The Effects of Pregnancy on Professional Pianists

7:00 am – You wake up. Already, you are envisioning the day, the week, the month. You have lots to do. You are a professional pianist; you have two upcoming performances, you are the rehearsal pianist for an opera, you play for a community choir, and you have a full studio of piano students. You have lots to do.

7:30 am – You haven’t gotten your period – it’s a week late. Hmm. You decide to grab a pregnancy test and take it.

7:40 am – Positive. You’re pregnant!

7:41 am – After a moment of disbelief, a thousand feelings flow through your body. Excitement, panic, fear, joy. Thoughts flood your mind, but one thought is loud, ringing like an alarm: how am I going to continue my work as a pianist while pregnant?

When pregnant, your body goes through massive changes.

Pregnancy affects “essentially every system in a woman’s body” (Draper, 2006, p. 217). It’s normal to wonder how these changes to your body are going to affect your daily activities and work. But first, it might help to look at exactly what is going on in the body to create these changes.

Many of the changes to your body during pregnancy are due to major pregnancy hormones including estrogen, progesterone, human chorionic gonadotropin (hCG), human placental lactogen, and relaxin. These hormones are responsible for respiratory, cardiovascular, gastrointestinal, musculoskeletal, skin and hair, and psychological and emotional changes (Draper, 2006, p. 217).

These hormones act as part of the body’s endocrine system.

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The endocrine system includes a collection of organs, endocrine glands, that “secrete chemical messengers called hormones directly into the bloodstream, which then carries them to their destinations throughout the body” (Films Media Group, 2009, The Endocrine System). Endocrine organs include the hypothalamus, pituitary gland, pineal gland, thyroid gland and parathyroid glands, thymus gland, pancreas, adrenal glands (cortex and medulla), and gonads.

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Hormones are signals that move through the body, notifying organs to make changes. Endocrine glands release hormones, which are sent into the bloodstream to target cells. Target cells have receptors, and the hormone fits into the receptor as a key would fit into a lock. Once the hormone attaches, the receptor causes a specific change in the target cell.  As signals, hormones “announce to the organism the state of the secreting cell as well as the state of the hormone-producing organ; they are like semaphore flags” (Kleine & Rossmanith, 2016, p. 12). Each target organ has a specific set of cells that will recognize the distinct hormone. Because of this, “the effect of a hormone is solely within the target organ” (Kleine & Rossmanith, 2016, p. 12).

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Hormones are released in pulses. Some are released immediately by diffusion, such as steroids, and others are stored in vesicles and released on demand. After a signal is sent to the pituitary gland, the pituitary releases other hormones which induce hormonal synthesis and release in other endocrine glands. After leaving the organ of release, the hormone travels through the bloodstream freely until it attaches onto a target organ. This whole process is referred to as the endocrine process, “by which a substance is released in one organ and transferred via the blood to its target organ” (Kleine & Rossmanith, 2016, p. 12). At one end, “synthesis and release occur, then undirected transport in the blood occurs, and finally reactivity occurs at a distant cell or organ.” (Kleine & Rossmanith, 2016, p. 12).

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Some of the hormones that either increase or are released for the first time in pregnancy include:

Physiological changes due to pregnancy hormones can cause some discomfort, pain, and other difficulties.

Some of these difficulties might directly impact a pianist’s ability to continue playing, teaching, and performing, mostly due to pianists’ lifestyle of long hours of sitting and demanding use of arms, hands, and fingers. Let’s look at some of these changes, their potential impact on a professional pianist, and some ways to ease the discomfort or mitigate the effects of such changes.

I feel out of breath when I sit at the piano for long periods of time.

Likely due to increases in progesterone, the respiratory system is “especially impacted during pregnancy. By the end of pregnancy, women require 15% to 20% more oxygen to meet the demands of maternal oxygen consumption and fetal oxygen needs” (Draper, 2006, p. 217). Because of this, “Most pregnant women quickly become short of breath when ascending a flight of stairs” (Draper, 2006, p. 217).

For a pianist, who may sit for hours and hours each day, “It becomes increasingly difficult for [pregnant women] to catch their breath or breathe deeply when sitting in a chair because the gravid uterus and growing fetus push the diaphragm upward” (Draper, 2006, pp. 217-218). As a result, pregnant pianists may need more time to complete tasks to compensate for the increased oxygen consumption of pregnancy, especially when they are sitting at the piano. When at all possible, pianists should try to avoid sitting for long periods of time. For example, you could study your score while standing and try standing during any breaks, instead of sitting. More than anything, take care of yourself by adjusting your expectations to know that, while you may have done things quickly in the past, you may need more time now (and patience with yourself!) to get things done.

When I sit on the piano bench, my back hurts and my abdomen gets in the way.

Sitting at the piano bench can become difficult during pregnancy for two primary reasons: first, due to back pain, and second, due to the increasing size of the abdomen. Many pregnant women experience back pain during pregnancy, due to the changes in spinal posture such as an “increase in thoracic kyphosis and decrease in lateral deviation” (Betsch et al., 2015, p. 1287). Such changes could be in part responsible for low back pain in pregnant women, which would end up influencing a pianist’s ability to sit comfortably on a piano bench.

Furthermore, the abdominal diameter increases during pregnancy, “shifting the body’s center of gravity anteriorly,” which “leads to an increase in load and stress on the lower back” (Betsch et al., 2015, p. 1287). This increased abdominal volume can also make it difficult to perform daily acts of living (Sunaga et al., 2013, p. 797). One of these acts may be sitting at the piano bench. A pregnant pianist may need to adjust bench height and or distance in order to find a comfortable distance from which to play in order to overcome the physical changes due to the abdomen and back, and the potential pain and discomfort that arises from both. As always, it is important for pregnant women to take breaks and to change position frequently.  

I’m having a hard time standing up from the piano bench.

Mostly due to the hormone relaxin, changes during pregnancy include changes to posture and ligaments. Near the end of the second trimester, “women begin to display the ‘waddling gait’ of pregnancy caused by the increased ‘S’ curve of the lumbodorsal vertebrae and their attempt to compensate for changes in the center of gravity.” (Draper, 2006, p. 21). Pregnancy effects spinal posture, and many women experience back pain and discomfort while pregnant.

During pregnancy, “As the uterus enlarges, […] the position of the center of mass (COM) shifts forward and downward. To compensate for such changes, thoracic kyphosis and lumbar lordosis increase or decrease” respectively (Sunaga et al., 2013, p. 792). Because of this, the center of mass “shifts backwards to assure postural stability in the standing posture during pregnancy” (Sunaga et al., 2013, p. 792). These changes happen even in the first trimester of pregnancy, when physical changes may not be yet as noticeable as in the second and third trimesters. “Because posture during pregnancy is unstable, motion strategies will be different from those in the non-pregnant state. Consequently, pregnant women may be at increased risk of falling when they transition from rising to walking” (Sunaga et al., 2013, p. 793).

For a pianist, the motion of rising to walking is crucial when performing, rehearsing, and teaching, depending on the circumstances of each job. To adapt to postural and therefore motion changes in rising to walking, Sunaga et al. suggest the following:

1. Use chairs with a bit of a higher seat (Sunaga et al., 2013, p. 796).
2. Press on armrests or use other upper limb support (Sunaga et al., 2013, p. 796).
3. Find a stable standing position after rising before walking (Sunaga et al., 2013, p. 797).

Furthermore, in their longitudinal study, Gilleard et al. suggest that “sufficient space would need to be available in any workspace and an adequate chair size and structure used in order to allow increased width between the feet and between the thighs to facilitate rising from a chair” (Gilleard et al., 2008, p. 784).

For a pianist, this may look like requesting an adjustable bench or an adjustable chair with back support. While pianists will not have benches or chairs with armrests, a pianist might use her hands on the piano to help with rising; this could even look like a pianist pressing her hands on the closed piano lid for support. Finally, pianists should take time to stand up slowly and steadily before bowing, walking to their student, or walking off stage.

When I stand up from the piano, I feel faint.

Pianists, whether while teaching, performing, or just practicing, rise to standing from sitting frequently. “Feeling faint, especially when standing up quickly, is a common complaint during pregnancy” (Draper, 2006, p. 219). This is a normal experience for pregnant women. For these women, fainting is often “caused by a combination of factors including physiologic changes that decrease maternal blood pressure and vascular resistance, increase overall blood volume, and decrease venous blood return from the lower extremities” (Draper, 2006, p. 219). All of these factors, influencing blood pressure, help facilitate fetal growth. However, it “can be dangerous if the woman loses consciousness in the work environment and is injured when she falls” (Draper, 2006, p. 219). When rising from the piano bench, make sure to take the time you need, support yourself whenever possible with your hands and arms, and keep breathing. It might be especially hard to take the time you need to rise from the piano bench in performance settings, in which you may feel the need to rush and in which your hormone levels may already be affected. As much as possible, resist the urge to rush to stand from sitting. It never feels as long to the audience as it does to us performers!

I’m experiencing tingling, numbness, or pain in my hands and wrists.

One other difficulty that pregnant pianists might experience includes hand and wrist numbness, discomfort, or pain. The prevalence of hand and wrist complaints is high in pregnant women (Balik et al., 2014). Some of these changes are a result of increased relaxin. “These changes occur due to postural and hormonal fluctuations, and weight gain and fluid retention” (Balik et al., 2014, p. 479). Hormones responsible for fluid retention include renin, angiotensin II and aldosterone. With increased fluid retention, pressure and swelling can increase in blood vessels, effecting especially tight places such as the carpal tunnel areas. While some hand and wrist disorders during pregnancy are specific, some are nonspecific. “Nonspecific disorders include wrist ailments, and the main complaint is pain. Other complaints include weakness and cramps in muscles, drowsiness, sensations of needle stick and burning” (Balik et al., 2014, p. 480).

One of the most common specific disorder and musculoskeletal disturbance among pregnant women is carpal tunnel syndrome (Oliveira et al., 2019, p. 623). Balik et al. found the prevalence of carpal tunnel syndrome in pregnant women to be 10.2%, however other studies range all the way from 0.34% to 62% (Balik et al., 2014, p. 481). This wide range of findings could be due to differences in study design and diagnostic methods. Regardless of the exact prevalence, authors such as Balik et al. suggest that “hand and wrist complaints” including carpal tunnel syndrome are common enough that they “should be considered during antenatal checkups” (Balik et al., 2014, p. 482). According to Balik et al., “Carpal tunnel syndrome occurs more frequently in women, [inceases] in pregnancy and is the most common mononeuropathy of pregnancy” (p. 481). This syndrome is “the most common trap neuropathy which affects the motor and functional status of the hand and wrist,” and it “develops due to median nerve compression in the wrist” (Balik et al., 2014, p. 481).

Carpal tunnel syndrome “can be associated with overuse of the wrists and hands through repetitive movements such as typing, using a computer mouse, and working on an assembly line” (Draper, 2006, p. 219). For many pianists, the repetitive motion of practicing could also be associated with carpal tunnel syndrome. Carpal tunnel syndrome “Symptoms […] include numbness and tingling of the hands and fingers, decreased grip strength, and burning in the thenar part of the hands (the short muscles of the thumb that form the thenar eminence, or ball of the thumb)” (Draper, 2006, p. 219). Other symptoms include diminished hand dexterity and weakness of tactile sensibility (Oliveira et al., 2019, p. 623). Symptoms can affect both hands, but often affect the “dominant hand more severely,” and can, “in severe cases, […] irradiate proximally to the forearm, arm, and in some cases, up to the shoulders” (Oliveira et al., 2019, p. 623).

It is possible that specific at-home exercises could reduce the severity of carpal tunnel syndrome in pregnant patients. In a randomized control trial, Keskin et al. found that “nerve and tendon-slip exercises for patients with mild-moderate [carpal tunnel syndrome] symptoms in the second and third trimester of pregnancy were […] simple and reliable methods that can be applied to patients in order to increase the function of the patients and reduce the severity of the disease” (Keskin et al., 2020, p. 206). While these exercises could be helpful for the treatment of carpal tunnel syndrome, one should always consult her doctor before beginning any exercise program related to carpal tunnel syndrome.

Hand and wrist pain or discomfort, such as that associated with carpal tunnel syndrome, would pose a problem for pianists who are using their fingers, hands, and arms in specific and frequently demanding ways. If you experience pain or discomfort while playing, it is essential to take a break from the instrument. Pregnant pianists would find it beneficial to spread out practice time and attempt to incorporate more mental practice in order to limit playing time and physical intensity, force, and pressure. It is most important for pianists to know that it’s possible for these hand pains to develop. While playing the piano, pay close attention to how your wrists, hands, and fingers are feeling in order to discover any discomfort early on and to prevent such discomfort from getting worse.

Will I still have hand and wrist pain after pregnancy?

Similar to other studies, Keskin et al. noted that “after childbirth, there was a marked improvement in the symptoms of the hand” (Keskin et al., 2020, p. 206). Furthermore, in Mondelli et al., “women with pregnancy-related CTS had a probability of improvement 3– 4 times greater than women with the idiopathic form, and this improvement was long-lasting” (Mondelli et al., 2007, p. 783). There is light at the end of the tunnel!

I’m having trouble pedaling because my ankles are swollen.

Many women experience swelling in their feet, ankles, and legs during pregnancy. Prolonged sitting can exacerbate this problem (Draper, 2006, p. 221). Pianists might find this affects their ankle flexibility and range of motion for using the pedals. “Pregnant women should be advised to elevate their feet in the evenings. While at work, they can be advised to move their feet back and forth for at least 5 minutes each hour. This action will enhance blood return from the lower extremities back to the heart. Some pregnant women may require rest breaks to elevate their feet” (Draper, 2006, p. 221).

While working at the piano, set a timer so that you are reminded to move or elevate your legs for a few minutes at a time.

I’m just exhausted.

When pregnant, it’s normal to be exhausted. Your body is working on supporting two beings – that’s no small task! It is important for pregnant pianists to know that “Some pregnant women may require more frequent rest breaks than others” (Draper, 2006, p. 220). Planning your days realistically and prioritizing rest breaks in your rehearsal, performing, teaching, and practicing schedules will help combat exhaustion. Furthermore, it’s important for pregnant women to eat a variety of foods and to eat frequently. Fuel will provide you with more energy to support your body. While it’s very easy for rest and snack breaks to be eaten up by other duties, these breaks are essential to your body’s ability to support the development of your baby. You may find that you have to actually write “take a break,” “snack time,” or “nap” into your schedule in order to hold yourself to them.

In Conclusion…

While many workplaces are becoming increasingly more accessible for pregnant women, you may find that your workplace is not acceptable. Many might argue that women should not work while they are pregnant, and that to do so is putting both mother and baby at risk. However, mothers are increasingly responsible for family incomes, and single-parent families are more common than they used to be. As a result, pregnant women often remain in the workforce for as long as they can. As a pianist, you may be faced with times in which you cannot stop working, even when pregnant. Are there ways for you to adjust your habits while working as a professional pianist? For example, could you create moments to take brief walks, set a timer to remember to change positions, pack plenty of snacks the day before so you don’t forget, or find a stool on which to elevate your feet for one minute at a time? Is there anything that your director or manager could do to help you? For example, could you ask the opera staging director if you can stand while he is staging the singers, as opposed to remaining seated? At your teaching studio, could you ask your manager to schedule students 15 minutes apart so that you have time to rest and recover in between? During pregnancy, it is important for pianists to stay in-tune with their body and its needs and to advocate for themselves.

Understanding the effects of pregnancy will allow you, as a professional pianist, to monitor your health, know when to rest, and continue creating – creating music, and new life!

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Works Cited

Balik, G., Sabri Balik, M., Ustuner, I., Kagitci, M., Sahin, F. K., & Guven, E. S. (2014). Hand and wrist complaints in pregnancy. Archives of Gynecology & Obstetrics, 290, 479-83. https://dx.doi.org/10.1007/s00404-014-3244-2

Betsch, M., Wehrle, R., Dor, L., Rapp, W., Jungbluth, P., Hakimi, M., & Wild, M. (2015). Spinal posture and pelvic position during pregnancy: A prospective rasterstereographic pilot study. European Spine Journal, 24, 1282-8. https://dx.doi.org/10.1007/s00586-014-3521-6

Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0 https://creativecommons.org/licenses/by/3.0, via Wikimedia Commons

Draper, L. (2006). Pregnant women in the workplace: Distinguishing between normal and abnormal physiologic changes. AAOHN Journal, 54, 217-23; quiz 224-5.

Films Media Group. (2009). The endocrine system. Films On Demand. Retrieved October 3, 2022, from https://fod.infobase.com/PortalPlaylists.aspx?wID=103901&xtid=39512.

Gilleard, W., Crosbie, J., & Smith, R. (2008). A longitudinal study of the effect of pregnancy on rising to stand from a chair. Journal of Biomechanics, 41, 779-87. https://dx.doi.org/10.1016/j.jbiomech.2007.11.015

Keskin, Y., Kilic, G., Taspinar, O., Posul, S. O., Halac, G., Eren, F., Erol, E., Urkmez, & B., Aydin, T. (2020). Effectiveness of home exercise in pregnant women with carpal tunnel syndrome: Randomized control trial. JPMA – Journal of the Pakistan Medical Association, 70, 202-207. https://dx.doi.org/10.5455/JPMA.1846

Kleine, B., & Rossmanith, W. G. (2016). Hormones: Some definitions. In Hormones and the endocrine system: Textbook of endocrinology (pp. 11-17). Springer. https://doi.org/10.1007/978-3-319-15060-4

Mondelli, M., Rossi, S., Monti, E., Aprile, I., Caliandro, P., Pazzaglia, C., Romano, C., & Padua, L. (2007). Prospective study of positive factors for improvement of carpal tunnel syndrome in pregnant women. Muscle & Nerve, 36, 778-83. https://doi.org/10.1002/mus.20863

Oliveira, G. A. D., Bernardes, J. M., Santos, E. S., & Dias, A. (2019). Carpal tunnel syndrome during the third trimester of pregnancy: Prevalence and risk factors. Archives of Gynecology & Obstetrics, 300, 623-631. https://dx.doi.org/10.1007/s00404-019-05233-6

Primal Pictures Ltd. (n.d.). Anatomy. TV. Retrieved November 15, 2022, from Human Anatomy and Physiology – Endocrine system Sunaga, Y., Anan, M., & Shinkoda, K. (2013). Biomechanics of rising from a chair and walking in pregnant women. Applied Ergonomics, 44, 792-8. https://dx.doi.org/10.1016/j.apergo.2013.01.010

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