How does pregnancy affect the voice?

Pregnancy is a hugely life-changing event for any woman. For a female performer, though, there are added concerns that need to be considered. Pregnancy has significant impact on many of the systems that are involved in voice production. The profound rise in estrogen and progesterone changes almost every aspect of a woman’s body.

Vocal effects include:

  • Swelling (edema) of the vocal folds
  • Altered or shifted range
  • Increased risk of bruising from fragile blood vessels
  • Increased incidence of acid reflux (LPR)
  • Decreased lung capacity and access to breath support
  • Nasal congestion and decreased nasal/sinus resonance
  • Altered posture and accompanying inefficiency

Swelling/edema of vocal folds and Altered or shifted range

Pregnancy produces swelling everywhere, and the vocal folds are no exception. Retained fluid causes increased weight or heaviness of the vocal folds, which can alter the singing range.  Specifically, a singer may lose top notes but gain notes at the bottom.  It is important not to strain to access missing top notes them. Blood vessels are more fragile during pregnancy and are more likley to rupture and cause vocal injury. Swollen vocal folds are more likely to tear as well.

Increased fragility of vocal fold blood vessels

Blood vessel dilation occurs everywhere (i.e., vulvar swelling, hemorrhoids, varicose veins); the blood vessels in the vocal folds also dilate.  This makes them more prone to rupture. Bruising from blood vessel rupture is the first step in vocal injury. It is wise to get checked for any voice changes that occur during pregnancy.

Increased incidence of LPR

This is very familiar for anyone who has ever been pregnant.  Hormones cause relaxation of the lower esophageal sphincter, which is responsible for keeping food in your stomach (and preventing it from coming up into your throat). Also, stomach capacity is less; when it gets full (which happens quicker than normal), you’re more likely to regurgitate acid.  Heartburn, throat clearing, postnasal drip, and altered voice are all symptoms and increase the risk of vocal injury.

Decreased lung capacity

It is harder to get a full breath in when a baby is pushing your diaphragm (and every other organ) up.  This may cause decreased endurance, vocal fatigue, and inability to sustain notes.

Decreased nasal/sinus resonance

Your nose is no exception to the “everything swells” rule and rhinitis of pregnancy results in decreased ability to breathe through your nose.  Sound also can’t resonate through the nose and into the sinuses, which may result in less lustre in the voice.

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Altered posture

Shifts occur in the back, pelvis, and chest during pregnancy.  This alters the vocal support mechanism, enough that some women can’t sing in their last trimester.  The most important thing is to not push and to listen to the limitations your body has.

All these changes mean that it will likely be more difficult to sing, although some women report it’s easier for them to sing, particularly in the second trimester.  Those who note limitations should accept them, understanding that the voice and your body have changed.  This is the safest way to get through your pregnancy with your singing voice unaffected. Most of the voice changes related to pregnancy will resolve after delivery and/or breastfeeding.

You should get an evaluation by a laryngologist if you note:

  • A sudden change in voice while singing or speaking, or after coughing or sneezing
  • Pain with singing/speaking
  • Significant loss of vocal range (i.e., more than five notes)

Most singers also choose to get cleared to sing prior to resuming after delivery. This ensures no injury or trauma occurred during the birthing process as well. A trusted laryngologist can compare your post-partum exam to your pre-pregnancy one and help you adjust to any changes.