Synopsis

Pregnancy has become an experience that is complicated by new technology, financial pressures, mothers age, and a host of other emotional issues that are moving faster then our abilities to process them.

Full text

"Congratulations, you're pregnant!" ----A woman never knows how loaded that statement is until she becomes pregnant. Pregnancy is usually depicted in soft-glow focus, but the hard-core reality is that difficult emotions can affect a woman's pregnancy.

Each woman's pregnancy is a unique physical and emotional journey, and although the clinical lexicon can describe and categorize the physical events that define pregnancy, emotions are more complex. While a woman may feel happy, or even exuberant, about being pregnant, it is not uncommon to feel confused, anxious, or even depressed. In fact, when researchers in England studied 9000 women throughout their pregnancies and up to a year postpartum, they found that more women were depressed during pregnancy than after. Over 1000 of the women, or 13.5%, were clinically depressed during their 8th month of pregnancy, compared with 9.1% eight weeks postpartum. [1] In a separate study, physicians in Texas tracked 305 single women of different ethnic backgrounds with full-term pregnancies. They found that by the last trimester, 70% of women reported feelings of depression. [2] This data goes against the notion that women are somehow protected from depression during pregnancy, and reinforces the fact that pregnancy can ignite complex feelings, ranging from outright joy and feelings of extraordinary power to a sense of diminished self-esteem, feelings of inferiority, insecurity, and relentless anxiety.

Numerous factors can affect a woman's emotional state during pregnancy, including: whether her pregnancy is planned; whether she has a partner and how supportive her partner is; experience with previous pregnancies, including miscarriage, stillbirth, or abortion; maternal age; health status; financial status; career conflict; and family and other social support. In addition, feelings about mortality can come up either in the form of a pregnant woman mourning the end of her girlhood, sadness over loved ones who have died, or a general sense of moving closer to death even as she houses new life. Traditionally, the society-defined "ideal" situation for a pregnant woman was being married with a solid base of financial security and family support. However, what is ideal for one woman may be stifling for another or simply not part of her current reality. But regardless of circumstance, all pregnant women need support. [3]

According to clinical studies, approximately 25% of postpartum depression starts during pregnancy. Addressing emotional issues therapeutically during pregnancy enhances a woman's overall prenatal and postpartum health, and the health of her child. [4] How does clinical data translate into reality for today's pregnant woman? In Misconceptions: Truth, Lies and the Unexpected on the Journey to Motherhood (Doubleday 2001), Naomi Wolf addresses this head on. She discusses how identity is challenged during pregnancy and how gender issues suddenly ignite, fueled by the primordial nature of reproduction. Additionally, Wolf examines the difficult relationship between women who face "an appointment with the birthing table" and the by-the-book medical establishment. [5]

Another 24-year-old married woman aptly expressed how many women feel. In a letter [6] to the British Medical Journal she wrote, "This should be a happy and exciting time and mostly it is. Nevertheless..." She went on to describe her hatred of her growing belly and the measures she took to control her weight---eating as little as possible and walking miles at a time even while ignoring dizziness and achy joints. Citing her guilt about the effect this behavior could have on her baby she wrote, "There exists both an innate desire to destroy myself and the potential of producing and nurturing new life." Though this woman had a history of an eating disorder, she is not an anomaly. Pregnancy catalyzes intense and conflicting emotions.

The best ways to cope with emotional issues during pregnancy are to understand the challenges, seek therapy, and interact with others who have similar concerns. What happens next? First the challenging reality: physical and emotional changes are part of pregnancy. During the first trimester of pregnancy, feelings of anxiety and intense emotions are normal, and in the third trimester, pregnancy-fatigue kicks in along with a sense of frustration over the physical heaviness and immobility that happens right before the baby is born. Now for the empowering reality: pregnancy is temporary, and after almost ten months, a woman brings a new life into the world. During pregnancy, any unresolved issues that affect self-esteem or interpersonal relationships are exaggerated. But, as a nice counterpoint, like everything else, the therapeutic work a woman does during this time is amplified. In effect, seeking emotional balance can encourage balance in other areas: disciplined eating and health habits and a desire to exercise and be healthy throughout the pregnancy. Under these circumstances, the experience of giving birth can symbolize a re-birth of self and a purging of negative experiences and feelings. And then, the new mother can emerge from her pregnancy stronger, healthier, more optimistic and capable of mothering her new child.