When we imagine having a baby, our minds create narratives about the hoped-for child. Along with the child we envisage raising, we hold scripts about the kind of parents we hope to be.

Then we become pregnant, and these fantasies intensify.

The narratives we hold are formed by our past, and by the meaning we derived from the relationships we’ve experienced and observed. We unconsciously amass information and draw conclusions about parents and children, family compositions, siblings, and the meaning of gender within these relationships.

When we find out the sex of our baby (whether in utero or after birth), this intricate web of preconceived ideas springs to the surface. Stories about ourselves, our relationships, our fears, our regrets, and our desires. Some or all of these things can be wrapped up in our perceptions about the sex of our baby. 

Not everyone has a strong preference for the sex of their baby, but for some women (and less commonly, men), the gender of their baby is steeped in personal meaning. When the baby is not the hoped-for daughter or son, some people experience mild to extreme disappointment, grief, and even depression.

Before you judge with “surely a healthy baby is all that matters”, let’s make it clear that a healthy baby is the wish of all parents. But for some parents, the meaning of their baby’s sex is so deeply-rooted in their psyches that the loss of their hoped-for child can be devastating.

To truly understand gender disappointment and the grief women can experience, we need to respectfully understand the particular meaning for the individual. People’s reasons and stories differ uniquely. However, there are some common themes.

The themes
From the vast response I received to my Facebook post (both publicly and privately), there were some noteworthy themes.

1. Gender disappointment appeared to be more commonly experienced by women. A small proportion of women spoke about their male partners’ gender disappointment (equally in relation to wished-for boys as compared to wished-for girls). 
2. The majority of women’s gender disappointment was in relation to the preference for a girl. This was followed by the preference for one of each sex. And less commonly, by the preference for a boy.

The wish for a girl was associated with the following narratives:

• I grew up with sisters. It’s what I know.
• I never had a sister, and always longed for one.
• From a young child, I imagined having a daughter.
• I had a close relationship with my sister but not my brother.
• I have a close relationship with my mum and want to replicate this.
• I have a poor relationship with my mum and want to repair this.
• My brother has a terrible relationship with my parents.
• I am a feminist and work in a female dominated industry. Being a woman is a strong part of my identity.
• I lost a boy, and I want a girl so that I don’t feel like the next baby replaces the baby who died.
• I’ve seen families where the sons have poor relationships with their parents as adults, and I’m fearful this could happen with boys.
• We only want one child, and I want a girl so we can be close. 
• I identified very much as a ‘girlie girl’ when I was growing up, and I want to share this with a daughter.
• I feel like a female will look after me when I’m old, much more so than a male.
• I want to be part of a daughter having her own family (rather than being the mother-in-law who might struggle with a daughter-in-law who prefers her own mum).

The wish for one of each was associated with the following narratives:

• I desperately want the experience of being a parent to both sexes.
• I want my partner to have a boy/girl.
• I have a picture of what each child would share/experience differently with each parent.
• I have a brother, and I loved that.
• I had a competitive relationship with my sister so I want there to be one of each.

The wish for a boy was associated with the following narratives:

• I’d always seen myself as a ‘boy mum’.
• I had an awful relationship with my mum and always hoped for boys because of this.
• I grew up having male friends. I was sporty and not a ‘girlie girl’.
• I didn’t want my child to go through what I went through as a teenager, and I thought a boy would have less social issues.
• Life is simpler with boys. Girls are more complex, especially in the teenage years.
• I had a very close relationship with my brother.
• I am close to my dad, and we are very alike.
• I lost a boy and want another boy.
• I lost a girl and want the opposite sex to the baby I lost.
• I wanted a brother for my son.
• For cultural reasons.

 “Why can’t you just be happy to have a healthy baby?” (A common judgement)
As indicated by the women who responded to my post, gender disappointment does not negate their appreciation and gratitude for a healthy baby. Nor does it (in most cases) preclude loving the baby who was born. 

The disappointment and grief is about the baby who was not born, the baby who had been yearned for and mentalized, in some cases from as far back as a woman can remember.

Extrapolating from the many reasons women offered for their gender disappointment, I propose that these feelings can be understood by three types of projections:

1. REPLICATION
Women seek to replicate what they experienced or witnessed, because it was positive.
2. REPAIR
Women seek to repair what they experienced or witnessed, because it was negative.
3. REFLECTION OF SELF
The wished-for child is a reflection of the woman’s perceptions of self (identity, regrets, hopes, fears, dreams).

The grief associated with gender disappointment is real, and can run deep.

The grief
When the sex of one’s child is opposite to that of the wished-for child, and the family composition differs from the imagined picture, there is a loss of a strongly held ideal. An ideal that may sit alongside one’s self-identity (including one’s cultural identity) and one’s amalgamated past. When this is the case, the depth of grief may be intense.

Sadly this grief tends to be disenfranchised. Most women believe that other people don’t understand their distress (and indeed, many people do not), so they grieve alone or minimise their feelings to reduce cognitive dissonance.

Women often feel ashamed and guilty for their feelings of disappointment. They judge their feelings as unjustified because they haven’t lost a ‘real’ baby. And when they have lost a baby or have experienced fertility difficulties, the guilt and shame can be worse.

Beneath their shame there may be questions like these: 

• “Shouldn’t I just be happy to be pregnant?”
• “If I feel sad that I’m not having the gender I wanted, does this mean I won’t love my baby?” 
• “If I express my feelings to other people, will they think I’m a horrible mother?” 
• “If I express my feelings to others, will they be offended thinking that I’m judging the sex of their child?” 
• “Do these feelings make me an awful person?”

The grief from gender disappointment needs time for reflective processing to acknowledge and work through the feelings and layers of loss. 

How does therapy help?
In some cases, the feelings can be overwhelming and may affect a woman’s mental health and her capacity to bond with her baby. Therapy can be a helpful way to learn to see and appreciate the arrived baby for the unique individual they are, whilst recognising that it’s okay to mourn the loss of the idealised baby.

Therapy can also help women to examine their assumptions and biases about gender, and the meaning they’ve attributed to it through the lens of their past.

The truth of the matter
The truth is that our narratives are not truths. Our narratives are stories we’ve compiled over the course of our lives. These stories are based on subjective conclusions we’ve drawn about boys and girls, sons and daughters, sisters and brothers, in the context of our own history.

As we parent the children we have, we grieve many idealised images or expectations along the way. There are all sorts of things parents wish for in their children that may not come to fruition. Who they are, how they think, what they do, can differ considerably from what we had hoped for and from who we are.

Once again, our unconscious wishes to replicate, repair and reflect ourselves, stem from the experiences and meaning derived from our pasts. 

In essence, parenting is a constant process of recalibrating what we wished for in accordance with what we have. Ultimately, when we are not blinded by our projections, we free ourselves to accept and cherish our children for the unique individuals they are.  

This doesn’t mean we don’t have pangs of sadness, wondering what life would be like with that dreamed for little girl or little boy. But when we acknowledge our grief and accept our reality, we can more readily foster the kinds of relationships and experiences we value with our children, irrespective of their assigned sex.

This article was written with stories shared both publicly and privately on the Facebook page of the Antenatal & Postnatal Psychology Network.

Compiled and written by Dr Renée Miller, with gratitude to the many women who shared their feelings and experiences on this deeply personal topic.
Principal Perinatal Clinical Psychologist
Antenatal & Postnatal Psychology Network

Conception, pregnancy, childbirth, the postnatal period, and the early parenting years can pose difficulties for many people. Researchers and practitioners need to stay abreast of the experiences people face to continue to update their understanding of how best to support people with such challenges.
 
Back in 2001, over 300 new mothers participated in my research study - for which I will be eternally grateful. As a result, the findings of this research furthered our understanding of postnatal anxiety, at a time when postnatal depression had received the preponderance of postnatal research, and anxiety was conspicuously lacking in research attention. 
 
Ongoing research is vital for practitioners and policy makers to integrate people’s lived experiences into the work and support they provide. 

The psychologists at the Antenatal & Postnatal Psychology Network are passionate about facilitating the collection of data for researchers whose research studies support the mental health of perinatal women, men, couples and ultimately, children. 

How you can help
Do you have some time to participate in a research study that could further inform practitioners who work with hopeful parents, pregnant women, birthing women, women and partners in the postnatal period, and early parenthood?
 
The Antenatal & Postnatal Psychology Network provides an online research portal for academic researchers (in the perinatal field) to post their studies, giving visitors to the APPN site the option of supporting research, and striving for further meaning from their personal experiences. 

Studies requiring participation
 
Under each listed study, you will see the participants being sought. If you meet the criteria for participation, you will find links to the study on our website here.

Charles Sturt University investigating childbirth experiences and trauma in first time mothers.
Participants required: First time mothers over 18, who have given birth over one month ago at 37+ weeks gestation.

University of Queensland investigating resilience to stress, in families following preterm birth.
Participants required: Parent of a preterm infant, child, or adolescent who is now 0-18 years of age.
 
QUT Investigating how mothers use social media and what effects social media use can have on mothers. Participants required​: Mothers of children aged between 0-4 years. 
 
Melbourne Uni undertaking Delphi expert consensus study: Establishing expert consensus about interventions for preventing and ameliorating the impact of Adverse Childhood Experiences.
Participants required: Health practitioners, educators, policy makers, researchers or program managers whose work relates to family or child health and well-being in Australia. 
 
Royal Women’s Hospital & Monash University evaluating different approaches to improving sleep for first-time mothers who currently experience sleeping difficulties.
Participants required: First-time mothers who are less than 32 weeks pregnant and currently experiencing sleep difficulties.  

University of Adelaide investigating experiences of Secondary Infertility: Emotions, Support and Coping Strategies.
Participants required: Women and/or their partners who have tried unsuccessfully to conceive for at least 12 months after having had a successful pregnancy/pregnancies. 
 
University of Adelaide LGBTQI+ Experiences of Pregnancy Loss: Perceptions of Formal and Informal Support and the Impact on Mental Health.
Participants required: People who identify as LGBTQIA+ who have experienced pregnancy loss more than 6 months and less than 10 years ago. 
 
University of Melbourne investigating women’s and men’s experiences of miscarriage, with the ultimate goal of ending the silence around miscarriage.
Participants required: Women, partners and family members affected by miscarriage more than 3 months ago but within 2 years. 
 
Monash University. This study aims to understand how the brain changes in the transition to motherhood. Participants required: First-time mothers 10-14 months postpartum with or without a diagnosis of postnatal depression. 
 
University of the Sunshine Coast exploring the impact that fertility issues have on Australian's women's quality of life whilst trying to conceive.
 Participants required: Women currently trying to conceive, experiencing fertility difficulties. 

Deakin University investigating whether late pregnancy affects women's cognitive functioning.
Participants required: 20 women in their third trimester of pregnancy and 20 women who are not pregnant, have never been pregnant and are not planning to become pregnant in the next 12 months. 
 
Latrobe University aiming to understand factors associated with well-being in same-sex attracted women during the perinatal period, to improve services for this group.
Participants required: Same sex attracted pregnant women and new mums​. 
 
Curtain University aims to establish a set of clinical guidelines for health professionals on the assessment, treatment, and management of individuals with perinatal OCD.
Participants required: Parents with personal experience of perinatal OCD, and clinicians/researchers with expertise in perinatal OCD. 
  
Swinburne University explores the potentially different postnatal experiences of First-Time and Experienced Mothers, including well-being, feelings about motherhood and perceptions of Maternal and Child Health Nurse support.
Participants required: All mothers who have had a baby within the last 2 years, are over 18 years of age, living in Australia, and speak fluent English. 
 
University of Liverpool is looking at how infant feeding attitudes change from pregnancy to the postpartum period. 
Participants required: Women in the third trimester of pregnancy (over 35 weeks). 
 
University of South Australia is looking at whether what you eat in pregnancy affects your mood during pregnancy and after.
Participants required: Women who are 8-15 weeks pregnant at the start of the study (now). 
 
Bond University is conducting research on couples experiencing infertility in order to contribute to the development of helpful fertility related psychological support programs.
Participants required: Couples experiencing infertility. 
 
CQ University's study Experiences of Pregnancy and the Year After Birth, is being conducted to further improve screening and treatments for perinatal mood disorders.
Participants required: Women over the age of 18, who are currently pregnant or have given birth in the last 12 months. 

Please click here to check your eligibility to participate in one of the listed studies.

Your experience could make an enormous difference to the experiences of others.

Thank you for your consideration and potential contribution towards these important research studies.

Dr Renée Miller
Principal Clinical Psychologist
​Antenatal & Postnatal Psychology Network and The Perinatal Loss Centre
 

 "I never expected to be flooded with so many emotions".
"I feel intensely protective and utterly fearful".
"I feel helpless and sometimes, useless".
"I have this constant worry that something bad is going to happen".
"I was traumatised from seeing my partner in labour, but I knew I had to be strong for her".
"Work seems irrelevant but I feel a pressure to perform because my family is depending on me".
"I don't know who I am anymore".
"What's happened to my wife?"
"I feel exhausted all the time".

These are just some of the thoughts and feelings men have shared in the therapy rooms of the Antenatal & Postnatal Psychology Network.

Depression, anxiety and stress is common in new dads, but the focus is often on new mums. This can mean that dads feel unjustified in seeking help, and worse still, they feel like seeking help in some way implies weakness.

New parenthood is a developmental stage (just like toddlerhood, adolescence, adulthood). With it comes change, uncertainty, new learning, and a need for re-definition (both for the self, and for the couple relationship). Struggling is par for the course. 

New parenthood forces people to acknowledge the ways in which they were parented. This can be confronting, and can present challenges for new parents, especially when their parenting backgrounds were difficult, traumatic, or significantly different from that of their partners'. Some men feel paralysed with fear about parenting like their own parents, but don't know how to do things differently, especially in the toddler years. Parenting support and guidance can make an enormous difference.

Some men struggle because their partners become unwell in pregnancy or the postnatal period (with depression, anxiety, stress or in rare cases, psychosis). We often see men who have 'held the fort' while their partners were being treated, who then 'hit the wall' themselves - buckling under the unexpected pressure of taking care of their partners and babies, while trying to function at work.

Speaking to a mental health professional is about resourcing yourself to better manage in this new life role. Arguably, the most important role of your life. As the Royals William, Harry and Kate discuss in this youtube video, "talking is medicine".
www.youtube.com/watch?v=45RqUmxDXiY

If you are struggling as a new dad, you can contact the phone counsellors at PANDA on 1300 726 306, see your GP, or seek the help of a psychologist. You may have a work Employee Assistance Program (EAP) that you could access.

Centre of Perinatal Excellence (COPE) offers free emails to new dads (synced with the stage of fatherhood they are at), with trustworthy and supportive insights, strategies and advice. Dads can sign up for their emails here:  www.cope.org.au/readytocope/

If you're interested in reading quality parenting articles (curated by a Clinical Psychologist), you can follow the Facebook Page of the Antenatal & Postnatal Psychology Network. Stay informed about evidence-based parenting approaches that support you through the challenges of parenthood (especially through the toddler years).

You could also follow Dr Matthew Roberts's Town Hall Dads Facebook page - dedicated to fathers.

Written by Dr Renée Miller
Principal Clinical Psychologist
Antenatal & Postnatal Psychology Network

If you've become a parent, you're likely to have been catapulted into a vastly different life to the one you had before. A new identity, new roles responsibilities and routines, and lots of questions about how you're going and how you're feeling as a parent. Parents often look to other parents or professionals for good quality information to help guide them in both their parenting and in their life adjustments.

The psychologists from the Antenatal & Postnatal Psychology Network have compiled a list of resources that we recommend to our clients, that you might find helpful.

The Ted Talks We Love is an ever evolving page on our website that lists Ted Talks on topics such as building emotional security and resilience in children; self-compassion and self-esteem; managing anger; the strength in vulnerability; the pressures of modern day life and the importance of slowing down; and understanding introversion.

These Ted Talks can be found here.

We also have a selection of videos that cover topics of mental health in new parents, and parenting.
These videos can be found here.

Hope you find these resources helpful.

​Dr Renée Miller
​

Insomnia in pregnancy and in new parenthood can be torturous. Many women present to our service with frustration and exhaustion related to insomnia. Women report feeling 'tired but wired', with increasing pressure to sleep when they can, and resulting low mood or anxiety when they can't. The 'bedtime battle' can become an anxious loop of fearing not sleeping, imagining not coping the next day, thereby stimulating the brain in ways that ignite alertness, and prohibit sleep. Interestingly, little research has been done in this area.

Sleep experts and researchers at the Royal Women's Hospital and Monash University are investigating this phenomenon in their efforts to design treatments that best support women to manage sleep disturbances. They are seeking participants for this important research. Can you help?

The SMILE Study is recruiting first-time mothers who are less than 32 weeks pregnant.

As a part of the project you will be allocated to 1 of 3 sleep programs and receive either:
1. A new ‘smart’ bassinet designed to help baby’s sleep.
2. Sleep information and strategies via email at 6 different times during pregnancy and after your baby is born.
3. A booklet containing sleep information and sleep hygiene.

The programs are completely free, and you can receive up to $60 in gift vouchers as a token of thanks for participating. 

All aspects of participation are completed from the comfort of your own home via the internet or telephone!

For more information and sign up, click on the link below.
https://redcap.cdms.org.au/surveys/?s=MN8MX3RPDY
Royal Women’s Hospital Human Research Ethics Committee Number: 19/17

In the craziness of COVID-19, people have had to adjust their coping skills in order to manage the stress and uncertainty that this pandemic brings. While recognising what is in and out of our control, we've had to rapidly adjust our homes, routines, and minds to optimally cope at this difficult time.

The psychologists from the Antenatal & Postnatal Psychology Network have put together a series of posters to help you to be a COVID-19 coper.

​These posters can be downloaded here.

You are parents now, and things have changed with your mother in law.

As a psychologist who specialises in working with new parents, I often hear stories about fractured relationships with mothers in law once a baby comes along. Here are some of the reasons why.

I feel constantly criticised by my mother in law. She often says "when MY kids were little...
You can finish that sentence with any number of things her children did perfectly (compared to mine).

My mother in law makes snide remarks about how uptight we are as parents. It seems that anything we do with our baby - that differs to what she did - is about us being anxious parents.

I'm exhausted, and doing my best to manage the house, parenting and work. But somehow, I always fall short in my mother in law's eyes. In her recollection, her house was perfectly organised, and her children were perfectly behaved at all times. 

My mother in law runs a commentary about me through my children. "Oh, no, look mummy has made you cry again". She buys their affection by undermining me. It's infuriating. All I'm doing is setting boundaries for my children, and their grandmother tries to collude with them against me.

My mother in law tells me I'm pandering to my son, and that he's going to grow up being a weakling. My partner and I are parenting consciously. We are aware that our son has a sensitive temperament, and we are showing him that we understand his difficulties, while empowering him to try new things. My mother in law thinks we should push him more. She says things to him like "come on, don't be a cry baby".

We are a same sex couple. My mother in law constantly comments on how much our child looks like her daughter (the biological mother), and how lucky our daughter is to have her family's genes. I find this insensitive and cruel.

The thing that drives me crazy about my mother in law is that she thinks she's the expert on feeding, sleep and safety. With no knowledge of current practices, she harps on about how things were done in her day. My wife and I pride ourselves on being informed about these things, and of course, we want what's best for our child.

My mother in law competes with my mother. It's at the point that I have to hide and lie about some of the things I do with my mum. It started with my mother in law wanting to be in the birth. We said "no". Since then she has demonised me and blamed me for leaving her out of things. My own mother was not at the birth. She now calls my husband at work to complain about how little time she gets to see her grandchild.

​The difficulties I'm having with my mother in law are causing problems in my relationship.

These are just some of the example of what people say.

Can you relate?

Part of my role as a psychologist is to help new parents to do three main things:

1.  Differentiate your sense of worth from the comments or judgements made by your mothers in law.

2. Understand what your mother in law is saying about herself through her comments, rather than personalising her comments to mean something about you.

This can be hard when you're a sleep deprived parent who is trying your best to manage the demands of a new baby, and determine how you want to parent. When there is a mother in law offering gratuitous advice, you may feel disempowered, feel like avoiding her, or quite frankly, enraged.

Even if your mother in law is overtly critical of what you are doing as a mum, REMEMBER THIS:

• She parented a long time ago. Things have changed.
• She may want to prove to you that she did a great job parenting her own children.
• She may recognise she did a less than ideal job raising her children, and may be seeking to repair this by getting it right with her grandchildren - resulting in her over involvement.
• She may interpret that the way in which you are parenting (that differs from how she did things) is somehow a slight on the way she parented, therefore fuelling her advice, criticism or defensiveness.
• In all likelihood, she thinks she's being helpful.
• She may have a high need to be needed.
• She may have a high need for control and order.
• She may be used to getting things her way.
• She may feel she is an expert because she's done it before.
• She may not have stopped 'mothering' her own children (and her grandchildren are an extension of this).
• Giving advice might be a way in which she manages her own anxiety.
• Being critical of you may be a reflection of her own self-criticism.

Take a deep breath. It's your turn to parent now. You get to choose how you want to raise your child/children. To do this, it's important to be clear on your values as a parents, and for you and your partner to be on the same page.

3.  Learn how to communicate assertively with your mother in law. This means respecting her view (recognising where it may be coming from). Then, confidently thanking her for her advice, while stating how you and your partner are choosing to parent. This may be different from her 'pearls of wisdom', but it's your child, your family. Also, be sure to thank her and let her know when her advice is helpful, bearing in mind that she does have experience as a mother, and we as parents, will never stop learning.

Written by Dr Renée Miller
Principal Clinical Psychologist
Antenatal & Postnatal Psychology Network
​The Perinatal Loss Centre

Miscarriage is commonly dismissed as the 'loss of a pregnancy'. For happily expectant parents, miscarriage is the loss of their baby. It represents a loss of parents' hopes, dreams, and future plans. For many people, the idea of parenthood is conceived some time in their early lives. Although the timing of these inklings differ for different people, there are unconscious stories people amass as they themselves were parented, and as their developing selves evolve over time. A kind of knowing that one day, they too will become parents. For some people, an opportunity to rectify or better the less-than-ideal parenting they received.

Often the work lives and the intimate relationships of hopeful parents have come to a point where there is an existential readiness for children. A baby becomes nurtured in their minds. The woman's body is primed to create and protect a precious new life.

Once pregnant, a woman (and couple) typically begin to imagine their new lives. Anchored by the due date of their baby and alongside the lifestyle sacrifices made for optimal gestation, they begin to integrate their baby into their decision-making, into their future plans, into their homes, and into their families. Once announced, the broader family narrative may begin to incorporate the baby.

When a pregnancy ends in miscarriage, the physical and emotional ramifications can be devastating. The baby conceived of in body and mind, has died. The process of miscarrying can be painful, protracted and traumatic. The woman may have felt or seen her tiny baby, and she may regret where her baby ended up. Most people are unaware of what a woman might have experienced in the midst of miscarrying, and may have no idea about the depths of her grief over the loss of her child.

When miscarriage happens repeatedly, hopes are raised and dashed time and time again. The accumulation of loss and grief can be crippling, with plummeting self-worth, and for some women, increased self-blame, hopelessness and depression.

​Women often remark that they observe other women seemingly 'popping out' babies with little effort. Pregnancy and babies everywhere. There is no escape from the enthusiastic pregnancy and birth announcements. And even worse, the unplanned, 'surprise' pregnancies that can engender a silent rage in the bereaved parent, who is acutely aware of the inequities of parenthood.

How easy it seems for others. How alone the woman feels. So desperately wanting to settle into the next phase of life. Wanting what everyone else seems to have. Feeling guilty for her envy. Avoiding her usual supporters, for fear of her inability to conceal her grief. Questioning what she is doing wrong, and why this is happening to her. 

The staggering truth is that at least one in four pregnancies end in miscarriage. The sad reality is that many women don't talk about it. The secrecy surrounding miscarriage is in part due to the convergence of women's perceived shame (as if in some way it is their fault), and society's minimisation of the loss not being as valid as the loss of a living child.

As a result, isolation can accompany the pits of grief, maintaining the illusion that other women and couples - seemingly unaffected by loss - conceive easily, and give birth to healthy babies. This misguided belief ultimately reinforces the perceived shame, and renders the bereaved parent alone in their mourning, believing that no one really understands what they are going through.

​Interestingly, when women open up about miscarriage, they are often surprised, and comforted by the number of other women who have also experienced loss. Women can find some solace in online support groups, but the supportive nature of these groups is time limited, as people's situations change.

Miscarriage brings emotional implications for subsequent pregnancies. Although relieved to be pregnant, the woman no longer feels the unbridled joy she may have once felt. Instead, there can be questions, doubts, fears and anxieties. Thoughts and feelings that need to be managed, milestones that need to be passed, uncertainty that needs to be endured, and hopes and dreams that need to be quelled.

This is the devastation of miscarriage. 

If you are reading this because you have experienced miscarriage, we are so sorry for your loss. 

If you are interesting in supporting research into miscarriage, find out more here. 

Written by Dr Renée Miller
Principal Perinatal Clinical Psychologist
Perinatal Loss Educator
Co-founder The Perinatal Loss Centre, Melbourne, Australia
Founder Antenatal & Postnatal Psychology Network, Melbourne, Australia

Pregnancy is a time of great uncertainty - a time when horror stories are rife and fears about harm befalling one’s baby, 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 pre-dispose women to heightened anxiety in pregnancy, especially in the face of stressful life events.

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, and sleep disturbance (Wenzel, 2011).  

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 postpartum.  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.  

Written by Dr Renée Miller
Principal Perinatal Clinical Psychologist
Founder Antenatal & Postnatal Psychology Network
Co-founder The Perinatal Loss Centre

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.