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Stress management in pregnancy.

Recognizing the stressors unique to pregnancy and applying appropriate stress management techniques may lead to more positive health outcomes for mothers and their babies. While pregnancy is often a time of excitement and anticipation, many women also experience stress, anxiety, or depression (Dunkel-Schetter & Glynn, 2011). Maternal stress in pregnancy may lead to serious and severe consequences, including preterm labor, preterm delivery, and intrauterine growth restricted babies, and less severe but common complications such as dehydration (Dunkel-Schetter & Glynn, 2011). Childbirth educators and providers caring for pregnant women should identify stressors in pregnancy and encourage exploration of relaxation and coping techniques to manage stress.

Stressors in Pregnancy

Researchers offer many different definitions of stress in pregnancy (Contrada & Baum, 2011). Pregnancy is a unique life event, which may induce feelings of stress (DunkelSchetter & Glynn, 2011). Likewise, the experience of being pregnant may introduce daily hassles that are distressing (Dunkel-Schetter & Glynn, 2011). Common stressors in pregnancy relate to various issues and may include fear of labor, sleep deprivation, fatigue, fear of birth outcome, finances, lack of support, teen pregnancy, complications in pregnancy or high rick pregnancy, and work or job problems (Hall et al., 2009).

Fear of labor centers around the unknown of what may happen during labor and the fear of pain related to labor (Hall et al., 2009). Sleep deprivation and fatigue often exist during pregnancy. Sleep deprivation may result from frequent night urination as well as complications from increased discomfort and reduced mobility, especially in the third trimester (Couret, Jamin, Kuntz-Simon, Prunier, & Merlot, 2009). Maternal fear may center on labor itself, with increasing concerns of how unpredictable labor can be. The pregnant woman may fear a long labor or fetal trauma during labor as well as fear the potential of a cesarean section (Hall, et al., 2009). Anxiety about financial difficulties may surface with concerns arising regarding infant and maternal health care, clothing, diapers, formula if not breastfeeding, and future concerns for school, activities, and college (Zachariah, 2004). Support systems may ease distress, but for women faced with the task of raising a child alone, lack of support may increase stress, particularly with regard to finances, childcare, and emotional and physical support that would otherwise be obtained from a partner (Zachariah, 2004). Teen pregnancy increases maternal stress related to the social impact from fellow classmates, embarrassment, risk of expulsion, possible absenteeism, failure to earn a grade promotion or pass a class, or dropping out of school (LaRue & Herrman, 2008).

The potential for complications may also lead to additional stress, which has the potential to further complicate high-risk pregnancies. Complications or high-risk pregnancy may include chronic hypertension, diabetes prior to pregnancy, gestational diabetes, preeclampsia, intrauterine growth restriction, sickle cell disease, obesity, preterm labor, and preterm birth. Any of these complications may lead to preterm delivery, admission to the neonatal intensive care unit, maternal bed rest for several weeks, fatigue, and fear (Contrada & Baum, 2011). Employment issues may increase maternal stress secondary to missed work because of sickness, forced bed rest related to complications of pregnancy, inability to perform job description during pregnancy, unwillingness of supervisor to arrange for pregnancy issues or problems, and fear of losing her job (Contrada & Baum, 2011).

Managing Stress

Management strategies for stress in pregnancy vary widely; however, some stress management strategies stand out more than others do. Relaxation therapy creates an avenue for women to engage in various relaxation exercises to reduce stress during pregnancy (Alder, Urech, Fink, Bitzer, & Hoesli, 2011). Relaxation therapy has become a standard for treating anxiety in non-pregnant and pregnant women. Relaxation therapy shows a reduction in anxiety among pregnant women; however, the reduction in anxiety through relaxation therapy may result in minimal effects for some women in pregnancy (Alder et al., 2011). The positive element of relaxation therapy relates to the cost effectiveness of this particular intervention (Alder et al., 2011). Pregnant women can learn these relaxation skills, and utilize them at home when maternal anxiety increases (Alder et al., 2011).

Adequate sleep decreases anxiety and increases coping skills. Maternal preparation for sleep may incorporate a warm bath prior to bedtime, a foot massage, warm noncaffeinated herbal tea before bed, deep breathing, and relaxation exercises before bed. Many times a woman has difficulty sleeping because her mind continues to process tasks that need to be accomplished. Encouraging her to keep a journal or notepad and book or novel at her bedside may help her meet her needs (Worzer, 2004).

Music therapy may influence the brain network located in the limbic system, creating a release of endorphins in the right brain, producing a feeling of pleasure. Music changes the interaction of the thalamus, producing a feeling of muscle relaxation, decreased blood pressure, decrease in heart rate, respiratory rate, and affects emotions (Chang, Chen, & Huang, 2008). Wray (2011) studied pregnant women who sung different lullabies during pregnancy and found that singing reduced stress and anxiety and encouraged bonding between a woman and her unborn child by increasing maternal connection, love, and communication with the baby. These strategies support maternal wellbeing by decreasing anxiety and providing tools to encourage bonding with her unborn baby. By decreasing stress, preterm birth and preterm labor, as well as other pregnancy complications may decrease or resolve.

Incorporating the following techniques into daily life may decrease the frequency of pregnancy discomforts:

* Take time to take care of yourself

* Make an appointment to get a massage

* Ask your partner to draw you a warm bath after work

* Make time for muscle relaxation exercises before bed

* Put your feet up and drink water during your lunch hour, or coffee break

* Go to bed early and read a book or journal

* Listen to relaxing music while driving in your car

* Share your music with your unborn baby with the belly headphone device

* Listen to music at lunch while relaxing

* While relaxing at night, listen to nature sounds and read a book or make journal entries

* While taking a warm tub bath, relax with your favorite music

* Practice deep breathing exercises during breaks at work, lunchtime, after dinner and before bed (Alder et al., 2011).

Other resources for stress management may be found through various websites by utilizing key words such as stress management techniques in pregnancy.

Lynette Talley received her BSN from Linfield School of Nursing in Portland OR. She served 4 years on the United States Air Force as a nurse. She received her MSN from University California San Francisco and has a private practice in Albany GA as a CNM and WHNP. She is currently a PhD student at Walden University in the psychology program.


Alder, J., Urech, C., Fink, N., Bitzer, J., & Hoesli, I. (2011). Response to induced relaxation during pregnancy: comparison of women with high versus low levels of anxiety. Journal of Clinical Psychology in Medical Settings, 18(1), 13-21.

Chang, M., Chen, C., & Huang, K. (2008). Effects of music therapy on psychological health of women during pregnancy. Journal of Clinical Nursing, 17(19), 2580-2587. doi:10.111/j.1365-2702.2007.02064.x

Couret, D., Jamin, A., Kuntz-Simon, G., Prunier, A., & Merlot, E. (2009). Maternal stress during late gestation has moderate but long-lasting effects on the immune system of the piglets. Veterinary Immunology And Immunopathology, 131(1-2), 17-24.

Dunkel-Schetter, C., & Glynn, L. M. (2011). Stress in pregnancy: Empirical evidence and theoretical issues to guide interdisciplinary research. In R. J. Contrada & A. Baum (Eds.), The handbook of stress science: Biology, psychology, and health (pp. 32H343). New York, NY: Springer Publishing.

Hall, W. A., Hauck, Y. L., Carty, E. M., Hutton, E. K., Fenwick, J., & Stoll, K. (2009). Childbirth fear, anxiety, fatigue, and sleep deprivation in pregnant women. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 38(5), 567-576. doi:10.1111/j.1552-6909.2009.01054.x

LaRue, D. E., & Herrman, J. W. (2008). Adolescent stress through the eyes of high-risk teens. Pediatric Nursing, 34(5), 375-380.

Worzer, L. (2004). Stress and sleep deprivation in pregnancy. International Journal of Childbirth Education, 16-18.

Wray, J. (2011). The limerick lullaby project: An intervention to relieve prenatal stress. Practising Midwife, 14(11), 40-42.

Zachariah, R. (2004). Attachment, social support, life stress, and psychological well-being in pregnant low-income women: A pilot study. Clinical Excellence for Nurse Practitioners, 8(2), 60-67.
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Author:Talley, Lynette
Publication:International Journal of Childbirth Education
Article Type:Report
Geographic Code:1USA
Date:Jan 1, 2013
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