By: Heather Marcoux | September 02, 2021
"Labor Day began in the 1800s because factory workers were tired of working 70 hours a week. Here we are 200 years later and surveys still show that mothers report working nearly 100 hours a week, and don't get days off. And it's just getting worse.
Before the pandemic moms were tired and burned out. Now, we're desperate. According to the 2020 World Economic Forum the COVID-19 pandemic has resulted in women around the world losing paid work hours while taking on more unpaid work.
Studies show the pandemic has resulted in moms working fewer hours in paid roles while dads have only reduced their hours by a statistically insignificant amount. We know millennial mothers are almost three times more likely than millennial fathers to report being unable to work due to a day care or school closure.
"Considering women already shouldered a greater burden for child care prior to the pandemic, it's unsurprising the demands are now even greater," says Gema Zamarro, senior economist at the University of Southern California's Center for Economic and Social Research. "While men are more likely to die from infection by COVID-19, overall the pandemic has had a disproportionately detrimental impact on the mental health of women, particularly those with kids."
Why the work of parenting is even more unequal during a pandemic
Today's mothers are spending more time doing paid work than previous generations did, but we're also spending more time on childcare. Today's fathers, too, are spending more time on childcare than previous generations, but there is a big difference in how moms and dads in heterosexual partnerships spend time with their kids.
This can be seen in the aftermath of COVID-19: In a 2020 study that looked at dual‐earner, heterosexual married couples with children, researchers found "the greater childcare and family demands brought on by day care and school closures throughout the pandemic appear to have caused a major reduction in work hours for mothers." Dads aren't seeing reduced work hours but are seeing the benefit of more time with their kids. Nearly 70% of fathers in the United States felt closer to their children during the pandemic than they did before the pandemic, according to research from Harvard. Meanwhile, pregnant women and moms with young children reported 3 to 5 times more anxiety and depression symptoms.
Why are dads happier now while moms are more stressed? It's in part because mothers are more likely to be doing unpaid care work while spending time with the children—the bathing, the cleaning, the feeding—while research finds that fathers' time with kids is more often spent on play and leisure activities.
If you're a dad, it might seem like having a spouse who does most of the household labor is a good deal (and a growing body of research does prove that fathers are happier parents than mothers) but the research also shows that dads want to be more than the fun, weekend guy because while care work is incredibly undervalued and unequal it can also incredibly fulfilling (if the carer is also allowed to rest).
Mom doing all the drudge work and handing out snacks while dad is at the office (or locked in his home office) sounds like an outdated notion, and that's because it is. When researchers at Boston College surveyed professional fathers in 2015, they found fewer than 5% of the fathers saw themselves as just a financial provider. The survey found most fathers believed they should share their children's caregiving equally with their spouses (but only about 30% said they were actually doing that)."
"Anyone who's ever had a professional massage knows that both body and mind feel better afterwards — and the same goes for prenatal massage, which can feel extra wonderful when extra weight and changes in posture stir up new aches and pains.
Here’s everything moms-to-be need to know about getting a massage during pregnancy.
What is a prenatal massage?
Prenatal massages are adapted for the anatomical changes you go through during pregnancy. In a traditional massage, you might spend half the time lying face-down on your stomach (which is not possible with a baby belly) and half the time facing up (a position that puts pressure on a major blood vessel that can disrupt blood flow to your baby and leave you feeling nauseous).
But as your shape and posture changes, a trained massage therapist will make accommodations with special cushioning systems or holes that allow you to lie face down safely, while providing room for your growing belly and breasts. Or you might lie on your side with the support of pillows and cushions.
Can pregnant women get massages?
Prenatal massages are generally considered safe after the first trimester, as long as you get the green light from your practitioner and you let your massage therapist know you’re pregnant. But you’ll want to avoid massage during the first three months of pregnancy as it may trigger dizziness and add to morning sickness.
Despite myths you might have heard, there’s is no magic eject button that will accidentally disrupt your pregnancy, and there isn't much solid scientific proof that specific types of massage can have an effect one way or the other. Some massage therapists avoid certain pressure points, including the one between the anklebone and heel, because of concern that it may trigger contractions, but the evidence on whether massage actually can kickstart labor is inconclusive (to nonexistent).
It is a good idea to avoid having your tummy massaged, since pressure on that area when you're pregnant can make you uncomfortable.
If you are in the second half of your pregnancy (after the fourth month), don't lie on your back during your massage; the weight of your baby and uterus can compress blood vessels and reduce circulation to your placenta, creating more problems than any massage can cure.
And don’t expect deep tissue work on your legs during a prenatal massage. While gentle pressure is safe (and can feel heavenly!), pregnant women are particularly susceptible to blood clots, which deep massage work can dislodge. That, in turn, can be risky. On other body parts, the pressure can be firm and as deep or as gentle as you’d like. Always communicate with your therapist about what feels good — and if something starts to hurt."
"Infertility is difficult to live with. That said, sometimes, we make things harder on ourselves. Not intentionally or consciously, of course. We may not know it can be any other way. Or we just don't realize we're self-sabotaging ourselves.
Here are some things you should stop doing if you are fertility challenged, so you can start living a better, fuller life.
1. Stop Blaming Yourself
Maybe you waited "too long" to start a family. Maybe something foolish you did as a college student has wreaked havoc with your fertility. Maybe you wonder if that year you decided to live on only fast food wasn't the brightest idea.
Or, perhaps you have no idea what could possibly have led to your current fertility woes. But you're sure it's something you could have stopped had you only known better.
You need to stop blaming yourself. Even if you can find a way to somehow make it "your fault," you should still stop blaming yourself. It doesn't help. It just depresses you.
Plus, most cases of infertility are either not preventable or not predictable. You really can't know if you had done something different whether you'd be a Fertile Myrtle or not. Drop the blame, and focus on what's most important now--moving forward and tackling the problem.
2. Stop Waiting for a Miracle
If you have been trying to conceive for more than a year (or more than six months, if you're over 35), and you have not succeeded, it's time to see a doctor. Some couples decide this advice isn't really for them, though. It's for those other people. You know, the infertile ones. They decide to keep trying on their own and pray for a miracle.
Here's the problem with that thinking: There are some causes of infertility that worsen with time. While you pray for your miracle, your chances may be quickly disappearing.
There's nothing wrong with deciding to keep trying and wait on treatment, or even deciding not to pursue fertility treatment in the end. But you shouldn't avoid fertility testing. At least find out what is wrong and what your options may be.
Get checked out, both you and your partner, and confirm that whatever is wrong can wait. Then, if you want, set a "miracle waiting" period. Speak to your doctor about how long they think you can try without losing valuable time.
3. Stop Feeling Hopeless
A diagnosis of infertility can hit a person hard. Sometimes, it's difficult to see past the next couple of days or weeks. You may feel hopeless, certain that you will never conceive or that your life will never be happy.
If you can't conceive a biological child, maybe you can use an embryo donor, egg donor, or sperm donor. If you can't use donor gametes, maybe you can adopt. If you can't adopt, remember that people can live childfree and have happy, normal lives.
To be clear, these other possibilities don't magically make the pain go away. You will need time for grieving and healing from the trauma of infertility.
However, when you start to wonder if you will never have a child, or when you start to think your life is ruined, try as best as you can to hold onto at least a sliver of hope. There is life after infertility. Please remember that.
While it's possible you won't conceive, you'll feel better if you can keep your thoughts focused on the positive possibilities. Low-tech treatments work for many couples. Your chances for success may be better than you think. Speak to your doctor about your particular prognosis.
4. Stop Acting Helpless
Most couples are extremely pro-active in their care. But not everyone realizes they are the decision makers.
To the couples whose doctors tell them they are "too young," despite trying for over a year...
To the couples whose fertility clinics refused to try IVF with their own eggs because their chances aren't great, not realizing that the clinic probably doesn't want to "ruin" their track record with a risk...
To the women whose doctors won't test or treat them until they lose weight, but leave it to them to figure out how exactly to do so...
You are not as helpless as it seems. If the doctor you're seeing refuses to run an evaluation, go find a new doctor. If a clinic turns you down because your chances are "too low," seek out a second opinion.
If your doctor tells you to lose weight, be sure they evaluate and treat any hormonal imbalances that may make losing weight difficult, and ask for a referral to a nutritionist.
Maybe go get a second opinion on whether you really need to lose weight first.
You have so much more power than you realize. Don't be afraid to stand up for yourself.
4. Stop Living in Two-Week Increments
This is a basic one but so common it deserves special mention. When you're trying to conceive, your life can easily fall into two-week increments: the two weeks you wait for ovulation, followed by the two weeks you wait to take a pregnancy test.
The worst part about this is there are no breaks; there's no anxiety-free time when you're anxious about ovulating or anxious about feeling pregnant.
While it's unrealistic to think you'd be able to just drop all the fretting, you should at least try to live beyond the two-week wait craziness. You may need the support of friends, a support group, or a counselor to learn how. But it's possible.
4. Stop Basing Self-Worth on Fertility
Infertility can make you feel worthless. Broken. Ashamed. These are all very common feelings, experienced by men and women who live with infertility.
Before you started trying to conceive, before you ever realized you faced infertility, you probably felt different about yourself—hopefully more positive. You need to remember that the old you is still there. You don't become someone else when you're diagnosed with infertility.
If you were awesome and lovable before infertility, then you're just as awesome and lovable after. If you doubt this, think about what you'd say to a friend who told you they felt ashamed and worthless because of their infertility. You probably wouldn't say to them, "Yep, you're right. You're worthless!" No way.
You know it's not true of a friend, and you need to understand it's also not true of yourself. You are so much more than your fertility."
Written by Matthew Thorpe, MD, PhD and Rachael Link, MS, RD — Medically reviewed by Marney A. White, PhD, MS — Updated on October 27, 2020
"Meditation is the habitual process of training your mind to focus and redirect your thoughts.
The popularity of meditation is increasing as more people discover its many health benefits.
You can use it to increase awareness of yourself and your surroundings. Many people think of it as a way to reduce stress and develop concentration.
People also use the practice to develop other beneficial habits and feelings, such as a positive mood and outlook, self-discipline, healthy sleep patterns, and even increased pain tolerance.
This article reviews 12 health benefits of meditation.
1. Reduces stress
Stress reduction is one of the most common reasons people try meditation.
One review concluded that meditation lives up to its reputation for stress reduction.
Normally, mental and physical stress cause increased levels of the stress hormone cortisol. This produces many of the harmful effects of stress, such as the release of inflammatory chemicals called cytokines.
These effects can disrupt sleep, promote depression and anxiety, increase blood pressure, and contribute to fatigue and cloudy thinking.
In an 8-week study, a meditation style called “mindfulness meditation” reduced the inflammation response caused by stress.
Furthermore, research has shown that meditation may also improve symptoms of stress-related conditions, including irritable bowel syndrome, post-traumatic stress disorder, and fibromyalgia.
2. Controls anxiety
Meditation can reduce stress levels, which translates to less anxiety.
A meta-analysis including nearly 1,300 adults found that meditation may decrease anxiety. Notably, this effect was strongest in those with the highest levels of anxiety.
Also, one study found that 8 weeks of mindfulness meditation helped reduce anxiety symptoms in people with generalized anxiety disorder, along with increasing positive self-statements and improving stress reactivity and coping.
Another study in 47 people with chronic pain found that completing an 8-week meditation program led to noticeable improvements in depression, anxiety, and pain over 1 year.
What’s more, some research suggests that a variety of mindfulness and meditation exercises may reduce anxiety levels.
For example, yoga has been shown to help people reduce anxiety. This is likely due to benefits from both meditative practice and physical activity.
Meditation may also help control job-related anxiety. One study found that employees who used a mindfulness meditation app for 8 weeks experienced improved feelings of well-being and decreased distress and job strain, compared with those in a control group.
3. Promotes emotional health
Some forms of meditation can lead to improved self-image and a more positive outlook on life.
For example, one review of treatments given to more than 3,500 adults found that mindfulness meditation improved symptoms of depression.
Similarly, a review of 18 studies showed that people receiving meditation therapies experienced reduced symptoms of depression, compared with those in a control group.
Another study found that people who completed a meditation exercise experienced fewer negative thoughts in response to viewing negative images, compared with those in a control group.
Furthermore, inflammatory chemicals called cytokines, which are released in response to stress, can affect mood, leading to depression. A review of several studies suggests meditation may also reduce depression by decreasing levels of these inflammatory chemicals."
"This 10 minute mindful meditation will give you the mental clarity and space necessary to ground yourself with beautiful focus and set your day on the perfect track for success and fulfillment."
Medically reviewed by Lynn Starr, RNC-OB — Written by Shannon Conner on September 9, 2015
"Most moms-to-be spend a lot of time worrying about their developing baby. But remember, it’s just as important during the next nine months to tune in to someone else’s cues: your own.
Maybe you’re exceedingly tired. Or thirsty. Or hungry. Maybe you and your growing baby need some quiet time to connect.
Your doctor or midwife may say, “Listen to your body.” But for many of us, that’s followed by, “How?”
Meditation can help you listen to your voice, your body, that small heartbeat — and help you feel refreshed and a bit more focused.
What Is Meditation?
Think of meditation as some quiet time to breathe and connect, be aware of passing thoughts, and to clear the mind.
Some say it’s finding inner peace, learning to let go, and getting in touch with yourself through breath, and through mental focus.
For some of us, it can be as simple as deep, in-and-out breaths in the bathroom stall at work as you try to focus on you, your body, and the baby. Or, you can take a class or retreat to your own special place in the house with pillows, a mat, and total silence.
What Are the Benefits?
Some of the benefits of practicing meditation include:
Moms who have high levels of stress or anxiety during pregnancy are more likely to deliver their babies at preterm or low birth weights.
Birth outcomes like those are a pressing public health issue, especially in the United States. Here, the national rates of preterm birth and low birth weight are 13 and 8 percent, respectively. This is according to a report published in the journal Psychology & Health.
Prenatal stress can also impact fetal development. Studies have shown that it can even affect cognitive, emotional, and physical development in infancy and childhood. All the more reason to squeeze in some meditation time!"
"After the birth, there are oh-so-many ways your body will ache. We asked midwife Tracy Hydeman and other experienced parents for their soothing suggestions.
1. When you’re breastfeeding, massage your breasts to ward off mastitis. You can also use warm compresses or take a hot shower.
2. Get hydrated with natural electrolytes (which help regulate nerves and muscles) by mixing water, sea salt and freshly squeezed orange or lemon juice.
3. Soak your bottom in an Epsom salt bath at least two times a day. Add herbs like comfrey leaf and witch hazel to help tears heal and reduce inflammation.
4. Cabbage leaves are a “fantastic thing for engorged breasts,” says Hydeman. They cup the breasts naturally and relieve inflammation.
5. Eat a beef and barley stew—the beef is good for replenishing your iron, and the barley will help your milk come in.
6. If necessary, book an appointment to see a physiotherapist for pelvic-floor and diastasis recti physio ASAP.
7. That little peri bottle you got from your hospital nurse or midwife? It’s a new mom’s best friend when it comes to keeping things clean down there postpartum. (Any tearing or incisions will make it difficult to wipe after delivery.) Simply fill it with warm water and squirt to cleanse yourself after using the toilet or squirt while peeing to dilute the urine if you have any burning or discomfort.
8. Homemade “padsicles”
– Spritz sanitary pads with water or top with witch hazel. Many moms also swear by adding aloe vera gel and lavender oil.
– Fold up the pad and insert it into a zip-top bag or seal with plastic wrap. Freeze. Place on the perineum for cold comfort.
9. If you have a supportive partner or help at home, take advantage of that by embracing the “babymoon” period. Try to stay in bed for at least 72 hours after the birth.
10. Organize (or ask a friend or family member to organize) a meal train, which is a system in which people can sign up to bring you meals. Don’t be shy about mentioning any food preferences or allergies."
Written by Katey Davidson, MScFN, RD, CPT on February 5, 2020 — Medically reviewed by Natalie Butler, R.D., L.D.
"When you’re feeling down, it can be tempting to turn to food to lift your spirits. However, the sugary, high calorie treats that many people resort to have negative consequences of their own.
Thus, you may wonder whether any healthy foods can improve your mood.
Recently, research on the relationship between nutrition and mental health has been emerging. Yet, it’s important to note that mood can be influenced by many factors, such as stress, environment, poor sleep, genetics, mood disorders, and nutritional deficiencies.
Therefore, it’s difficult to accurately determine whether food can raise your spirits.
Nonetheless, certain foods have been shown to improve overall brain health and certain types of mood disorders.
Here are 9 healthy foods that may boost your mood.
1. Fatty fish
Omega-3 fatty acids are a group of essential fats that you must obtain through your diet because your body can’t produce them on its own.
Fatty fish like salmon and albacore tuna are rich in two types of omega-3s — docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) — that are linked to lower levels of depression.
Omega-3s contribute to the fluidity of your brain’s cell membrane and appear to play key roles in brain development and cell signaling.
While research is mixed, one review of clinical trials showed that in some studies, consuming omega-3’s in the form of fish oil lower depression scores.
Although there’s no standard dose, most experts agree that most adults should get at least 250–500 mg of combined EPA and DHA per day.
Given that a 3.5-ounce (100-gram) serving of salmon provides 2,260 mg of EPA and DHA, eating this fish a few times per week is a great way to get these fats into your diet.
Chocolate is rich in many mood-boosting compounds.
Its sugar may improve mood since it’s a quick source of fuel for your brain.
Furthermore, it may release a cascade of feel-good compounds, such as caffeine, theobromine, and N-acylethanolamine — a substance chemically similar to cannabinoids that has been linked to improved mood.
However, some experts debate whether chocolate contains enough of these compounds to trigger a psychological response.
Regardless, it’s high in health-promoting flavonoids, which have been shown to increase blood flow to your brain, reduce inflammation, and boost brain health, all of which may support mood regulation.
Finally, chocolate has a high hedonic rating, meaning that its pleasurable taste, texture, and smell may also promote good mood.
Because milk chocolate contains added ingredients like sugar and fat, it’s best to opt for dark chocolate — which is higher in flavonoids and lower in added sugar. You should still stick to 1–2 small squares (of 70% or more cocoa solids) at a time since it’s a high calorie food.
3. Fermented foods
Fermented foods, which include kimchi, yogurt, kefir, kombucha, and sauerkraut, may improve gut health and mood.
The fermentation process allows live bacteria to thrive in foods that are then able to convert sugars into alcohol and acids.
During this process, probiotics are created. These live microorganisms support the growth of healthy bacteria in your gut and may increase serotonin levels.
It’s important to note that not all fermented foods are significant sources of probiotics, such as in the case of beer, some breads, and wine, due to cooking and filtering.
Serotonin is a neurotransmitter that affects many facets of human behavior, such as mood, stress response, appetite, and sexual drive. Up to 90% of your body’s serotonin is produced by your gut microbiome, or the collection of healthy bacteria in your gut.
In addition, the gut microbiome plays a role in brain health. Research is beginning to show a connection between healthy gut bacteria and lower rates of depression.
Still, more research is needed to understand how probiotics may regulate mood.
Bananas may help turn a frown upside down.
They’re high in vitamin B6, which helps synthesize feel-good neurotransmitters like dopamine and serotonin.
Furthermore, one large banana (136 grams) provides 16 grams of sugar and 3.5 grams of fiber.
When paired with fiber, sugar is released slowly into your bloodstream, allowing for stable blood sugar levels and better mood control. Blood sugar levels that are too low may lead to irritability and mood swings.
Finally, this ubiquitous tropical fruit, especially when still showing green on the peel, is an excellent source of prebiotics, a type of fiber that helps feed healthy bacteria in your gut. A robust gut microbiome is associated with lower rates of mood disorders."
BY ANNE LORA SCAGLIUSI | May 25, 2021
"Jen Schwartz, mental health advocate and CEO of Motherhood Understood, first experienced perinatal depression a day after giving birth. “The biggest red flag was that I was having scary thoughts about wanting to get hurt or sick so I could go back to the hospital and not have to take care of my baby,” she says. “I had no interest in my son. I thought I had made a huge mistake becoming a mother and I couldn’t understand why I was failing at something that I believed was supposed to come naturally and that all other women were so good at.”
According to the World Health Organization, about 10 percent of pregnant women and 13 percent of new mothers will experience a mental disorder, the main one being depression. Without appropriate intervention, poor maternal mental health can have long term and adverse implications for not just these women, but their children and families, too. In most cases, however, women may not be aware of the help available or even that they might need it.
“Most of the time, they mistakenly think they are failing at parenting,” says Wendy Davis, executive director of Postpartum Support International (PSI). “They don't realize they are going through a temporary, treatable experience that many others have gone through.”
To find out more during World Mental Health Awareness Month, Vogue speaks to a range of global mental health experts and women who have experienced perinatal depression.
What is perinatal depression?
"Perinatal depression is the experience of depression that begins during pregnancy [prenatal depression] or after the baby is born [postpartum depression]. Most people have heard of perinatal depression, but what’s equally common for mums to experience is perinatal anxiety either separately, or with depression,” explains Canadian therapist Kate Borsato. Perinatal depression does not discriminate. “Some people are surprised when I tell them that I experienced postpartum anxiety, because of my job as a therapist for mums. But mental illness doesn’t really care who you are or what you know.”
While anyone can experience it, there are some known risk factors that increase women’s chances of developing mental health difficulties in the perinatal period. According to Australia-based social worker and founder of Mama Matters, Fiona Weaver, these include a “previous history of depression or anxiety, those who have limited support networks, have experienced birth or pregnancy trauma, infertility or who may be genetically predisposed to it.”
What are the signs and symptoms to look out for?
Symptoms differ for everyone, and may include feelings of anger, anxiety, fatigue, neglecting personal hygiene and health or surroundings, fear and/or guilt, lack of interest in the baby, change in appetite and sleep disturbance, difficulty concentrating/making decisions, loss of enjoyment or enthusiasm for anything, and possible thoughts of harming the baby or oneself.
Women can also develop postpartum obsessive-compulsive disorder, and postpartum psychosis. Copenhagen-based content creator Clara Aatoft was diagnosed with severe postpartum depression and psychosis months after becoming a new mum. “For the first three months, I didn't sleep at all. I was constantly aware of my daughter’s needs. She was later diagnosed with colic. When I gave up breastfeeding and switched to the bottle, my depression and psychosis went full-blown.” She continues, “I started thinking that my daughter was a robot that someone placed a chip inside at the hospital. I attempted suicide and ended up in the psychiatric ward. I’m very well now, still medicated on antidepressants. But my daughter and I have the best relationship.”
"Over 1 billion women around the world will have experienced perimenopause by 2025. But a culture that has spent years dismissing the process might explain why we don’t know more about it.
By: Jessica Grose | April 29, 2021
"Angie McKaig calls it “peri brain” out loud, in meetings. That’s when the 49-year-old has moments of perimenopause-related brain fog so intense that she will forget the point she is trying to make in the middle of a sentence. Sometimes it will happen when she’s presenting to her colleagues in digital marketing at Canada’s largest bank in Toronto. But it can happen anywhere — she has forgotten her own address. Twice.
Ms. McKaig’s symptoms were a rude surprise when she first started experiencing them in 2018, right around when her mother died. She had an irregular period, hot flashes, insomnia and massive hair loss along with memory issues she describes as “like somebody had taken my brain and done the Etch A Sketch thing,” which is to say, shaken it until it was blank.
She thought she might have early-onset Alzheimer’s, or that these changes were a physical response to her grief, until her therapist told her that her symptoms were typical signs of perimenopause, which is defined as the final years of a woman’s reproductive life leading up to the cessation of her period, or menopause. It usually begins in a woman’s 40s, and is marked by fluctuating hormones and a raft of mental and physical symptoms that are “sufficiently bothersome” to send almost 90 percent of women to their doctors for advice about how to cope.
Ms. McKaig is aggressively transparent about her “peri brain” at work, because she “realized how few people actually talk about this, and how little information we are given. So I have tried to normalize it,” she said.
An oft-cited statistic from the North American Menopause Society is that by 2025, more than 1 billion women around the world will be post-menopausal. The scientific study of perimenopause has been going on for decades, and the cultural discussion of this mind and body shift has reached something of a new fever pitch, with several books on the subject coming out this spring and a gaggle of “femtech” companies vowing to disrupt perimenopause.
If the experience of perimenopause is this universal, why did almost every single layperson interviewed for this article say something along the lines of: No one told me it would be like this?
“You’re hearing what I’m hearing, ‘Nobody ever told me this, my mother never told me this,’ and I had the same experiences many years ago with my mother,” said Dr. Lila Nachtigall, a professor of obstetrics and gynecology at N.Y.U. Grossman School of Medicine who has been treating perimenopausal women for 50 years, and is an adviser to Elektra Health, a telemedicine start-up.
Dr. Nachtigall said her mother had the worst hot flashes, and even though they were living in the same house when her mother was experiencing perimenopausal symptoms, they never discussed it. “That was part of the taboo. You were supposed to suffer in silence.”
The shroud of secrecy around women’s intimate bodily functions is among the many reasons experts cite for the lack of public knowledge about women’s health in midlife. But looking at the medical and cultural understanding of perimenopause through history reveals how this rite of passage, sometimes compared to a second puberty, has been overlooked and under discussed.
From ‘Women’s Hell’ to ‘Age of Renewal’
Though the ancient Greeks and Romans knew a woman’s fertility ended in midlife, there are few references to menopause in their texts, according to Susan Mattern, a professor of history at the University of Georgia, in her book “The Slow Moon Climbs: The Science, History, and Meaning of Menopause.”
The term “menopause” wasn’t used until around 1820, when it was coined by Charles de Gardanne, a French physician. Before then, it was colloquially referred to as “women’s hell,” “green old age” and “death of sex,” Dr. Mattern notes. Dr. de Gardanne cited 50 menopause-related conditions that sound somewhat absurd to modern ears, including “epilepsy, nymphomania, gout, hysterical fits and cancer.”
By Ivana Kottasová, CNN | July 31, 2021
(CNN)-"The Delta variant of Covid-19 is dominating cases worldwide, and health officials in some countries are sounding alarm over its impact on pregnant women.
Several of England's top health officials issued a joint statement on Friday urging pregnant women to get vaccinated against the coronavirus. They pointed to new data showing that 98% of expectant mothers admitted to the hospital with Covid-19 in the country since May were unvaccinated.
The World Health Organization (WHO) has also previously said that infected, pregnant women face an increased risk of developing severe Covid-19 compared with non-pregnant women of a similar age.One concern is that risk might be even higher with the Delta strain, which has been shown to be more contagious and can cause more severe disease compared to the earlier variants of the virus.Here's what you need to know.
Is Delta more dangerous if you're pregnant?
The Delta variant is more contagious and can cause more severe disease for everyone, including pregnant women.The latest data gathered by the UK Obstetric Surveillance System (UKOSS) showed the number of pregnant women that are being admitted to hospital with Covid-19 is increasing in the UK due to the Delta strain.
"Compared to the original Covid virus the new variants (alpha and then delta) caused progressively more severe disease in pregnant women," Andrew Shennan, professor of obstetrics at King's College London, said in a statement to the UK's Science Media Centre. "This included need for ventilation, intensive care admission and pneumonia, more than 50% more likely to occur," he added.
The data collected by UKOSS show that around 33% of women in hospital with Covid-19 needed respiratory support and that 15% needed intensive care.
The UKOSS data only includes pregnant women. However, the group said that while the increase in hospitalizations was broadly in line with the current rise in Covid-19 hospital admissions in the UK's general population, the data highlights an increase among pregnant women needing care for acute symptoms.
What about risks to the baby?
Previous studies have shown that Covid-19 infection raises the risk of negative outcomes for both the mother and the baby. These risks include preeclampsia, infections, admission to hospital intensive care units and even death.
According to an April study published in JAMA Pediatrics that looked at over 2,000 pregnant women in 43 medical institutions across 18 countries, babies born to mothers infected with the coronavirus were also at a somewhat higher risk of preterm birth and low birth weight.
The new data collected by UKOSS showed that one in five women admitted to hospital with serious Covid-19 symptoms went on to give birth prematurely, and the likelihood of delivery by C-section doubled. One in five babies born to mothers with coronavirus symptoms were also admitted to neonatal units.
Is the vaccine safe for pregnant people?
Yes. Studies and real-world data have shown there are no specific safety concerns for pregnant people or their babies on taking a Covid-19 vaccine.
"Hundreds of thousands of pregnant women worldwide have been vaccinated, safely and effectively protecting themselves against Covid and dramatically reducing their risk of serious illness or harm to their baby," Gill Walton, the chief executive of the Royal College of Midwives in the UK, said in a statement on Friday.
The US Centers for Disease Control and Prevention, the Joint Committee on Vaccination and Immunization in the UK and Australia's Technical Advisory Group on Immunization all advise pregnant women to get a Covid-19 shot. The WHO says that pregnant women should get the vaccine in situations where the benefits of vaccination outweigh the potential risks -- such as if they are living in areas with high number of cases."
By Christin Perry | February 25, 2020
"Almost as soon as those two pink lines pop up on a pregnancy test, your hormones get the message that something's different at mission control. Progesterone and human chorionic gonadotropin (hCG) begin pumping to signal your body to halt production on your next menstrual period, and begin forming that cluster of cells into a mini-you instead. As you probably already know, as these hormones get to work, you'll experience an onslaught of early pregnancy symptoms like nausea, fatigue, and breast tenderness.
As pregnancy progresses, our bodies produce extraordinary amounts of estrogen and progesterone, says Aumatma Shah, fertility specialist and naturopathic doctor at the Bay Area's Holistic Fertility Center. "These two steroidal hormones are key to creating dopamine and serotonin, two neurotransmitters in the brain that are important in feeling calm and happy. This is why a lot of women feel amazing when pregnant: Pregnancy offers a surge of hormones and neurotransmitters that help us feel great."
But what happens to those feel-good pregnancy hormones once your baby is born? "Unfortunately, immediately postpartum and the week following delivery, estrogen and progesterone will both plummet. Simultaneously, there will be a surge in prolactin and oxytocin," says Shah.
These wildly swinging hormones are to blame for those crazy emotions you'll experience after giving birth. Here's a closer look at what happens to your hormones postpartum and when so you know what to expect—and so you know the loony emotions you're feeling are all completely normal.
What Happens to Hormones Immediately After Giving Birth?
The birth of your sweet bundle of joy is undoubtedly one of the most exciting moments of your life. No matter how long you labor or what time you give birth—yes, even if it's at 3 a.m.—you'll likely feel an amazing, indescribable high when you meet your baby for the first time, or shortly thereafter. But those surging hormones will plummet over the next few days. Here's what's going on:
Postpartum Hormones at 3 to 6 Weeks
After those first few weeks pass, you may start to feel those rollercoaster-like emotions start to regulate a bit as you begin to get into the groove of caring for baby and get used to the lack of sleep. Ashley Margeson, a naturopathic doctor says, "the first three months are a bit of a whirlwind of sleep loss and emotions as your system runs mostly on adrenaline to move you through the day."
Around the six-week mark, she says, symptoms of postpartum depression may begin to show as those positive post-birth hormones continue to fade. "The changes you should look for closely are not wanting to shower or focus on hygiene, being afraid of leaving your baby with someone else, not being able to sleep fully due to continually checking on baby, and lack of desire for common tasks like eating, drinking, being around people, and leaving the house."
By: Jessica Grose | February 4th, 2021
"In early September, as the school year inched closer, a group of mothers in New Jersey decided they would gather in a park, at a safe social distance, and scream their lungs out. For months, as the pandemic disrupted work and home life, these moms, like so many parents, had been stretched thin — acting as caregivers, teachers and earners at once. They were breaking.
As are mothers all over the United States.
By now, you have read the headlines, repeating like a depressing drum beat:
“Working moms are not okay.” “Pandemic Triples Anxiety And Depression Symptoms In New Mothers.” “Working Moms Are Reaching The Breaking Point.”
You can also see the problem in numbers: Almost 1 million mothers have left the workforce — with Black mothers, Hispanic mothers and single mothers among the hardest hit. Almost one in four children experienced food insecurity in 2020, which is intimately related to the loss of maternal income. And more than three quarters of parents with children ages 8 to 12 say the uncertainty around the current school year is causing them stress.
Despite these alarm bells clanging, signaling a financial and emotional disaster among America’s mothers, who are doing most of the increased amount of child care and domestic work during this pandemic, the cultural and policy response enacted at this point has been nearly nonexistent.
The pandemic has touched every group of Americans, and millions are suffering, hungry and grieving. But many mothers in particular get no space or time to recover.
The impact is not just about mothers’ fate as workers, though the economic fallout of these pandemic years might have lifelong consequences. The pandemic is also a mental health crisis for mothers that fervently needs to be addressed, or at the very least acknowledged.
“Just before the pandemic hit, for the first time ever, for a couple months, we had more women employed than men,” said Michael Madowitz, an economist at the Center for American Progress. “And now we are back to late 1980s levels of women in the labor force.” The long-term ramifications for mothers leaving work entirely or cutting back on work during this time include: a broken pipeline for higher-level jobs and a loss of Social Security and other potential retirement income.
“Covid took a crowbar into gender gaps and pried them open,” said Betsey Stevenson, an economist at the University of Michigan. Her long-term concerns are even more fundamental: Will watching a generation of mothers go through this difficult time with little support turn the next generation of women off from parenthood altogether?
The economic disaster of the pandemic is directly related to maternal stress levels, and by extension, the stress levels of American children. Philip Fisher, a professor of psychology at the University of Oregon who runs an ongoing nationally representative survey on the impact of the pandemic on families with young children, points out that the stressors on mothers are magnified by a number of intersecting issues, including poverty, race, having special needs children and being a single parent.
“People are having a hard time making ends meet, that’s making parents stressed out, and that’s causing kids to be stressed out,” Dr. Fisher said. This buildup can lead to toxic stress, “And we know from all the science, that level of stress has a lasting impact on brain development, learning and physical health.” Almost 70 percent of mothers say that worry and stress from the pandemic have damaged their health.
The statistics on stress levels are shocking, but they are sterile; they don’t begin to expose the frayed lives of American mothers and their children during this pandemic. A young mother who self-identified as American Indian/Alaska Native summed up her situation in response to Dr. Fisher’s survey: “We are requesting government help for food. Relationship between partner and I are tense. I am personally struggling more now with depression and anxiety. My toddler has become more anxious as well and shown aggressive behavior. She seems overwhelmed most of the time.”
Times editor-at-large Jessica Bennett spent months communicating with three women, who kept detailed diaries of their days, for a look at just how much American mothers are doing every waking second."
By: Pregnancy & Postpartum TV | March 6, 2019
"Prenatal Yoga Bedtime or Prenatal Yoga Before Bed. Help get to sleep with this prenatal bedtime yoga or prenatal bedtime stretch. Prenatal yoga bedtime as a pregnancy insomnia remedies."
"What Is Prenatal Depression?
Prenatal depression, also called perinatal depression, is depression experienced by women during pregnancy. Like postpartum depression, prenatal (or perinatal) depression isn’t just a feeling of sadness—mothers who experience this mental health disorder may also feel anxious and angry.
You've likely heard of postpartum depression—and that's a good thing. The more that postpartum depression is talked about and understood, the more mothers will seek the help they need so that they can feel better and live full and healthy lives as new moms.
But prenatal depression is a maternal mood disorder that hasn’t gotten nearly as much attention as it should. While prenatal depression can be treated, many expecting mothers don’t even know that it’s a “thing” and therefore don’t seek treatment for it.
Many feel ashamed to even share how they are feeling. After all, you are supposed to be overjoyed and excited when you are expecting a baby, right? It’s easy to feel guilt and shame when you are feeling the exact opposite.
Here’s what you should know about prenatal depression, including how common it is, what to look for in terms of symptoms, and most importantly, how to get help.
How Common Is Prenatal Depression?
Like postpartum depression, which impacts as many as 1 in 7 new moms, prenatal depression is actually quite common.
According to a journal article by Maria Muzik, MD, and Stefana Borovska, published in Mental Health in Family Medicine, 13% of pregnant moms experience depression.
As the authors note, perinatal depression (both prenatal and postpartum) is even more common among mothers facing adverse experiences, such as a history of depression or economic hardship.
“The prevalence of perinatal depression is even higher in vulnerable groups with certain risk factors,” the authors explain. “Young, single mothers, experiencing complications, with a history of stress, loss or trauma are far more likely to succumb to depression. Furthermore, one study found that up to 51% of women who experience socioeconomic disadvantage also report depressive symptoms during pregnancy.”
It's important to note prenatal depression doesn’t discriminate: You can experience it whether or not you have pre-existing risk factors. Always remember there is no shame in experiencing a serious bout of depression during pregnancy, and you are not alone.
Similar to postpartum depression, experts can’t pinpoint one particular cause of prenatal depression, but have hypothesized that it’s likely caused by a confluence of factors—a “perfect storm” of triggers that come to a head for some mothers during their pregnancies.
Either way, it’s important to note that whatever caused your prenatal depression, it most certainly wasn’t your fault. There was nothing you did wrong, and you are not a bad mom (or going to be a bad mom).
“Depression and anxiety during pregnancy or after birth don't happen because of something you do or don't do—they are medical conditions,” notes the Academy of American Pediatrics (AAP).
“Although we don't fully understand the causes of these conditions, researchers think depression and anxiety during this time may result from a mix of physical, emotional, and environmental factors,” they add.
Prenatal depression manifests differently for every mom—you may even experience it differently from one pregnancy to another. It’s important to understand that anytime you feel overwhelmed by your emotions, unable to function in your day-to-day life, or just “off,” you should reach out to discuss your feelings with a trusted loved one or medical provider.
Here are some of the most common symptoms of prenatal depression:
For more mental health resources, see our National Helpline Database."
Depression During Pregnancy Affect Infant’s Brain Anatomy, But No Change with Prenatal Exposure to SSRIs
By MGH Center for Women's Mental Health | June 22, 2021
"When a woman comes in for a consultation regarding the use of medications during pregnancy, we spend most of our time reviewing the potential risks of exposure to medications during pregnancy. However, we must also include a discussion of the effects of untreated psychiatric illness in the mother on the developing child, for there is a growing body of literature which demonstrates that what happens in utero, while the fetus is developing, may have effects on the child that persist into adulthood.
A number of recent studies have examined the brain anatomy of infants born to depressed mothers. Neuroimaging has revealed changes in connectivity between the amygdala and the prefrontal cortex (reviewed in Duan et al, 2019), and it is hypothesized that these alterations are responsible for the children’s increased vulnerability to anxiety and depression.
In a recent study Sethnaa and colleagues add to this literature, using MRI to compare regional brain volumes in 31 3-to-6-month-old infants born to women with a diagnosis of major depressive disorder (MDD, confirmed using the SCID) and 33 infants born to women without a current or past psychiatric diagnosis. The study recruited women during the second and third trimesters of pregnancy from antenatal clinics and perinatal psychiatric services in South London.
MRI assessments were conducted in infants between the ages of 3 and 6 months. Compared to infants born to non-depressed mothers, infants born to mothers with depression during pregnancy have larger subcortical grey matter volumes and smaller midbrain volumes. This finding persisted after adjusting for potential confounders, including medication use during pregnancy, postpartum depressive symptoms, and infant sex.
These findings are consistent with other studies looking at different types of insults, such as hypoxia and substance use, suggesting that these subcortical structures are particularly susceptible to changes in the in utero environment. The authors note that this finding of an association between maternal antenatal depression and midbrain development is not surprising given the midbrain’s role in stress regulation."
By: Robin Elise Weiss, PhD, MPH | June 14, 2021
"Affirmations are statements that you use intentionally to instill a sense of positivity and purpose in your mind about a particular subject. You can use these short phrases and sentences to help yourself focus on and accept a positive message that you wish to remember.Affirmations are an example of using positive thinking to set an intention and increase the likelihood of positive results. Even better, they are simple to do, free, and accessible to all.
Why They Work
While there is no guarantee that affirmations will actually change the outcome of your pregnancy, some studies suggest that affirmations can reduce stress and anxiety—which can make it easier to rest, eat, and avoid issues such as headaches and fatigue. Plus, positive thoughts tend to cultivate positive feelings, which may help to make your pregnancy experience more enjoyable and relaxed.
Studies show that using positive affirmations impacts brain pathways, increasing activity in the areas of the mind responsible for self-worth, self-regulation, and core values. Researchers believe that making a regular practice of saying affirming statements can effectively shift your focus from negative emotions or stressors to your own expansive capacity to cope, bolstering your confidence and bringing you new ideas, strategies, energy, and hope for the future.
Write Your Own
The beauty of positive affirmations is that you can write your own to use whenever you like. They can be said out loud or silently in your head, quietly whispered to yourself, or written down. In lieu of writing your own, you can also use one you have read or heard elsewhere. If it makes you feel strong, positive, and hopeful, then you're on the right track.
Remember, your affirmation should be in the present tense, as if what you wish to happen is already occurring. For example, someone who is worried about coping with childbirth might say, "I am strong." A person who is trying to get pregnant and having difficulty might say, "I am a good parent to my child."
This person might decide to repeat the affirmation every morning as a reminder of their goal and to foster their hope for this desired outcome. During infertility treatments, they might visualize this affirmation while undergoing procedures and tests, as well. During pregnancy, daily pregnancy affirmations may serve to enhance the mother's bond to their growing baby while also alleviating the worry that something might go wrong.
How to Do It
Anything that speaks to you can work as an affirmation. If you're unsure, brainstorm statements that connect to the feelings, values, and intentions you want to affirm. If you have a specific worry or negative thought that keeps coming to mind, try flipping it around to a positive one.
If you catch yourself thinking, "I can't do this," counter that with, "I can do this." "Childbirth is scary" becomes "childbirth is beautiful." Simple is good. Setting your positive intention can literally change your mind.
To help you get started writing your own affirmations, consider beginning with phrases like the following:
By MGH Center for Women's Mental Health | June 10th, 2021
"When we meet with women for perinatal psychiatry consultations, we now ask about vaccinations. It’s not something we typically do, but after the last year, we are now getting involved in their decisions regarding vaccination against COVID-19. Just as we counsel women to avoid alcohol and to consistently take their prenatal vitamins, providing information on the COVID-19 vaccine is an important aspect of promoting the health of pregnant and postpartum women.
Considering a growing body of evidence indicating that pregnant women are more likely to have certain manifestations of severe COVID-19 illness, including admission to the ICU and mechanical ventilation, the American College of Obstetricians and Gynecologists (ACOG) has urged the CDC’s Advisory Committee on Immunization Practices to include pregnant and lactating women in the high-priority populations for COVID-19 vaccine allocation. ACOG clearly states that all pregnant and lactating people should be allowed to receive the vaccine, and that their decision to do so should be based on a careful discussion of risks and benefits with their healthcare provider.
From our vantage point, there are other benefits to the COVID-19 vaccine. During the past year, before the vaccination was available, we watched as pregnant and postpartum patients undertook the most extreme forms of lockdown. Many of these women were literally housebound: never leaving the house and cutting off contact with friends and family, while at the same time taking on more childcare responsibilities as outside care providers and day care centers were no longer available. And all the while wondering what would happen if they or a member of their family felt ill?
We are yet to fully appreciate the impact of the COVID-19 pandemic on perinatal women, but preliminary studies indicate that during the lockdown, pregnant and postpartum women reported higher levels of stress, loneliness, depression, and anxiety. And this is not really a surprise. So many of the things we typically recommend to reduce stress and social isolation, such as exercising regularly or spending time with friends and family, vanished.
While it might seem like the pandemic is fading into the distance, the resurgence of the pandemic in places like India and Brazil where immunization rates are low, we cannot be so sure about this. So far the most successful way to avoid becoming seriously ill with COVID-19 is to get vaccinated.
A recent article in Medscape, however, suggests that mothers appear to be less likely to get vaccinated than others in the general population. According to a recent poll from Morning Consult, about two-thirds of adults in the US have either already been vaccinated against COVID-19 or plan to do so. In contrast, mothers are the most likely to be hesitant about the vaccine. In this study, 51% of the mothers reported that they are unwilling to get vaccinated or are uncertain about getting vaccinated, at 51% (compared to 32% of other women and 29% of fathers)."
By familydoctor.org editorial staff.
"The amount of sleep you get while you’re pregnant not only affects you and your baby, but could impact your labor and delivery as well. Lack of sleep during pregnancy has been tied to a number of complications, including preeclampsia (a serious condition that affects your blood pressure and kidneys). This condition could result in pre-mature birth. Now is the time to take sleep seriously.When you become pregnant, one of the first symptoms you may notice is being overwhelmingly tired, even exhausted. Sleep will be irresistible to you. You can most likely blame your changing hormones for this, especially the extra progesterone that comes with being pregnant. In the beginning, pregnancy also lowers your blood pressure and blood sugar, which can make you feel tired.
Shortly after the first trimester, your energy should return. Sometime during the third trimester, you’ll begin to feel tired again. Some of this feeling can be blamed on the sheer physical exhaustion that comes from growing a baby and the stress that it puts on your body. However, your weariness during this time is in direct relation to your inability to get a good night’s sleep.
Even if you’ve never had trouble sleeping before, you may find it much more difficult while you’re pregnant.
Path to improved health
Sleep should never be seen as a luxury. It’s a necessity — especially when you’re pregnant.
In fact, women who are pregnant need a few more hours of sleep each night or should supplement nighttime sleep with naps during the day, according to the National Institutes of Health.
For many pregnant women, getting 8 to 10 hours of sleep each night becomes more difficult the farther along they are in their pregnancy. There are many physical and emotional obstacles to sleep in this stage. Anxiety about being a mom or about adding to your family can keep you awake. Fear of the unknown or about the delivery can cause insomnia. Plus, there is the getting up every few hours to go to the bathroom. It also can be difficult to find a comfortable position in bed, especially if you are a former stomach sleeper.
If any of the following is keeping you awake at night, try these strategies for getting a good night’s sleep.
At some point in their pregnancy, most pregnant women suffer from heartburn, which is a form of indigestion that feels like burning in your chest and throat. Heartburn can wake you up in the middle of the night and ruin a good sleep. Minimize the chance for this by avoiding spicy foods. Also, cut down on rich foods for dinner.
Restless leg syndrome
Few things are more distracting than restless legs syndrome (RLS), especially when you are trying to go to sleep. While you can’t take traditional RLS medicines when you are pregnant, you can try to reduce the feelings of RLS with a good prenatal vitamin that includes folate and iron.
Morning sickness — at bedtime
Despite the name, morning sickness can occur any time and is often worse later in the day. Try eating a few crackers at bedtime and keep a stash in your nightstand in case a wave of nausea hits as you are trying to go to sleep.
There are many ways insomnia can creep in and compromise your sleep time. Often, it’s just about being able to shut down your brain. Most medicines for insomnia should not be taken while you are pregnant. Instead, try journaling some of the things you are anxious about. Write down what is stressing you and try to let it go as you go to sleep. Also, stop drinking caffeine by early afternoon. Try not to take long naps during the day. Doing any — or all — of these things can help ease you back into sleep at a reasonable bedtime.
Not many things can wake you as quickly and painfully as a leg cramp. Sometimes called a charley horse, these cramps are usually a contraction of your calf muscle. Less frequently, they can occur in your thigh or your foot. These can plague you in pregnancy because of a lack of minerals, especially calcium and magnesium. They also are more common if you are dehydrated. To guard against leg cramps, make sure that you continue to take your prenatal vitamin and drink plenty of water and other fluids during the day.
Finding a comfortable position
As your body grows, sleep becomes a little harder to come by, especially in the third trimester. It’s difficult to get comfortable. It’s harder to move around and shift positions in bed. If you’ve been a stomach or back sleeper, it can be hard to adjust to sleeping on your side. The best position to sleep in when you’re pregnant is on your left side. This improves blood flow and, therefore, nutrient flow to your baby. Try lying on your left side, knees bent with a pillow between your knees. It also helps to tuck a pillow under your stomach, as well, for extra support.
Frequent bathroom breaks
With the baby pushing down on your bladder, you likely can’t make it all night without waking at least once to go to the bathroom. You can help minimize nighttime bathroom trips by cutting down on how much you drink in the evenings. Just be sure to get adequate hydration during the day. Bright lights can make it harder for you to fall back asleep, so use nightlights so that you will not need to turn on the lights when you get up to go to the bathroom.
In addition to minimizing the common obstacles to getting a good night’s sleep, there are also ways to encourage good sleep habits. This is called good sleep hygiene.
Things to consider
Sleep is essential to health. Lack of sleep is associated with many chronic diseases, including type 2 diabetes, obesity, depression, and even heart disease. If you’re pregnant, not getting an adequate amount of sleep can put you at risk for some serious conditions. Lack of sleep can also complicate your delivery.
In one research study, pregnant women who slept less than six hours at night late in pregnancy had longer labors and were more likely to have cesarean deliveries.
Another study reports that the sleep you get in your first trimester can affect your health in the third trimester. Women who don’t get enough sleep (less than five hours per night) in the first trimester are nearly 10 times more likely to develop preeclampsia late in pregnancy. Preeclampsia is a condition associated with pregnancy-related high blood pressure, swelling of hands and feet, and protein in urine.
If you’ve ever had a sleep disorder, it could be made worse by pregnancy. If you’ve had sleep apnea in the past, your snoring may get worse during pregnancy. This is especially true if you were already overweight when you became pregnant. Expect that RLS will worsen during this time. Heartburn will intensify, too."
"For a new mom-to-be, experiencing sleep deprivation after the baby is born is a given. But you probably didn’t realize that it could also occur during the first trimester of pregnancy.
Most women experience sleep problems during pregnancy. Pregnant women tend to get more sleep during their first trimesters (hello, early bedtime) but experience a big drop in the quality of their sleep. It turns out that pregnancy can make you feel exhausted all day long. It can also cause insomnia at night.
Here are some of the most common culprits for insomnia during early pregnancy, plus a few tips to help you get a better night’s sleep.
What is insomnia?
Insomnia means you have difficulty falling asleep, staying asleep, or both. Women can experience insomnia during all stages of pregnancy, but it tends to be more common in the first and third trimesters. Between midnight bathroom breaks, out-of-control hormones, and pregnancy woes such as congestion and heartburn, you might be spending more time out of your bed than in it. The good news: While insomnia might be miserable, it’s not harmful to your baby.
Sheer logistics play a role as well. By the end of a pregnancy, many women have a hard time just getting comfortable enough to sleep well. During the first trimester, you might not have much of a baby belly to accommodate, but there are other issues that can prevent a good night’s sleep.
What causes insomnia during pregnancy?
Expecting? There are many reasons you might be wide awake in the wee hours. These can include:
It can be difficult to distract yourself from these thoughts, but try to remember that worrying isn’t productive. Instead, try writing down all of your concerns on paper. This will give you a chance to consider possible solutions. If there are no solutions, or there is nothing you can do, turn the page in your journal and focus on another worry. This can help empty your mind so you can rest.
Being up front with your partner about your feelings and worries can also help you feel better.
Develop a bedtime routine
One of the best things you can do to manage insomnia while you’re pregnant is to set up good sleep habits.
Begin by trying to go to bed at the same time every night. Start your routine with something relaxing to help you unwind.
Avoid screen time at least an hour before bed. Blue light from the TV, your mobile phone, or tablet can have an impact on your body’s circadian rhythm. Try reading a book instead.
Taking a soothing bath might also make you sleepy. Just be careful that the temperature isn’t too hot — that can be dangerous for your developing baby. This is especially true during early pregnancy.
To be safe, avoid hot tubs.
Diet and exercise
Diet and exercise can have an impact on your sleep.
Drink plenty of water throughout the day, but minimize drinking after 7 p.m. Try to avoid caffeine starting in the late afternoon.
Eat to sleep
Eat a healthy dinner, but try to enjoy it slowly to reduce your chances of heartburn. Eating an early dinner can also help, but don’t go to bed hungry. Eat a light snack if you need to eat something late in the evening. Something high in protein can keep your blood sugar levels steady through the night. A warm glass of milk can help you feel sleepy, too."
"Seaneen Molloy was excited to discover she was expecting her second baby during lockdown. With a history of mental illness, she carefully planned the pregnancy, but when her baby arrived she experienced the "terrifyingly rapid" onset of a crisis which left her unable to hold baby Jack."
"Having a baby is supposed to be a joyful experience, and for lots of women it is. However, up to 20% experience mental ill health during pregnancy and the year after birth. Tragically, suicide is the leading cause of death in new mothers.
Women who already have a mental illness are at a high risk of relapse during pregnancy - that's women like me.
I have a diagnosis of bipolar disorder and an anxiety disorder. This meant that pretty much from the moment I became pregnant, the perinatal mental health team were involved.
This includes specialist midwives, psychiatrists, nurses and social workers whose goal is to support women to stay well, and intervene quickly if they don't.
Normally, I manage my mental health by being careful with my sleep and leading a pretty boring life away from overwork and alcohol, but pregnancy chucks in a host of factors you have no control over.
Hormones rage through your body, wreaking havoc upon your mood, your energy levels and your ability to keep your lunch down. You either can't stay awake or are awake for hours - peeing a thousand times and being hoofed by tiny feet.
I had managed to stay well, and off medication, for years, but in the run-up to birth antipsychotic medication was introduced to prevent postpartum psychosis. This can cause women to develop delusions and lose touch with reality.
It's the one I was most at risk of developing due to my history of bipolar disorder, but in the end, I experienced postnatal anxiety.
My mental health had been largely OK during my pregnancy and my labour and after-care were carefully planned.
I had a calm elective Caesarean section due to a traumatic first birth, a room of my own and the baby was whisked away on his inaugural night so that I could get some all-important sleep (this bit was hard - it went against every natural instinct). A procession of midwives, doctors and social workers visited to see how I was doing.
Although I found it intrusive, it helped me feel safe. When I was discharged from hospital with my baby, Jack, I felt swaddled in care and confident everything would be OK.
It was a complete shock that I did get ill.
In the chaos of newborn-life I forgot a dose of my anti-clotting medication which is given to mothers after C-sections.
And this one tiny event broke my brain.
I went from mildly chiding the home treatment team for their postnatal visits, because I was fine, to a full-blown mental health crisis within about 12 hours. It was terrifyingly rapid - which is why perinatal mental illness can be so deadly.
My mild anxiety exploded into an all-consuming panic that I was going to die imminently from a blood clot in my lung. I couldn't think of anything else but the black terror of certain death that was coming for me - how I was going to leave my children, how I'd brought a new child into the world never to know me.
I called out-of-hours GPs describing symptoms I was convinced I had, sobbed, screamed and couldn't breathe. I terrified my husband and myself.
Then we hit the emergency button.
The psychiatrist came over with the home treatment team. They took my fears seriously, which I appreciated, and gave me a physical examination and the missed dose of medication. My antipsychotic medication was increased to the maximum dose and benzodiazepines - a type of sedative - prescribed, to try and calm me down.
I wasn't allowed to be left alone and the mental health team were to visit me every day where I tried to articulate my terror to their masked faces.
At first I resented their visits, but they became a 30-minute space where I could let down the exhausting facade and share how I was really feeling.
My anxiety then transformed into an obsession that Jack was going to die. I was afraid to leave the room and rested my hand on his chest all night.
If my husband took him out to the shops with his brother, I cried and paced about, imagining they had all been hit by a car. I texted him incessantly.
Everyone was saying I needed "rest", so he tried to give me space. But after the second or third breakdown, he agreed to keep his phone on loud and to answer quickly. The home treatment team also advised he give me clear timescales so I knew when to expect them home.
But the medication also caused intense restlessness. I couldn't sit still. I couldn't get comfortable enough to hold my baby for more than a minute."
By MGH Center for Women's Mental Health | May 19th, 2021
"This is a question we often hear. One of the challenges in answering this question is the interpretation of the word “best”. On one hand, the best antidepressant is the one that is the most likely to be effective. On the other hand, the best antidepressant is the one that carries the least risk when used during pregnancy. What this means is that there is no single answer. Each situation is different, and our recommendations are based on a careful assessment of the patient’s course of illness, treatment history, past medication trials, and the most up-to-date information on reproductive safety. Added to this calculation is the understanding that untreated depression also carries some risk in terms of maternal well-being and has been associated with worse pregnancy outcomes.
Stay with the Same Treatment or Switch?
We often meet with women who have switched to a different antidepressant medication in preparation for pregnancy. Other women make a switch when they discover they are pregnant. These switches are motivated by the belief that there is a “safer” medication to be used during pregnancy. The reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus. What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others. But even this distinction is disappearing; we have data to support the use of most SSRIs (with less data on fluvoxamine or Luvox), the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor), and bupropion (Wellbutrin). Tricyclic antidepressants, although not commonly used today, also have data to support their reproductive safety.
We have very little data on the reproductive safety of the MAO inhibitors. In addition, MAO inhibitors may have serious interactions with other medications frequency used during pregnancy and labor and delivery, specifically medications used to manage pain, such as nalbuphine (Nubain) and meperidine (Demerol). In women taking these medications, we are likely to suggest switching to another antidepressant with a better reproductive safety profile.
At this point, we have less data on the use of the newer antidepressants. There is some data on mirtazapine, with the most recent study including 334 cases of neonates with prenatal exposure to mirtazapine. While these data are reassuring and there is no indication that mirtazapine carries significant teratogenic risk, the number of mirtazapine exposures remains small. Ideally we would like to have data from 600-700 exposures to get a better estimate of risk. Making decisions regarding safety on studies with small sample sizes can lead to miscalculations of risk in either direction.
The data is even more limited with regard to the use of vortioxetine (Trintellix), vilazodone (Viibryd), levomilnacipran (Fetzima). If there are effective alternatives, we typically recommend switching to another antidepressant.
In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile. It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.
What About Zoloft? Isn’t Zoloft the Safest?
At some point in the early 2000s, there emerged the belief that sertraline (Zoloft) was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy. It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant. Reflexively switching women to sertraline puts women at risk for recurrent illness.
While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed. The typical starting dose is 50 mg; however, many individuals will need 150 mg to 200 mg to effectively manage their symptoms. Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms.
What About Paxil? Doesn’t It Cause Heart Defects?
The most current data regarding the use of paroxetine (Paxil) during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations. However, in 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.
However, in 2008, a study from the Motherisk Program in Toronto reported on the outcomes of over 3000 paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations. Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites (including reputable sites like the Mayo Clinic) continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations.
At this point, we typically do not recommend switching from paroxetine to another antidepressant for pregnancy. Although paroxetine is an SSRI, there are definitely situations where an individual may respond better to paroxetine than to other SSRIs. Thus, switching to a different antidepressant may increase risk for relapse.
What About Lexapro? And Pristiq?
There are some newer antidepressants that are derived from older parent antidepressants. For example, citalopram (Celexa) is a racemic mixture, composed of R- and S-enantiomers (or mirror images) of citalopram. While the S-enantiomer is clinically active, the R-enantiomer is not. Escitalopram or Lexapro contains only the active S-enantiomer. Because the S-enantiomer is contained in the original citalopram formulation, we can infer that the reproductive safety of escitalopram (Lexapro) is the same as that of citalopram (Celexa).
Another example is desvenlafaxine or Pristiq. For venlafaxine to be effective as an antidepressant, it must first be metabolized by the body to desvenlafaxine. Pristiq contains only the active metabolite desvenlafaxine. Because desvenlafaxine is a metabolic byproduct of the original venlafaxine formulation, we can infer that the reproductive safety of desvenlafaxine (Pristiq) is the same as that of venlafaxine (Effexor).
The Bottom Line
No two situations are identical; thus, we must carefully consider each woman’s clinical history and preferences in order to select a treatment plan that makes sense. Ideally this discussion should occur long before a woman is pregnant, so that there is ample time to consider the various options and to make changes, if necessary.
When we meet with women to discuss the use of antidepressant medications during pregnancy, we typically consider a number of issues:
The perinatal psychiatry consultation should be viewed as a collaborative venture, where provider and patient decide together what is the best option for treatment during pregnancy."
-Ruta Nonacs, MD PhD
By: Love Amy Michelle | October 28, 2017
"Love Amy Michelle is a space for you to reconnect with yourself + to find some peace amidst the chaos."
Depression During the COVID-19 Lockdown Highlights the Importance of Social Connections for New Moms
By MGH Center for Women's Mental Health | May 18th, 2021
"Because pregnant and postpartum women face unique challenges in the context of the COVID-19 pandemic, they may be at increased risk for mental health problems in this setting. In a recent study, researchers from the University College of London surveyed 162 new mothers in London between May and June 2020 using a social network survey designed to assess the impact of the COVID-19 lockdown.
Almost half (47.5 percent) of women with babies less than six months of age had depressive symptoms suggestive of postpartum depression assessed using the Edinburgh Postnatal Depression Scale. This is a huge increase in the expected prevalence of postpartum depression; studies carried out prior to the pandemic have shown that about 10% to 15% of women report depressive symptoms during the postpartum period.
The researchers also observed that the more contact new mothers had with other people — whether remotely or face-to-face — the less likely they were to report depressive symptoms. While this finding suggests that social isolation incurred as a result of the COVID-19 lockdown may have increased risk for depression, another interpretation is that women with greater social networks are less vulnerable to depression (whether or not there is a lockdown). However you interpret the data, multiple studies have demonstrated that social isolation is a risk factor for depression, in general, and having adequate social support reduces the risk for postpartum depression.
We often encourage new mothers to bolster their support networks and often recommend new moms groups. While this is a reasonable approach to managing the social isolation of new parenthood, many new mothers struggle to get out of the house and are unable to establish new social networks. One of the silver linings of the pandemic has been increased access to support groups on virtual platforms. For example, Postpartum Support International or PSI now offers a wide array of online group meetings for women who are pregnant or postpartum. Whether or not a lockdown is in effect, these social networks are so important to a new mother’s emotional well-being and may potentially decrease risk for psotatum illness."
-Ruta Nonacs, MD PhD
By MGH Center for Women's Mental Health | May 6th, 2021
"While we have relatively limited information regarding the prevalence of obsessive-compulsive disorder (OC) during pregnancy and the postpartum period. Previous studies have indicated that women may be more vulnerable to the onset of OCD during the postpartum period. Other studies indicate that women with OCD may experience worsening of OCD symptoms during pregnancy and the postpartum period.
A recent study published in the Journal of Clinical Psychiatry looks at the prevalence of OCD symptoms during pregnancy and the postpartum period. They speculate that using standardized instruments for the diagnosis of OCD may fail to capture perinatal OCD, and their study incorporates a detailed assessment of obsessions of infant-related harm and corresponding compulsions.
In this study, 763 English-speaking women living in the Canadian province of British Columbia were recruited into this longitudinal study following women from the third trimester of pregnancy until 9 months postpartum. The Structured Clinical Interview for DSM-5 (SCID-5) was used to confirm DSM-5 diagnoses of OCD.
The weighted prevalence of OCD during pregnancy was 7.8%, and the weighted prevalence increased to 16.9% across the postpartum period. The estimated point prevalence of OCD diagnosis was 2.6% during pregnancy (6 weeks prior to delivery) and increased to 8.7% at 8 weeks postpartum. The point prevalence of OCD remained high (6.1%) at 20 weeks postpartum.
The incidence of new OCD cases was estimated to be 4.7 new cases per 1000 women each week during the postpartum period. By six months postpartum, the cumulative incidence of new cases of OCD was 9.0%. Most cases emerged during the first 10 weeks postpartum.
In total, the researchers observed that 100 women reported symptoms consistent with a diagnosis of OCD at some point during pregnancy or the postpartum period. In this group, 60 of the women reported onset of OCD symptoms during pregnancy or the postpartum period. The remaining 40 women reported that their OCD symptoms preceded the pregnancy.
High Prevalence of OCD During Pregnancy and the Postpartum Period
The lifetime prevalence rate of obsessive-compulsive disorder (OCD) has been consistently estimated to be 2%-3% in the general adult population in the United States. The current study indicates that the weighted prevalence of OCD during pregnancy was 7.8% and increased to 16.9% across the postpartum period. Consistent with previous studies, Fairbrother and colleagues conclude that pregnancy and the postpartum period is a time of increased vulnerability to OCD. In addition, new onset of OCD is relatively common during pregnancy and the postpartum period, with 9% of women reporting postpartum onset of OCD in this study.
These estimates of prevalence are higher than those reported in previous studies, a finding that the researchers attribute to using a more comprehensive evaluation of perinatal-specific OC symptoms, including intrusive thoughts of infant-related harm. However, the authors note that some women joined the study after childbirth and may have been attracted to the study because of their experience of postpartum intrusive thoughts. Nonetheless, this is one of the largest studies we have regarding the incidence of OCD during pregnancy and the postpartum period and is noteworthy in that it used the SCID to confirm OCD diagnoses.
Current guidelines for screening perinatal women do not specifically recommend screening for OCD. This study indicates that perinatal OCD is relatively common and the authors recommend more careful screening for perinatal-specific OC symptoms. They note that standardized assessments for OCD include questions about obsessions involving dirt, germs, arranging and ordering; however, perinatal OCD is more often characterized by intrusive thoughts related to harming the infant (e.g., unwanted thoughts or images of harming the infant on purpose, harm to the infant stemming from parental distraction or neglect, being sexually inappropriate with the infant). Furthermore, given the shameful and horrifying nature of these thoughts, many women are hesitant to share these thoughts with others."
-Ruta Nonacs, MD PhD