Staying in shape after childbirth

2009/10/11

Reese Witherspoon, Gwyneth Paltrow, Uma Thurman and Denise Richards have done it - shed kilos of baby weight in the blink of an eye. But AUDREY VIJAINDREN wonders whether this is putting extreme pressure on Malaysian women to slim down speedily after pregnancy.

WHO would want to shed some extra pounds to slip into a tight little black halter dress? Every woman, especially if she's found herself "larger than life" after having had her bundle of joy. But, would a woman jeopardise her health and her baby's life for it?

"There's a lot of hype about C-tucks (having a tummy tuck the same time as a Caesarean)," says Sunway Medical Centre consultant plastic and reconstructive surgeon Dr Tan Geok Puan.

"Rumour has it that celebrity mums-to-be are scheduling C-sections during their eighth month of pregnancy to avoid the extra bulging and stretching that occur during the ninth month of baby-bearing.

"According to Internet buzz, some of today's starlets undergo a tummy tuck procedure immediately after a C-section to trim off excess skin and ensure that stretch marks don't see the light of flash bulbs.

"Celebrity bloggers claim that Britney Spears, Denise Richards, Jaime Pressly and Gwen Stefani all used the 'C-tuck' method to regain their famously photogenic figures.

"Whether these rumours are true or not, from the medical point of view, having a C-tuck is not recommended," says Dr Tan.

He says many celebrity mums are younger, very healthy and have great skin.

"These factors are likely to help celebrity mums snap back into shape after pregnancy. This is especially so since they also have other advantages, such as personal chefs and trainers."

Sime Darby Specialist Centre Megah consultant plastic and reconstructive surgeon Dr V. Surendranathan believes that the media and beauty centres are making things worse.

"Newspapers and beauty salons are not helping when it comes to impressions of beauty and body image through iffy advertising.

"When celebrities like Nicole Kidman are doing everything they can to look their best after delivery, it is difficult for Malaysian women to say 'no' to possibilities out there.

"Advertisements on slimming after pregnancy are deceiving and false. The pictures almost always show a young Chinese woman who has lost weight after three to six months of delivery. But, it is basically genetics."

When it comes to weight and body structure, he adds, much of it has to do with family genetics.

"Chinese women tend to lose baby weight faster than Malay and Indian women. You can easily see this. Just look at a Chinese woman's and an Indian woman's hips after three or more children."

But the debate, he says, is whether pregnant women should consider having "work done" during delivery.

"Women who are considering it should get their priorities straight. The main objective during delivery is to get the baby out, recover and recuperate.

"There are many issues that need to be thought through before opting for tummy tucks, liposuctions or breast reductions during delivery. A safe period would be three months after delivery, nothing sooner."

He says one of the most common misconceptions is that it is not a problem to have a tummy tuck during a C-section.

"People claim that it's OK, because it's done in Western countries, but that is just sad. If women really want to consider plastic or reconstructive surgery, they should do it after their last child. Otherwise, it's just a waste of money because the same situation will repeat itself.

"Plastic and reconstructive surgery should yield 100 per cent results. There is no place for error. What's the hurry? It should be done when conditions are optimum for the patient, not the doctor."

Some women, he says, have unrealistic expectations that cause desperation.

"Women come to me saying, 'When I was 17-years-old, I looked beautiful, what do I do to get that way again?'

"What's running through my mind at that time is, 'What the hell is she talking about?' Different patients age differently, and sometimes it's just luck. But you can't expect to look the same throughout your life."

BabyCenter Malaysia editor Wong Mei Leng does not agree that Malaysian mums are dying to be a size-0.

"Malaysian women, like others around the world, want first and foremost for their babies to be healthy.

"Our poll on the duration it takes to fit into your pre-pregnancy clothes saw the biggest majority (35 per cent) admitting, 'I'm still working on it', 30 per cent saying, 'within three months', and only one per cent claiming, 'I am not trying - I'm happy with my new shape'.

"Malaysian women are concerned about losing their baby weight, but they are also becoming educated about the need to do so sensibly and healthily."

Wong says highest on the list of queries by pregnant Malaysian mothers is health and baby's development.

"Many new mothers are concerned about weight gain in pregnancy, but it's more to do with getting a sense of what's a healthy amount of weight to gain rather than being fearful of getting fat."

"I don't think our women are obsessed about baby weight. But the mass media has certainly made everyone more body-conscious, pregnant or not!

"We also have to remember that many women today go back to work outside the home after having a baby. Almost 70 per cent go back between two and four months after the baby, and they want to look good in the workplace."


Modern mothers reluctant to breast-feed

PSYCHOLOGISTS are convinced that self-esteem and education will pave the way to a healthier post-pregnancy life.

"The unrealistic perception that comes from peers and celebrities is more an urban issue than a rural one.

"Pregnant women can't control many things, such as hormones, so after delivery they find that weight is the only thing they can control and tend to use that as reinforcement," says Monash University psychology lecturer Dr Carina Chan.

"The problems that accompany weight gain are tied to control. Some women tend to overeat after delivery because they've been deprived of certain pantang foods during their pregnancy and confinement."

People should not allow themselves to be influenced by the media, Chan adds.

"They must appreciate that there are individual differences when it comes to body image. Focus on other aspects of life as well, not just weight.

"There are right and wrong ways to get back in shape. It comes down to setting realistic goals, having a plan and sticking to it. Focus on the process instead of the outcome and don't jump on the weighing scale every chance you get. Losing baby weight is a gradual process."

Monash University School of Medicine senior lecturer and Sunway Medical Centre consultant clinical psychologist Paul Jambunathan says it's a problem getting modern mothers to breast-feed.

"Doctors who are pro-lactation will tell you that many use the excuse that they don't have milk but, the fact is, they haven't tried hard enough. Many are afraid their breasts will get too large and sag.

"I've come across a newborn who developed a serious infection after being breast-fed by the maid. His socialite mother didn't want the feeding to affect her figure."

Jambunathan says the fashion industry is making pregnancy more glamorous.

"In recent years, more and more designer maternity wear has flooded the fashion market causing more pregnant women to look and feel good about themselves, even with a 'bump'."

A pregnancy can be a very emotional experience.

"Some husbands have affairs while their wives are pregnant, and the wives blame their figure for the infidelity. Many women are afraid to lose their husbands when they get pregnant so after delivery they try to resume their attractiveness quickly."

Post-natal depression in Malaysia is definitely on the rise, he says.

"There is an increase, although it may not be as severe as in western countries. Any sort of obsession can lead to depression. If someone is obsessed with their figure even before pregnancy, then chances are they will be obsessed with their weight during and after pregnancy.

"The mental state of a person is very important. It's about challenging your beliefs and changing your role. Support groups are important as well.

"Self-esteem is a big thing when it comes to this issue. There should be education on responsibilities, change in lifestyle, depression, change of diet and many other things.

"Although previously our culture did not advocate being super-slim, cultures evolve. We must face the fact that it is a real problem that needs to be addressed.

"Women should ask themselves 'what is my weight... in self-esteem and confidence?'"


Q & A with DR WONG PAK SENG, consultant obstetricuian and gynaecologist.

Q: What is an ideal weight gain during pregnancy?

A: Women in their first pregnancy may expect to gain between 12kg and 18kg, while women in their subsequent pregnancies may gain between 8kg and 12kg.
It is important to look at overall weight gain and not a month-to-month weight gain, which may cause unnecessary anxiety to the mother.


Q: Are there certain diets to help achieve a weight goal?

A: It is important for women to eat sensibly -- well balanced with the necessary amount of protein, carbohydrates, fibre and vitamins.
She certainly does not need to "eat for two". In fact, there is no need for extra calories in the first six months of pregnancy. Only for the last three months, should she take an extra 200 calories per day.


Q: How important is the weight issue during pregnancy? What are some of the complications that could arise if a mother-to-be is underweight or overweight?

A: A mother who is extremely underweight may be predisposed to pre-term labour or a growth retarded baby if she is undernourished as well.
On the other hand, a mother who is extremely overweight may be predisposed to gestational diabetes, hypertension in pregnancy and a difficult labour due to a big baby.


Q: What's the ideal weight to get back to after pregnancy? Are there certain diets that might help shed those extra kilos safely?

A: The ideal body weight is the pre-pregnancy weight, which is a good start. But, if she has been under or overweight, it is a good opportunity to set a new target.
A "weight-losing diet" is a diet that is balanced with emphasis on cereals, nuts, fibres and protein but low in fats and oils. Also, the woman must not forget to exercise regularly. Aerobic exercise lasting 30 minutes three times a week is ideal.


Q: Is there a healing period after delivery, before one starts exercising?

A: A good time to exercise is when a woman feels ready, usually after six weeks. But, after a Caesarean birth, it is advisable to wait for two months before embarking on any weight bearing exercise.
Most obstetricians would recommend women to do aerobic exercises, pelvic floor exercises and certain weight exercises to tone the muscles.


Q: Is a tummy tuck during a C-section advisable for women?

A: It is generally not advisable to have tummy tucks during C-sections. It is best to allow the tummy to regain its tone first after the confinement period so that the surgeon can best assess the amount of excess tissue to remove.
Also, pregnancy is a hyper dynamic state, which means there could be unnecessary blood loss during the procedure.
The risk of infection is greater if a tummy tuck is performed during a C-section, due to possible contamination of fluids from the genital tract. But, if the woman is aware of the risks, and she does not want to go under the knife or anaesthesia again, then a tummy tuck can be performed.