Eating disorders fall under the general category of psychosomatic disorders (Tam & Chung, 2007). These psychological disorders are as a result of mental and/or emotional maladjustment (Vaschenko, 2005). Postpartum depression has been widely acknowledged as a prevalent psychosomatic disorder that is prevalent among pregnant women. However eating disorders are also prevalent among this group. Eating disorders are far more prevalent among females than males.
According to the National Eating Disorders Association approximately 10 million females, as compared to only one million males, are affected by eating disorders in the United States (as cited in Mehlenbeck, 2007). Eating disorders usually involve unhealthy eating practices such as abstaining from food, purging after eating, exercising excessively to burn up calories eaten among other similar practices. The two most prevalent eating disorders are anorexia and bulimia nervosa (Martos-Ordonez, 2005). Mazzeo et al.
(2006) observes that women with eating disorders are becoming mothers, contrary to the belief that pregnancy was uncommon among this group because of their health status. According to Patel, Lee, Wheatcroft, Barnes and Stein (2005), pregnancy poses an important challenge for persons with eating disorders as motherhood may bring about unwanted body changes. Eating disorders may therefore potential impact pregnancy outcomes. However there is not adequate information on the impact of eating disorders on pregnancy. James (2001) reports that eating disorders negatively affect approximately one percent of pregnancies.
Franko and Spurrell (2000) identify miscarriages, low birth weight, postpartum depression, vaginal bleeding, hypertension and cesarean deliveries, among some of the ill effects of eating disorders. Martos-Ordonez (2005) adds pre-eclampsia, breech presentation and forcep deliveries to this list. This research is concerned with the impact of eating disorders on delivery outcomes, to determine their prevalence among women who have normal or cesarean section deliveries. Though some researchers have suggested that eating disorders are a risk factor for cesarean sections, there have been conflicting findings.
Bulik et al. found a prevalence of cesarean sections among 16 percent of patients with eating disorders but this rate was only three percent within the equivalent control group that did not have an eating disorder (as cited in Franko & Spurrell, 2000). Franko and Spurrell attempt to account for this high prevalence, not based on the necessity of the procedure, but based on the perception of obstetricians that these patients are a high risk group and thus cesareans are chosen as precautionary measures.
In a subsequent study Franko et al. (2001) discovered that mothers with eating disorders did not only have higher instances of cesarean sections, but postpartum depression as well. Tam and Chung (2007), on the other hand, did not observe any direct association between cesarean deliveries and eating disorders, except to the extent that eating disorders were linked to postpartum depression. Similarly Kouba, Hallstrom, Lindholm and Hirschberg (2005) did not find a correlation between cesarean deliveries and eating disorders.
What they did find, however, was that these patients tend to have poorer health outcomes than their counterparts without eating disorders five weeks after delivery. More specifically patients with eating disorders more frequently experienced decreased appetite, among other problems and, in terms of delivery, produced children with lower birth weight and smaller head circumference than mothers who delivered normally. On the other hand some researchers have argued that pregnancy can have a rewarding effect on patients with eating disorders.
Newton and Chizawsky (2006) suggest that mothers may be motivated to adopt better eating behaviors during pregnancy out of a concern for the fetus. Consequently they may either reduce the negative eating behavior or stop it completely. Of course the effects may not necessarily endure postpartum. There have been some weaknesses in previous research into the prevalence of eating disorders among cesarean and normal deliveries.
Stein and Fairburn (1996) lament that there are limited studies that examine the issue during the postnatal phase but rather researchers tended to focus on the eating disorders prior to and during pregnancy. An examination of the prevalence of eating disorders even after delivery is important if a full understanding of the relationship between these variables is to be realized. Additionally the vast majority of researches available tend to examine the prevalence of postpartum depression among mothers who have had either vaginal or cesarean deliveries.
The researches on the prevalence of eating disorders are very limited. Furthermore there seems to be no research studying the possible interplay of eating disorders and postpartum depression. Research has suggested that other psychological disorders, including depression, may lead to eating disorders and thus postpartum depression may be a risk factor for eating disorders. This research will fill the gap by providing a comparative analysis of the long-term postpartum outcome of eating disorders on mothers delivering via cesarean or vaginal delivery.