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Less positive emotions
Depression

Everyone expects you to feel elated and special but you just feel even less like getting out of bed in the morning. Depression can be particularly isolating in pregnancy, yet it’s rarely talked about. One recent study found that not only is antenatal depression considerably more common than was previously thought – around 10 per cent of pregnant women, the study found, are depressed – it is mostly missed by doctors. In the study, only five of the 41 women with antenatal depression were identified by their GP as depressed.² Depression can have serious effects on your health and that of your baby: depressed women may be less likely to keep antenatal appointments, eat well and do what’s best for their baby. There is also thought to be some link between antenatal depression and postnatal depression. You should always tell your midwife or doctor if you are feeling depressed as you may need their help.

If you are already depressed and taking antidepressants you’re hardly alone: according to mental health charity MIND, between 1990 and 1995 the number of prescriptions for antidepressants such as Prozac rose by 732 per cent in England alone. Being pregnant does not necessarily mean you have to ditch your meds and feel suicidal for nine months: some depression drugs are considered safe to take in pregnancy but others are not. So talk to your doctor the minute you know you’re pregnant.

Where to go for help:

Start with your GP, midwife or health visitor.

The Depression Alliance provides information for mothers and pregnant women who are isolated and lonely or experiencing depression. 35 Westminster Bridge Road London SE1 7JB. 0845 123 23 20 www.depressionalliance.org (ask for their booklet Depression During and After Pregnancy)

Meet-a-Mum Association Postnatal Illness Helpline can also help with pregnancy depression. 0845 120 3746

The mental health charity MIND has an online information service for users of mental health services, carers and other groups. For information on types of mental distress, treatments, therapies and legal information: 08457 660163 (9.15am–4.45pm everyday) www.mind.org.uk

Online:

www.depression-in-pregnancy.org.uk

Further reading:

Antenatal and Postnatal Depression by Siobhan Curham (Vermilion, UK, 2000)

Just feeling low

Milder ‘feeling down’ moods are also very common in pregnancy. This can be particularly overwhelming in the early stages when your hormones are flying all over the place. No matter how many times people say ‘hormones’ to you, you still think it’s life, not chemicals, that is making you feel so low. Your partner may find this disconcerting (my husband, having been through two previous pregnancies with me, was still unnerved by my dismal mood in the early stages of my third pregnancy). He may have no idea what to do to help you, so spend some time thinking about what you need from him then try to talk to him about it – if possible at a time when you’re not feeling murderous. Tell him that feeling low in pregnancy is common, chemical, but no less powerful or real for that. Suggest ways that he can help you (even if it’s just to leave you alone, buy you chocolate or give you a massage). The good news is that your dismal moods should pass. Talk to your midwife about this, or your GP or the Health Visitor at your doctor’s surgery. If your mood doesn’t alleviate, see above for where to get help.

Specific worrying

Even if pregnancy makes you basically happy, you may find yourself plagued by worries. Anxiety, like depression, is common in pregnancy and takes many forms.

WORRY THAT A PAST PROBLEM WILL RECUR | Some serious medical issues in the past (such as infertility, miscarriage, birth defects or other complications) can make your worries pretty specific and understandable. Many women who have had a miscarriage in the past, for instance, worry furiously up to the point at which the previous miscarriage occurred (and sometimes beyond). Get the most up to date information on whatever condition or event you fear. Ask questions, get referrals and second opinions. Start with your GP or midwife and don’t rest until you have answers. Information will not eradicate worry but it may help. Learning relaxation techniques may also help you to manage your more panicky moments. (See Find Out More, Chapter 4: Fear and Pain, page, for ideas and techniques.)

WORRYING ABOUT THE BIRTH | The vast majority of us (most studies put it at around 80 per cent) are scared of giving birth. We fret, often aimlessly, about this: will the birth be traumatic? Painful? Disastrous? Easy? Will it be like that horrendous one on ER last night? The good news is that pregnancy gives you time to prepare yourself mentally for giving birth. You can use this time to decode your fears, worries and preconceptions so that you can make intelligent choices about how, when and with whom you want to give birth. This book will show you how.

Generalised worry

There’s nothing like impending motherhood for bringing out the paranoid within. The world, suddenly, is filled with peril: pollutants, aggressors, toxins, accidents waiting to happen. ‘Throughout my pregnancy I worried the entire time about chemicals in body lotions harming the baby,’ says Jazz, mother of Karim (2). ‘I think I read it in some newspaper somewhere. It didn’t stop me putting lotion on every day, but it really bothered me.’

The rule is: if you find yourself worrying about some half-reported issue, physical twinge or weird feeling discuss it with your GP or midwife, no matter how mad or silly you feel. If they are vague or don’t have the answer, ask them where you can get it. For a good midwife, no question is too silly. If your general anxiety is stopping you sleeping, eating or otherwise preoccupying you, talk to them about the anxiety itself. Counselling, as well as treatment for more serious anxiety disorders, is available and now is a good time to get it (parenthood is unlikely to make it go away).

The root of worries

Much of this kind of paranoia boils down to the basic belief that pregnancy (and by implication birth) is both scary and dangerous. From TV, film, newspapers and magazines, you’ll absorb frightening images and stories of pregnancies that go disastrously wrong. This makes great TV and copy, but serious, life-threatening pregnancy complications are rare (how do you think we all got here?). Your ‘pregnancy/birth is unsafe’ mindset is not going to help you when you are in labour. For the vast majority of us pregnancy and birth are healthy, normal events. They’re neither threatening nor perilous.

Stress

‘Stress is definitely something pregnant women need to get to grips with. But you can do it. I have seen highly anxious, stressed out women at the beginning of pregnancy become, by the end, calm, relaxed and prepared simply by refocusing and making even slight changes to their busy lives,’ says midwife Jenny Smith. If your days are spent juggling million pound budgets, wiping your toddler’s bottom or – God forbid – doing both, you can still have a healthy pregnancy and be in good physical and mental shape for this birth.

We’re a stressed bunch these days: one survey of about 5,000 women³ found that women who work full time say they still do most of the household chores. Only 37 per cent of working couples share jobs equally around the home, and only 3 per cent of men do more ironing and washing than their partners. If you’ve already got children, the chances are you’re even more frazzled: the same survey found that 93 per cent of mothers feel stressed out, trying to cope with all the demands made on their lives. Add pregnancy to this and you get a heady cocktail of neurosis.

We stress about our inability to eat balanced portions of home-prepared food, our failure to attend a regular antenatal exercise class, to be productive enough at work, to get enough sleep or to relax – especially when we’re supposed to be relaxing. And then we worry that we’re worrying too much. The key question here is: will your stress harm the baby? The answer: it is extraordinarily unlikely to.

A handful of studies have suggested that a very high level of stress can increase your risk of having the baby too early, or having a low birth-weight baby by sparking off certain hormones.⁴ Certainly, if you are extremely stressed you are more likely to skip meals, reach for ciggies, booze or even drugs at the end of the day, all of which have been linked to low birth-weight (alcohol and drugs are also linked to birth defects). If any of this sounds familiar to you, don’t brush this under the carpet. Talk to your GP, Health Visitor or midwife.

TEN QUICK WAYS TO MINIMISE STRESS

1 Learn ‘mini’ stress relieving techniques. These can be very useful for labour, not to mention further down the line when you have an illogical toddler on your hands.

2 Make a list of things that, in the past, have reduced your stress levels, and do some of them if you can (leave anything chemical, nicotine-related or alcoholic off this list for obvious reasons).

3 Become an idler: leave the washing, let the carpet stay dirty, ask for deadline extensions and generally give yourself a break. Now is not the time to ‘prove’ anything to anyone.

4 Throw money at the problem. If you can’t do the above, and can possibly afford it, get a cleaner, get a cleaner more often or even bung a teenager a few quid after school to do ‘maid’ type duties for an hour or so. If you’ve got no money, divide your tasks into small, manageable chunks and plan meticulously for them: e.g. laundry (day 1), floors (day 2), bill-paying (day 3).

5 Negotiate divisions of labour with your partner. If studies are right, he probably does a fraction of what you do around the house, even if you are both working outside it. Inequalities like this will only be exacerbated when you have babies to cope with. He needs to be roped on board even (or perhaps especially) at this stage. Be aware that his standards and yours may differ (this does not mean it is his fault). He may in fact be exceptionally glad to feel useful at this point in your pregnancy.

6 Do small, beneficial things for yourself. Eat a yogurt before bed (calcium), keep fruit on your desk for snacks (and a water bottle), book yourself a lunch-hour massage (enforced relaxation), buy posh bath oil and use it religiously, at least once a week, and – why not? – treat yourself to an hour in the Waterstones café with a chocolate muffin and a good book.

7 Book an alternative therapist. Even if you’re a sceptic, things like massage or aromatherapy can help us all, at least temporarily. Sometimes just being listened to and pampered for an hour with smelly oils can really turn things around.

8 Get support: family, friends, neighbours can all be drafted in, even if just in small ways around the house, garden or with your other kids. But this involves asking for help. Which means no longer seeming perfect.

9 Try gentle exercise (if ok’d by your doctor or midwife). It is clinically recognized to lower stress levels. You don’t have to go to the gym but when you want to bludgeon a colleague or spouse, take a walk round the block. Ideally, join a pregnancy yoga class. Or try and walk for half an hour a day. But don’t beat yourself up about it if you can’t. You may just want to lie in a darkened room with earplugs in. That’s fine too.

10 Get help: counselling or even life-coaching can help you decode your stress and work out how to handle it better.

Career worries

Worrying that your career will evaporate when this baby arrives is also common.

‘Most women need to remember that their careers do not necessarily go away when they have children,’ says midwife Jenny Smith. ‘Maternity leave actually goes very quickly: to have 6–8 months off is nothing in terms of one’s whole life and what is most important right now is preparing your body and mind to nurture this baby. It’s a shame so many women ruin this precious time by worrying about work.’

If your pregnant-and-working life, like your belly, is starting to strain at the seams the hardest thing can be finding time to do something about it. The first thing to do is stop meta-worrying. Stress is a known part of pregnancy and to some extent we all feel it. But going into labour in a frazzled state is not ideal: you’ll have fewer physical reserves, be less able to relax during contractions, potentially have less endurance and then not be in the best position to cope with pain. A crucial part of your childbirth preparation should be to make stress-relief a priority. One way to start is by sorting out the practicalities of your maternity leave and eventual return to work so you can stop worrying about this for now.

Where to go for help:

Working Families is an organisation that gives practical help and information for parents about choices in childcare and employment rights; it also campaigns for changes in the law, and persuades employers to adopt practices which work for them and you alike. 020 7253 7243 www.workingfamilies.org.uk

Also try the webzine Mother@Work: www.motheratwork.co.uk. This is a good place to get a sense that other women are struggling with the same issues. The Daycare Trust This national childcare charity, promoting high quality affordable childcare, can help you find out more about childcare for when you return to work. 21 St George’s Rd, London SE1 6ES 020 7840 3350 info@daycaretrust.org.uk www.daycaretrust.org.uk

Further reading:

Balancing Pregnancy and Work: How to Make the Most of the Next 9 Months on the Job by Nancy Hall (Rodale Books, US, 2004) is worth a look, as is: Working Woman’s Pregnancy by Hilary Boyd (Mitchell Beazley, UK, 2004)

A WORD ABOUT TWINS AND MULTIPLE BIRTHS | In the UK about one in 35 babies is born a twin or triplet (in 1980 the figure was one in 52; the rise is mainly due to fertility treatments). There are nearly 10,000 multiple births in the UK every year. About a third of twins born in the UK are identical and two thirds are non-identical. Having twins can be a very different experience from your ‘average’ pregnancy but equally, you don’t want to end up feeling that nothing applies to you. ‘If you are carrying twins, you get a lot of fuss made of you by friends and colleagues and by the medical profession, but I also felt rather excluded from the “baby club”,’ says Rachel, 36, mother of Nick and Ella (4). ‘It started when we were told by the medics that “twin births are not normal” and then all the books I’d been religiously reading as a first timer stopped really applying. Even though I was getting excited about having two rather than one, I began to feel a bit of an outsider.’

Most of the issues we cover in this book should be as relevant to you as they are to singleton mothers. It is just as important to prepare for this birth if you are carrying more than one baby; to face your fears, understand your options, inform yourself, have a meaningful plan and good support. But as a healthy mother of twins or multiples you may face certain specific challenges. One of these is that your experience of pregnancy is likely to be more ‘medical’ than it would if you were expecting a single baby. You may have more frequent antenatal checks and your babies will be scanned regularly – very regularly towards the end of the pregnancy – to monitor their development. This is because pregnancy complications are more common with multiple births, such as pre-eclampsia, pre-term labour, anaemia or exhaustion.

‘We went for the first (of many) scans at twenty weeks and I think the nurse thought we must already know. She said, “There’s the baby” and gave us our first sight of Nick and then said “and there’s the other baby” meaning Ella, and Martin and I just looked at each other and laughed. I remember thinking “this is like a film” and I felt like everything had changed. I went home to bed and lay there thinking about two of everything, names and cots and buggies. The image of the little girl baby that I had been so sure I was carrying disappeared and I had to re-bond with two.’

RACHEL, 36, MOTHER OF NICK AND ELLA (4)

The birth itself may also be more ‘medical’ than you might like, as doctors will want to monitor the babies carefully, and you have a statistically higher chance of intervention. However, it’s worth remembering that you are not ill, or stupid and that your preferences still count. You can negotiate about any proposed intervention and talk, in full, to your obstetrician about any issue that worries you. Finally, having a caesarean section is a real possibility (about half of all twin births are vaginal), so make sure you read Chapter 6: Surgical Birth.

The main advice for a twin or multiple pregnancy isn’t terribly technical – it’s SLOW DOWN. This pregnancy is going to put more strain on your body than a singleton pregnancy would. You will also gain more weight, and get significantly bigger, though twins are generally born earlier – on average around 37 weeks.

Where to go for help:

TAMBA (Twins and Multiple Births Association): 2 The Willows, Gardner Road Guildford, Surrey GU1 4PG. 0870 770 3305; information and listening service call Freephone 0800 138 0509, evenings and weekends. www.tamba.org.uk

Multiple Birth Foundation 020 83833519 www.multiplebirths.org.uk

Further reading:

Twins and Multiple Births: The Essential Parenting Guide from Pregnancy to Adulthood by Carol Cooper (Vermilion, UK, 2004)

The Twins Handbook by Elizabeth Friedrich and Cherry Rowland (Robson Books, UK, 1998)

Twins, Triplets and More by Elizabeth M Bryan (Penguin, UK, 1992)

Multiple pregnancy tip:

Peggy Fitzgerald, a doula and mother of one-year-old triplets says, ‘Expect to get big fast: buy maternity clothes early but not too many, because you will outgrow them and need to find bigger ones. (Even at 25 weeks, I outgrew most of the biggest maternity clothes I had – luckily I didn’t have many – but still needed SOMETHING for doctor’s visits….) Under the belly pants are more useful than ones that cover the belly – they just aren’t made the shape you’ll need. Also, make sure, early in pregnancy, that you stock up your freezer with meals: not just for the times when you can’t cook (or the possibility that you’ll be on bed-rest), but for your postpartum too.’

A few other worries

Here are a few common worries and what to do with them. The list is potentially endless, so here’s the rule: ask your health professional if something is worrying you, no matter how silly and embarrassing it sounds. They’ll have heard it before and even if they haven’t, they won’t be shocked: they’re here to help you.

WHAT YOU DRANK BEFORE YOU KNEW YOU WERE PREGNANT | Many of us drink too much alcohol in the early weeks of pregnancy before realizing there’s a zygote in there. That Hen night you went on when two weeks pregnant, however, is not something to worry about. The real worry is if you can’t stop now you know you’re pregnant (see drinking advice below). Drinking too much alcohol throughout pregnancy can lead to fetal alcohol syndrome (where your baby is damaged because you are drinking 40–50 units of alcohol every week, or binge drinking). Get reassurance from your midwife and doctor about your early pregnancy behaviour, then move on to no more than two units (i.e. a couple of small glasses of wine) a week. This is the current UK government recommendation.

AIR TRAVEL | There is no evidence that holiday or business air travel will do you any harm whatsoever when pregnant. However, if you have pregnancy complications do consult your doctor before flying. The best time to travel is probably in your second trimester – in the middle three months. You will be less sick, more mobile, energetic and not yet the size of Free Willy. Take a large bottle of water, a bag of healthy snacks and move around a lot to avoid any chance of deep vein thrombosis (potentially fatal blood clots). Most airlines have a policy about pregnancy and air travel; most say you should not travel after a certain point in your pregnancy, usually 28–36 weeks. It may be hard to find this on a website, so try phoning the airline. Many will take your word as to how many weeks pregnant you are, though some may require a letter from your doctor. If you’re considering stretching the truth, however, remember airline staff are generally not trained medical professionals. Giving birth 8,000 feet above the Atlantic would be less than ideal.

Where to go for help:

About.com has a list of airlines and their rules about pregnancy and flying: www.airtravel.about.com

The Royal College of Obstetrics and Gynaecology also have guidelines for air travel safety on their website: www.rcog.org.uk