Contrary to the cultural fantasy (read: pregnant women living in bliss for all nine months of pregnancy), pregnant women experience a vast range of both welcomed and unwelcomed emotions as they prepare for their baby’s arrival. Anxiety is one of them. Feeling anxious while pregnant is not always a reason for concern about mental health or the ability to handle the demands of the postpartum period. Here is what you might like to know about anxiety during pregnancy and coping strategies to help alleviate it.
All pregnant women feel anxious
Being anxious is part of being human (though I genuinely wish it was not!). We all have worries about different aspects of our lives and experience a sense of restlessness, unease, and nervousness at times about things we cannot fully control. Anxiety is a sense of apprehension and concern about what is to come. Wouldn’t it be unusual if a pregnant woman experienced no concern about what was awaiting her — no fears related to sleepless nights, no questioning of what kind of parent she would become, how she would give attention and love to the infant without making her older child(ren) feel rejected, how she would face the financial burdens, and so on?
Anxiety can serve a useful purpose in pregnancy…
By helping women tune into what matters to them and make preparations to prevent or mitigate some of the anticipated challenges. Once she learned she was having a boy, my friend Lisa started reading books about effective discipline and even attended a workshop on this topic – all while still pregnant. This quieted her worry about being ill-equipped to handle a boisterous, active child, especially as she always envisioned herself as a mother to little girls. Another friend, Mary, was concerned about her post-pregnancy body and dealt with this anxiety by attending prenatal yoga classes. In the process, she met other women with similar concerns which also had the welcomed effect of making her feel more understood and ultimately more accepting of her changing body. Yet another woman, Mia, had a history of severe anxiety which flared up when she moved from San Diego to Chicago some years ago. Although she wasn’t feeling overwhelmed while pregnant, she very was concerned about symptoms returning during this period of transition. She found a good therapist and focused her attention on prioritizing her self-care and building a better support network. As you can see, anxiety is a call to action, and the action you take may actually result in an increased sense of wellbeing.
Anxiety is uncomfortable, especially during pregnancy
Have you ever met anyone who said: “I love feeling anxious!”? Me neither. When you are pregnant, you might find that your ability to tolerate this unpleasant experience diminishes further. It’s not surprising – your pregnancy forces you to tolerate so much as-is. You likely already feel stretched (literally and figuratively): all-day sickness, fatigue, mood swings, stress, unwelcomed comments from strangers, and surging hormones may leave you feeling vulnerable and slightly raw. One of my psychotherapy clients put it well when she commented: “My emotional sensitivity is like the crazy sense of smell I have now. The smell of coffee which I used to love makes me reach for the trashcan, but I could smell chocolate all day long. When I feel happy, it’s this ‘on-top-of-the-world feeling’, but when I am scared, it’s a freefall.” It’s hard to tolerate and cope with these present-moment experiences and also be in touch with the reality of not being able to anticipate exactly how your pregnancy will unfold, what childbirth will be like, and what kinds of experiences you will have as a parent.
Some anxiety is okay, but you need to seek help when it becomes too much
Since the purpose of anxiety is to make us more alert and try to resolve or avoid something that we are stressed out about, it is accompanied by a sense of agitation and readiness for action. In the ideal world, we would get to alleviate anxiety-provoking concerns and move on. But what if it is not clear what action we can take, or actions we take cannot possibly resolve all of the anxiety? Sometimes anxiety takes a life of its own and begins to threaten a woman’s wellbeing in ways that require help from a mental health professional.
One of my clients, Katie (name changed to protect confidentiality), had a history of two miscarriages and was anxious about the possibility of this happening again. Many pregnant women share and struggle with this fear. Although her obstetrician felt Katie did not need to limit her physical activity, she decided to stop exercising – just in case. She became picky about the food she ate. She tuned into every cramp and Googled miscarriage symptoms. Words of reassurance from her obstetrician were not soothing. She lived through the pain and grief of miscarriage and no one could reassure her it would not happen again. Reaching the second trimester provided no relief. It didn’t help that one of her good friends who was pregnant at the same time as Katie experienced stillbirth. She grew more agitated and exhausted, and her husband finally convinced her to see a therapist. Once her anxiety diminished, she said: “I don’t know what came over me; it was like I couldn’t stop spiraling.”
In order to distinguish whether anxiety you feel is just a normal, though unwelcome, companion of your pregnancy, or a clinical symptom that needs further evaluation by a mental health professional, consider four key dimensions of your experience: distress, intensity, frequency, and degree to which anxiety is interfering with your life.
Anxiety likely falls within normal range of experience if:
- you can still enjoy your life and be present to positive aspects of your pregnancy even when anxiety is present (distress dimension),
- you are able to control how you feel with some ease; anxiety is fleeting and diminishes considerably thanks to your coping efforts; it shows up in response to a particular stressor and feels proportionate to it (intensity dimension),
- you are able to experience a variety of other emotions and anxiety does not dominate your daily life; you are able to return to a state of relative calm which is much more frequent than the state of anxiety (frequency dimension),
- you are able to engage in and enjoy important aspects of your life such as relationships, work, hobbies, or other activities (interference dimension).
If you are concerned about any one of these four dimensions, it is a good idea to speak with your obstetrician or midwife, and consider seeing a mental health professional to determine the best course of action. The good news is that anxiety is very treatable! You should never try to power through all-consuming, painful anxiety symptoms. The postpartum period, with all its accompanying stressors, tends to aggravate pre-existing anxiety so it is wise to tackle it before you are a in a sleep-deprived fog. Common symptoms that suggest that further evaluation is needed include panic attacks, recurrent muscle tension or heart palpitations, constant worry, fear, restlessness, obsessive thoughts, and not enjoying things that used to make you happy. You deserve to feel better; speak up if any of these apply to you or there are other symptoms you are concerned about!
There are things you can do to feel better
There are many strategies that can help alleviate anxiety during pregnancy. Some will work for you while others might not. Keep searching for what works and commit to daily practice. Here are five things you can do to reduce anxiety:
- Breathe, meditate, and do yoga. Anxiety is all about the future (What if I am not a good mom? What if we hate being parents? What if the baby is not healthy?) and it causes a buildup of tension and other uncomfortable physical symptoms. Breathwork, meditation, and yoga lessen anxiety because they teach us that the only moment that exists is here and now and that this moment is worthy of our attention and can be inhabited fully. The practices also soothes the body, allaying some of the physical aspects of anxiety and also calming the mind.
- Examine your thoughts. When you are anxious, your thought process becomes riddled with so-called “thinking errors.” These are irrational thought patterns that, unchecked, will make you feel more anxious and down. For example, catastrophizing is a common thinking error. As you wake up to use the bathroom for the fifth time during the night, you might think: “I will never be able to sleep again!” and this can lead to rumination and distress about what is to come. Look up other common thinking errors (there are many!) and make an effort to arrive at more balanced ways of viewing the situation.
- Find your tribe. Regardless of whether you are expecting your first or fourth child, you are in the process of a sweeping life transition which is not meant to be faced alone. The more isolated, misunderstood or unsupported you feel, the greater the likelihood of feeling worried and apprehensive. Connect with other women who “get it” and are willing to be real and vulnerable with you. Join a prenatal yoga class or a mom’s support group.
- Welcome humor. Easier said than done when you are feeling anxious, but making efforts to embrace humor and look on the bright side has tremendous benefits. When we laugh, our muscles relax, stress hormones drop, and our outlook changes. Rather than viewing the world as a scary place, we notice that it can be safe and fun. We become more positive and upbeat. In fact, humor is a key characteristic of resilience. Smile more, read cartoons, watch comedies, play games with friends – basically, do more of what usually makes you laugh. And most importantly, set the intent to laugh more, including at yourself.
- Improve your self-care plan and follow-through. Do you eat balanced meals? Do you spend some time outside in the sun every day? Do you drink enough water? Do you get adequate sleep? Do you put your phone or tablet aside at some point in the evening? Do you have a good sleep routine? Likely you have answered “no” to at least one or more of these questions. Commit to improving at least one self-care area at a time and follow through.
The hard truth is that you will not be able to rid yourself fully of anxiety. Even if it were possible, it would not be a good idea since mild, transient anxiety is needed to help you anticipate challenges and problem-solve. This being said, excessive, unrelenting anxiety should never be accepted. Untreated, it can wreak havoc on women’s mood, bodies, relationships, and other important parts of life. Do not wait to take action if you are concerned about how you are feeling. Start by implementing some of the strategies we explored and monitor your progress. If anxiety persists and still troubles you, talk to your doctor, nurse, or doula. You deserve to thrive, mama!
By Aga Grabowski, MA, LCSW
Aga Grabowski is a co-founder and psychotherapist at Wildflower Center for Emotional Health, a mental health practice in Chicago that is on a mission to help women thrive in their journeys through motherhood. Aga is also a mom of two rambunctious boys and one ridiculously cute Great Dane puppy who just joined the family this March.
Note: The content provided here is for informational purposes only and was not designed to diagnose or treat a health problem or disease. Please consult your health care provider with any questions or concerns you may have about anxiety!
