Strong As a Mother

How to Stay Healthy, Happy, and (Most Importantly) Sane from Pregnancy to Parenthood

St. Martin's Press

Contents

THE FIRST TRIMESTER: NERVOUS EXCITEMENT

You're Pregnant, Now What

Few things are as profound as looking down at a pregnancy test and seeing that second line slowly appear, and any emotional response you have to big news like this is completely acceptable. You might feel shock, glee, fear, deep satisfaction, relief, panic, incredible joy. You might shriek. You might cry. You might shout a joyful expletive. You might cuss in despair. You might just stare mutely in disbelief.

Maybe you've been trying for a long time and are used to seeing a blank space where that faint marker now appears. Maybe you just started trying and didn't expect to hit the jackpot right away. Or maybe you weren't trying at all and the news is not only unexpected but maybe not even welcomed. You may cycle through ten different emotions as your mind works to wrap itself around the news. Allow yourself to feel whatever comes up for you, and don't judge yourself for it. You're human. This is big news. However you respond is okay.

GIVE YOURSELF TIME TO LET THE NEWS — AND FEELINGS — SINK IN

However you feel as you consider what you have ahead of you, take time for yourself to settle into this new experience. Soon enough you will be swept into planning and decision-making. Take this time to celebrate. If the news arrives to mixed emotions, take some time to see what comes up for you. Maybe write down what you are feeling, or find a friend you can say anything to and tell her everything that comes to mind. Put it all out there. Take a look at what you're feeling and sit with those emotions. If this information represents an abrupt change of plans, give yourself the space to grapple with how you feel and how you want to move forward.

The bottom line is that no matter how you came to those two lines, many different experiences and choices will flow from it. Take as long as you need to sit with the news and see how the news sits with you. Learning to take a pause in the face of what may feel like impending chaos is a skill that will serve you throughout motherhood. Take a moment for you.

When you're ready, read on for guidance on managing the unexpected emotions of pregnancy, weathering the anxieties of the first trimester and beyond, strengthening your relationship with your partner, and learning how you can begin to take care of yourself now so you know how to do it well when your world changes.

Been There, Done That: Moms Share the Feelings They Had When They Found Out They Were Pregnant

Panic. Shock. For the first time in my life, I felt like, "I can't control this journey at all. I'm on the roller coaster now, just hold tight."

— Rachel, London, UK

Absolute joy. It was a difficult journey trying to get pregnant.

— Erica, State College, Pennsylvania

I was excited and terrified. Then I realized I'd have to actually give birth and had a panic attack.

— Becky, Decatur, Georgia

I was terrified, and I felt guilty for not wanting to be pregnant. So many of my friends were trying for babies, but we, who had never wanted children of our own, had accidentally gotten pregnant.

— Emily T.

Terrified, elated, and everything in between.

— Alexis, Saint Paul, Minnesota

I was happy, but also pretty confused by it. I felt pretty aware I didn't actually know yet what was happening or how my life was going to change.

— Laurel, Atlanta, Georgia

It's Natural to Worry: Anxiety in Early Pregnancy

Pregnancy launches you into the responsibility of parenthood — caring for another human life, and that is going to be scary at times (okay, maybe a lot of the time). Worrying will come with the territory, and one of the first places you may feel that concern is over miscarriage.

The reality is that as many as one in four pregnancies end in miscarriage. So it makes sense that women in the early weeks of pregnancy often spend some (or a lot of) time worrying about it. In fact, with technology to detect pregnancies before we even miss a period, we are learning we are pregnant earlier than ever and spending a longer period of time in a kind of early pregnancy limbo.

"We are born with millions and millions of eggs, which means that some won't be able to develop into full pregnancy, and our bodies know what to do with them," says Lauren Abrams, CNM, director of midwifery at Mount Sinai Hospital in Manhattan. "It can be devastating emotionally, but it's not abnormal and, in most cases, does not in any way mean you won't carry a pregnancy to full term." But waiting out those first seven to eight weeks, when the chance of miscarriage is highest, can feel like being on pins and needles.

THE DIMMER SWITCH

My husband was surprised when our first pregnancy didn't feel like an all-or-nothing proposition but rather like a "dimmer switch" that slowly brightened with each passing week and doctor's appointment — until we felt comfortable looking ahead with relative security. The point at which women feel confident in their pregnancies is different for different people.

Some may feel confident and future-focused from the moment they get the news. Others may not count their chicken until twelve weeks. And, for others, it may take longer, especially if they have experienced a pregnancy loss in the past (see "What If I Have Had a Pregnancy Loss Before?" here) or are experiencing confusing symptoms. Wherever you fall on that continuum, know that you are not alone.

"It's totally normal, if uncomfortable," says Sarah Best, LCSW, a psychotherapist in New York City who specializes in reproductive mental health. Each visit to the doctor — for your first ultrasound or to hear the baby's heartbeat — can feel like a hurdle to overcome on the road to feeling confident in your pregnancy. A lot of women "feel a little worried and a little hopeful every time they go," says Best.

If your level of concern is not interfering with your life and you are able to enjoy a little bit of fantasizing about what your life will be like with your new baby, Best recommends "riding that wave of worry" and doing what you can to take care of yourself (see here) in those early weeks. "Think about if a friend were in a similar situation," advises Best. "How would you offer her support?"

Ways to Manage Anxiety During Early Pregnancy

Experts will tell you that trying to wish anxious thoughts away will only make them stick around longer, so one approach is to acknowledge the thought you are having, accept that it is okay, and then move forward with some activities that will help you focus on the present moment you are in, rather than the imagined future in your head.

Best recommends taking a break from anxious thoughts by doing activities that involve coordination of your body and mind, such as:

• Crossword puzzles

• Painting

• Adult coloring books

• Sudoku

• Cooking from a recipe

• Yoga

• Walking with a friend

• Gardening

• Meditation

• Mindfulness exercises

"Anything that helps a woman get out of her own head is going to be a good choice," recommends Best.

What If I Have Had a Pregnancy Loss Before?

If you have experienced a pregnancy loss in the past — miscarriage or stillbirth — then the way you feel during this current pregnancy is likely to be very different from someone who is pregnant for the first time. At the Seleni Institute, where I work as editorial director, there is an amazing grief therapist, Christiane Manzella, PhD, who has a compassionate and honest approach to supporting patients through loss.

"I expect to see anxiety," says Manzella, "because their uncertainty is now heightened and uncertainty is one of the most difficult things for people to tolerate in life." And while part of the recovery from your previous loss can be pregnancy and a live birth, Manzella says that "neither is a fix for anguish and anxiety."

What can help is "talking with somebody who is able to listen to you and be present with you while you describe what you are going through. When you are able to talk and be heard, you are moving through your grief, not moving on. You've changed. You've lost some of your innocence, and this pregnancy may not have the warm fuzzies you may have had with your first." You may have lost the ability to see the birth of a baby as an inevitable end to your pregnancy journey, and that is expected, says Manzella.

Find someone with whom you feel comfortable and talk about what you are feeling and what has helped you in moments of anxiety in the past. Do you want people to just listen to what you are feeling? Do you want suggestions of what could help? If your current pregnancy allows, can you do some consistent mild exercise? Does listening to music help you? Would having a regular lunch with your supportive friend give you something to look forward to and a space where you know all your thoughts and feelings can be safely shared?

The professional support of a therapist, like Manzella, who is trained in grief and perinatal loss or reproductive mental health can be a tremendous support, especially if you find that your distress is intense. See here for places to find one. "Reach out," says Manzella. "There is no reason for you to suffer alone." And you are not alone. Many women have been — and are — where you sit now. See "Been There, Done That."

BEWARE THE GOOGLE TRAP

"You are never going to get straight answers from Google. There is going to be conflicting information even from reliable sources," warns Best. "A lot of the moms I work with will be experiencing some symptom — cramping, spotting, something — and they end up on a five-year-old message board with very extreme personal accounts that don't have happy endings. They might find a lot of stories with happy endings too, but the thing about humans is that we tend to dismiss the positives and assume that the one negative thing we read is the more likely outcome."

In general, information seeking, like repeatedly typing your symptoms into Google, usually heightens anxiety rather than alleviating it. "It's like scratching a mosquito bite," explains Best. "When the results come up, at first you feel some relief, but it's short-lived, and then the stress is there again. There is always the thought, 'If I just get some piece of information, this worry will go away,' but the reality is the information rarely makes it go away; it just reinforces the idea that you should keep looking for information."

DR. GOOGLE IS NOT A MEDICAL PROFESSIONAL — YOUR PROVIDER IS

"The best thing a woman can do in that early period is to develop a relationship with her care provider," says Best. "If you don't feel comfortable talking about these concerns with your OB or midwife, the first trimester is an excellent time to transfer to a provider with whom you are more comfortable." Once you feel comfortable with your health-care provider, rely on him or her in times of concern. Only he or she knows your specific situation and can speak to it with authority. "True information from a care provider familiar with your case can be an excellent balm," advises Best.

What If I Lose My Pregnancy While I Am Reading This Book?

If you have a pregnancy loss, first know that I am so, so sorry and wish I could be there to listen to everything you are feeling right now, and I hope you have a good friend or family member who can do that for you.

It's probably time for you to put this book back up on your shelf until it makes sense for you to take it down again, but before you do, let me offer some advice from grief specialist Christiane Manzella, PhD.

"Grief is a process that people move through," says Manzella. "During it, you will feel many feelings and thoughts — unexpected and expected — and sometimes you will have thoughts that seem crazy to you, and you may feel many different things at once. You may also experience physical sensations (and your body might be lactating or bleeding)." Manzella recommends first and foremost "making sure you eat, sleep, and get good support from your friends and loved ones."

It's also important to understand that if you are experiencing grief, it is real. Perinatal loss often goes unrecognized and unsupported. There are no mourning rituals for pregnancy loss — especially miscarriage. There are no culturally developed scripts to help people know what to say or do.

Which means that often even the people in your immediate family won't understand how you are feeling. They may think or say things like "What's wrong with her?" "When will she get over it?" or "You're young; you can have another." But if you are grieving, there is no "getting over" it; there is only moving through it. When you can give voice to what you are experiencing and feeling, says Manzella, "that is how you move through it."

Consider reaching out to a professional who specializes in perinatal loss. "Do it earlier than later," says Manzella, "just to have someone who understands the process of perinatal loss listen to you and help you move through grief in a way that is more adaptive and will help you to keep from getting stuck. Women do move through this."

There are more resources for getting the support you need here. I recommend making use of them, as well as your most understanding friends and family, until you are ready to pick this book up again. It will be here if — or when — you are.

HOW DO I KNOW IF I NEED HELP WITH MY ANXIETY?

If your worry starts to affect your day-to-day life — keeping you from sleeping or eating, functioning as you normally would, or enjoying your life — or if you find it hard to balance your concerns with a little optimism and constantly assume the worst is going to happen, Best recommends checking in with your obstetrician or a mental health professional who specializes in reproductive health (see here for more about anxiety in pregnancy). He or she can help assess whether you are experiencing anxiety that could benefit from treatment (which can be psychotherapy or medication or a combination of the two).

The first nine weeks of my second pregnancy were an anxiety-filled ride. I went to weekly therapy sessions and talked extensively with my obstetrician about the possibility that I might need to return to the antidepressant I had used for postpartum anxiety after my first daughter was born. But at nine weeks, the anxiety dissipated, and I entered a more hopeful, forward-facing stage of pregnancy.

The most important thing is getting the support you need until that happens for you.

Managing Anxiety Around Genetic Testing

One of the amazing parts of modern pregnancy is what we are able to learn about our developing babies. It can be incredibly helpful and comforting. But the amount of information can also be overwhelming and cause unnecessary anxiety. Psychologists will tell you that making decisions is one of the greatest sources of stress we face in life, and you are about to make a lot of them.

Find Out Your Choices

Ask your doctor or midwife what tests are routinely offered by their practice. Broadly speaking, there are two kinds of tests — screening tests and diagnostic tests. Screening tests cannot tell you whether your baby does — or does not — have a particular condition. These tests can only determine whether you have an increased risk of having a baby with a particular condition. Diagnostic tests, which are invasive — meaning that a needle is inserted into your womb to gather genetic information — can confirm whether your baby has a medical condition. Because they are invasive, they carry a small risk of miscarriage.

Ask What Information the Tests Can Provide

Before you say yes to a particular test, it's important to know what you will learn from the test and what you think you will do with the information. One of the reasons this is important is that, especially with screening tests, the results can sound scary even when they are not.

"There is not a 'yes' or 'no' answer in a screening test," explains Katie Stoll, MS, LGC, director of clinical services at the Genetic Support Foundation in Olympia, Washington, "just a higher or lower chance that your baby has a particular condition." And even an increased chance can still be a very remote one. It's also very important to find out how often the screening test can produce a false positive, meaning the test indicates you have a higher risk of having a child with a particular condition when she does not. Most practices have a genetic counselor you can consult if you have an abnormal result or are considering an invasive test.

Find Out Your Baseline Risk

The counselor or your doctor can tell you your risk of having a baby with a condition such as Down syndrome based on the age you will be when your baby is due. "Many women are low risk and will find reassurance by just learning what the probability is to begin with," says Stoll. If your baseline risk feels comfortable to you, you may decide not to screen for the condition.