From Bliss to the Blues

One minute you're ecstatic, the next you're snarling. And that's before your baby is even born! Our guide to the ups and downs you may experience during pregnancy

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Trang Burnett describes herself as rational and not prone to knee-jerk emotional reactions. Yet, when the Tampa, Fla., mother was pregnant with now-2-year-old son Bryson, all bets on her moods were off. "TV commercials really affected me—happy or sad, they always made me cry," recalls Burnett, 36.

Sound familiar? While pregnant, you will experience a gamut of emotions—many of which may be completely new to you. After delivery, the emotional roller coaster ride continues.

What's to blame? For one thing, you might be experiencing financial and other worries as well as a total upheaval of your old, familiar life. For another, your body and brain are going through major physical adjustments. "Hormonal changes play a huge role in your moods during and after pregnancy," explains Lucy Puryear, M.D., a clinical assistant professor of psychiatry at Baylor College of Medicine in Houston and author of Understanding Your Moods and Emotions When You're Expecting (Houghton Mifflin). "All women are different, but in some, the emotional changes can be extreme."

To help you cope with the potential swings in your temperament, here's a guide to your new feelings and attitudes, why and when each happens and how to cope when the going gets rough.

Your Pregnant Personality

Blissfully happy Why you feel that way Once a fertilized egg implants in your uterus, the developing placenta begins to secrete hormones essential to your baby's growth. One of these hormones is estrogen (another is progesterone). "Estrogen can produce a sense of well-being," explains Puryear. "Then again, a lot of women are just really excited and happy about being pregnant, especially those who've been trying for a while."

Coping strategies Who needs 'em? Enjoy it while it lasts!

Teary and irritable Why you feel that way "Hormones appear to play a significant role in the precipitation of emotional issues during pregnancy," explains Geetha Shivakumar, M.D., an assistant professor in the department of psychiatry at the UT Southwestern Medical Center at Dallas, who conducts clinical research in perinatal mood disorders.

"Common symptoms are irritability, sadness or anxiety, and they may be [more] prominent in certain months of pregnancy," Shivakumar adds. For example, the fluctuating levels of estrogen and progesterone in your bloodstream can make you especially moody during the first trimester.

Coping strategies First, explain to your partner that you're experiencing some pretty heavy emotions. By making sure that he understands your fickle humor has nothing to do with him, you can nip any potential relationship tension in the bud. Same goes for other family members and friends.

Second, take care of yourself: Regular exercise and a healthy diet can help abate the negative feelings and intensify the positive ones. "Good physical well-being is important for emotional well-being," says Shivakumar. "Preliminary data also suggest that eating omega-3 fatty acids may improve mood symptoms." (Certain kinds of fish are among the best sources; for information on safe seafood and how much you should eat, see "Mercury Rising?")

Finally, if you have a history of depression, be sure to tell your doctor, since it can not only recur during pregnancy, but also linger and become more severe after you give birth (See "Depression During Pregnancy" on page 3).

Surprisingly sexual Why you feel that way They don't call the second trimester the "honeymoon phase" for nothing. During this stage of pregnancy, your belly size is still manageable and your breasts may be larger, so your partner might find you incredibly sexy. For you, the increase in blood volume during pregnancy leads to, well, more blood flow—everywhere. "Your nipples and genitals are more sensitive, so you may feel more sexual," says Puryear. "Plus, the uterine contractions during orgasm feel more intense when you're pregnant."

Coping strategies Get your doctor's OK, then go for it!

Fatigued and foggy Why you feel that way In the early stages, the placenta produces yet another hormone, human chorionic gonadotropin (HCG); rising levels mean the pregnancy is progressing. That's the good news. The bad news is that in tandem with progesterone, HCG may also cause the crushing exhaustion and morning sickness many women experience in the first trimester. The fatigue can cause the drop in acuity many women complain about, but it may not be the only reason you're not as clear-minded as you used to be. "Your priorities change," explains Puryear. "You were once focused on meetings and deadlines; now you're fantasizing about baby names and being a mother."

Coping strategies If you have a job, compartmentalize: Try to keep work at work and concentrate on your baby registry list and other "mommy" tasks when you're at home. It's also helpful to write down your thoughts and to-dos; this will not just help you feel organized but will also prevent you from forgetting them entirely.

Most important, move your body even if you don't feel like it. "To give your energy and mood a boost, exercise," urges John Hobbs, M.D., an OB-GYN at Northwestern Memorial Hospital and a clinical instructor at Northwestern University in Chicago. "I tell my pregnant patients that taking a swim will make them feel a whole lot better."

If you're extremely exhausted and mentally sluggish, tell your doctor, who may want to perform tests to rule out such conditions as anemia (caused by having too few red blood cells) or hypothyroidism (a low-functioning thyroid gland).

Your Mind On Motherhood

Constantly cuddly Why you feel that way Once your baby is born, your body begins to produce a hormone called oxytocin (aka the "cuddle hormone"), which induces feelings of intense love for and bonding with your baby. "Oxytocin causes your milk to let down and makes you feel an attachment to your newborn," Puryear says. Take note: Women who breastfeed produce more feel-good oxytocin than those who bottle feed.

Coping strategies Hug, kiss and cuddle your heart out; despite what some say, you can't "spoil" a newborn.

Absent-minded (aka "mommy brain") Why you feel that way Estrogen and progesterone levels begin to fall dramatically immediately after the placenta is delivered. Then, breastfeeding keeps estrogen levels low. This prompts a state of forgetfulness that some women describe as total stupidity. "Low estrogen levels may contribute to this 'cognitive clouding,'" Puryear affirms.

Coping strategies Don't even think about multi-tasking! Focus solely on caring for your newborn and say "later" to extraneous tasks like laundry, cleaning your house, sending baby photos to your IM pals, writing thank-you notes, etc. If possible, take a daily short walk; it will help clear your head.

Lacking in libido Why you feel that way Have you heard the adage that a new mom's biggest fantasy is sleep? In addition, breastfeeding lowers estrogen levels, which in turn lowers libido.

"Plus, if you're breastfeeding, you have another human being on you all day long," says Puryear. "At night, you just may feel, 'I just don't want another person on me.'" Some women describe this as feeling "touched out."

Coping strategies Tell your partner how you're feeling, physically as well as emotionally. "Your spouse may not realize there are physiological reasons you're not interested in sex," says Puryear. "If you don't tell him, he may think you don't love him anymore." Schedule some time away from the baby for intimacy; it doesn't have to involve sex. Even just lying together and cuddling will make him feel wanted and needed. And if it does lead to sex, you will likely need to use a lubricant, thanks to your lowered estrogen level.

Down and blue Why you feel that way If even small hormonal changes can affect your mood when you're menstruating, imagine what a rapid decline in estrogen and progesterone can do to your disposition. Within 24 hours of your baby's birth, these hormones drop to pre-pregnancy levels, which can leave you feeling sad and stressed.

"After we brought [our son] home, my husband was excited, but I felt overwhelmed and isolated," recalls Trang Burnett. "I kept asking myself, 'Why don't I feel like he does?'"

"Sadness, fatigue, anxiety—most first-time mothers experience these symptoms," says Shivakumar. "They tend to resolve within two weeks."

Coping strategies Sleep. Hand the baby off to your partner and doze whenever possible. A few hours of much-needed rest will do wonders for your outlook.

If symptoms are severe, last longer than two weeks or start four weeks after delivery, you may have postpartum depression and should seek immediate medical attention. For information, visit the National Women's Health Information Center at 4women.gov; mededppd.org, a website developed with the support of the National Institute of Mental Health; and Postpartum Support International at postpartum.net.

Depression During Pregnancy

"For decades, pregnancy was thought to be a period of emotional well-being," says Dallas-based psychiatrist Geetha Shivakumar, M.D., who conducts clinical research in perinatal mood disorders. "However, recent studies have suggested that pregnancy poses a risk for recurrence of depression in women with prior histories of major depression."

Though 10 percent or more of women show symptoms of major depression during pregnancy, women often believe they result from normal hormonal changes and hence do not consult their doctors. But untreated, depression can be dangerous to both mother and baby, as it can lead to poor nutrition, drinking and smoking (which, in turn, are linked to premature birth, low birth weight and developmental problems). If you have any of the following symptoms for two weeks or more, discuss them with your doctor immediately: • Intense sadness or anxiety • Difficulty concentrating • Sleeping too little or too much • Change in eating habits • Loss of interest in favorite activities • Recurring thoughts of death, suicide or hopelessness • Feelings of guilt or worthlessness

Treatment options include support groups, cognitive-behavioral therapy, light therapy or pregnancy-safe antidepressant medications.

7 Ways To Survive The Ups And Downs Simple rules to get you through pregnancy and new motherhood with your sanity intact: 1. Remember that there's no perfect way to be pregnant. If you're temperamental and uncomfortable, it doesn't mean you won't be a wonderful mother. 2. Be flexible and patient and liberate yourself from unreasonable expectations. 3. When you cry over Jell-O ads, realize it's just business as usual during pregnancy. 4. Talk openly to your friends, partner and other family members about your moods and feelings. It will help them to be more understanding. 5. Excise the words "I'm supposed to feel [fill in the blank] when pregnant" from your vocabulary. 6. Be aware that the first six weeks after delivery are difficult for every new mom and that taking care of yourself is just as important as taking care of your baby. 7. Commit to memory and repeat this mantra often: "I do not have to be Supermom." and after you deliver will help you cope.

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