Stress during pregnancy: How to look after yourself if you’re pregnant in a crisis zone

This article was created in response to the ongoing war in Ukraine for people living in a crisis zone. Any information given below is done so with these circumstances in mind. If you'd like to read this piece in Ukrainian then you can do so for free in the Flo app. 

Living in a conflict zone or negotiating relocation can be incredibly frightening, especially if you’re expecting a baby. Limited access to nutritious food, medical support, and quiet spaces to manage anxiety can compound all the usual worries about whether your baby is doing OK. But know this: Your body will be making your baby its number one priority right now. 

“Fetuses can even thrive in environments that aren’t always ideal,” explains Dr. Sara Twogood, an OB-GYN (obstetrician and gynecologist). 

“I describe it to my patients as your body shunting energy and nutrients to the placenta and the baby. That’s why you can be in stressful positions or not have access to proper nutrients for a short period of time in your pregnancy, and the baby still grows fine. It’s using the maternal reserves as a way to get what it needs.” 

Still, it’s natural to be worried. That’s why we’ve got Dr. Twogood and Dr. Maria Corniero — an OB-GYN who works with Médecins Sans Frontières (aka Doctors Without Borders) — to share their expert advice on handling some of the most common concerns for those pregnant in a crisis zone ...

Managing stress during pregnancy

If you’re living in a conflict situation or in transit, it’s natural to be worried. You may be concerned about how this might impact your pregnancy. However, rest assured, research has suggested that short-term, acute stress doesn’t have lasting effects on pregnancy or your baby specifically. 

Still, it is helpful to find ways to manage stress as much as possible. When you’re feeling high levels of stress or anxiety, your body releases a hormone called cortisol. Your heart rate may increase, and your blood pressure might rise. However, there are activities you can do to both acknowledge how you’re feeling and try to lower your cortisol levels. Your blood pressure and heart rate should then return to normal. Try out the following:

Stress during pregnancy: Stretch or move

Dr. Corniero and Dr. Twogood highlight the benefits of light exercise or stretching during pregnancy. 

“There are a lot of aches and pains in pregnancy that are common, expected, and don’t mean that anything is wrong, but they might not make you feel good,” says Dr. Twogood. “If you’ve been recommended any stretches or exercises by your doctors, it’s really good to do them. It’s easy to dismiss them or not make them a priority.” 

Even if your doctor hasn’t previously suggested a particular exercise or stretch, practicing prenatal yoga poses or exercises may help relieve some discomfort as well as manage stress. And the good news is they’re really easy, and you don’t need much space to do them.

If you’re experiencing back pain, then try kneeling on all fours on the floor with your hands and knees shoulder-width apart. Use a cushion or clothing to put under your knees. Try to keep your back straight and avoid lowering your belly. Then tuck your tailbone under, round your back, and pull your navel toward your spine. This exercise stretches your back. 

You might also want to try standing in goddess pose for short periods of time. With a wall behind you for balance, enter a wide-legged squat. Only squat as far as feels comfortable to you. You can hold your hands on your stomach or rest them by your side. This exercise helps to stretch and open your hips and strengthen your pelvic floor. All of this may help you when it comes to giving birth. 

Stress during pregnancy: Breathe and meditate

You may find it really helpful to take some time out to breathe and be still. 

Try this exercise: Find a comfortable position, either sitting or standing and inhale for five counts through your nose. Inhale deeply and slowly. If five counts feels too long at first, then it’s fine to breathe in for as long as is comfortable. Then exhale slowly through your mouth. You can repeat this for five minutes or however long you need to.  

Stress during pregnancy: Rely on your community

You may not be with your loved ones right now but connect and rely on the people who are physically close to you. Your community may be able to assist you, both physically and emotionally. 

“Later in pregnancy, it can be hard to do certain things like picking up other children or bending down,” says Dr. Twogood. “It’s good to ask for help in doing things that are harder, like lifting or pushing. Do what your body feels like.” 

Similarly, Dr. Corniero says, “You should avoid loneliness. We know that can be a very hard objective in a crisis situation, but it’s important to take care of the people around you and to let them take care of you.” Even if you can’t be together physically, speaking on the phone or sending regular messages can keep that sense of connectedness going.

Stress during pregnancy: Food and nutrition

You might have imagined eating your healthiest diet ever during pregnancy, but that might be far from the reality you find yourself in right now.

But here’s the good news: “Long-term vitamin deficiencies are fairly rare,” explains Dr. Twogood. “A lot of vitamin deficiencies are chronic [i.e., caused by low intake over a long time], so not having certain vitamins for a short period of time wouldn’t be expected to cause obvious deficiencies.” 

If you still have access to prenatal vitamins, then she says this may help you fill in the gaps in your diet. Here are some key vitamins to look out for and where you might find them, even if your access to fresh food is limited: 

• Folic acid: In the first trimester of pregnancy, folic acid is considered to be crucial for your baby’s development. Beans are a good example of where you might find this. Kidney beans are a great source of folate. They also have high levels of magnesium and calcium. Lentils may also help you increase your intake of folate.
• Iron: “Even women with a normal, healthy diet can have anemia during pregnancy,” explains Dr. Twogood. Dried beans, chickpeas, and lentils are rich in iron. Pumpkin, sesame, and flax seeds will help you increase your intake, along with dried fruit like raisins and wheat pasta and bread.
• Calcium: Canned beans are also a great source of calcium, along with calcium-fortified foods like cereal. Canned leafy greens like collard greens and spinach may help you increase your calcium intake.

If you’re struggling to eat due to feelings of nausea or vomiting — which can be compounded by stress — Dr. Corniero recommends trying to eat smaller amounts of food but very often. She also notes that cold foods may be easier to tolerate. 

Stress during pregnancy: Lack of access to medical care

You may have previously been monitoring your pregnancy through medical milestones like scans and checkups. “Of course, my first advice is to search for a hospital or professional help and have at least one ultrasound scan (at around 12 and/or 20 weeks) if it’s possible,” says Dr. Corniero. 

But even if you have limited access to medical care or no longer feel safe visiting your hospital, there are ways you can continue to monitor your baby’s development: 

Monitor your last period: 

In the first 12 weeks of your pregnancy, Dr. Corniero says that you should make a note of your last period. This may help you track how many weeks pregnant you are in the early stages. 

Measure your uterine height: 

From around 20 weeks, Dr. Corniero explains that one of the best ways to monitor your baby’s development without a scan is to measure your uterine height. This is the distance from the top of the uterus (we’ll explain how to find it below) to the pubic bone with a measuring tape. 

It’s best to do this when you’re lying down flat, facing upward, and with an empty bladder. Your uterus grows as your baby does, so you’ll need to take measurements from different points on your stomach depending on how far along you are.

A good way to monitor your progress may be to remember that the height of your uterus in centimeters (plus or minus 2 cm) will be equal to your gestational age.

How to measure your uterine height:

20 to 26 weeks: Your uterus grows to the midpoint between your belly button and under your chest. Measure from this point down to your pubic bone. The healthy range of growth for this period of time is between 23 cm and 26 cm. 

26–36 weeks: Your uterus reaches right under your ribcage and chest. This is an integral time of growth, and you may take readings of around 27 cm to 34 cm.

While measuring your uterine height can provide you with some peace of mind that the baby is growing, Dr. Twogood says, “This can vary tremendously on how many pregnancies you’ve had before and what your baseline body weight is. So, compare your body to yourself rather than to other women who are the same gestational age as you are or what people think you should look like. It’s just a way for you to see that your body is changing and your uterus is getting bigger.” 

If your uterine height is measuring bigger or smaller than what’s considered to be the healthy range, then try not to worry. This just means that you may want to speak to a medical professional. 

If you’re living in an area where you feel comfortable going to the hospital or closest clinic, then you may be able to walk in to receive a checkup. Alternatively, if Médecins Sans Frontières is operating in your area, then they may be able to examine you, listen to your concerns, and offer you advice about what to do next.

Monitor your baby's movement:

You may start to notice the first movements of your baby between 16 (in following pregnancies) and 24 (in your first pregnancy) weeks. As you surpass 20 weeks, you may start to notice a pattern of movement from your baby. 

“It doesn’t have to be exactly the same every day, but a fairly consistent pattern can be a nice reminder that everything is fine,” says Dr. Twogood. “Decreased fetal movement doesn’t mean something is wrong but usually warrants more evaluation.”

Stress during pregnancy: When should you seek medical assistance?

At any point in your pregnancy, if you experience severe pain, bleeding, or a fever that’s higher than 38º C (100º F), Dr. Corniero recommends trying to access medical attention. 

If you have the means to test your blood pressure and it’s unusually high for more than two consecutive measurements at least 30 minutes apart from each other (over 140/85 mm Hg), then you may need to seek medical assistance. In order to get the most accurate reading, try to find as peaceful an environment as possible. Stress can temporarily raise your blood pressure, causing your heart to beat faster. Research has indicated that stress alone isn’t likely to cause long-term high blood pressure.

You may experience strong nausea or vomiting throughout your pregnancy. This isn’t necessarily something to worry about. However, if this becomes persistent, more than 3 or 4 times per day, and you lose more than 4–5 kg (10 lbs.), then you may be experiencing extreme pregnancy sickness or hyperemesis gravidarum. Dr. Corniero recommends that you seek medical assistance if you can. 

If you feel safe, then try to contact your perinatal team at the hospital or a clinic. Alternatively, reach out to the clinic closest to you. Médecins Sans Frontières has provided support and supplies to hospitals and sent doctors into communities to help those in need. They have established pop-up clinics that may be able to give you some guidance.