"What if" thoughts at the heart of anxiety

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Conception, pregnancy and new parenthood go hand in hand with uncertainty. Uncertainty can breed an environment of fear and worry, especially if a woman is biologically or psychologically vulnerable. Women struggling to conceive face the ultimate "what if" - "what if I can't fall pregnant?" Pregnant and postnatal women can find themselves stricken with endless "what if" thoughts about the safety or well-being of their babies. "What if" thoughts tend to be catastrophic imagined future outcomes. These thoughts are at the heart of what is often distressing and debilitating anxiety.

"What if I can't have children?"
"What if I fall pregnant, but something goes wrong?"
"What if I've eaten something that will harm my baby?"
"What if the fumes from that building site are toxic to my baby?"
"What if I have a stillbirth?"
"What if my baby gets sick because of something I did wrong?"
"What if my baby is getting into bad sleep habits?"
"What if my baby has a developmental delay?"
"What if I am a bad mother?"

According to a Harvard Health Publication, women experiencing infertility felt as anxious as patients diagnosed with cancer. Anxiety is reported to be higher in pregnancy than in the postpartum (Andersson, et al., 2006), with anxiety symptoms found in more than 25% of pregnant women (Ross & McLean, 2006). Significant anxiety during pregnancy puts women at risk for poor postnatal adjustment (Wenzel, 2011). And, anxiety in the postpartum can adversely affect the couple relationship, and the mother-infant relationship.
With or without full blown panic attacks, anxious women commonly report the following symptoms:

• Impending doom
• Dread
• Sick to the stomach
• Agitated
• Knot in the chest
• Heart flutters/palpitations
• Wired/trouble sleeping
• Fearful
• Nervous
• Shallow breathing
• Jittery

According to Wenzel (2011), a woman may be experiencing Generalised Anxiety Disorder (GAD) if she worries more than 50% of the time, especially if she cannot be reassured, she cannot control her worry, and when the worry interferes with her daily life. 
GAD and other anxiety disorders (Adjustment Disorder with Anxious Mood, Obsessive-Compulsive Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Social Anxiety Disorder) can be diagnosed and treated by psychologists or psychiatrists who specialise in pregnancy and the postpartum. With the use of medication and/or talking therapies (e.g., Cognitive-Behavioural Therapy), women can learn to manage "what if" thinking, and the associated physiological arousal, cultivating an optimal emotional environment for falling pregnant and enjoying their pregnancies and babies.
Written by Dr Renée Miller (perinatal clinical psychologist)

References
Andersson, L., Sundstrom-Poromaa, I., Wulff, M., & Astrom, M. (2006). Depression and anxiety during pregnancy and six months postpartum: A follow-up study. Acta Obstetricia et Gynaecological Scandinavia, 8, 937-944.
Ross, L.E., & McLean, L.M. (2006). Anxiety disorders during pregnancy and the postpartum period: A systematic review. The Journal of Clinical Psychiatry, 67, 1285-1298.
Wenzel, A. (2011). Anxiety in childbearing women. Washington: American Psychological Association.

http://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment