Dr. Nehama Dresner discusses how an altered body shape can contribute to Postpartum Despression.
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I have this wonderful cartoon that I show when I give lectures about postpartum depression. So it’s a picture of Rudolph the red-nosed reindeer lying on a psychoanalyst's couch with a psychiatrist behind him writing on a pad, and Rudolph says, “They used to laugh and call me names,” which gives you kind of a sense of a neurotic Rudolph who is very sensitive to criticism, and I show that slide to sort of accentuate the notion that we bring our personality traits, we bring our deficits and our strengths into pregnancy and into motherhood, just like we do in any other arena in life, just like we do into relationships, into marriages, into parenting, into our work situation. If we’re confident, easy-going person, that’s going to be a pervasive quality in all the arenas of our lives in which we interact. If we are less confident, if we are self-conscious, and particularly if body image is a concern, if I am the kind of person who looks in the mirror every day and says, “You know, I need to lose 12 pounds and I weigh, I am 5’6” and I weigh 120,” that might be an individual who has a distorted sense of how their body looks. Even in a sort of, not a disease state necessarily, but somebody who is sort of absorbed in their physical experience, is very conscious of their physical appearance, who may use exercise as a way to manage anxiety or to sort of control their appearance in a particular way, those are options that we sort of lose during pregnancy and early motherhood. Exercise may be restricted to some degree during pregnancy. Dieting or, you know, living on diet Coke and carrots isn’t something that you can do during pregnancy, if that’s the way you sort of manage your weight. And so, there are lot of changes that take place in terms of the kinds of behaviors that we need to adopt in order to protect the pregnancy and as new mothers, to sort of heal from the delivery and be able to nurture our child, even to feed our child, that are different from the way we might have managed our diet and our sort of lifestyle pre-pregnancy and pre-motherhood. If body image has been an issue for an individual, if they have a history of an eating disorder, of anorexia or bulimia, or more commonly, kind of a mixed eating disorder where there’s a lot of control and focus on food and exercise as a way to sort of manage other things in their lives, that may become exacerbated during pregnancy. When you really can’t exert the kind of careful control that an individual might before pregnancy, and it may persist postpartum when…what do I want to say? Yeah, it may persist postpartum. It takes many, many weeks, months, sometimes longer for a woman’s body to return to normal and because of the stretching that takes place in her skin, both in her belly and her breasts, her body may never look the same as it looked before and for some women that’s a tremendous loss. For other women, it’s sort of evidence of their having born a child and nursed a child, and it's sort of part of their evolution. I have a colleague who is an obstetrician who got a phone call from a patient two days after she delivered the baby and was expecting some question about pain or bleeding, and the patient, you could clearly hear in the background the sound of a treadmill going, and the patient was breathless, asking the doctor, “When is it okay for me to start exercising?” And so clearly this individual had only decided at two days postpartum to begin exercising. Hard to imagine, but again, for some individuals, it plays a tremendously important role. And sort of a balance, their emotional balance and their body image, and it may be something that's extremely difficult for them to let go of or to sort of ease up on during pregnancy and after delivery.