How can we, as midwives, support a woman with an eating disorder?

As midwives, how we accompany and how we offer health advice will be crucial, since we are present during moments of great vulnerability such as adolescence, pregnancy, postpartum, and menopause.

Today, one of the most measured parameters, for example, in pregnancy consultations, is still weight (the initial weight, at each visit, the total weight gained) and the health advice we offer is often focused on controlling that weight so that it meets that little chart that we all know that establishes ideal weight gains according to the body mass index (BMI).

These practices are not based on quality scientific evidence. In fact, it has been shown that when attention is focused on weight, it worsens a person's physical and mental health . Comments such as, for example, "watch what you eat," "don't eat for two, you've already gained all the weight you were supposed to," or "congratulations, you haven't gained any weight since the last visit" are inappropriate comments that generate more obsession with food, feelings of inadequacy, shame, and guilt. For a person with an eating disorder, it's like adding fuel to the fire.

So we must set aside the scale and put the person at the center. We must ask questions, listen, and support them with empathy and respect , accepting body diversity and understanding that health is a much broader and more subjective concept, determined by various modifiable factors (diet, movement, rest, consumption of toxins, leisure, stress management, etc.) but also by others beyond our control (weight, race, age, access to healthcare, belonging to a socially oppressed group, etc.).

Much more than a problem with food

Read more

Translating all of this into more concrete guidelines , they would be:

• Be aware that putting someone on a scale is an intervention that is not without risk. Assess the risk-benefit ratio and, if weighing is decided upon, offer a blind weighing.
• We must be mindful of how we give nutritional advice. We need to be aware that for a diet to be healthy, it's not just what we eat that matters, but how we eat it. It's important to have a flexible diet that takes into account nutritional needs, hunger, satiety, pleasure, the social aspect, and so on. It has been shown that rigid dietary approaches, as well as categorizing foods as good or bad, can lead to disordered eating habits. Remember, eating better will improve your health, even if your weight doesn't change.
• Include body diversity in consultation poster images and presentations to promote acceptance of body changes.