By Carol Sorgen
WebMD Feature

Reviewed By Brunilda Nazario

Your ankles are swollen, you're running to the bathroom every five minutes, and you can't find a comfortable position in which to sleep. Yep, you're pregnant, and most likely, you're also feeling, well, just a tad stressed out. Duh! you say.

The bad news is that stress during pregnancy is more than just an inconvenience; it's actually unhealthy for you and your baby. The good news is that there are ways to cope with it.

There are, of course, stresses that are particular to pregnancy, says David Whitehouse, MD, including:

Physical discomforts such as nausea, fatigue, frequent urination, swelling, and backache
Emotional vulnerability caused by hormonal changes
Fear of delivery, of parenting, and for the health of the baby

Add to those your concerns over a troubled economy, general instability in the world, ongoing threats of terrorism, and you've got an entirely new set of stressors. In fact, in a survey commissioned by CIGNA HealthCare entitled "Troubled Times: How Americans Are Coping In A Stressful World," findings indicate that 64% of expectant mothers say their lives are more stressful than they were a year ago. The survey, conducted in conjunction with CIGNA's support of the 2003 March of Dimes Prematurity Campaign, also found that 65% of expectant moms say they are concerned about the impact that stress during pregnancy is having on themselves and the health of their baby.

"For many women, having a baby is already stressful enough," says Whitehouse, medical director of CIGNA Behavioral Health in Bloomfield, Connecticut. "The additional concerns Americans face today around the war, a troubled economy, and job security may be leading some expectant mothers to experience stress overload."

According to the March of Dimes, one in eight babies in the United States is born prematurely. High levels of sustained stress, says Whitehouse, may be an important factor in causing these premature births. "That's why finding ways to manage stress is important for expectant moms," he says.

"It's well established that stress can affect your health," Whitehouse continues. "But research shows that pregnant women should pay particular attention to this connection." Some suggestions?

Take good care of yourself. Eat regularly and nutritiously, get plenty of rest, do moderate exercise, avoid alcohol, cigarette smoking, or drugs.
Don't stress out about stress. It's normal to feel stressed, especially during these turbulent times. But look at what's causing your stress and take whatever practical steps you can to address those things that you can control.
Avoid negative responses to stress. Some of the things we do to deal with stress only compound the problem. Unhealthy ways of coping with stress include withdrawing from people, sleeping to escape problems, skipping meals or eating junk food, and using alcohol and tobacco.
Schedule time for yourself. Many women have a difficult time saying no to everyone else's requests. This is the time to be selfish. Schedule regular leisure time for yourself to do those things that help you relax. Exercise, meditation, massage therapy, deep breathing exercises, even reading a book or listening to soothing music can be relaxing.
Ask for help. Surround yourself with love and support. Expand your support network of friends and family. Insist on help with regular chores. See if your employer offers prenatal or employee assistance programs that can provide information and support. If you have problems with sleep, appetite, sadness, crying, loss of interest in normally enjoyable activities, or excessive feelings of guilt, and these symptoms occur almost every day for more than two weeks, talk to a professional; you may be suffering from depression.

Making use of mind-body techniques, such as yoga and massage, can also help push the level stress during pregnancy way down. "Mind-body techniques are beneficial for both mother and child," says Ann Cotter, MD, medical director of The Atlantic Mind Body Center in Morristown, New Jersey. In the short term, she explains, they trigger the body's "relaxation response," which includes lowered blood pressure, lowered heart rate, and lowered respiratory rate. "When the body is relaxed," says Cotter, "all physiologic processes work more effectively.

"When done on a regular basis," she continues, "they also ... release endorphins and serotonin ... to bolster our ability to handle stress effectively." What that means for pregnant women are relaxed muscles, better ability to handle a changing body, increased relaxation and decreased pain during labor, improved sleep, and improved mother-baby bonding.

Cotter's favorite mind-body technique is yoga, since it increases awareness of breathing, which can become difficult in the later stages of pregnancy, as well as helps the body adjust to the significant physical changes that occur during pregnancy. "Patients who did not do yoga during their first pregnancy and started for their second pregnancy report easier labor, less fear, and less pain," says Cotter.

Meditation is also another recommendation of Cotter's, because it increases well-being and confidence, as well as relaxation during labor.

Don't overlook the pleasures --and benefits -- of a good massage. Garnet Adair, chair-elect of the National Certification Board for Therapeutic Massage and Bodywork, finds that during massage, the fetus moves around less actively. "This brings a moment of calm to the mom's body," says Adair, who adds that massage also relieves areas of stress and discomfort on the body during pregnancy, especially the lower back.

Before you run to the phone to schedule a massage though, check with your doctor.

When Jeanne Berkowitz was pregnant, she and her husband went to Hawaii for a "babymoon" (a good idea in itself!). While there, Jeanne received a massage from a woman who works frequently with pregnant women.

"She told me that it was important to massage my belly often to introduce the baby to human touch and to the world outside the womb," Jeanne says. "I'm not an expert on the benefits of prenatal massage, but it was fun for us, helped us (especially my husband) think of the baby as a real person, and I can't help but think it had to be good for the baby, too."

Published May 19, 2003.

SOURCES: David Whitehouse, MD, medical director, CIGNA Behavioral Health, Bloomfield, Conn. Ann Cotter, MD, medical director, The Atlantic Mind Body Center. Garnet Adair, chair-elect, National Certification Board for Therapeutic Massage and Bodywork.

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