The Emotional Complexities of Pregnancy

by Jeanne Faulkner, Contributing Writer

You can’t really know, what it’s like to have a baby on board until you’re knee-deep into it.  You think it’s going to be a certain way…and it is…but then you learn it’s also something entirely different.  It’s like those pictures that create the optical illusions:  Is it a face or a vase?  Turns out it’s both.  Pregnancy’s like that. Sure, it’s transcendent and miraculous, but it’s also kind of disgusting and uncomfortable.  To say it’s unlike any other physical or emotional experience is self-indulgent and unrealistic (it’s a universal experience shared by millions and millions of people all over the world every year), but it’s also spot-on accurate (no two parents or pregnancies are exactly alike).  The highs are exhilarating and the lows get really down and dirty. It’s hard to get your balance when you don’t know where the floor is from one minute to the next.  Pregnancy’s like that. 

Even as an expert obstetric nurse with plenty of hands-on baby experience, my own pregnancies resulted in a rollercoaster of emotions from delight to doubt – from Yippee to Uh-oh to WTF?  It was baffling, but I knew from decades of work with thousands of mothers that I was not unique.

Desiree Bley, MD, OB-GYN at Providence Portland Medical Center in Oregon and mother of three says, “The emotional complexities of parenting start long before a woman pees on her pregnancy test-stick and continue well beyond delivery.  Pregnancy demands intense personal, emotional and spiritual development.  It can be joyful, challenging, exciting, frightening, exhausting, depressing, nauseating, anxiety producing and entirely confusing; all that before you even meet your baby. That’s a lot to deal with on top of the physical symptoms, hormonal changes and mood swings women endure during pregnancy. When your considering all that, I’d say feeling emotionally off your game during pregnancy is par for the course.”

Benjamin Danielson, MD, pediatrician and medical director of the Odessa Brown Children’s Clinic in Seattle says, “There are so many legitimate reasons and ways to be emotionally impacted by a pregnancy or new baby. In a weird way, it’s a bit like experiencing grief – there are a million right ways to do it and very few inappropriate ways. Parents get concerned that if they don’t have entirely positive feelings, then something’s wrong or they’re going to mess up their child.  I’d argue that any parent who isn’t experiencing a full range of emotions isn’t being realistic. It’s very stressful and deserves a lot of support.”

One scientific study conducted in Boston found that 20 percent of pregnant women tested positive for anxiety disorders or depression. Psychiatric Times speculates that 50 percent of pregnant women experience anxiety. Multiple studies published by the National Institutes of Health report that anxiety and depression affect both parents during pregnancy and the postpartum period. Bley and Danielson agree, but suspect most expectant parents experience some emotional upheaval related to common reactions to pregnancy including:

• Excitement and/or resentment about the pregnancy
• Worry and/or delight about physical changes and symptoms
• Stress about healthcare access, finances and employment
• Doubt about parenting abilities
• Embarrassment about an unexpected pregnancy
• Protective feelings and privacy concerns regarding who/when to tell

• Fear about a partner’s/family’s reaction
• Anxiety about miscarriage, fetal development, labor, childbirth and birth injuries
• Confusion about personal identity changes
• Concern about couple/family dynamics
• Joy and wonder that something life-changing is happening

Among the most challenging tasks parents must maneuver involves shifting gears from being an independent person to being someone’s parent.  Bley says, “Once that child is born, your entire identity changes. I went from identifying myself primarily as Desiree, the doctor, to being Maddy’s mommy. That’s a huge shift.”

Not everybody handles a mixed bag of emotions gracefully, partly because there’s no single, best way to do it.  Bley says,  “Many societies, including our own, lack support networks that teach parents how to handle pregnancy. I have patients who already feel like bad moms because they’re not enjoying their pregnancy like they think they should. Expectant fathers worry they won’t be good dads because they haven’t ‘bonded’ yet with their unborn baby.  I reassure these parents they’re just like everyone else. Ninety five percent will successfully navigate the emotional waters of pregnancy and be good parents.

Does it get easier, the more kids you have?  Yes and no.  There’s usually less identity shock with subsequent pregnancies, but every one delivers a unique person, who alters the family dynamic, redistributes resources and creates new positive and negative stresses.

But what if your stress level is off the charts? There are plenty of ways parents can bolster their mental health:

• Ask questions. The more you know, the less you’ll worry.
• Expect the unexpected. Pregnancy, birth and parenting are unpredictable. Things go more smoothly when you stay flexible.
• Get support – Lean on friends, family, co-workers and community.
• Join a prenatal education class.
• Consider group prenatal care (Centering Pregnancy).
• Get help. Tell your family, partner and physician if you’re anxious, depressed or overwhelmed.
• Seek professional help from experts who can recommend supportive, therapeutic solutions.
• Consider couples counseling to hash out relationship stresses.
• Practice stress reduction – Simplify your lifestyle, exercise, do yoga, take walks, meditate and rest.
• Count on being normal – Dr. Danielson says, “Parents worries are always valid, but they’re also almost always entirely normal.
• Celebrate the birth of your parenthood along with the birth of your baby and recognize that both require patience, nurturing and time to grow.

Years ago when I was newly pregnant and somewhat freaked out with an entirely unplanned fourth baby, I had a Russian patient who was delivering her tenth child.  We grew close during the days I spent as her nurse in the maternity unit.  I asked if she worried about having so many children. She flat out laughed at me and said, “Of course, honey. Don’t be silly. I have too many children, but I don’t know which child I could live without. You’d be crazy not to worry, so don’t worry about it.”  Yeah, pregnancy and parenting are like that.

Resources:

US National Library of Medicine National Institutes of Health

Arch Womens Ment Health. 2011 Jun;14(3):247-55. Epub 2011 Apr 9.

Anxiety and depression in women and men from early pregnancy to 3-months postpartum.

Figueiredo B, Conde A.

J Psychosom Obstet Gynaecol. 2003 Sep;24(3):153-62.

Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: a longitudinal study.

Hjelmstedt A, Widström A, Wramsby HM, Collins A.

PsychCentral

Anxiety in Pregnancy

By Jane Collingwood