Anxiety in pregnancy

Pregnancy is a time of great uncertainty - a time when horror stories are rife and fears about harm befalling one’s baby are common.

Anxiety can be particularly significant for women who have experienced pregnancy losses (or vicarious losses through family or friends); been through the ‘roller coaster’ of fertility treatment; received diagnoses of fetal anomalies; or who have experienced a previous traumatic birth. In addition, an anxious temperament can predispose women to heightened anxiety in pregnancy, especially in the face of stressful life events.

For some women, pregnancy can be a time of feeling an enormous sense of responsibility for the life of their baby. They can become anxious about what they eat, what they do, and can doubt their ability to keep their baby safe and thriving. Women often report feeling better when the baby is born and the responsibility for their baby's safety is shared.
 
Although anxiety tends to be seen as the 'normal' emotional landscape for pregnant women, elevated levels of anxiety can be debilitating, and can contribute to emotional disturbance in the postnatal period.  Symptoms of antenatal anxiety might be overlooked by common symptoms of pregnancy such as increases in heart rate, shallow breathing, nausea and sleep disturbance (Wenzel, 2011). 

Emotional symptoms

• Worry or fear, that is persistent and uncontrollable (often about the baby's health, own health, birth, becoming a parent).
• Feeling restless, unable to relax or on edge.
• Irritability or changes in mood.
• A sense of fear that something bad will happen. Dread.
• Racing thoughts. 
• Difficulty concentrating.

Physical Symptoms

• Faster than usual heart rate. 
• Rapid breathing.
• Shortness of breath.
• Lightheadedness of dizziness.
• Feeling tense.
• Irritable bowel or nausea (that are anxiety-related rather than pregnancy-related, which can be hard to disentagle).
• Difficulties sleeping. Fatigue.

Behavioral Symptoms

• Avoiding things out of fear.
• Seeking excessive reassurance from others.
• Compulsive checking (e.g., excessive monitoring of fetal movements).

Cognitive Symptoms

• Distressing thoughts that may be intrusive or repetitive.
• Even when reassured, worry returns quickly.

In order to identify whether symptoms are problematic, the questions for women to ask themselves and/or their health practitioners are 1.  "Are my symptoms interfering with my life (e.g., avoidance of usual activities for fear of feeling anxious, relationship problems, sleep disturbance, constant reassurance seeking)?" and 2. "Are my symptoms causing me distress (e.g. upsetting or intrusive thoughts and/or distressing symptoms in the body)?" (Wenzel, 2011).

Women do not need to experience high levels of anxiety and worry in pregnancy or the postnatal period.  Cognitive-Behavioural Therapy (CBT) can help women to learn how to manage both the physiological (body) symptoms, and the mental worry, which can contribute to a calmer pregnancy, birth, and adjustment to new parenthood. 
 
Perinatal Clinical Psychologist, Dr Renée Miller shares a practical video to help with managing worry:
Managing Your Mind: Taming Worry

References

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.