When Anissa Bernardo was 14 weeks pregnant with her first child, her husband was diagnosed with Hodgkin's lymphoma. At that point, Bernardo's focus switched from self-care to shuttling her husband to chemotherapy appointments and nursing him through treatment side effects – all while working full-time as a hospital social worker. At the same time, the couple moved to a new apartment, and her husband started a new job. "I really don't know how I managed all that," marvels Bernardo, 43, a mother of two boys in Brooklyn.
Although not everyone will experience a serious family illness during pregnancy, life does not stop when you become pregnant. The same stressors you previously had will continue, and new ones may be added. According to The American Psychological Association's annual Stress in America survey, a study that examines how stress affects health and well-being, Americans report increasing stress levels each year.
"Pregnancy is already a time of great change," says Donna Rothert, PhD, a Bay Area psychologist who specializes in perinatal mental health. "Women experience changes in hormones, body shape, physical sensations and identity. If there is another significant stressor, such as a new job or sick spouse, it can increase the likelihood of physical symptoms, such as headaches or higher blood pressure, and psychological symptoms, such as anxiety or depressed mood."
Rothert also notes that when you're struggling to cope with stress, you might worry constantly or frequently, have trouble sleeping, experience extreme physical discomfort, and feel especially sad and moody. Many of these symptoms can be pregnancy-related, so it's important to differentiate between common, manageable pregnancy stress and the more severe signs that could indicate you would benefit from professional mental health support.
Experts advise that if the moodiness or worry persist for a few weeks and begin to interfere with your daily life, it's time to seek help. It is also important to remember that many women who experience postpartum depression and anxiety report that their symptoms actually began during pregnancy. But you can find your way through by getting the support you need.
For Bernardo, coping with the stress of her husband's illness, coupled with moving and a new job, came down to reminding herself (sometimes daily) of a simple truth: "The fact that I was pregnant was this gift. That's what we focused on," she said. "I knew that once my husband got better, we would [have] this baby, and it would be the very best thing to come out of all this." Additionally, Bernardo took many walks outside, received a tremendous amount of hands-on help from family and friends, and was blessed with a supportive boss at her job.
Seven ways to reduce stress during pregnancy safely
Exercise. During Aynsley Kirshenbaum's first pregnancy, her mother was battling aggressive cancer. "I flew to Seattle for a week every month during the first six months of my pregnancy and slept on the floor of her nursing home," says the 36-year-old Brooklyn nutritionist and personal trainer. As stressful and uncomfortable as this was, Kirshenbaum says that regular exercise helped her stay calm and focused during the last months of her mother's life. "I used guest passes at the gym near my parents' house, or I would run or do yoga at home. I knew that if I was going to care for her, I had to care for myself."
Physical activity such as aerobic and strength-conditioning exercises benefits most women having an uncomplicated pregnancy, according to The American Congress of Obstetricians and Gynecologists. However, the organization cautions that women should get the go-ahead from a healthcare provider before exercising during pregnancy.
Pay attention to your breathing. Deep breathing slows the heartbeat and helps stabilize blood pressure. To practice deep breathing (also known as belly breathing), sit in a comfortable spot and inhale slowly through your nose. You will notice your chest and belly rising as your lungs fill with air. Expand your belly fully. Then breathe out slowly through your mouth or nose.
You can also tell yourself a small direction such as "inhale relaxation" as you breathe in, and "exhale tension" as you breathe out. Never hold your breath between the inhalation and the exhalation. Repeat.
Rothert recommends doing this at the first sign of stress or as a five-minute daily practice. "Breathing to relax is a skill that improves with practice but is also helpful when used in the moment as needed, such as when driving or in line at the grocery store," she explains. Later in pregnancy, when you may be less comfortable, Rothert recommends deep breathing while lying on your left side.
Try out a mantra or two. Repeating simple, positive statements daily can be helpful during pregnancy to reduce stress, fear, and other negative thoughts, says Erin Polulach, a birth and postpartum doula and the founder of NYC Family Birth. Statements such as, "I'm dealing with a lot right now, and I'm getting through it," help normalize reactions and remind you that a particular situation will not last forever.
Make space for all your feelings. Even if you use a mantra to tap into positivity, it can be very helpful to find a friend or family member you can talk to about all of your feelings, says Christiane Manzella, PhD, senior psychologist at Seleni. "Otherwise, worries or fears can lurk around cast a huge shadow on your affirmative thoughts."
Prioritize self-care. During times of great stress, nourishing yourself, staying hydrated, and getting enough sleep are more important than ever. "Because of my work, I saw this pattern in a lot of my clients – people forgetting to eat right and not making it to the gym – and I saw how this cycle perpetuates itself," says nutritionist and trainer Kirshenbaum. "Maintaining my fitness and remembering to take a few minutes to eat nutritious food and hydrate really helped me make it through the six-hour airplane flights and the nights on the cot at my mom's bedside."
For Bernardo, prioritizing self-care meant carving out time in her busy day for low-impact exercise outdoors. "We walked around the city and through so many parks," she recalled. "That was so helpful. Just to get outside, exercise, breathe in fresh air."
Get support. Join a local support group for pregnant women and new moms. Meeting other women who are experiencing the ups and downs of pregnancy and life can help you feel less alone when you are coping with stress, and it will help you build a supportive community for after pregnancy. "Seeking out this support while still pregnant helps mothers build and reinforce their support network early on, which is critical," says Polulach. "Making these early connections can be so helpful in alleviating the common (and uncommon) stresses associated with pregnancy, the newborn stage, postpartum recovery, and early parenthood."
In some cities, local groups advertise in newspapers or parenting publications. You can also search Yahoo Groups or Meetup for groups in your area. You can use these directories to find groups with a specific focus. Check with your healthcare provider, local hospital, or community organization. Sometimes talking to another new mom might be the best way to find a great support group.
When a group is a good fit, you should feel safe enough to be honest about sharing the ups and downs as well as the nitty, gritty details of pregnancy and new motherhood. Above all, if you don't feel comfortable in a group after a few meetings, don't hesitate to keep looking.
Take things off your plate. Try not to add big things to your load – practically or psychologically – when it is already too heavy, cautions Rothert. "In a practical sense, this means thinking carefully about choices such as remodeling a home, moving, getting a puppy, or other optional significant stressors that may not be in your best interest at this time," she explains. "In an emotional sense, this means not beating yourself up for having strong reactions to significant stress, which can make you feel even worse."
When and where to get professional support
You can find support through organizations that help women and families deal with perinatal psychological challenges, such as Sidelines and Postpartum Support International. Sidelines provides support for women and families going through high-risk pregnancies, and PSI has a toll-free number you can call for information and support during pregnancy or postpartum. Coordinators can also help you find local providers.
Rothert advises seeking professional mental health support if you are experiencing panic attacks, insomnia that interferes with your quality of life, a depressed mood that feels like more than a fluctuating hormonal swing, or any other symptoms that are deeply affecting your day-to-day life. In addition to helping you feel better, getting professional support can mean you have someone you can tell anything that might be too much for those around you to handle. "This kind of support can be like a 'pressure release valve,' says Manzella. Ask your obstetrician to refer you to a local therapist or clinic.
Bernardo's husband has now been cancer-free for almost five years. Recalling her first doctor appointment after her husband's diagnosis, she said her obstetrician delivered perhaps the most stress-reducing guidance. "Your baby is well-protected inside your belly, my OB told me, and what you're feeling is not going to affect the baby," said Bernardo. "That helped me a huge amount. For me, once I knew all the information, and that my husband's prognosis was good, I felt I could handle what was to come."