Pregnancy & Work A Call for Understanding, Action
The World Health Organization defines maternal health as the well-being of women during pregnancy, childbirth, and the postpartum (after birth) period. It emphasizes that each phase of pregnancy should be a positive experience, enabling both mothers and their babies to achieve optimal health and wellness. However, work-related stress poses a significant threat to this goal. EBR’s Dr. Brook Genene examines how stress affects pregnancy and offers insights on how women can manage stress in today’s workplace.
Melat Abebe is a civil engineering graduate who works at one of the private banks in Addis Ababa. Shortly after acquiring her new role, she became pregnant. The challenge of carrying a baby, along with the requirements of her new job, made things difficult for her. “I was constantly stressed and had to navigate work, home life, and a Master’s degree in project management,” she told EBR.
Melat’s story is one of many inspiring young women who courageously navigate the delicate balance between work and family. Today’s women continue to work during pregnancy for various reasons, including financial necessity, career advancement, and preserving leave time after childbirth. Their resilience in the face of such challenges is indeed empowering.
The number of women working while pregnant has risen in recent times. This has added more stress to women. Reports have shown that psychosocial work stress doesn’t increase the risk of congenital malformations. However, specific workplace stressors such as long hours, high-pressure deadlines, and lack of support from colleagues or supervisors can adversely affect the mother and child.
Some fields of study and professions require significant education, causing individuals to delay childbearing. Such scenarios can contribute to adverse obstetric outcomes, such as pregnancy loss, preterm birth, and low birth weight, through advancing maternal age.
Pregnancy is associated with various physical, functional, and emotional changes. Many women work while pregnant without any interference from pregnancy-related changes. However, problems of nausea and vomiting, pain, and fatigue can negatively impact a woman’s work performance.
“Working in a stressful environment while pregnant can have a negative impact,” states Dr Belay Alemu, an Obstetrics and Gynecology specialist who works at General Hospital at Harar and a women’s health advocate.
Workplace odours or restrictions on eating can provoke nausea and vomiting. These problems can be managed with hydration, snacking as needed, taking a brief break, medication, and scheduling the most demanding work for times when the individual tends to feel less nauseous.
Some jobs may increase the risk of poor pregnancy outcomes, likely through a combination of physical demands, mental stress, fatigue, and work schedules (work duration and shift timing).
For women with healthy, uncomplicated singleton pregnancies, available evidence did not justify imposing mandatory restrictions to working hours, shift work, lifting, standing, and physical work during pregnancy.
More data are needed to demonstrate a clear cut-off at which work is detrimental to the health of most women and fetuses. “Being active during pregnancy is generally encouraged, but the point at which extreme activity transitions from benefit to harm is less clear,” explains Dr. Belay.
Dr. Belay emphasizes the importance of social support in managing stress during pregnancy. While work-related stress can be a significant factor, it’s essential to recognize that the occupational setting and job requirements can also provide positive influences, such as social support from coworkers, income stability, and access to nutrition. This reassures the public that they are not alone in their journey.
In addition, significant stressors can develop in non-work-related aspects of the patient’s life (e.g., childcare, family illness). Psychosocial factors, including social support, socioeconomic status, and life events, may influence pregnancy outcomes directly via physiological pathways (such as increased cortisol levels), indirectly via behavioural pathways (such as poor eating habits or substance abuse), or both. Understanding these factors is crucial for identifying and addressing sources of stress in pregnant women’s lives.
When effectively managed, stress can activate a series of physiologic adaptive responses in the maternal and fetal compartments, potentially leading to positive outcomes for both mother and child.
Children whose mothers are highly stressed, anxious or depressed during pregnancy may be at higher risk for mental health and behavioural issues during their childhood and teen years, according to research published by the American Psychological Association.
“Our research suggests that psychological distress during the pregnancy period has a small but persistent effect on children’s risk for aggressive, disinhibited and impulsive behaviors,” said study author Irene Tung, PhD, of California State University, Dominguez Hills. “These findings add to the evidence that providing widely accessible mental health care and support during pregnancy may be a critical step to help prevent childhood behavior problems.”
Stress also may exert potential adverse effects indirectly by affecting the pregnant woman’s behaviour. For example, women who experience high levels of stress may not follow good health habits. They may skip meals or not choose nutritious foods, or they may react to stress by reaching for cigarettes, alcohol or illicit drugs, all of which have been linked to low birth weight. The use of alcohol and certain illegal drugs also increases the risk of congenital disabilities.
“Any amount of alcohol taken during pregnancy harms the fetus especially if they are taken in the first trimester of pregnancy, the damage to the fetus is high,” warned Dr Belay.
A 2019 study titled Psychological Problems and Cope Methods among Pregnant Women in Two Bole Sub City Health Service Providers by Leyuwork Antonius, a counselling psychologist at the UNICEF project, indicated a high number of anxiety and depression in pregnant women. Prevalence of anxiety among 275 pregnant women revealed that 43.3% had moderate and 25.1% severe anxiety levels. Regarding depression, 44% showed moderate and 29.8% severe levels of depression. Depression and anxiety influence the day-to-day activities of pregnant women. Most pregnant women don’t want to talk with people and avoid intimacy with their partners.
Due to depression, some behavioural changes influence their relationship with relatives, neighbours, partners, friends and colleagues. The identified behavioural issues are getting easily irritated, crying, sleep disturbance, and emotional sensitivity. Most pregnant women highly preferred religious activities to cope with anxiety and depression, for instance, praying, going to church and self-distraction activities such as drinking coffee with neighbours, friends and family.
The prevalence of depression and anxiety in the study shows that the majority of respondents indicated moderate levels of depression (44%) and anxiety (43%).
“Having a good support network during this time is key,” said Dr Bereket Tsegaye, a Psychiatrist at Alert Hospital. Support can come from the pregnant woman’s husband, extended family, friends and others. This also helps a pregnant woman relieve stress. These individuals may provide information, emotional support or help with tasks around the home.
Because of the strong family support around her, Melat successfully achieved her targets. Her work performance didn’t suffer because of her pregnancy, and when the time came to give birth, she had everything she needed. “I gave birth to a beautiful baby girl and enjoyed my leave from work taking care of her,” she told EBR.
As Melat prepares to return to work, she faces another challenge: managing the difficulty of being a working mom. However, she is confident that she will fulfil both responsibilities well. “I am lucky to have a supportive husband and family, so I think I will manage,” she said. EBR
13th Year • November 2024 • No. 135