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Ask Dr. LaRusso: How do I take care of myself during pregnancy?

We’re kicking off a semi-regular Q-and-A with Dr. Elizabeth LaRusso, a perinatal and reproductive health psychiatrist. Send your question to [email protected], and Dr. LaRusso will answer it in a blog post in August. 

Q:  I am pregnant with our second child, due in July. With a full-time job, husband, busy toddler and house to take care of, I often feel burned out. I know I need to take care of myself too during pregnancy, but usually…I’m last on the list. How do you set boundaries for yourself/family/friends/work to stay healthy?

Dr. Elizabeth LaRusso

A: I think that the fact that you are asking this question at all signifies that you are way ahead of the game in terms of understanding the importance of prioritizing your own health and wellbeing.  But understanding and implementing are two different things, and you are not alone in feeling stretched thing between various roles and responsibilities.  There are multiple domains that contribute to optimal physical and emotional health during and after pregnancy, and I will review them in more detail below; but in my experience, many people are familiar with these areas and the problem is feeling like there is no time to engage in these healthy behaviors.  I remember back in medical school, reading an article someone had given me about decreasing stress.  The article listed different relaxation techniques, like taking a bath, going on a walk, etc.  I felt like it missed the entire point: of course, in an ideal world, I would be doing all of those relaxing activities, but the problem was I was too busy and overwhelmed to find the time.  And that was before I had children, and understood what being busy and overwhelmed really meant.

I’m sure you have been given information from your physician about the importance of restful sleep, regular exercise, and adequate nutrition to the health of you and your baby.  What your doctor likely won’t discuss with you is how you make time for these healthful activities, and what may be getting in the way of prioritizing your own needs.  At the end of the day, I think that each woman has to engage in self-reflection to identify major sources of stress, consider interventions that may decrease this stress, and identify what may be getting in the way of accepting help or modifying expectations.  Women deprioritize their own needs for many reasons, but one common theme is inadequate recognition of the critical role the mother plays in the family.  If the mother is not optimally supported and adequately functioning, the entire family unit will suffer.  All mothers are working mothers, and women cannot fulfill their caretaking role when they are overwhelmed and depleted.  The husband of one of my patients put it best: We were discussing modifications that the family could make to decrease the unsustainable workload my patient was facing and the important role she played in the family.  “You mean, happy wife, happy life, right?”  Right.

Sleep:  Nap when your child/infant naps.  Choose going to bed over cleaning the house or doing the dishes.  Plan for 30 minutes before bed to do a relaxing activity, like reading a magazine or taking a bath, in low light to get yourself ready for sleep.

Nutrition:  Don’t make this another source of stress.  Just choose easy foods, like cut carrots, bring them with you, and try to get a varied diet with a focus on more healthful foods.  Avoid overindulgence in unhealthy foods that you know make you feel worse after you eat them, but don’t obsess if you fall off the wagon now and then.

Exercise:  Getting 30 minutes of physical activity most days of the week is ideal, but anything is better than nothing.  Shoot for 10 minutes of brisk walking, take the stairs, and do some stretching at your desk at work or before bed at night.

Schedule pleasurable/relaxing activities:  Engaging in pleasurable and relaxing activities is not being self-indulgent, it is recognizing that you are an autonomous individual with unique interests and relationships that require nurturing.  If you do not plan in advance when you will engage in these activities, they won’t happen.  Try to pick one activity for each day of the week, identify when you will engage in it, then do it.  For example, plan to take a bath after you put your children to sleep each night, schedule a walk with a friend on the weekend, or choose a favorite TV show and watch it instead of cleaning the kitchen.

Work:  Women work outside the home for many different reasons, but one common theme is feeling like there is limited choice in modifying work schedules to accommodate the needs of the family.  I ask women to discuss with their partners if it is in their best interest to consider working part time, or taking extra time off postpartum, or considering a modified return to work schedule (ex: taking less time off for maternity leave and then going back to work one day less each week for the first several months).  Frequently patients say “We  can’t afford to do that,” and I understand the real financial pressures families face.  I encourage people to think in smaller chunks of time, like six months or one year postpartum, and to reframe the question as “Can you afford not to?”  The answer is different for every individual.

Goals:  Set realistic goals, and include as your primary goal setting limits that promote your own health and wellbeing.

Standards:  Lower them!  Pregnancy and the postpartum period are the time to decrease your expectations about how much you will accomplish, how clean your home will be, how many projects you will complete.  Try to become more comfortable with doing less, focusing on the things that are most important to you and your family and letting the rest slide.

Avoid optional responsibilities:  During my first pregnancy, I decided in advance that I could not take on optional responsibilities at work.  Since this was difficult for me, as it is for many women, I promised myself that I would respond to any request by saying, “Thanks very much, that sounds like a great opportunity, please let me think about it and get back to you next week.”  Then I would have time to decide if this were something I could manage or not, and generally the answer was no.  I think that this approach can be helpful in various domains of life, and making a goal to take on less, and a prepared response to requests, can be helpful in limit-setting.

Enlist your partner/friends/family:  Explain to the people who love you that you are feeling overwhelmed, that you are trying to limit your responsibilities and to prioritize your health, and that this is difficulty for you and that you need their help.  Being specific about how they can help you, ex: “Can you watch my toddler for one hour on Saturday so I can go for a walk?” is much more effective in getting the help you need.