Plenty of attention is given to the physical changes and discomforts in a woman's body during pregnancy, but the emotional changes she could be experiencing may not always get discussed.
In addition to her physical health, a woman's emotional well-being and her mental outlook can also play important roles in pregnancy.
During the nine months, a woman's moods and emotions can range from the highs of feeling overjoyed and excited about having a baby to the lows of feeling impatient, worried and terrified as the delivery and motherhood approaches.
Pregnancy can also bring up other issues, such as difficult family relationships, insecurities and unrealistic personal expectations, which may have previously been suppressed or ignored. In many ways it's helpful that a woman and her partner have almost a year to adjust to the realities of becoming parents.
"Pregnancy is a huge transition in a woman's life, and it involves a complex mix of emotions, both good and bad," said Dr. Mary Kimmel, medical director of the Perinatal Psychiatry Inpatient Unit and an assistant professor of psychiatry the University of North Carolina School of Medicine in Chapel Hill.
Pregnancy is a unique time for a number of reasons, she explained.
"At a biological level, the hormones estrogen and progesterone are ramping up, and some women are more sensitive to progesterone changes and this may make them more irritable," Kimmel said.
Kimmel, who specializes in women's mood disorders, said there are also a lot of issues for mothers-to-be to work through both psychologically and socially, such as what will a baby mean for her life going forward? How will it affect her relationships, and will she have support from her partner and family members once the baby arrives? Will she be a good mother, and can she handle her new responsibilities?
There are also practical concerns when bringing a new life into this world, such as being prepared financially for an addition to the family or living on one income, if a woman decides not to work outside the home.
Pregnancy can be an exciting time but it's also very stressful, and that can cause emotions to run high, Kimmel said. She advised women to be aware of their thoughts and feelings, and to find a place to talk about them and work through them.
Here are some common emotions a woman may experience during her pregnancy and after she delivers. To learn more about a woman's emotional health during and after pregnancy, see the book "Understanding Your Moods When You're Expecting" (Mariner, 2008), by Dr. Lucy Puryear, a psychiatrist specializing in women's reproductive mental health and director of the Baylor Psychiatry Clinic at Baylor College of Medicine.
Whether it's described as moodiness, irritability or crabbiness, pregnancy can bring a roller coaster of emotions.
"Pregnancy is a transition point in a woman's life and during any time of transition, a person's emotions can be up and down," Kimmel told Live Science. She said that some women's emotions don't change that much when they are expecting, but it's not unusual for women to have mood swings, especially during the early and late stages of pregnancy.
It's not entirely clear why these mood changes occur, Kimmel said, because a number of different changes are happening in a woman's body at any time, and they are all tied in to her emotions.
One key reason may be a flood of hormones. "Some women are sensitive to changes in estrogen, while others are affected by increases in progesterone or rising levels of stress hormones," Kimmel said.
Fear is another common emotion during pregnancy. In the first trimester, a woman might be afraid of having a miscarriage or doing something that will affect her baby's health; in her second trimester, she might start to question whether she will be a good mother and be frightened by the enormous responsibilities of caring for a newborn.
By the end of her pregnancy, a woman might be scared of the pain of labor or that something could go wrong during delivery.
"There is a lot a woman does not have control over during pregnancy," Kimmel said. And this uncertainty can fuel fearful thoughts. Having some fear is normal, but a woman needs to recognize when a fear is getting stuck in her head or whether she can cope with it, Kimmel explained.
Often anxiety and fear can go hand in hand, Kimmel said, adding that the fear of uncertainty that often comes with pregnancy can lead to anxious thoughts.
Anxiety is a normal emotion and people have it for a reason, Kimmel pointed out. She explained that on a biological level, both the anxiety and fear systems in the brain ramp up during pregnancy, which helps make sure that a woman keeps her baby safe, cared for and protected after she gives birth.
One study found that infants born to mothers who had high levels of anxiety during pregnancy had a weakened immune response to vaccines by 6 months of age compared with babies of relaxed moms.
If a woman has had anxiety in the past, she is more at risk of having it during her pregnancy because of the high levels of stress going on, Kimmel said.
The mental fogginess and occasional memory lapses that cause a woman's keys to be misplaced and cell phone to go missing has sometimes been described as "pregnancy brain" or "baby brain." (These same symptoms are referred to as "mommy brain" or "momnesia" after giving birth.)
Although a common complaint, studies of memory and other cognitive changes in pregnancy and early motherhood have shown mixed results. Some research has suggested that fuzzy thinking and forgetfulness before and after birth may be a result of hormonal fluctuations, especially higher levels of progesterone, sleep deprivation or the stress of adjusting to a major life transition.
There's some evidence that the hippocampus, the part of the brain involved in memory, may change during pregnancy, Kimmel said. With all that's going on in a woman's body and mind when she is pregnant, it makes sense that she may not be remembering some things, but it might be that a mother-to-be is prioritizing things differently and doing more multitasking, Kimmel suggested.
Some women may find themselves crying at a sappy pet commercial, bursting into tears after throwing up in early pregnancy, or getting misty eyed after looking at baby clothes.
Women may cry more easily and frequently when they're expecting and in the early stages of new motherhood because pregnancy involves a complex mix of emotions, and as humans, sometimes tearfulness is how our emotions come out, Kimmel suggested. And fluctuating hormone levels may contribute to crying spells.
If a woman has been crying a lot and it doesn't seem to let up, it may be a symptom of depression, which can affect about 10 percent of women during and after pregnancy.
Body image issues
During the second and third trimesters, as a woman's baby bump becomes more visible and she gains more weight, she may feel dissatisfied with her body and its appearance, and this may affect her self-esteem.
Some pregnant women marvel at their rapidly changing bodies and feel radiant and vibrant, while others worry about the weight gain and regaining their figures after delivering.
These changes to a woman's looks, shape and perceived attractiveness may bring up a complicated mix of feelings, Kimmel said. Some of these body-image concerns may mean accepting the fact that a woman is pregnant and her body is changing, she said.
The evidence is mixed about whether a "nesting instinct" is a real occurrence during pregnancy, Kimmel said.
Research has shown that there are changes in the brain of pregnant women, she explained. Toward the end of pregnancy, the reward system in the brain ramps up in preparation for the baby's arrival, and this helps make parenting a rewarding experience, Kimmel said.
There are also social activities and preparations for motherhood, such as attending a baby shower, baby-proofing the house and decorating the nursery, which can all lead to a nesting instinct. Some women may feel a strong urge to cook, clean and organize during the third trimester as a way to mentally prepare for the major changes a new baby will bring and to feel more in control of the situation.
It was once thought that being pregnant was protective against depression and also prevented other psychiatric illnesses because of high estrogen levels, but now its known that this is not the case. A pregnant woman has a similar risk of becoming depressed as a woman who is not having a baby.
The postpartum period is a particularly vulnerable time for women, especially for depression, Kimmel said. The risk for postpartum depression may increase due to a sharp drop in estrogen and progesterone after giving birth and also because a new mother may not be sleeping or eating well.
In the first few days after giving birth, up to 80 percent of women may experience the "baby blues," which includes symptoms such as feeling sad, anxious, moody, weepy or overwhelmed, difficulty sleeping and a lack of appetite. These symptoms usually go away two weeks after delivering.
But if a woman has more severe symptoms that last more than two weeks, such as feeling numb, extremely sad or angry, or lacking interest in her baby, or she is having thoughts that life is not worth living or of hurting her baby, she needs to reach out and seek help, Kimmel advised. These are all signs of postpartum depression.
It turns out that the brains of women experiencing postpartum depression are different from those who are well, according to research published in 2010 in the American Journal of Psychiatry.
Researchers at the University of Pittsburgh Medical Center compared mothers who had delivered infants within the past 12 weeks, 14 of them were depressed and 16 were healthy. Each mother was shown images of angry and scared faces while the researchers watched their brain activity using magnetic resonance imaging (MRI).
They found regions of the brain related to processing emotions their own as well as those of others were less active in the women with postpartum depression. This may explain why these mothers typically have trouble bonding with their newborns, the researchers said.
The study also identified a brain circuit that didn't "light up" in the depressed moms as they viewed the negative images, but was active in the healthy mothers. This neural pathway connects two regions of the brain (the left dorsomedial prefrontal cortex, which is involved in social cognition, and the left amygdale) and could be important for "emotional response to unpleasant stimuli, such as a crying baby," the researchers reported in their study.
While the condition is still not completely understood, studies like this have "the potential to guide the development of more effective treatments for postpartum depression," researcher Eydie Moses-Kolko, a professor at the University of Pittsburgh School of Medicine, said in a statement.
Kimmel reminds mothers who have just had a baby that they need to make time for self-care, whether that means taking a shower or going for a walk.
"What's really important when taking care of others is to make sure a woman builds in some time to take care of herself," Kimmel said.
For women who are experiencing depression or anxiety before or after their baby is born, there are a mix of treatments for these medical conditions, including talk therapy, support groups as well as safe medications, Kimmel said.
"Having a healthy, well mom outweighs the risk of using medication, if it's needed," Kimmel said.