Monday, September 19, 2016

Book Nook: Finding Calm for the Expectant Mom

I never quite understood the "glow" of pregnancy. Although I didn't hate being pregnant, I certainly never felt radiant! Many soon-to-be mothers don't either, with all the psychological, hormonal, and physical changes going on.

I recently had a chance to review Finding Calm for the Expectant Mom: Tools for Reducing Stress, Anxiety, and Mood Swings During Your Pregnancy by Alice Domar, Ph.D., a bestselling author, pioneer in the field of mind/body medicine in women’s health, and associate clinical ObGyn professor at Harvard Medical School. This would have been an excellent book to read during pregnancy - it wasn't just all about the medical changes, nor was it written with too much glowing optimism. It tackles some excellent challenges that come up with pregnancy - communicating with family, partner, and workplace; dealing with unexpected low moods or negative emotions; coping mechanisms; and prescription drugs.

I found it to be quite well-written, very comprehensive, and honestly full of information that I don't recall reading in a single pregnancy book. Soon-to-be mothers put so much stress on themselves - this is a great way to help minimize the pressure and maintain a healthy attitude during pregnancy.

Here's a Q&A to learn more.

1.     In addition to being an exciting and often happy experience, pregnancy can also be very stressful and many women are caught off-guard by their thoughts and feelings. What are some pregnancy symptoms that aren’t often addressed?
When people think of pregnancy symptoms, they list nausea, fatigue, and frequent trips to the bathroom. However, there are many other common but often surprising symptoms of pregnancy, both physical and emotional. Many women feel guilty complaining about these symptoms, since society expects pregnant women to be radiant and blissful, which compounds the challenges of coping. Depression is incredibly common and many pregnant women feel uncomfortable taking medication to treat it. There are risks and benefits to taking antidepressant medication during pregnancy but for many women, non-pharmacologic approaches work just as well.

2.     How do I know if I’m just struggling with pregnancy emotions or if I have depression?
This is a really good question. In fact, the most common symptoms of early pregnancy and depression are exactly the same- fatigue, change in appetite, change in libido, lethargy, lack of energy, not looking forward to things the way you used to, etc. So in fact, if you are experiencing any of these symptoms, it could mean either or both. If you sense that this might be more than pregnancy hormones, check in with your health care team. They can ask you more specific questions to determine what is going on. There are lots of ways to treat depressive symptoms during pregnancy other than medication, ranging from physical exercise, cognitive-behavior therapy, and even partner massage!

3.     Say I’m pregnant and have to tell my boss – what’s the best way to break the news and what are some things I should keep in mind as I approach the conversation?
Come prepared to the meeting. Be aware of state and federal laws for maternity leave, know what your company’s short and long term disability policies are, and definitely be aware that as happy as your boss may well be for you, he/she is going to immediately focus on the impact your pregnancy is going to have on everyone else. Thus, be ready to talk about how you plan to maintain your work integrity during your pregnancy, and ideas you might have for coverage while out on maternity leave.  But be aware that no one can discriminate against a pregnant woman, and you don’t have to tell your plans for after the baby is born.

4.     Sleeping well is unfortunately pretty rare at all stages of pregnancy – what are some techniques pregnant women should keep in mind to help them get the sleep they need?
Lack of sleep is one of the most unrecognized issues during pregnancy, and it impacts the majority of women throughout their pregnancy.  There are numerous contributing factors, ranging from bathroom trips to difficulty finding a comfortable position, to the “midnight imp” lying awake and worrying. There are many ways to improve the quantity and quality of sleep, including becoming more aware of liquid intake in the evenings, staying adequately hydrated during the day to decrease the risk of leg cramps, using pillows to support more comfortable positions, and perhaps most importantly, learning stress management and relaxation strategies to soothe the mind which allows one to fall and stay asleep.

5.     We’re all prone to catastrophic thinking now and again, and when you’re pregnant, it might become pretty normal as you focus so much on the future. What would you advise to rein in those runaway thoughts?
The pregnant brain does indeed seem to gravitate toward the negative, which makes sense because there are so many physical and psychological changes happening so quickly. There are numerous approaches to minimizing stress, including cognitive-behavioral approaches which challenge and restructure automatic irrational thoughts, relaxation techniques, tools to increase social support, methods to improve partner communication, and self-nurturing strategies.

6.     What are some of the most common triggers for stress during pregnancy and what can we do to avoid them or reduce them?
Some of the most common triggers are physical symptoms (it’s hard not to feel stressed when you feel lousy or can’t do what you used to be able to do), worries about your health or the health of the baby, the impact on your relationship with your partner, and perhaps the most surprising, the intrusiveness of others. Pregnant women seem to be treated as community property in our culture and other people, even strangers, feel entitled to touch a pregnant belly, make comments about how big a baby the woman is carrying, and even criticizing proposed baby names.

Here are a few tips to reduce or avoid these common triggers:
·       Be cautious about any information other than from your health care team. Your mother in law's first cousin may claim to know more than your obstetrician, but if your doctor isn't worried, that is the advice you should heed.
·       Don’t google things - there is so much inaccurate information on the internet. If in doubt, ask your doctor or nurse.
·       Learn to trust your body and don’t feel bad about needing to ask for help.
·       And remember that being anxious can be part of every normal pregnancy. Recognize the signals of anxiety and think about what you can do to feel better. Take a walk, call a good friend or relative, share your concerns with your partner, and try to relax.

7.     What is one of the most common issues your patients face but that they might not anticipate?
From Facebook to print magazines to product marketing, pregnant women are faced with an unrealistic expectation of what pregnancy should look like - and it can have an impact on anxiety and stress levels. People don’t post pictures of stretch marks or note how many times they vomited that day, or how few hours of uninterrupted sleep they got. You only see the perfect baby bump, the listing of expensive strollers and the ecstatic mom to be at her shower(s). Pregnancy is hard but this isn’t generally acknowledged. Pregnant women can be uncomfortable, tired, depressed, and overall resentful. These are all totally normal reactions to pregnancy, but more women need to know that so that they don’t feel isolated or worry that they aren’t going to be a good mother. 

Alice D. Domar, PhD, is the founder and executive director of the Domar Centers for Mind/Body Health and conducts groundbreaking research on the relationship between stress and various women's health conditions. She is an associate clinical professor of obstetrics, gynecology, and reproductive biology, part-time, at Harvard Medical School, director of integrative care at Boston IVF, and a senior staff psychologist at Beth Israel Deaconess Medical Center. She lives in the Boston area with her husband and two children.

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