Does Christmas, the occasion of one of the more famous births in history, permit a segue to a discussion of singing while pregnant? Perhaps it’s a stretch (a truly inadvertent bad pun), but the issue is timely. While in bygone times a career and childbearing were not considered compatible, today’s opera singers not only have families but also continue to sing late into their pregnancies.
This was dramatically illustrated to me several years ago. I was enjoying a wonderful performance of Così fan tutte, in traditional costume, when at intermission I was called backstage to attend to the mezzo. I opened the dressing room door, and found the lady in question sitting on a chair, her feet up on a stool, eight months pregnant. Although she complained of some fatigue, her pregnant state did not audibly impair her voice, and the hoop skirt hid her now obvious condition from all. To the audience, she seemed a perfect Dorabella.
The nine months of pregnancy represent a time of profound physiological changes, many of which have an impact on the voice and vocal health of the singer. Each of the three trimesters presents its own potential problems. Although in early pregnancy there may be no visible changes, the first three months are the most crucial for the baby’s development. This is the time when hormonal changes cause both swelling of the mucous membranes and the beginning of water retention. Morning sickness may be a major problem for some women, with recurrent and persistent daily nausea. And yet, you are asked to limit the ingestion of medication, since all ingested substances circulate through the placenta, to the baby. I generally hesitate to prescribe medication to singers, and will often check with the obstetrician regarding a specific drug. I ask patients to do the same with over-the-counter medications. The use of decongestants such as Sudafed or even nasal spray can constrict circulation to the placenta. Prednisone and other forms of steroids should be categorically avoided. While some antibiotics are safe, others (such as tetracycline) can cause mottling of the baby’s permanent teeth. My recommendation for morning .sickness would be ginger capsules (in moderation), a dietary supplement which suppresses nausea. Salt restriction will limit edema, including edema of the vocal folds. Nasal congestion can be managed with saline spray, or a mild (pediatric strength) decongestant spray.
The second trimester usually begins well for the singer. The voice often is clear and powerful, which goes along with a general feeling of well being. As the baby grows, however, there is increasing limitation to the excursion of the diaphragm. At the beginning of this trimester, the top of the uterus is at the level of the top of the pubis, but by the end it is well above the navel. Deep inhalation becomes more difficult, and breath control is limited. The uterus continues to push upward through the seventh month, when it is at the lower end of the breast bone ( the sternum). Singers often need to rely more on thoracic breathing, or on expanding laterally with the breath. You may need to rethink your phrasing, since it becomes difficult to sustain or sing longer phrases on a single breath.
This is also a time for acid reflux. The baby is pushing up on the stomach, stretching the opening in the diaphragm through which the esophagus passes to the stomach. This opening, the hiatus, may become permanently stretched, allowing the stomach to herniate up into the chest (hiatus hernia). The compression of the stomach means more frequent and smaller meals, and the avoidance of substances such as coffee, which can aggravate acid formation. During childbirth, the pushing associated with contractions causes additional pressure on the stomach. The regurgitation of acid during this time (which, if severe, can cause pneumonia), carries the strangely musical name of Mendelssohn’s Syndrome.
Naturally, there is variation among women in terms of how severe these symptoms are. They are exacerbated by carrying the baby high and gaining excess weight, minimized by carrying the baby low and maintaining a lower weight.
At the beginning of this column, I alluded to hormonal changes, which continue during pregnancy and through the period of lactation. The voice may become somewhat limited in range, unwieldy, and lacking some brilliance. This is normally not a time to extend your range or learn new challenging repertoire. Nonetheless, there is no reason to stop singing, always remaining within the limits of comfort and reason. Remember, a delayed or cancelled audition is just that, but a healthy child is a life-long joy.
