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The Perfect Little Bump

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The truly chic aim to avoid maternity clothes—even Liz Lange—for as long as possible. A fashion-marketer lady-who-lunches who asked me not to use her name led me from floor to floor of Barneys on a tour of what’s in her pregnant-waif’s wardrobe: clingy Missoni halter dresses, anything Diane Von Furstenberg, Pucci hot pants teamed with Hanes T-shirts, and terry-cloth Juicy dresses. At five months pregnant, she was wearing size-27 Seven jeans.

Proving that no one, no matter how tiny, is immune from wanting to be tinier, my Barneys guide also indulged in what I’ll call gestation-inflation. She said she’d gained nine pounds at six months, but when she gave me her due date, I discovered she was just over five. Now, I have no idea whether this was conscious, unconscious, or just bad math, but I recognized the move because I, too, was a fairly skinny pregnant person with my first baby, and I vaguely remember shaving off a few weeks here and there. I never planned to do it, but when asked for the umpteenth time “How far along are you?,” a rounded-up number just popped out of my mouth.

Kate Walsh never allowed her husband to remain in the examining room for her weigh-ins, and the effort to keep the top-secret number from him eventually reached sitcom-ish proportions. “Matt had no idea how much I’d put on until I was getting the epidural and the anesthesiologist asked, ‘How much do you weigh?’ I knew I couldn’t lowball, because then I wouldn’t get enough drugs, so in the middle of a contraction I’m trying to whisper the number to the doctor, and he’s saying, ‘What? I’m sorry, I can’t hear you.’ So I blurted it out and whipped around to see Matt’s reaction. He didn’t even blink, bless him.”

So to cut to the elephant in the room: Is all this downsizing hurting kids? While the medical literature is flecked with horrifying case histories of a bulimic vomiting immediately after delivery and tearing out her episiotomy, of another exercising so compulsively as to require hospitalization, the consensus is that women with actual eating disorders tend to get a grip on them while they’re pregnant. (Most true anorexics stop menstruating and can’t get pregnant in the first place.) “It’s almost like, ‘This foreign object in there—let me take care of it,’ ” says Mount Kisco psychotherapist Kristin Lore, an eating-disorders specialist. “But once the baby’s out of there, it’s about them again.”

The real question, then, is: Would gaining the bare minimum of recommended weight, or perhaps even a tad less, harm a developing child? The answer from obstetricians and nutritionists is, basically, no, though the topic has surprisingly controversial aspects. The goal isn’t to hit a specific weight, experts say, but to eat a well-balanced diet, including some carbs (Tenenbaum’s dreaded “white foods”). “Babies don’t need their mothers to gain that much,” says Mount Sinai maternal-fetal-medicine specialist Larry Rand, who’s been so struck by the anguish of new mothers left with a “big chunk of weight” that he’s launching a study to investigate the association between mild postpartum depression and gain during pregnancy. “The general gist you get in medical school is that even in times of famine, it’s never so bad.”

What he means is that it practically takes a famine for things to get bad. The Ur-study on the subject of maternal weight gain is the Dutch famine project. Surveying the health of babies born to women pregnant during a Nazi-induced famine in the Netherlands in 1944–45, Columbia University husband-and-wife researchers Zena Stein and Mervyn Susser found that women exposed to the famine during the third trimester gave birth to babies who were on average 10.6 ounces lighter than others. (Fetuses exposed in the first or second trimesters were not born smaller; most fetal weight gain occurs in the third trimester.)

Now, chopping ten ounces off average birth weights across a population is dangerous business. “Low birth weight” (under five pounds, eight ounces) and, worse, “very low birth weight” (under three pounds, five ounces) babies have higher rates of everything from cerebral palsy and blindness to infant mortality. Smaller babies also seem to have lower IQs, but only by a point or two. And, in a cruel irony for pregnant punys, there’s also a tentative finding that smaller babies are more likely to become obese adults. The theory is that the exquisitely malleable fetal brain adapts to some sort of prenatal nutritional deprivation that is then out of sync with the supersize American diet.

What makes this all complex, however, is the extent to which—outside of famine—a mother’s caloric intake causes low birth weight. Most light babies, for one, are simply born too early, and the amount women eat doesn’t seem to be a major factor in prematurity, at least not in the United States. What’s more, a baby’s growth can be impaired by anything that alters blood flow through the placenta, such as smoking, maternal infections, and exposure to toxic substances like lead. Doctors also believe each child has a genetically set “optimal birth weight,” which may well be smaller for smaller mothers, yet there’s no way to know what that ideal is. Doctors and nutritionists also say genetics plays a part in how much weight an expectant mother gains. While there are no studies that pinpoint the degree of influence, the conventional wisdom is that some portion of weight gain is essentially out of women’s control. One thing is for sure, says Tufts maternal-nutrition expert David Rush: He knows of no successful attempt to “feed women up.” In one oft-cited example, he and Mervyn Susser tried to enrich the diets of poor African-American women in Harlem in the early seventies. “The [women] gained maybe a pound or two,” Rush says. “Trivial stuff.” With babies, he adds, “the typical increment we’ve been able to make, even with aggressive feeding, has been an ounce to an ounce and a half.” Rush’s fellow eminence in the field of maternal nutrition, McGill University pediatrician Michael Kramer, is no less convinced that a physician could get a woman to gain more than she’s predisposed to gain. “In the U.K., they don’t weigh women during pregnancy because there’s no evidence that knowing how much weight you’re gaining actually affects the outcome of the pregnancy. It has no effect, other than to make a woman feel bad.” So why the Institute of Medicine guidelines? “It’s helpful to recommend a range,” says Barbara Abrams, a University of California, Berkeley, public-health professor and co-author of the Institute of Medicine recommendations. “We owe women and their doctors as much guidance as possible.”

Finally, is there any meaning behind the desire not to look too fat in pregnancy other than the desire not to look too fat in pregnancy? It’s a truism that everyone in New York came here to make it big (preferably metaphorically)—and women’s discomfort about the threat children pose to their identities can thus only be more acute. Larry Rand says he often hears this from patients: “I’ve waited until now to have this baby. I’m very accomplished, I’m fit, I go to the gym five times a week, and I really don’t want this pregnancy to change my life.” Going home from the hospital in the jeans you wore before you got pregnant becomes a “symbol,” he says: You’re the same person you used to be.

I recognize in myself a certain resistance to letting a child change my life, and I hear glimmers of it from other women. “I want to look like myself again,” says Diana Becker. “Soon.”

Johns Hopkins psychologist Janet DiPietro says she finds her subjects’ weight-restrictive behaviors unnerving. “The pregnancy and the delivery is all about them; it’s almost like they can’t see that they’re going to get a baby out of this deal,” she says. “If you can’t invest in your baby by gaining weight, I think it’s a harbinger for lack of investment in the child.”

But surely that is going too far, at least not without understanding each weight-worrying mother. Rand, in fact, believes the focus on staying thin is largely benign. “I don’t want to feed into the culture of ‘You must be skinny,’ ” says the self-described fat kid. “But I have a lot of empathy for what it feels like to lug around too much weight. If we lived in a world where nobody gave a crap . . . but we don’t.”

In her 1996 book Mother Love, Mother Hate: The Power of Maternal Ambivalence, British psychoanalyst Rozsika Parker observes that health professionals under the sway of Freud have treated “disliking the physical changes of pregnancy” and experiencing symptoms like nausea as a rejection of motherhood. The thesis of her book is that all women experience strong feelings of dislike and resentment toward their children, feelings that recede and advance, from conception to adolescence and beyond. But that doesn’t mean nobody’s a “good enough mother,” of course.

Not long ago, I had breakfast with Margot Tenenbaum and Pam Berger. At one point, Tenenbaum began chastising herself for being preoccupied about her weight when there are so many more important things for a mother-to-be to be preoccupied about. Berger should know. She almost lost her first child, Louise, to a rare infection during pregnancy. Still, she told Tenenbaum she was being silly. “You can be deadly serious about wanting to have a healthy baby but also wanting to feel good in your own body,” Berger said. “Women’s brains are big enough to worry about two things at once.”

Sarah Bernard contributed to this story.


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