The human voice is extremely sensitive to hormonal changes. Good examples of this are pre- and post-menstrual voice changes and pre- and post-menopausal voice changes. Many of these changes are caused by a change in fluid build-up beneath the mucosa of the vocal folds or the superficial lamina propria . Voice changes due to pregnancy are known as "laryngopathia gravidarum".1 During pregnancy, estrogen and progesterone levels are markedly increased and cause edema or swelling of the vocal fold tissue. This swelling changes the mass (weight) of the vocal folds, making them heavier and changing the nature of vibration. The voice quality may be slightly breathy or slightly hoarse, and it may be more of a challenge to get the voice warmed up and sing into the upper range (some notes may be lost) effortlessly. The voice may seem muffled. As a result, the singer will feel that singing takes more effort, experience fatigue, and may begin to engage muscles in the head/neck, throat, jaw and tongue-base to help compensate. This behavior to clear up the sound actually can put the singer at risk for injury to the vocal fold tissue, including a mucosal tear or a small bleed of a capillary on the surface of the vocal fold. In these cases, the singer will experience a sudden voice change (usually hoarseness or no voice). This is an indication that the singer must stop using her voice and seek the care of a laryngologist to ensure that she is safe to sing. Remember, not all Ear, Nose, and Throat doctors have the training to work with singers. At the minimum, a strobovideolaryngoscopy should be performed for an accurate diagnosis. If that is not available to you, you should specify your need to see a Laryngologist, and ENT specialist who completed an additional year of fellowship training focusing on the care of the professional voice. If you need a laryngologist in your area, feel free to email me and I will find the closest specialist in your area.

In very rare cases, androgens are released by the body during a normal pregnancy that can result in unsteadiness of the voice, rapid changes of timbre, and lowering of the fundamental frequency (pitch) of the voice. The androgenic changes will be permanent, so the new voice will have fewer high notes available and deeper and fuller low notes than prior to the androgen being introduced into the system. However, it has been possible in some cases to return singers with androgenic voice changes to a professional singing career.

As you may have guessed, abdominal distention during pregnancy can interfere with abdominal muscle function and support of the voice. The abdominal distention can also significantly alter posture and alignment for optimal connection to your breath. This would be reason enough to seek out a certified Alexander Technician to help you adjust to your new balance and alignment. It would be important, also, to work with a voice teacher you trust to help optimize abdominal support. "Any singer whose abdominal support is compromised substantially should be discouraged from singing until the abdominal disability can be resolved."1 This recommendation is made to prevent possible acute injuries to the vocal fold tissues by imposing significant pressure on the vocal folds through compensatory mechanism to help create the sound that is acceptable to the singer. Some singers sing through their entire pregnancy with adequate support, and others run into difficulties in the fourth and fifth month of pregnancy.

The other aspect of abdominal wall changes is the after delivery re-conditioning process. Remember that it will take some time to get your abdominal muscles to return to normal, so plan on specifically targeting these muscles in a strength and conditioning program. Singing is one good way of doing this. Other ideas, pending your Obstetrician's ok, include leg lifts and crunches and Pilates work.

Gastroesophageal Reflux Disease (GERD) is a problem that many pregnant women experience, but is seen even more often in pregnant singers. Reflux occurs when the lower esophageal sphincter (the little one-way valve from the esophagus to the stomach) weakens and allows stomach contents, including stomach acids/juices to escape into the esophagus and as high up as the pharynx (back of the throat) and the larynx. GERD can be a problem for singers, as it is a constant irritant to the back of the throat, and occasionally can promote coughing or a tickle in the throat when singing. Merely the presence of reflux can trigger compensatory behaviors that promote tension in the throat, head/neck, jaw and tongue-base. Ultimately, the compensatory behaviors create work during singing, making the singing process more effortful and puts the performer at a greater risk for sustaining a phonotraumatic (damage to the vocal fold mucosa) injury.

Facial paralysis (usually on one side of the face) can be precipitated by pregnancy, although not commonly. This condition, sometimes called "Bell's Palsy" is generally a temporary one, (typically resolves within a year) but can be devastating for a singer, as this kind of paralysis creates cosmetic and functional difficulties for articulation, resonance, and stage presence issues. Typically, the affected side droops, the eye cannot close fully which leads to dryness, and the corner of the mouth does not seal, which can cause drooling and imprecise articulation.

Not surprisingly, interrupted sleep patterns, scheduled feedings, and a new life adjustment can cause fatigue and stress. Fatigue/stress impacts the voice as a whole-body issue. When you are fatigued and stressed, you have less energy to give to yourself for practicing and performing. Your energy is primarily directed toward your new child and his/her needs. You also have to adjust to carrying around car seats and toys, diaper bag, and child. That can be extra weight your body is not used to. Balance the weight across your body. Do not put all the weight on one side, as it can cause an imbalance in the larynx. Be smart about how you lift heavy objects. Do not hold your breath, or you may injure your vocal fold tissue, particularly if you vocalize while doing so.

Click here for "Breastfeeding and the Voice"

References

1. Sataloff RT, Emerich KA, Hoover CA. "Endocrine dysfunction" In: Sataloff, RT ed. Professional Voice: The Science and Art of Clinical Care, Singular Publishing Group, Inc., 1997, pp.293-295.
2. Brodnitz F. Hormones and the human voice. Bull NY Acad Med. 1971; 47:183-191.
3. Abitbol, J, de Brux J, Millot G, et al. Does a hormonal vocal cord cycle exist in women? Study of vocal pre-menstrual syndrome in voice performers by videostroboscopy, glottography and cytology on 38 women. J Voice, 1989; 3:157-162.

Kate Emerich, B.M., M.S., CCC-SLP Voice Pathologist and Singing Voice Specialist at the Wilbur James Gould Voice Center, a Division of the Denver Center for the Performing Arts and site for the National Center for Voice and Speech, has worked extensively with healthy and injured voices, specializing in the care of the injured speaking and singing voice. She completed a degree in vocal performance before completing her master's degree in communicative disorders at the University of Wisconsin-Madison, and continues to sing professionally. She spent l993-l998 working with Drs. Robert T. Sataloff, Joseph R. Spiegel, and Karen M. Lyons in Philadelphia in a private practice specializing in care of the professional voice. Kate has published numerous articles regarding voice and singing voice issues and lectures frequently to young singers on the care of the voice and prevention of voice problems. She is an internationally recognized clinician in the area of voice disorders. Copyright © 2000 The National Center for Voice and Speech