: THE WOMANLY ART OF BREASTFEEDING ("Nutritional Know How" chapter), Eat Well, Lose Weight While Breastfeeding, by Eileen Behan, RD, and Eating Expectantly, by Bridget Swinney, MS, RD.
Commit yourself to change, but do it "gradually and with love." It took nine months to put the weight on, and during that time, you probably weren't responsible for the care of a totally dependent human being. Give yourself some time to make life-altering changes. Getting fit and staying fit requires a lifetime commitment to healthful eating and exercise, and this kind of change doesn't happen overnight. People who lose weight rapidly are less likely to maintain the loss for life. Women's Bodies, Women's Wisdom, by Christiane Northrup, includes two chapters on changing your diet gradually and incorporating exercise into your life.
While breastfeeding does help most mothers lose weight, there are limits. A mother who has not met her weight loss goals may feel frustrated, especially if other new mothers she knows look fabulously flat-tummied soon after birth. One way to avoid discouragement is to set realistic goals that are meaningful to you. Try aiming for the largest clothing size you'd be happy with rather than the clothing size of a model. Or make your goal the lowest weight you have maintained for a year since you've become an adult rather than what you weighed when you graduated from high school. Some women decide that all they want to do is to feel more fit so they can manage the stairs or keep up with their toddlers at the playground without feeling out of breath. You can always set new goals later. Losing just five to ten percent of your current weight can bring major physical and psychological benefits. Becoming more fit can increase your enjoyment of life.
Write down all your accomplishments, whether you exercise for 15 minutes or 45, lose two pounds, or resist the sweet desserts at a family party. Find ways other than the scale to track your improvements. Check your measurements, your blood pressure, your endurance, your resting heart rate, or the fit of your clothes. It's common to reach a "plateau" where weight loss slows or even stops for a while. If this happens, focusing on other goals and improvements can help keep you motivated. Reward and congratulate yourself every step along the way with nonfood treats. Over time, you'll be able to look back and see how much you've changed your life and improved your health.
Visualize yourself fit and healthy. Admire the parts of your body that you do appreciate. Avoid restrictive or extreme eating plans, which can lead to a feeling of deprivation and decrease your milk supply. They are also harder to follow in the years when you are responsible for a small child. Reduce your portions, use common sense, and eat a healthful diet. Eat frequent, regular, small meals, especially breakfast. Skipping meals slows metabolism. After a fast of eight or more hours during the night, your body needs the first meal of the day to stabilize blood sugar and energize itself.
Drink at least eight to ten glasses of water a day. If you feel like munching, try a glass of water instead. Sometimes we get our thirst and hunger signals confused. It helps everyone to keep drinking water handy, particularly in warmer months when you're on the go. It can be tempting to have a snack or a meal when you're really just thirsty.
Most women find that they need to exercise to keep their weight under control. We live in a sedentary society yet our bodies were made to do physical work each day. Walking is fine, free, and fairly easy to do with your baby in a sling or stroller. Start out slowly, building up to a faster pace and longer distance. Choose an activity you like and work toward doing it for 30-45 minutes each time. The more you work exercise into your daily routine, the more likely you are to continue with it.
Remember that exercise does more than help burn fat. It also increases your energy level and boosts your sense of well-being while reducing stress, and symptoms of premenstrual syndrome. Exercise also compensates for the metabolic drop that usually comes with weight loss. People who exercise along with any type of diet see faster, longer-lasting results. See the sidebar on page 158 for more tips about exercise.
No Shortcuts Available
Despite studies showing that breastfeeding mothers tend to lose more weight over the course of the first postpartum year, some women put a high priority on getting back to their size and shape from before pregnancy. They may choose to wean or never nurse at all so that they can use crash diets to lose weight quickly. However, weaning is not necessary if a mother follows a well-balanced, sensible weight loss plan.
Many new mothers turn to commercial diet centers, and in response, some of those companies now provide weight loss programs designed for nursing mothers. These may or may not reflect the nutritional needs of a nursing mother. However, research by James Hill, a nutritionist at the University of Colorado in Denver, shows that as many as 90 percent of clients never complete the commercial programs, and of those who do, many regain all or part of the weight. No diet program offers an easy answer, so a mother who is thinking about weaning in order to try a quick weight loss diet should think again. She will be sacrificing many health benefits for herself and her baby with little reason to believe that she will lose all the weight she wants to lose and keep it off for the long term.
Remember you've gained more than pounds by having a child. You've acquired memories of your baby's precious infancy, when all he wanted was your voice, your body, and your smile. You've grown strong from caring for your baby when he was ill. You've gained wisdom from learning to lovingly guide your clever explorer. You've discovered that even though your body may not meet pre-determined standards of beauty, it can nurture a baby in the best way possible. You've earned the body of a mother. Celebrate that body and appreciate the emotional and physical strengths you've gained. Compared to all that, a few extra pounds are insignificant.
To Get More Exercise Gradually
- Park your car farther out in parking lots.
- Use only the upstairs or farthest bathroom.
- Walk around the block before you sit down for lunch or a TV show.
- Walk in place while talking on the telephone.
- Play with your children outside.
- Stand whenever you can; standing burns twice the calories of sitting.
- Encourage yourself to go for a walk by telling yourself that you have to walk only one or two blocks. Chances are you will start feeling so good while you're walking that you'll want to keep going.
- Start a buddy system and walk, bike, or exercise with a friend.
- Ease into your workouts to minimize injury or soreness. Remember to warm up, cool down, and stretch.
- Smile as you work out even if you don't feel like it and even if no one is looking.
- As you cool down, make a mental note of how good and proud you feel now that you are finished. Remember that feeling when you need motivation to start another session.
- Consider exercise time to be at least as important as any other health or grooming task. Doing your workout is just as important as any chores around the house. Take the phone off the hook or turn down the volume of the answering machine to reduce distractions. If you have older children, set them up with a snack, water, and special activities to do while you work out.
Korte, D. Every Woman's Body. New York: Fawcett Columbine, 1994.
LLLI, THE WOMANLY ART OF BREASTFEEDING. Schaumburg, IL: LLLI, 1997.
Mermel, Lee, RD. Lecture on nutrition at Solano College, Suisun, CA, March 1991.
Mohrbacher, N., Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, IL: LLLI, 1997.
Northrup, C. Women's Bodies, Women's Wisdom. New York: Bantam, 1998.
Sears, W. and Sears, M. The Pregnancy Book. Boston: Little, Brown, 1997.