What to Expect (Psychologically) When You’re Expecting
Pregnancy obviously brings huge physical changes to a woman’s body. Accompanying these changes are profound emotional and cognitive adjustments. This article explores some of the most common psychological changes to be expected when you’re expecting.
HORMONAL CHANGES
Before diving into the psychological impact of pregnancy, let’s briefly consider the hormonal changes which occur, as these heavily influence a women’s emotional state.
Human chorionic gonadotropin (hCG)
hCG is produced by the cells in the placenta during pregnancy. It is responsible for many of the physical changes women experience, especially during the first trimester. hCG rises rapidly during the first eight to ten weeks of pregnancy, and then doubles every couple of days. After peaking in the first trimester it stabilises for the rest of the pregnancy. hCG is associated with some of the challenging symptoms of early pregnancy, such as nausea, vomiting, restlessness and fatigue.
Human placental lactogen (hPL)
This hormone, made by the placenta, gives nutrition to the fetus and stimulates a woman’s milk glands to prepare her body for breastfeeding.
Oestrogen
A woman will produce more oestrogen during pregnancy than throughout her entire life when not pregnant. The increase in oestrogen during pregnancy helps the uterus and placenta to form blood vessels, transfer nutrients, and supports healthy development of the baby. It increases steadily throughout pregnancy, peaking in the third trimester. Its rapid rise during the first trimester often brings symptoms of nausea with it.
Progesterone
This is another chief pregnancy hormone. It is made by the ovaries and the placenta, and stimulates the thickening of the uterine lining for implementation of a fertilized egg.
Emotional Changes
In addition to the initial excitement that often (although not always) accompanies the discovery of pregnancy, the sudden hormonal changes during the first trimester can lead to mood swings, anxiety, irritability and tearfulness. As a woman’s body adapts to the higher levels of these hormones, these symptoms usually wear off. However, some women will continue to experience such symptoms throughout pregnancy.
Common positive feelings of delight, anticipation and wonder often co-exist alongside feelings of anxiety, low mood, irritability, vulnerability and overwhelm, triggered by the huge changes pregnancy and the reality of a new baby bring.
COGNITIVE CHANGES
A woman’s fantasies, hopes and expectations of pregnancy will influence her experience of it. For example, does the reality of pregnancy match pre-conceived expectations of it? Or is there a mismatch? Does the pregnancy represent the fulfilment of a lifelong dream? Or is it a shocking or distressing experience? The meaning of a pregnancy is unique to each pregnancy (not just each individual; different pregnancies can mean very different things to one person). Women are often surprised by the deep impact the way they think about their pregnancy has on their mental wellbeing – in both a positive and negative way.
Pregnancy often brings up thoughts of self-doubt (e.g. about your ability to parent or new identity as a mother) as well as worrying thoughts (e.g. about your career, finances, relationships or the health of you and your baby). Women who have experienced difficulties in previous pregnancies or baby loss are particularly vulnerable to worry. The profound physical changes which occur throughout pregnancy can, for some women, be quite distressing. This is especially true for women who may have had pre-existing body image issues.
Expectations
Cultural, societal and familial expectations will influence a parent’s expectation of pregnancy and parenthood. For example, stereotypical expectations of the father as the main breadwinner and the mother as the primary caregiver. Mothers and partners may have different expectations of each of their responsibilities and roles. These expectations may only get aired when the reality of parenthood is looming as a result of a pregnancy, and can sometimes bring up challenging conversations and conflict.
Maternal Preoccupation
Maternal, or paternal, preoccupation can be experienced by mothers, fathers, partners or close family members. Maternal preoccupation describes the very normal and common experience of being deeply preoccupied by thoughts and feelings related to pregnancy or parenthood. Women often report feeling “obsessed” with thoughts about their pregnancy and these thoughts will often override usual thoughts and thinking patterns. It’s important to acknowledge that this is normal, and the intensity of it will be influenced by your previous experiences (e.g. your fertility journey or previous baby loss).
“We don’t have to do all of it alone. We were never meant to”
- Brene Brown
SUPPORT DURING PREGNANCY
For many women, pregnancy can be a very exciting and positive time. But not for everyone. If you find you are struggling with distressing thoughts or feelings during pregnancy, it’s really important not to suffer in silence. There is evidence-based and effective psychological treatment which can help you overcome distress and overwhelm. The sooner you get support the better.
The first step is telling someone how you are feeling. Choose someone you feel safe with, maybe your partner, a close friend of family member or a qualified health professional. You can access evidence-based resources and support for perinatal mental health on the Resources page of this website or get in touch to find out how I could support you.
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