The emotional challenges of pregnancy

By JoLyn Seitz, MD May 08, 2017

You’re pregnant. You expected to be jubilant. Or maybe you didn’t. Whether this was a planned pregnancy or a surprise, you are feeling lots of emotions. And this is just the beginning of those emotional swings. Get on board for nine months of it! They are going to be part of your journey, and understanding why can help you ride them out and better cope with the emotional challenges of pregnancy.

The ups and downs can be harder to bear if you are one of those moms who planned this pregnancy and are incredibly happy that it is happening now. Then, all of a sudden, you are weepy, angry, irritable — how can this be? You’ve been looking forward to every stage of this phase of life! You may even feel a bit guilty that you aren’t feeling giddily happy all the time.

Take comfort in the fact that there likely isn’t a mother anywhere — including yours — who didn’t have some emotional ups and downs during pregnancy. It’s a time of tremendous changes, and many questions can creep in to sully the dream. What if my baby isn’t healthy? What if I lose my baby? What if I’m not as good a mother as I want to be? What if delivery is more painful than I can stand? What if I don’t recuperate quickly and have to go back to work before I’m ready? What if I end up responsible for raising this child alone? And so those worrisome thoughts go, creeping in at inopportune moments and taking you down with them.

Motherhood is probably the most permanent life change you make. You can change jobs, careers, friendships, even life partners, but once a mother, you will always be a mother. It’s natural to have some anxiety and questions in your mind that accompany such an enormous responsibility.

And the down side isn’t something you hear young mothers sharing over coffee. How many women talk about their fears, their anxiety, their worries about being a mom to their friends? More common are the laughing, joyous conversations about shopping for baby clothes, decorating the nursery and anticipation of baby coming home. If you share your worries, you may worry they might think something is wrong with you. If you have struggled with infertility before getting pregnant or have lost a baby to miscarriage previously, guilt probably eats at you too. You think, “I should just be grateful I am pregnant.”

Wherever you fit, comfort yourself with the fact that you are normal! Your emotions are not relative to whether or not you wanted this baby, how badly you wanted it, what happened previously that influences this pregnancy, how good a parent you will be, etc. In fact, experts say you are more normal than the woman who denies having any emotional ups and downs during pregnancy. That woman, they suggest, may be in denial about the monumental changes taking place in her life.

Feelings, what are these feelings!
You may be surprised to hear this, but many women cite changing emotions as one of the most common side effects during pregnancy. It’s frustrating, even exhausting, to hit so many highs and lows, sometimes all in the same day. You maybe don’t even know which emotion you feel or why you are feeling it.

Trying to identify the emotion and understand the reason may help. For instance, starting a family is a joyous occasion, but it brings both positive and negative stress. You may find yourself more worried about your future, finances, employment, medical care and other things important to your family stability. The resulting stress contributes to emotional outbreaks. Fear is another common worry bead. In the first trimester, every unpredictable body change may make you worry something is negatively affecting your baby’s health or can cause a miscarriage. As the pregnancy progresses, fear changes: you start to question other things like whether or not you are capable of taking care of a baby or whether or not something disastrous might happen during the baby’s delivery. The many things you lack control of during a pregnancy contribute to fearful thoughts that can become overwhelming.

One…two…three trimesters
The First Trimester: Are we ready to be parents? Can we afford a child? What if I miscarry?

  • Response tips: Remind yourself you are like many women; you are not unusual. Look at baby photographs and picture that healthy baby growing inside you. Pick the right people to talk to about your worries. You need a good sounding board but not one that will increase your worries. Feel free to talk to your OB/GYN about worries regarding miscarriage or other medical distress issues.

The Second Trimester: Where did my waistline go? Will it ever come back? Does my husband still find me attractive?

  • Response tip: Don’t beat yourself up for worrying about your body image. It’s one of the most common concerns pregnant women mention. Again, you are not alone! This is a good time to think about how fixated American society is on women’s body image and to realize that spousal love is much deeper than that! Treat yourself to a couple of new maternity tops, get a haircut, do things that will help you feel better about the way you look. But don’t do it to the point that it overwhelms you too!

The Third trimester: How painful will labor and delivery be? What if I can’t handle it? What if there are problems with the delivery? What if my baby is born with serious disabilities? As your due date approaches, your subconscious begins to focus on what’s coming. Hormonal shifts, interrupted sleep and other pregnancy related factors can make you forgetful and feel sluggish.

  • Response tips: Slow down, rest, meditate, pray, journal. Do things that help you stay positive and get ready for the end of this journey and the beginning of a new one!

Help! I want to get off this roller coaster
Unless you are extremely fortunate and one of those rare women who really doesn’t experience a lot of emotionalism during pregnancy, you are probably on the roller coaster until your baby is born. But there are things you can do to make the ride more enjoyable and less bumpy.

    1. Educate your partner. Men don’t really know what to expect, and if this is your first pregnancy, you don’t either. You can share what you read and discuss in advance, rather than in the heat of the moment. Pregnancy seems to be typically accompanied by highs and lows. Your partner needs to keep in mind your highs and lows are not logical and not personal. Ask him to support you and be patient through these moments. You and your partner both need to understand how you felt and responded to certain things in the past may not be the same way you respond during pregnancy. You can look back on these conflicts later and laugh.
    2. Realize that physical discomfort can contribute to feeling low. Morning sickness, fatigue, breast tenderness and other physical discomforts during pregnancy can make your tolerance level lower for little irritations. Depending on your body image and expectations, you may feel less physically attractive as you observe body changes. Try to get more rest and use whatever means you can find to decrease your focus on your physical discomfort and self-esteem.
    3. Allow for hormonal changes. During pregnancy, women experience an increase in the production of hormones, such as progesterone and estrogen. This increase can impact your emotions and your brain’s ability to monitor them. While hormones are not the only cause of emotional swings, they do contribute to moments or days that make life even more challenging. Women who say they don’t cry easily find themselves dissolving into tears at things that would have left them unmoved pre-pregnancy. Women who would define themselves as patient snap irritably at their spouse over petty things. Remind yourself that these changes in your personality are temporary and “talk to yourself” to return to a more stable state of mind.
    4. Accept that it is OK to have fear. Some women desperately want a child but are terrified of childbirth. Some desperately want a child but are terrified that they won’t be a good enough mother. Whatever the fear, learning to express it and talk through it can help you better manage it. Look for someone you trust and feel comfortable talking to openly, someone who will listen and allow you to vent. If your fears are overwhelming, make an appointment with a professional therapist.
    5. Get plenty of rest. Many women have trouble sleeping well during pregnancy. Lack of sleep is proven to have a major impact on emotions. Some women say they have wild dreams or their changing body prevents them from finding comfortable resting positions. Do what you can to help sleep come: keep the room a cool, comfortable temperature, keep it dark, do relaxation exercises and/or deep breathing before sleep. Experiment with sleeping positions and let your partner know if you are having difficulty sleeping. The two of you can work together to see that you get the sleep you need.
    6. Eat right. Healthy eating will help with your moods. Consuming healthy, nutritional, non-processed foods will give you better emotional stability as well as improving physical and mental health.
    7. Make time for yourself. Soak in the bathtub. Read a book purely for pleasure. Get a pedicure or massage. Choose the kind of activities that make you feel relaxed and do them!
    8. Prepare where you can. Well before your due date, you and your spouse should take childbirth classes to prepare for labor and delivery. Women who are prepared have less fear and pain.
    9. Enjoy social activities but pace yourself. Baby showers, decorating the nursery, shopping for baby clothes and similar activities can all be part of the enjoyment of pregnancy. But don’t push yourself to the limit. Balance your days with rest and relaxation too.
    10. Surround yourself with people who are supportive and encouraging. This is one of the best things you can do to manage the emotional turmoil. Look for people you trust first of all but who are also likely to understand the particular turmoil you feel. For instance, if you have a successful career, you may be wrestling with how you are going to combine two roles or even whether or not you want to return to work. Choose a trusted friend who has been down that road to listen to you.

Above all, don’t let your emotions get out of hand. If you start feeling extremely unstable or are having severe depression or thoughts of suicide, talk to your doctor immediately! About 10 percent of women are affected by depression during and after pregnancy.

For more resources, read books that can help you through this journey. A couple that include information on pregnancy’s emotional side include: ‘Excited, Exhausted, Expecting: The Emotional Life of Mothers-to-Be’ by Arlene Modica Matthews and ‘Understanding Your Moods When You’re Expecting: Emotions, Mental Health and Happiness’ by Dr. Lucy Puryear. Your local bookstore is also a good place to check for reading selections.

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