Understanding Stress During Pregnancy

Pregnancy can be a highly stressful time for expecting parents — especially mothers — which makes it a bumpy road for developing fetuses, too. The gestational period is a time of high neuroplasticity, during which both genetics and environmental factors can directly influence fetal brain development. More so than a fully developed brain, fetal brains are highly pliable and particularly susceptible to both physical and emotional stress experienced by pregnant mothers.1

Stress can certainly be an uncomfortable experience, but low-level stress or anxiety will likely not influence the health and development of a growing fetus. Prolonged, elevated, or highly variable levels of stress during pregnancy, however, have been shown to impact the emotional development of many children.1

Every parent’s pregnancy experience will come with a unique set of challenges, and no matter how prepared we think we are, there’s plenty we have likely overlooked or forgotten. This guide lays out some of the general causes of and complications related to stress during pregnancy to help you identify and understand its risks.

There are a range of challenges that are certain to arise when starting or expanding a family, which makes the pregnancy period an especially complex time for prospective parents. Hormonal changes during pregnancy are unavoidable, and any parent who has suffered a miscarriage will be understandably concerned about having another. As new and difficult as so many things might seem during this time, however, most are a highly normal part of the pregnancy experience.2

Expected challenges

Disturbed sleep patterns and physical symptoms related to pregnancy (such as nausea, constipation, fatigue, and aches and pains) can bring about feelings of stress and anxiety during pregnancy, which is stressful on its own. It’s also completely normal to worry about how a baby will affect your routines, relationships, and finances. You’ll likely have less time for your partner, friends, and family, not to mention the expense of fully supporting another human being.

Most parents also experience uncertainty about work. For instance, when will you tell your employer about your pregnancy? Or what if you feel too sick to work? And how does your company handle maternity or paternity leave?

Nearly all soon-to-be-parents worry about these issues, as well as the delivery experience and the health and safety of their future child.2

Effects of prenatal stress

When studying human health and development, researchers give a significant amount of attention to the prenatal period, given the intricate physiological relationship between pregnant mothers and developing fetuses. Excessive stress in expecting mothers can produce a cascade of effects, including changes in blood flow to the uterus and shifts in the intrauterine environment, that make minuscule effects on fetal development.3

This nine-month bond between mother and baby is why researchers believe many of the behavioral or temperamental traits that manifest in children are associated with prenatal maternal distress. However, these same traits can also simply be manifestations of similar characteristics expressed in their parents. To fully understand what is and isn’t in your control, understanding stress and stress management during pregnancy crucial.3

Some low-level anxiety is necessary for our survival, and a certain number of stressful life events will undoubtedly arise throughout our lives. Don’t be alarmed if, during the pregnancy and infancy periods of your child’s development, you experience more frequent bouts of stress or anxiety.

With every pregnancy, a whirlwind of ups and downs and mini-emergencies can be expected. When events like these occur, parents typically deal with them in the moment and then forget about them. (This is called acute stress.) Acute stress can be defined by short episodes of stress that have a defined beginning and end. Once the stressful event ends, you tend to feel better.

By contrast, chronic stress is more long-term and insidious. It doesn’t have a specific end point but just compounds and builds upon itself over time. It’s ongoing chronic stress from things like health problems, financial strain, or a bad work environment that should be more of a concern for everyone, not just expecting mothers.

For many people, their stress is a product of the circumstances that make up their daily lives: poor living or working conditions, financial hardship, ongoing health problems, or tumultuous relationships. Over time, we become accustomed to these challenging circumstances, along with the underlying feelings of anxiety they often bring about.

Caught up in the hectic nature of daily life and the many changes that come with pregnancy, it’s easy for expecting parents to accept and adapt to adverse stress levels. But failure to recognize and disrupt these negative circumstances, as well as the uncomfortable mental states associated with them, can have long-term impacts on the health of both mother and child.4

According to the American Psychological Association (APA), one in four pregnant women experience physical symptoms related to stress and anxiety. Unchecked, these physical manifestations of stress can significantly contribute to the risk of preterm birth (birth before 37 weeks of pregnancy).

Prolonged bouts of general anxiety experienced during the first trimester can contribute to the risk of preterm birth by predisposing women to more serious problems that may arrive later in their pregnancy. Anxiety experienced during the third trimester appears to have a more notable impact on the likelihood of preterm birth.5

That said, worrying about your child’s health and the challenges associated with pregnancy are, for most people, an unavoidable part of an otherwise wonderful process. Doing your best to take care of yourself, while being mindful of any physical or mental changes, is the best thing you can do for both yourself and your future baby.

Signs and symptoms

While not all of these symptoms are necessarily caused by stress, and some women experience few or none of them, a significant proportion of pregnant women do experience a range of physiological changes that can contribute to feelings of stress, especially for first-time mothers:6

• Increased levels of estrogen and progesterone cause the mammary glands to enlarge in preparation for breastfeeding, often making the breasts tender and swollen.
• The areolas may also enlarge or change color, while the veins on the surface of the breasts become more noticeable.
• As the uterus continues to grow it can start to press on the bladder, resulting in an increased need to urinate. Constipation is also common, as the growing uterus presses on the rectum and intestines.
• Regular bouts of nausea, often accompanied by vomiting — commonly referred to as “morning sickness” — are common and can last throughout the entire pregnancy.
• The muscular contractions of the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone. This may, in turn, cause heartburn, indigestion, constipation, and gas.
• Over the course of your pregnancy, cardiac volume can increase by as much as 40-50%, resulting in increased cardiac output and elevated blood pressure levels.

Furthermore, if you have preexisting physical health or mental health conditions, these symptoms may be more pronounced during your pregnancy. This can add to fatigue, anxiety, and general discomfort.

Most women who experience these changes will do so to different degrees and for different durations. Some of these symptoms continue for weeks or months, while others only last for a short time. But all of these changes are simply natural responses of the body, designed to nourish and protect the fetus growing inside it.6

Unfortunately, modern society doesn’t often encourage us to slow down and take time for ourselves, which makes balancing the physical and emotional demands of pregnancy a challenge for many soon-to-be parents. Implementing various stress-reduction techniques, though, can provide health benefits for both mother and baby — including the increased likelihood of a full-term pregnancy.7

Here are a few of our favorite ways to practice stress management.

Mindfulness practices

1. Connect with your breath. Follow the inhalation/exhalation cycle without trying to control or change your breathing. When feeling overwhelmed, mindful breathing can help ground your body and quiet your mind. Simply note how your breathing feels and take note of any thoughts or bodily sensations that arise.
2. Acknowledge your feelings. Instead of getting caught up and letting your feelings run away with you, try just noticing and labeling them. If you are feeling stressed, call it what it is: say to yourself, “I’m feeling stressed.” Be mindful of any judgments you have on your feelings and try to avoid letting them dictate your next action.
3. Practice meditation. Try using one of the many available mindfulness or meditation apps. Most of these apps include short lectures, guided meditations, and a range of other self-soothing techniques.

Quality sleep

1. Time your naps. Pregnancy undoubtedly comes with increased feelings of fatigue, but try and limit daytime naps to 30 minutes or less. If possible, aim for continuous quality sleep (as much as you can sneak in) overnight.
2. Stay away from caffeine. While we don’t know much about caffeine during pregnancy, the American College of Obstetricians and Gynecologists (ACOG) recommends drinking two cups of coffee or less daily during pregnancy, if you opt for it at all. Caffeine can have a half-life of anywhere from 5-10 hours. To promote better sleep, it’s best to avoid consuming caffeine later in the day and in the evening.
3. Avoid food that provokes indigestion before bed. Rich, heavy, fatty, spicy, or fried foods, citrus fruits, and carbonated beverages can all lead to gastrointestinal discomfort or indigestion and disrupt sleep.
4. Get some sun. Dial in your internal clock by getting adequate light exposure during the day and optimizing your sleep space for deep, quality rest by ensuring that it remains cool and dark throughout the night.
5. Optimize your sleep space. Make sure that you are sleeping on a comfortable mattress and try to keep the room as cool and dark as possible. Remove clutter, as it’s often associated with increased stress.

Physical activity

1. Move a little. Exercising for as little as 20-30 minutes every day can greatly reduce stress during pregnancy. Even 10 minutes of daily aerobic exercise, such as walking, can produce noticeable results.
2. Try some yoga. For those on a tight schedule, most prenatal yoga classes also incorporate an element of mindfulness, making them a great way to move the body and calm the mind.
3. Be ready to change your workout. As your pregnancy progresses, you’ll likely find that it isn’t safe — or fun — to do the same exercises anymore. No matter how you move, it’s a good idea to choose an activity where the duration and intensity can be continually adjusted as your pregnancy progresses. Ultimately, finding any physical activity you enjoy, then implementing a reasonable and safe amount of it into your daily routine, is really the best way to go.

Support systems

1. Ask for help. Start by identifying people in your life whom you can count on for tangible support (such as meals, transportation, and household tasks) and emotional support throughout your pregnancy. Then, don’t be afraid to speak up and ask them for help when you need it.
2. Find community support. Joining a pregnancy or parenting group can also be an excellent source of support. Through these groups, you might connect with others sharing your experience; they are typically offered both in-person (through your local clinic or hospital) and online.
3. Accept help when people in your life offer it. Reducing your daily burden, in whatever ways you can, can be one of the most impactful tools for managing stress during pregnancy.
4. Seek professional support. Individual or couples perinatal counseling can be extremely beneficial during your pregnancy. A therapist can help you better understand your triggers and prepare yourself for taking care of your baby.

Remember: what’s best for your physical and mental health is also what’s best for your baby.

Whether you’re having your first child or your third, the arrival of a new baby can trigger a range of intense emotions. Everything from excitement and joy to fear and anxiety can be caused by hormonal changes, as well as disturbed sleep, changes to your diet, and a lack of physical activity.8 But there are other serious concerns to keep in mind beyond your daily stress levels.

According to the Mayo Clinic, most new mothers experience some symptoms of postpartum depression. These symptoms typically begin within the first few days after delivery and can last for weeks or months.8

Symptoms to be aware of include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of or highly increased appetite
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities
• Intense irritability and anger
• Fear that you’re not a good mother
• A sense of hopelessness
• Feelings of worthlessness, shame, guilt, or inadequacy
• Diminished ability to think clearly, concentrate or make decisions
• Restlessness, severe anxiety, or panic attacks
• Thoughts of harming yourself or your baby
• Thoughts of death or suicide

As soon as any of these symptoms appear, it’s a good idea to call your doctor and schedule an appointment. If you do have postpartum depression, prompt treatment (including counseling or medication) is the best way to manage it.8 If not addressed, these symptoms can continue to progress over time and affect your ability to take care of yourself and your baby.

Keep in mind that postpartum depression can look different for everyone. Some people find that they just experience a sense of numbness or apathy throughout the day. Others feel guilty that they aren’t as bonded as they’d like to be with their new baby. Some mothers may experience a profound identity crisis about who they are and what their lives now look like.

Many new mothers who feel depressed after their babies are born also feel embarrassed and are reluctant to admit these feelings to others. Postpartum depression isn’t a character flaw or a sign of weakness, or an indication that you’re not a good mother — more often than not, it’s simply a temporary yet uncomfortable part of being a new parent.8

Research clearly shows that psychosocial, cultural, and environmental stressors experienced during pregnancy can have a negative impact on fetal health. Prenatal stress can range from severe trauma to moderately stressful life events, and even the mild hassles of daily life can impact fetal health if left unchecked. Just about anything that negatively affects the mother may impact the fetus, possibly affecting both its development and later life as the consequences of prenatal stress are regularly passed from one generation to the next.9

While acutely stressful events, such as a flat tire or carton of spilled milk, are still stressors, chronic or ongoing stress, such as illness or financial insecurity, poses a bigger risk for both mother and child. Luckily, there is a range of self-care techniques available to ensure that you and your baby make it through the pregnancy as safely as possible.