While preparing to get pregnant can be a joyful time, it can also be stressful, especially when we experience issues such as infertility, pregnancy loss, or mental health concerns. So much of the advice we get when trying to get pregnant focuses on the baby-to-be, but how can we make sure we are taking care of ourselves when our path to parenthood seems stormy and unclear? Let’s explore some perinatal challenges and strategies for moving forward.

Infertility
Infertility rates are difficult to track globally due to vast cultural differences in how fertility is understood and reported. One estimate suggests that as many as 48.5 million couples may experience difficulty conceiving — that’s roughly 15 percent of couples, and doesn’t include single folks trying to have children. For women, an inability to conceive is often related to underlying conditions such as Polycystic Ovary Syndrome, low egg reserve, or hormonal abnormalities. For men, conditions such as diabetes or autoimmune disorders or behavioral concerns such as substance use could be at play. Frustratingly, nearly one third of all folks dealing with infertility will not be able to pinpoint a reason, which can negatively impact individual and relationship health during what is already one of the most stressful events a couple can face. 

Pregnancy loss
Pregnancy loss is a painful topic that many expectant parents avoid discussing, despite the fact that anywhere from 10 to 20 percent of pregnancies will miscarry, most within the first 12 weeks after implantation. Most miscarriages result from abnormalities within the developing fetus, but many expectant parents blame themselves. In her book on psychotherapy, fertility, and pregnancy loss, psychologist Janet Jaffe reflects, “Because it is medically common, the impact of miscarriage is often underestimated.” As such, lingering grief and fear of losing future pregnancies can go unnoticed and untended. 

Strategies for moving forward
Many of us try to get pregnant with a heart full of hope and exciting expectations for our lives as parents. When those dreams fall short, negative emotion is unavoidable and often overwhelming. Our natural urge to make sense of painful events can manifest in finger pointing or feelings of guilt, which can harm us and our relationships. 

It’s easy to get stuck in loops of self-blame, beating ourselves up for having too much caffeine, for not going to a specialist sooner for our uterine fibroids, or for struggling with the eating disorder that threw off our hormone levels. Or perhaps we blame our partners, angrily cataloguing every bad decision we imagine contributed to problems conceiving. But so often our guilt and blame are distractions from grief. If we can pause with the pain of loss rather than defend against it with criticism, we increase our resilience and compassion, preserving our relationships with ourselves and our partners in the process. 

Below are some tips for moving forward. 

• Seek support: Groups for pregnancy loss and infertility can be a safe space to process feelings of sadness, anger, grief, and guilt with folks who are in the same boat. Groups are often sponsored by OBGYN offices, midwives, doulas, and other reproductive health providers. 
   
• Use “I” statements: Staying connected with your partner during this challenging time is easier if there’s room for you both to express how you’re feeling. Using language such as “I feel” instead of externalizing language such as “you always” or “you never” invites support rather than defensiveness. 
   
• Ritual: We have elaborate social rituals (funerals, wakes, and other cultural practices) for when a loved one dies, but when our losses are not as tangible, as is the case with fertility struggles and pregnancy loss, our pain does not have an established outlet, resulting in what mental health professionals call disenfranchised grief. To help heal, consider creating your own ritual practice to help process the loss, inviting in trusted friends and supports. 

History of mental illness
It’s not uncommon for us to question how pregnancy will impact our well-being, but the issue can be even more complicated for folks with histories of mental illness such as depression, anxiety, obsessive compulsive disorder, or bipolar disorder. Folks with mental illness have to consider whether to stay on or go off of medications when pregnant and how pregnancy could impact symptoms. Having a mental illness prior to getting pregnant increases the risk of perinatal mood and anxiety disorders (even if symptoms are in remission at the time of pregnancy). Let’s break down some strategies for prevention and care.

• Who’s on your team: Having a supportive and knowledgeable care team can help prevent negative outcomes. If you have the option to choose your doctor, consider asking them how they approach treatment for folks with histories of mental illness. Do they recommend discontinuing or staying on medication and why? How will they screen for changes in psychiatric symptoms during the pregnancy and what sort of support do they offer post pregnancy should symptoms increase or change? Regarding medication, it’s important to know that your providers are taking your wellness into account as well as your baby’s. The risks of going off medications can outweigh the potential benefits if symptoms return while you’re pregnant. 
  
  If you have a therapist or other mental health provider, consider asking about their background working with folks during pregnancy. If they don’t have perinatal mental health training, they may be able to connect you with someone who does as an add-on to your current treatment plan.
   
• Track your experience: There are so many physical and emotional changes that can happen during pregnancy, it can be hard to know what’s “normal” and what’s problematic. Keeping a bullet journal of moods, energy levels, and action urges (such as wanting to self harm, isolate, or any impulsive urges) can help you and your care team be responsive to changes.
   
• Broaden your tool box: The tools available to cope with psychiatric symptoms may shift during and after pregnancy. If running is your go-to symptom management strategy, you’ll likely need other options for late pregnancy and as your body heals postpartum, especially if you have a cesarean section. Consider coping strategies that you could use no matter what your level of mobility so you can stay on top of self care as your body changes. 

General tips for prenatal stress management

• Move your body: There are plenty of reasons that physical movement supports a healthy pregnancy, but it can also be a strong protective factor against perinatal mood and anxiety disorders. It’s important to be responsive to your body’s changing needs during and after pregnancy however, so listen to your body and/or consult with a professional regarding safe perinatal exercises.
   
• Limit your research: With so much information available to us regarding what to do and what not to do to ensure a healthy pregnancy, it’s easy to get overwhelmed. Stay informed, but put some limits around how much time and energy you spend trying to figure out if every little change is normal or an indicator of a problem. These boundaries will help you to manage your stress levels.
   
• Establish a mindfulness practice: Mindfulness practices such as yoga and meditation can improve how our bodies and minds respond to stress, and can even help folks in recovery from postpartum mood disorders. Adding mindfulness to your daily life before getting pregnant or during your pregnancy helps to set the stage to maintain the habit during those intense newborn days. 

Every parent has a story! How did you navigate the terrain of pregnancy? What would you do the same or differently to manage stress? Share your thoughts in the comments.

References

Agarwal, A., Mulgund, A., Hamada, A., & Chyatte, M. R. (2015). A unique view on male infertility around the globe. Reproductive Biology and Endocrinology, 13(1). https://doi.org/10.1186/s12958-015-0032-1

Chandra, A., Copen, C. E., & Stephen, E. H. (2013). Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth (No. 2013). US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

Infertility | Reproductive Health | CDC. (2021, April 13). Cdc.Gov. Retrieved December 30, 2021, from the CDC.

Jaffe, J., Diamond, M. O., & American Psychological Association. (2011). Reproductive Trauma. American Psychological Association.

Poyatos-León, R., García-Hermoso, A., Sanabria-Martínez, G., Álvarez-Bueno, C., Cavero-Redondo, I., & Martínez-Vizcaíno, V. (2017). Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials. Birth, 44(3), 200–208. https://doi.org/10.1111/birt.12294

Sheydaei, H., Ghasemzadeh, A., Lashkari, A., & Ghorbani Kajani, P. (2017). The effectiveness of mindfulness training on reducing the symptoms of postpartum depression. Electronic Physician, 9(7), 4753–4758. https://doi.org/10.19082/4753