Stress Less Pregnancy
Many pregnant women fret too much about the wrong things, and pay too
little attention to issues that can genuinely harm their pregnancy and baby.
See how your concerns compare to other women’s, then learn whether or not your
fears are well-founded and—the bottom line—what you can do to have a healthy
and happy pregnancy.
First comes the excitement, followed immediately by the worry. Once you’ve
adjusted to the fact that you’re pregnant, you may find yourself stressing
about whether your baby will be born healthy . . . or you might have a
miscarriage . . . or you won’t be able to stand the pain of labor . . . or be
able to breastfeed. The list goes on and on.
If you tend toward worrying in the first place, there’s plenty of fodder in
the news to keep you on high alert (killer cat litter, toxic sushi, collapsing
cribs), and even the more laid-back among you may have moments of anxiety when
the nurse is searching for the baby’s heartbeat on the ultrasound, it’s time
for prenatal tests or seemingly strange symptoms arise. Add the surge in
pregnancy hormones, and you’ve got a surefire recipe for angst.
But pregnancy risks are generally low, especially for healthy women, and
don’t warrant a high level of concern on the part of most moms-to-be. To
counter excess anxiety, experts advise trying to change the negative chatter in
your head and tone down any extreme thoughts. “To do that you need to focus on
the evidence that contradicts your worrisome thoughts,” says Sari Shepphird,
Ph.D., a psychologist in Los Angeles.
That’s why we asked experts to provide a reality check on 10 of the things
pregnant women worry about most, based on a recent March of Dimes survey (the
number beside each worry is the percentage of respondents who reported having
that concern). “If you keep reminding yourself of the facts, it will reduce
speculation, which in turn reduces worry and stress,” says Shepphird. Also, she
says, instead of worrying about things you can’t control (that martini you had
before you knew you were pregnant), focus on what you do have control over (how
much weight you gain during pregnancy).
Here’s the bottom line on some of the fears you’re likely to face during
pregnancy, along with issues you might want to pay more attention to (see “5
Things You Should Worry About,”). Plus, we tell you what really counts—the
simple things you can do to move past worry and improve your chances of having
a healthy pregnancy and baby.
1. Birth defects (78%)
REALITY CHECK:
About 97 of every 100 babies born in the U.S. arrive without a major birth
defect, such as spina bifida or Down syndrome. That’s the optimist’s way of
viewing the 3 percent risk of delivering a baby who does have one. Plus, many
birth defects, such as club foot, webbed toes and even some heart defects, are
minor or very treatable. “Surgical treatments are available nowadays, and many
of them are very successful,” says Richard Olney, M.D., a clinical geneticist
at the National Center on Birth Defects and Developmental Disabilities in
Atlanta.
If you’re not in a higher-risk group, the chances that you’ll have a baby
with a birth defect may be even lower: Risk factors include diabetes, epilepsy,
smoking, drinking alcohol and obesity, although for 70 percent of all birth
defects, the cause is unknown.
WHAT YOU CAN DO:
Act as if you’re pregnant as soon as you decide you want a child (or even
before—half of all pregnancies in the U.S. are unplanned). “Most structural
birth defects occur as early as a week or two after you miss your period,”
explains Michael Lu, M.D., associate professor of obstetrics and gynecology at
the David Geffen School of Medicine at the University of California, Los
Angeles. Waiting until you know you’re pregnant may be too late to prevent
these defects.
Take at least 400 micrograms of folic acid daily to reduce the risk for
neural-tube defects, such as spina bifida; eat a healthy, balanced diet; avoid
fish that contain mercury; stop drinking alcohol, smoking cigarettes or using
recreational or over-the-counter drugs; don’t eat undercooked meat or change
the cat’s litter box (both are possible sources of toxo- plasmosis, an
infection that can cause birth defects); lose weight, if needed; and make sure
your blood sugar levels are normal.
2. Miscarriage (75%)
REALITY CHECK:
The risk of miscarriage is probably lower than you think. For women younger
than 35, it’s 10 to 12 percent; for 35- to 39-year-olds, it’s 18 percent. (It
does rise to 34 percent for women 40 to 44 years old.) But a great many
pregnancies are lost so early that a woman never even realizes that she
conceived. What’s even more reassuring is that by the time you see a heartbeat
on an ultrasound (usually by week six or seven), the chance of having a
miscarriage drops to less than 5 percent, says Lu.
WHAT YOU CAN DO:
Remind yourself that most miscarriages occur because of chromosomal
abnormalities that cannot be prevented; research does not show that exercise,
sex or even heavy lifting can cause a miscarriage. One lifestyle caveat: Recent
studies have shown that drinking two or more cups of coffee a day may increase
your risk, as may contracting certain infections, including sexually
transmitted diseases and gum disease.
3. Too much stress (74%)
REALITY CHECK:
Everyday stressors like having to work late, getting stuck in traffic or
arguing with your husband are not likely to pose a risk to your pregnancy or
your child. But ongoing
major
stress accompanied by depression (the two often go hand-in-hand) may
increase your risk of preterm delivery or having a low-birth-weight baby or a
child with long-term behavioral issues.
“If you are impaired in some way by the stress—you aren’t able to get along
with your co-workers or partner, say—that’s when it may have an impact,” says
Tom O’Connor, Ph.D., a professor of psychiatry and psychology at the University
of Rochester Medical Center in New York. “If your stress doesn’t reach that
level, it may not be significant in terms of pregnancy complications,” he says.
WHAT YOU CAN DO:
For ongoing stress or depression, see a cognitive behavioral specialist who
can teach you coping strategies, such as questioning the anxiety-causing
chatter in your head. She can also teach you relaxation exercises and
visualization to lower your stress hormone levels. You can even use the
breathing exercises taught in childbirth classes. While practicing deep
breathing, imagine what concerns you as you’re inhaling; then, while exhaling,
picture yourself releasing the thought or concern that is on your mind. You can
also use a phrase like “let it go” when you breathe out, says Shepphird.
4. Prematurity (71%)
REALITY CHECK:
Prematurity is a legitimate concern.
However, worrisome as pre-term birth is, the great majority of babies in the
U.S. are born after 37 weeks, which is considered full term (this may be
changing; see “Rethinking ‘Full Term'"). An estimated 12 percent are born
preterm, which increases their risk of health problems, but keep in mind that
70 percent of them are born between weeks 34 and 37. These so-called
“late-term” babies still have increased risks, but they are less vulnerable
than the tiniest ones. The biggest risk factors for preterm birth are having
had a previous premature delivery, being pregnant with multiples, and having
certain uterine or cervical abnormalities. Still, about half of women who
deliver prematurely don’t fall into any high-risk category.
WHAT YOU CAN DO:
Obesity, high blood pressure and
diabetes are risk factors for prematurity, so try to maintain a healthy weight
and make sure your blood sugar and blood pressure levels are normal. Avoid
smoking, alcohol and recreational drugs (all are linked to prematurity), get
good prenatal care and make sure you have all your necessary immunizations and
have any infections (even minor ones) treated promptly, as infections are a
leading cause of preterm birth. Ongoing major stress can also trigger preterm
labor, so be sure to treat any severe anxiety or depression. Many mood-altering
medications are considered safe during pregnancy; ask your doctor which ones
might be best for you.
5. Labor pain (70%)
REALITY CHECK:
We’re not going to tell you labor doesn’t hurt—most women rate it as a 7 or
8 out of 10 on the pain scale—but you have options when it comes to easing both
your pain and your fear of it. If you want to avoid medication, there’s much
you can do to reduce the pain and the anxiety surrounding it, such as laboring
in a tub of water, changing positions often during labor and practicing
relaxation techniques like guided imagery.
Or, you may want to opt for pain meds. If you’re worried about the risks,
rest assured that today’s epidurals are safe and mom-friendly. Though you may
have heard that pain medications prolong labor, they don’t prolong the
first—and longest—stage of labor, and may even shorten it, says Cynthia A.
Wong, M.D., a professor of anesthesiology at Northwestern University Feinberg
School of Medicine in Chicago. Epidurals do tend to lengthen the shorter
“pushing” phase because they dull the otherwise intense urge to push, but
there’s no convincing evidence that they increase the risk of Cesarean section
or low Apgar scores for your newborn.
WHAT YOU CAN DO:
First, educate yourself about all your pain-relief options and their risks
and benefits. If you are trying to avoid using medication, research suggests
that a birthing coach or doula can help you “go natural” by reminding you to
breathe, talking you through the stages of labor and reassuring you that
nothing is wrong as the pain intensifies. Also learn what to expect, because
the unknown can cause more anxiety. “If you know exactly what is causing the
pain, it can reduce your anxiety,” says Erika Bleiberg, a doula in Glen Ridge,
N.J. Anxiety can cause tension, which can make breathing more dif-ficult and
the pain worse, she adds. Sign up early for a childbirth course, such as
Lamaze, the Bradley Method or HypnoBirthing; classes fill up fast.
Also have a birth plan, but don’t make absolute decisions beforehand. “Women
get disappointed and feel guilty when they have a plan and things change,” Wong
says. If you’re on the fence and not sure how you’ll handle the pain, don’t try
to be a hero and wait until you can’t stand it anymore. It takes at least 20 to
30 minutes between the time you say, “Give me the drugs!” until they’ve been
administered and you feel relief.
6. Eating sushi (61%)
REALITY CHECK:
Most experts recommend avoiding raw
fish while pregnant because of the risk of being exposed to bacteria and
parasites (these infections are often difficult to treat during pregnancy
because some medications can be unsafe). But your actual risk may be quite low.
“If sushi chefs are well trained and freeze fish adequately before serving it
raw, the risk should be extremely low,” says Jeffrey Jones, M.D., of the U.S.
Centers for Disease Control and Prevention. The other concern, though, is the
mercury in some fish: Tuna can be high in this toxin.
WHAT YOU CAN DO:
Rest assured that if you desperately need to quell a sushi craving or you
had some sushi before you knew you were pregnant, chances are you’re fine. To
keep mercury consumption down but still benefit from the healthy omega-3 fatty
acids in certain seafood, do not eat more than 6 ounces of fresh tuna a week,
but do eat up on things to 12 ounces of canned light tuna or other low-mercury
seafood, such as shrimp, wild salmon, catfish, sardines and anchovies.
7. Breastfeeding (60%)
REALITY CHECK:
You may have heard reality TV star Bethenny Frankel (or even one of your
friends or family members) say that breastfeeding was “the hardest thing in the
world.” The truth is, 90 percent or more of women can successfully breastfeed,
given patience, realistic expectations and support. Most women think they will
click with the baby right away and breastfeed effortlessly. If they don’t, many
new moms worry that they have an unsolvable problem. “It takes two to three
weeks before the mother and baby really know each other and the milk production
matches the baby’s needs,” says Laura Viehmann, M.D., a pediatrician in
Pawtucket, R.I.
WHAT YOU CAN DO:
Before you give birth, imagine yourself happily nursing your baby, and have
a lactation counselor or doula lined up to provide expert advice if you need
it. Also consider visiting a breastfeeding support group before your baby is
born. “Women who have seen other women breastfeed are much more able to do so
successfully,” Viehmann says.
Nipple pain is one of the most common reasons women give up on nursing, but
this can be avoided with a good latch-on technique (watch our step-by-step
video here). If you experience even a little pain when nursing, seek help
immediately.
Another concern new moms have is that the baby is not getting enough milk,
but your expectations may be too high. Newborns only drink about 1 1∕2 ounces
of milk in the first 24 hours, and only a few ounces a day in the next few
days, because you’ll produce colostrum— the calorie-dense, nutrient-rich
“pre-milk”— before your milk comes in on day four or so.
Finally, try to surround yourself with people who will be positive and
supportive of your efforts to breastfeed. “It’s a lot harder if you have people
around you suggesting that you give the baby a bottle,” Viehmann says.
8. Losing the pregnancy weight (59%)
REALITY CHECK:
This is a valid concern, especially for the 41 percent of women who gain too
much weight during pregnancy and for those who were very overweight before they
got pregnant.
WHAT YOU CAN DO:
Stick to the Institutes of Medicine guidelines for weight gain during
pregnancy and you’ll have an easier time taking it off later. If you’re normal
weight (your body mass index, or BMI, is 18.5 to 24.9), gain 25 to 35 pounds;
if you’re underweight (BMI less than 18.5), gain 28 to 40 pounds; if you’re
overweight (BMI 25 to 29.9), gain 15 to 25 pounds; and if you’re obese (BMI 30
or higher) gain 11 to 20 pounds, though some experts believe obese women should
stay at the low end of that range.
Try to stay active during your pregnancy and start exercising after giving
birth as soon as you get the green light from your OB. Studies show that diet
and exercise together to 12 ounces of canned light tuna or other low-mercury
seafood, such as shrimp, wild salmon, catfish, sardines and anchovies. can help
you lose weight postpartum faster than either tactic alone. And breastfeed:
Recent research found that if you stay within the prenatal weight-gain
guidelines and feed your baby nothing but breast milk for the first six months,
you’ll likely lose all your pregnancy weight during that time.
9. Heavy lifting (57%)
REALITY CHECK:
There’s some evidence that being on your feet all day or having a job that
requires heavy lifting may raise your risk of preterm labor, but the research
is inconsistent.
WHAT YOU CAN DO:
If you’re at increased risk for preterm labor, you will be advised to avoid
heavy lifting and prolonged standing. Worried about either? Talk to your boss
about switching to a job that allows you to sit more or take more frequent
seated breaks.
10. Getting to the hospital on time (55%)
REALITY CHECK:
Though it always makes the news when a woman delivers in a taxi or on the
bathroom floor, in real life, it’s rare. In a study from England, 137 out of
31,140 babies were born before they arrived at a hospital over a five-year
period—that’s less than a 1 percent chance. If it’s your first baby, you should
have plenty of time: From the time your cervix is dilated 4 centimeters (when
experts say you should head to the hospital) you still face an average of six
hours for the first stage of labor (when your cervix dilates to 10 centimeters)
plus another two hours of serious pushing, says Siobhan Dolan, M.D., M.P.H., an
associate professor of clinical obstetrics and gynecology and women’s health at
the Albert Einstein College of Medicine in the Bronx, N.Y. If it’s your second
baby, the first stage of labor usually lasts two to 10 hours.
WHAT YOU CAN DO:
Most women don’t need to worry about this if they follow the guidelines
above. If you had a very quick labor previously or you live far from a
hospital, you should check in with your doctor or midwife sooner rather than
later, Dolan says.
5 things you SHOULD worry about
In the March of Dimes survey, fewer than half of the pregnant women said
they were concerned about the following issues, all of which, experts say, pose
serious potential risks.
1. GETTING AN INFECTION
Infections can be more serious during pregnancy and lead to complications
such as preterm birth. In 2009, 5 percent of pregnant women who reported having
the H1N1 virus (the “swine flu”) died, and 22 percent were admitted into the
intensive care unit. Even a common urinary tract infection can lead to a
dangerous kidney infection and preterm birth when you’re pregnant, so see your
doctor immediately if you have symptoms of infection, such as fever,
inflammation or pain. “Things that you might sit on when you’re not pregnant
should be addressed more quickly when you are,” says OB-GYN Siobhan Dolan,
M.D., M.P.H.
2. GAINING TOO MUCH WEIGHT
A three-state survey found that 41 percent of pregnant women are gaining
more than the recommended amount of weight, the U.S. Centers for Disease
Control and Prevention reports. Doing so can put you at risk of pregnancy
complications, prematurity, birth defects, retaining the weight postpartum and
having an overweight child. Try to eat twice as healthy when you’re pregnant,
not twice as much.
3. NOT EXERCISING ENOUGH
Only 23 percent of pregnant women get the recommended 30 minutes or more of
moderate exercise a day, according to a recent study. Lack of exercise can
contribute to excessive weight gain, loss of strength and stamina just when
you’re going to need them most, and pregnancy complica- tions. If you’re not
exercising yet, start with leisurely short walks, then gradually increase your
speed and walking time.
4. USING HOME CLEANING PRODUCTS
Try to avoid using bleach and other strong chemicals or use them only in
well-ventilated areas, says Ted Schettler, M.D., science director of the
Science and Environmental Health Network and co-author of
In Harm’s Way:
Toxic Threats to Child Development. The same is true for home improvement
projects like painting or refinishing. Find nontoxic alternatives whenever
possible, and forgo air fresheners, pesticides and lawn chemicals entirely. For
more ways to protect yourself and your developing baby, go to
fitpregnancy.com/goinggreen.
5. DEVELOPING GESTATIONAL DIABETES
About 6 to 8 percent of pregnant women develop gestational diabetes, which
can raise the risk of serious pregnancy complications, and the numbers are
growing. Plus, new research is showing that even expectant moms with borderline
gestational diabetes—elevated blood sugar levels that are below the current
cutoff point—have an increased risk of complications like preeclampsia, preterm
delivery, having a too-large baby and needing a C-section. Exercise regularly,
watch your sugar intake and cut back if you’ve been diagnosed or told your blood
sugar is elevated.
