The Ups and Downs of Pregnancy Emotions

Here's a trimester-by-trimester guide to surviving -- and thriving -- during your wild pregnancy ride.

Feeling forgetful? Dr. Obosa Osawe gets to the bottom of what's commonly called "pregnancy brain.

Alli Arnold

The Pregnancy Roller-Coaster

The diaper commercial was a lighthearted montage of wild animals with their babies. Here was a zebra circling her foal, here was a penguin protecting her chick, and so on. Rod Stewart's "Forever Young" played in the background. Ten seconds in -- right around the time the elephant mom was wrapping her trunk around her little one -- I was weeping. Actual tears.

Did I mention I was eight months pregnant? Expectant friends, beware of sappy TV ads. The fact is, pregnancy can have a powerful effect on emotions, which can change by the minute.

Why the drama? Blame rising hormone levels. Experts have found a relationship between hormone levels and the brain's neurotransmitters -- especially serotonin, a chemical that regulates mood. "There are certain women who are more sensitive to those shifting hormones," says Robin Kopelman, MD, MPH, assistant professor at the University of Iowa's department of psychiatry.

And even the lucky souls, pregnant or not, whose moods aren't affected by rising hormone levels still face challenges that can influence emotions. Consider how you feel when you're fatigued, uncomfortable, or stressed by a big life change. Rare is the woman who sails through pregnancy without meeting one of those challenges! Step right up. It's a roller-coaster ride.

First Trimester:

Any woman who has ever stared down at a positive pregnancy test will tell you: It's a heart-pounding, life-changing moment. It might also be frightening or upsetting.

Hello, Hormones

Ironically, those soaring hormones are a pregnant woman's best friend -- and her baby's lease on life. Human chorionic gonadotropin, or hCG (which rises sharply in the first trimester, then dips and levels off around four months), keeps the embryo firmly implanted in the uterine lining. Progesterone and estrogen (which increase throughout the nine months) help sustain the pregnancy and cause the buildup of nourishing blood vessels.

"This hormonal bath, which is so beneficial to the baby, is sometimes very hard for you to take," says Lucy Puryear, MD, director of the Baylor Psychiatry Clinic, in Waco, Texas. hCG, for example, may cause morning sickness, and estrogen and progesterone are often linked with moodiness and tearfulness.

Frequently, rest isn't an option, especially if you're caring for older children. And when expectant mothers don't feel the joy they imagined, they might feel guilty about it or think something's wrong with them. There isn't. "Give yourself a break," says Dr. Puryear, who wrote Understanding Your Moods When You're Expecting (Houghton Mifflin). "And know that 99.9 percent of women who have had children have experienced some of the same things you're feeling."

Losing Control

Candace Kelleher, of Dearborn, Michigan, had planned for her pregnancy -- but not for the havoc it might wreak on her career. "I'd always been great at managing my time," she says. But after she got pregnant, she was forced to scale back her workload. "I was at the mercy of my body -- feeling exhausted, getting sick to my stomach, and not being able to think as clearly."

"Until you're pregnant, you can't tell how easy or how hard it will be for you," Dr. Puryear says. And if you have a sense of being in control of your life, the unpredictable nature of pregnancy can be a rude awakening. Suddenly, you're thinking, What else am I not in control of?

Obviously, moms-to-be should try their best to let go of the issues they can't control. "Get as much sleep as you can," Dr. Kopelman says. "Communicate your needs. Use social support."

Second Trimester:

Hallelujah! The second trimester typically brings relief from morning sickness and other symptoms. (hCG has leveled off, while progesterone and estrogen are rising slowly.) You're starting to show, and you're sharing your happy news with more people. Most mothers agree: Feeling your baby's first kicks -- another second-trimester milestone -- is an indescribable joy.

Stressful Tests

While you're flying high, you might not imagine that this roller-coaster ride could take a downturn. And maybe it won't. But don't be surprised if it does, because now you're facing some potential stress triggers.

Between the 15th and 17th weeks, you might opt for a blood test that assesses your baby's risk level for certain birth defects, like Down syndrome. If the results -- which are never precise -- show a higher than average risk, you'll need to choose whether to pursue amniocentesis or CVS (chorionic villus sampling). These tests carry risks, including possible miscarriage.

Geena and Karl Umberto, of Miami, were anguished when a blood test showed their baby had a higher than average risk for Down syndrome. Even though they declined the amniocentesis, which they felt was too invasive, they fretted about their readiness to raise a child with special needs. "I ended up wishing I'd never gotten the blood test," Geena says. When the baby was born healthy, she was jubilant. But she also became firm in her conviction: "No blood test with the next one!"

So before jumping in, consider your personal degree of comfort with the possibility of receiving scary news that might turn out to be wrong anyway.

Relationship Strains

Jill Rengarden, of Atlanta, had another concern: she never anticipated the pressure that impending parenthood would put on her marriage. "I was freaked out about how much weight I was gaining," she says. "I just felt vulnerable and unattractive. My husband wasn't exactly insensitive, but he wasn't encouraging me either." And when her belly began to protrude, they stopped having sex. "I knew he still loved me," Rengarden says. "But I felt so disconnected from him -- right when I needed him most."

Lots of men miss the mark in the sensitivity department, Dr. Puryear says. All relationships go through growing pains, and it's typical for men and women to process this extraordinary life event in different ways. Even the sex lull is (sigh) typical. "And remember," she adds, "pregnancy is a temporary condition."

As for losing control of your figure, that's another widespread worry. And your physician may unintentionally make things worse by encouraging you to gain only a certain amount. He's simply trying to curb your risk for conditions like diabetes. "The truth is, some people just gain a lot," says Dr. Puryear, who reminds her patients that most women, through diet and exercise, get back to a normal weight after delivery.

Alli Arnold

Third Trimester:

You're just a few months away from meeting your child! If you're like most women, you can hardly wait. Unfortunately, that's exactly what you have to do.

Tired of Being Tired (and Big)

Isn't it ironic? In the last few months of pregnancy, you're at your heaviest, most uncomfortable weight. You're achy and sleep-deprived, and the hormones that mess with your mood are really flooding your system now. And this is when strangers start rubbing your belly and relatives arrive at your baby shower with lots of unwanted advice.

On top of all that, let's not forget that you're getting closer to childbirth, which can provoke fear. "Nervous but hopeful" is how Ginny Parrot, of Morris Plains, New Jersey, described her feelings about going into labor for the first time. But when some friends visited and detailed their difficult birth experiences, her nervous feelings blossomed into full-fledged terror.

Kendall Wolfson, of Indianapolis, recalls that in her last trimester, she wasn't so much scared as irritated. With her protruding bump and swollen legs, she just couldn't get comfortable enough to sleep through the night. During the day, she walked around in a daze, trying to tie up loose ends before the baby arrived.

In the last month of pregnancy, estrogen and progesterone levels are at their highest. You are practically expected to have mood swings. "This is a time when you need to be sure that you are taking care of yourself and not trying to prove something to yourself or your family," Dr. Puryear says. "And if you are tired, go to bed. You may not be able to sleep for several hours in a row, but intermittent sleep is better than no sleep."

Hang on. The ride is almost over. And a whole new ride is about to start. Welcome to motherhood!

Should I Be Stressed About Being Stressed?

It's a typical catch-22. If you're prone to anxiety, you're likely to worry about the health of your baby. But could this stress itself do your baby harm?

Probably not, in most cases. "Almost all pregnant women worry," says Dr. Kopelman. "Being worry free is unusual!" But if you are so distressed that it's interfering with your ability to function, that's another matter.

In 2006, a study found that during early pregnancy, women with high levels of the stress hormone cortisol were three times more likely to miscarry than women with normal levels of the hormone. "That's one of a host of studies in this area," Dr. Kopelman says. She hopes that the findings will motivate women with overwhelming anxiety to see a doctor.

The takeaway: "Don't get worried about being worried," she says. "Do something about your worry." See a mental health professional to get treatment, which might include medication.

Copyright © American Baby magazine.

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