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Anticipating the Stork: Stress and Trauma During Pregnancy and the Importance of Prenatal Parenting

Pamela Scorza and Catherine Monk

Abstract

The transition to parenting (Galinsky, 1987) can be a tumultuous time, particularly when parents have experienced traumatic and stressful life circumstances. Interventions to help these parents often focus on the first 2 years after birth because of the importance of this sensitive period for babies’ developing brains. However, we describe research showing that babies’ experiences in the womb matter just as much as the experience after birth. We give examples of interventions to support expecting parents by addressing prenatal stress and trauma. These types of intervention can help in the transition to parenting and promote positive development for both parents and their future children.

Yasmina can’t shake the horrible feeling that something will go wrong before her baby is born. Her immigration status is a constant threat, and she hesitates to use medical services unless she absolutely has to. Her landlord is threatening to kick her and her boyfriend out because they’re late paying rent. Her boyfriend often comes home drunk, if he comes home at all, and Yasmina is afraid he is going to leave her because of the responsibility that the new baby will bring. Sometimes she wonders if she actually wishes something would go wrong before the baby is born. That thought makes her feel guilty and worse about herself than she normally does. Why does she always get herself into terrible situations like this? What kind of mother is she going to make, and what kind of life is she going to be able to provide for this baby?

Luckily, a friend told Yasmina about a clinic for prenatal care where the staff wouldn’t ask about her immigration status. The clinic even had behavioral health services for mental health problems integrated into the prenatal care visits. Through a process of supportive counseling, Yasmina and her therapist identified some “ghosts in the nursery” (Fraiberg, 1995). Yasmina’s father was killed when she was very young, and she was exposed to a great deal of violence when she was growing up. Her mother was overwhelmed trying to take care of her and her sisters, and she often left them alone in their dangerous neighborhood for several days while she went to the city to try to earn some money for the family. Later, when Yasmina made the arduous journey to the United States, she was raped.

Her therapist made Yasmina feel like someone really cared about her and was equipped to help her overcome her fears. The therapist helped Yasmina see how her boyfriend’s absences made her feel emotionally abandoned as she had felt as a child, and full of protest and criticism as she couldn’t do when she was younger. Unfortunately, her responses contributed to his pulling away more, which made her feel worse. In addition, the trauma from her past was held in her body; her shoulders tightened and her breathing became shallow every time she thought about her past or about her fears for the future. Yasmina learned mindfulness techniques that helped her gradually work through this stress in her body. Her therapist also made sure that a social worker helped Yasmina secure temporary housing when she was eventually kicked out of her apartment and connected her with other resources Yasmina needed. The therapy focused not only on Yasmina’s past and her vision for the future but also helped her start to connect with her baby, to envision the possibility that she could care for her baby as she wished she had been cared for when she was a child. Through the course of therapy, Yasmina started to realize how much she already cared about her baby and that she had tools and support to start a new kind of life for her and the baby.

Stress in pregnancy is a common experience for many parents, particularly for those who have a history of past trauma. Poverty, family instability, and traumatic events from childhood or more proximal periods can make the transition to parenthood a particularly rocky time. Interventions to help at-risk parents often focus on the period after birth when the baby is young because research has shown that parents’ stress and trauma can affect caregiving, and thus the baby, at this crucial postnatal time of brain development.

Yet a baby’s development actually begins long before birth. Independent of what happens after the baby is born, maternal stress (which often includes associated symptoms of anxiety and depression) can put babies at higher risk for poor development and mental and physical health problems throughout their lives. It is relatively recent that researchers have been able to probe beyond the woman’s pregnant belly to understand how prenatal stress can affect the baby’s in utero development. In this article we describe potential pathways by which prenatal stress can affect fetal development.

Parents who have experienced trauma in their own childhood or as young adults often find the transition to parenting especially stressful. Many women who are depressed or anxious in pregnancy have experienced early trauma, and evidence suggests that early trauma predicts prenatal depression even more so than it predicts postpartum depression (Blackmore et al., 2013). The ongoing effects of their own trauma can make it difficult for parents to manage the typical anxiety every woman experiences during pregnancy such that they have much higher levels of it. Pregnancy is a time when expecting parents may reflect on their own childhood experiences with their parents, and painful memories can become activated. Prenatal parenting for this group must address parents’ own trauma and work to build a bond with their future baby. We describe interventions during the transition to parenting that address stress and trauma during pregnancy and help expecting parents develop the confidence that they can give their child a brighter future than the past that they experienced.

Poverty, family instability, and traumatic events from childhood or more proximal periods can make the transition to parenthood a particularly rocky time.

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