Preparing for Motherhood: Why it is Important for Women to Optimise their Emotional Wellbeing before Falling Pregnant.

As a practising procedural GP obstetrician, that is, a doctor who looks after women and their partners through their pregnancy, birth and postnatal period, I see many cases of perinatal distress. This can occur at any stage throughout the course of the woman’s journey. The impact of perinatal distress can be significant, affecting the woman’s physical and emotional health during the pregnancy and consequently the development of her unborn child; her experience of child-birth; her ability to bond with and care for her baby; her day-to-day functioning as a new mother; and her relationship with her partner.

For all of these reasons, I believe it is critical for any woman who is planning to become pregnant to optimise her emotional wellbeing before she conceives. There are a number of factors that contribute to emotional wellbeing, and by examining these from a “root-cause” perspective, a woman can ensure that each of these factors is considered and addressed as she prepares for pregnancy.

There are a number of personal lifestyle and environmental factors that will determine a woman’s emotional wellbeing during and after pregnancy. These include:

1.     Sleep and relaxation

2.     Exercise and movement

3.     Nutrition and hydration

4.     Stress and resilience

5.     Relationships and social networks

6.     Previous and current trauma

7.     The microbiome and other microorganisms

8.     Environmental toxins and pollutants

It is also important to consider a woman’s genetic predisposition to mental health issues, as well as her life experiences, attitudes and beliefs that will impact on her pregnancy, her experience as a mother and her role in the world. Women who have a previous history of depression, anxiety or other psychiatric conditions are advised to seek advice and support from their doctor and/or psychologist before they conceive, especially if they are taking medication that may affect the fetus.

Pregnancy is “the great unmasker”, with a myriad of physiological, hormonal, immunological and psychological changes occurring in the woman’s body and mind. These changes can reveal underlying physical, emotional and spiritual predispositions that can be a new challenge for the woman to learn about and adjust to. It is therefore worthwhile for each woman to consider the expectations she places on herself during her pregnancy, birth and postnatal period, and how she will manage if these expectations are not met. It is highly recommended that the woman include her partner in her discussions about her expectations, so they can identify if there are any conflicts or issues that need to be addressed.

I can appreciate that there is so much for women to learn about pregnancy, birth and motherhood, and there is a lot of uncertainty about what is “normal “with regards to emotional wellbeing. I, therefore, advise every woman to find a health practitioner who is an expert in the field of pregnancy and postnatal care who she can trust. It is important that the woman develop an ongoing relationship with this health practitioner, who can provide woman-centred support, education and shared decision-making.

One of the most important factors that I believe is key to a healthy pregnancy, but that is often overlooked by women, is the optimisation of stress levels. Frequently, newly pregnant women come to see me for the first time, struggling to manage a number of different stressors, or even just one major stressor, that is having an impact on their physical and/or emotional health. Often, these stressors could have been prevented or at least reduced by some proactive pre-conception planning. There are obviously times when new stressors arise in pregnancy or the postnatal period that are completely unpredictable. I believe it is important to minimise preventable stressors and develop simple stress-management strategies that become a daily habit so that when the unexpected stresses occur, women have the skills and resilience to manage the stressor without creating excessive perinatal distress.

With regards to preventable stressors, I would advise a pregnant woman to locate herself near her social support networks if at all possible. Becoming a parent for the first time is a steep learning curve and no-one is meant to do it alone. For those women living away from their families, I encourage them to temporarily move closer to their family or have the family move to them for at least one month, preferably two, around the time of the birth. The role of family is to support the woman and her partner with cooking, cleaning, shopping, etc while the mother and father focus on their own wellbeing and their new baby. In my practice, I have observed a number of families from Eastern cultures carry out this tradition, and the positive outcomes for the mothers and children are obvious to me.

I would also advise against making any major life changes during pregnancy. Quite often I witness couples trying to build or renovate a house and move in before the new baby arrives, and the excessive stress that comes along with this process. Sometimes, the stress can be so significant that the woman goes into pre-term labour or develops perinatal anxiety. It is important to realise that the emotional state of a mother during pregnancy has a direct effect on the brain development of the fetus. The stress hormone cortisol crosses the placenta and can change the way the fetal brain forms, in particular, the part of the brain that is involved in responding to stress. Please understand that I am not trying to make women feel guilty about getting stressed during pregnancy, but rather attempting to educate mothers-to-be about the importance of managing stress effectively during pregnancy.

Further to this, I would recommend that women finish work before 36 weeks gestation, and plan to reduce hours of work around 28-32 weeks if she is working full-time if this is possible. Women often underestimate the impact of pregnancy on their physical and emotional wellbeing, meaning they need to cut down or finish work prior to the date they had planned to go on maternity leave, which itself can create more stress. I understand that financial strain can often be the reason why women chose to work up to 37 or even 38 weeks gestation, so my advice to these women is to aim to save up some money prior to falling pregnant, which can be put away until it is required during maternity leave.

Finally, I would like to suggest some simple daily practices that women can incorporate into their daily routine before they get pregnant, which they can continue to practice during the pregnancy and after the baby is born. These include mindfulness meditation; gentle exercise such as walking and yoga; being creative through drawing, painting, journaling, playing music or dancing; spending time with family and friends who are enjoyable to be with, including mothers group; and visiting a health practitioner who nurtures emotional wellbeing, such as a massage therapist, osteopath, psychologist or kinesiologist. It’s not essential to do all of these every day, but making a commitment to optimising stress-levels before conception is a worthwhile investment for the woman and her family.

Author: Dr Sarah Moore, GP Obstetrician, Busselton

 To learn more from Dr Sarah about how to optimise your health and wellbeing during pregnancy, visit here