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Pregnancy Stress

She’s an invincible icon every pregnant woman is expected to live up to: the Pregnant Superwoman. This imaginary superhero never needs to sit down and take the weight off her feet, or catch her breath at the top of the stairs. She runs a marathon in her third trimester and works 12-hour days until her water breaks. She’s just like a non-pregnant mortal, in fact, only better, and she has become the unattainable standard against which women measure themselves during pregnancy.

The Pregnant Superwoman may have gotten her start when women entered the workplace in large numbers in the 1960s and 1970s. Getting ahead required proving that nothing about being female – including the inconvenient tendency to get pregnant – would interfere with one’s performance or one’s commitment to the job. A woman could work just like a man, even when carrying thirty extra pounds of blood, fluid, tissue and kicking, squirming fetus. The mythology of the Pregnant Superwoman got another unintended boost from the women’s health movement of the 1970s. Feminist activists exhorted the medical establishment to treat pregnancy not as a disease but as a natural, normal condition – a worthy aim that was understood by some to mean that pregnant women required no special attention or treatment from the world at large.

These attitudes linger on today, as does an expectation that women will not burden bosses and coworkers, or friends and family, with their needs during pregnancy. Over time external pressures like these became internal ones, as women began to take pride in not giving any ground to pregnancy, in not being weak or dependent. “I know that when I was pregnant, I liked being macho,” one fetal-origins researcher confessed to me. “I’d stand on a chair, hammering a nail, and if my husband objected, I’d tell him, ‘Don’t treat me with kid gloves! I’m not an invalid!'”

Hearing yet another story of a woman who went into labor at her desk or in a business meeting, I wonder if we’ve taken all this too far. Our superhero stoicism during pregnancy might make life easier for spouses and bosses and coworkers. But how does it affect the pregnant woman herself, and her fetus?

Spend some time reading the research literature and you’ll see that prenatal stress is a scientific gray zone, filled with varying findings and opinions. One who believes that work stress may well be problematic is Calvin Hobel, an obstetrician at Cedars-Sinai Medical Center in Los Angeles and a pioneer in the study of stress during pregnancy. When he began his research on the impact of stress on preterm birth twenty-five years ago, he tells me, “a lot of people thought it was just ridiculous – stress wasn’t even on the list of suspected causes of preterm birth. Now it’s at the top of the list.”

He points to studies like one recently conducted by researchers at University College Dublin and published in the British Journal of Obstetrics and Gynecology. Enrolling more than 600 working women in Ireland, the study found that women who worked at physically demanding jobs had four times the risk of delivering an underweight baby than women whose jobs were less taxing. Women whose jobs were temporary had four times the risk of delivering a premature baby than women who held permanent positions.

Hobel has worked to develop programs for disadvantaged pregnant women who suffer the stresses of poverty, racism, crime and domestic violence. But he also worries about his more affluent patients. “Some of the most stressed-out women I see are the lawyers and executives who continue to work long hours, all the way to the end of their pregnancies,” he says. “Even when they’re put on bed rest, they take their laptops and their phones into bed with them and keep working.” Ideally, says Hobel, a woman planning to have a child would work with her doctor to identify and reduce sources of stress before pregnancy. Once she’s pregnant, her stress level would be evaluated each trimester.

Those with moderate levels of stress, like me, can take comfort from the work of another expert, Janet DiPietro. DiPietro, a developmental psychologist at Johns Hopkins University in Maryland, has a somewhat different take than Hobel: “Most pregnant women can stop worrying about stress hurting their fetuses,” she says flatly. An enzyme in the placenta, she notes, breaks down the cortisol in a pregnant woman’s blood, preventing most of it from reaching the fetus (though this mechanism can be swamped when extreme stress produces very large amounts of cortisol). And moderate stress, her own research has found, may actually be good for the fetus, accelerating its maturation.

Just as adults find that some amount of stress focuses their attention and pushes them to perform at their best, for fetuses, “mild stress may be a necessary condition for optimal development,” DiPietro has written. In a study of 94 women and their offspring, published in 2006 in the journal Child Development, she and her coauthors found that women who reported modest anxiety and daily stress during pregnancy had children with better motor and mental development scores at age two. This finding persisted even after controlling for other possible contributing factors, such as the anxiety and stress the women experienced post-pregnancy. In another, more recent investigation, DiPietro reported direct biological evidence of this relationship between prenatal stress and accelerated development. The study of 112 mother-child pairs found that the two-week-old infants of women who experienced relatively more stress during pregnancy showed faster neural conduction – evidence of a more mature brain.

“Among its many functions, the stress hormone cortisol plays a role in the maturation of body organs, and exposure to relatively higher levels of this chemical could enhance the fetus’s development,” DiPietro explains. Women who experience periods of stress in their daily lives, she speculates, may effectively be giving their fetuses’ nervous systems a beneficial workout, toning and conditioning fetal responses in a way that persists after birth. That’s not to say pregnant women should run themselves ragged, DiPietro emphasizes: “I tell pregnant women: You should avoid stress because it’s bad for you. Not because it’s bad for the fetus, because I don’t believe it is. Doing yoga, cutting back on your work hours – if it makes you feel better, that’s a good thing. But don’t worry that you’re harming the baby.”

Hobel and DiPietro’s different takes on the effects of everyday stress during pregnancy mirror a split in the literature: some studies suggest grounds for concern, while others conclude it’s not a problem. To the question of whether such stress unfavorably affects pregnant women and their fetuses, we may have to settle for that profoundly unsatisfying answer: it depends. It depends on whether you work long hours, at physically demanding tasks. It depends on whether you’re energized by a fast pace and a load of responsibilities, or exhausted by them. It depends on whether you have a sense of control at work, and a source of emotional support at home. DiPietro offers the useful concept of the “inverted U-shaped curve”: most people, pregnant women and their fetuses likely included, do best when they have a moderate but manageable amount of stress in their lives. Aim for the fat middle of the inverted U, she says, rather than one end (too little stress) or the other (too much stress).

So what to do about the Pregnant Superwoman? I think women themselves keep her aloft: she reassures us with her cheerful invulnerability, her bulletproof resistance to all the changes – physical and emotional and logistical – that come along with having a child. Her fearless independence allows us to evade the fact that pregnancy and childrearing do, in fact, make us more dependent on others. The Pregnant Superwoman embodies the insistence that pregnancy doesn’t change anything, a fable that may hold as much appeal for pregnant women as it does for spouses and employers. She tells us that, for nine months more, we can hold off the tidal wave of change we know is coming – but at the cost of slighting the needs that have already arisen, and ignoring the changes that are already here. It’s time to send her packing.

Adapted from Origins: How the Nine Months Before Birth Shape the Rest of Our Lives by Annie Murphy Paul, published in September by Free Press.

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