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 Pregnancy: Singing Your
Way Through by Dr. Anthony
Jahn
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.
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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. |
Anthony
Jahn, M.D., noted author and professor of clinical
otolaryngology at Columbia University College of
Physicians and Surgeons, has offices in New York
and New Jersey. Contact Dr. Jahn: Jahn@classicalsinger.net, or PO Box
278, Maplewood, NJ, 07040. |
- This
article first appeared in Classical Singer Magazine
12/99 and is reprinted here with permission.
Copyright 1999 by Classical
Publications, Inc. All rights reserved.
Inclusion of links and contact information does
not imply endorsement of the contents.
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