Helping your anxious pregnant patients

Pregnancy is a time of immense uncertainty for women - a time when horror stories are rife and fears about harm befalling one’s baby, palpable. Antenatal anxiety is common, and can present as constant reassurance seeking from health professionals.
Anxiety can be significant for women who have a) experienced pregnancy losses (or vicarious losses through family or friends); b) been through the ‘roller coaster’ of fertility treatment; c) received diagnoses of fetal anomalies; and d) experienced a previous traumatic birth. In addition, an anxious temperament can pre-dispose women to heightened anxiety in pregnancy and the postpartum, especially in the face of stressful life events.
Although anxiety is commonly seen as the 'normal' emotional landscape for pregnant women, elevated levels of anxiety can be debilitating, and not surprisingly, can contribute to a trajectory of emotional disturbance in the postpartum.
Symptoms of antenatal anxiety can be overlooked by common symptoms of pregnancy such as increases in heart rate, shallow breathing, and sleep disturbance (Wenzel, 2011). Wenzel (2011) suggests that clinical anxiety can be efficiently identified by asking women whether their fear, worry or symptoms (if indeed they are displaying such) are causing them life interference (e.g., avoidance of usual activities, relationship problems, sleep disturbance) and/or distress (e.g. upsetting or intrusive thoughts or symptoms).
So, how do you determine this when many women conceal the extent of their anxiety with health practitioners? Apart from anxiety that women openly disclose (i.e., panic attacks, distressing thoughts, extreme worry/fear, a personal history or family history of an anxiety disorder and/or depression), there are some clues that might signal further enquiry:
Women can be reassured that they do not need to experience high levels of anxiety and worry in pregnancy or the postpartum, and that help is available for them to learn how to manage both the physiological aspects of anxiety and their fearful cognitions. Early intervention can reduce the impact of maternal anxiety on the baby, and can lessen the likelihood of future episodes of distress, most importantly in the postpartum (Wenzel & Kleiman, 2015).
To provide your patients with information about Melbourne Clinical Psychologists who can assist with antenatal anxiety, order free flyers for your practice here, from the Antenatal & Postnatal Psychology Network.
Wenzel, A. (2011). Anxiety in childbearing women. Washington: American Psychological Association.
Wenzel, A. & Kleiman, K. (2015). Cognitive Behavioral Therapy for perinatal distress. New York: Taylor & Francis.
Anxiety can be significant for women who have a) experienced pregnancy losses (or vicarious losses through family or friends); b) been through the ‘roller coaster’ of fertility treatment; c) received diagnoses of fetal anomalies; and d) experienced a previous traumatic birth. In addition, an anxious temperament can pre-dispose women to heightened anxiety in pregnancy and the postpartum, especially in the face of stressful life events.
Although anxiety is commonly seen as the 'normal' emotional landscape for pregnant women, elevated levels of anxiety can be debilitating, and not surprisingly, can contribute to a trajectory of emotional disturbance in the postpartum.
Symptoms of antenatal anxiety can be overlooked by common symptoms of pregnancy such as increases in heart rate, shallow breathing, and sleep disturbance (Wenzel, 2011). Wenzel (2011) suggests that clinical anxiety can be efficiently identified by asking women whether their fear, worry or symptoms (if indeed they are displaying such) are causing them life interference (e.g., avoidance of usual activities, relationship problems, sleep disturbance) and/or distress (e.g. upsetting or intrusive thoughts or symptoms).
So, how do you determine this when many women conceal the extent of their anxiety with health practitioners? Apart from anxiety that women openly disclose (i.e., panic attacks, distressing thoughts, extreme worry/fear, a personal history or family history of an anxiety disorder and/or depression), there are some clues that might signal further enquiry:
- Excessive calls or appointments to check that the baby is ok
- Constant questions about what the woman has eaten or been exposed to, and the possible harm to the baby
- Questions that signal worry about bad things that could happen (“what ifs”) when there is no evidence for such
- Sleep disturbance (over and above pregnancy discomfort)
- Pressured speech
- Avoidance (e.g. of social activities, work, public transport, etc.)
- Apprehension or ambivalence around bonding to the baby or feeling positive about the pregnancy
- Obsessive information seeking (e.g. internet, books) and distrust of your advice
- High need for control
- Excessive fear of childbirth
- Observable or reported relationship tension related to the woman's worry
Women can be reassured that they do not need to experience high levels of anxiety and worry in pregnancy or the postpartum, and that help is available for them to learn how to manage both the physiological aspects of anxiety and their fearful cognitions. Early intervention can reduce the impact of maternal anxiety on the baby, and can lessen the likelihood of future episodes of distress, most importantly in the postpartum (Wenzel & Kleiman, 2015).
To provide your patients with information about Melbourne Clinical Psychologists who can assist with antenatal anxiety, order free flyers for your practice here, from the Antenatal & Postnatal Psychology Network.
Wenzel, A. (2011). Anxiety in childbearing women. Washington: American Psychological Association.
Wenzel, A. & Kleiman, K. (2015). Cognitive Behavioral Therapy for perinatal distress. New York: Taylor & Francis.