Pregnancy is a time of enormous transition. Whether this is your first pregnancy or your third, pregnancy often comes with a roller coaster of emotions. Unsurprisingly, anxiety is a frequent one. Anxiety is a normal and expected part of pregnancy because it’s a normal, expected and necessary part of being a human. While some degree of anxiety is typical, if your worry is feeling all consuming, gets in the way of daily life or is impacting your sleep or physical health, you may have an anxiety disorder. Studies suggest that approximately 20% of pregnant people meet criteria for an anxiety disorder pregnancy (antenatal anxiety), and my clinical experience suggests this number is likely much higher.
As it turns out, pregnancy is an extremely vulnerable time for the development or resurgence of mental health concerns, including anxiety. While this may seem surprising, it makes sense given the confluence of physical, hormonal, psychological and identity changes that come with pregnancy. Additionally, for people who’ve experienced infertility, pregnancy loss or are navigating a high-risk pregnancy, the stress and trauma associated with these experiences can contribute to anxiety.
Common symptoms of anxiety during pregnancy can include
- cognitive symptoms such as worry
- rumination (often about the health of the developing fetus)
- poor concentration or a sense of dread or doom
- poor sleep
- rapid heart rate
- stomach aches
While most people will experience these symptoms some of the time during pregnancy, experiencing them persistently, intensely or for a long period of time differentiates more typical worry from an anxiety disorder.
Unfortunately, many people believe they should just “muscle through anxiety” or tell themselves “I’ll feel better when the baby is here.” Some have their symptoms dismissed or missed by healthcare providers. In fact, while it is common practice to screen for depression during pregnancy, it is not typical for providers to assess for anxiety. This concerns me greatly as research suggests that when severe anxiety during pregnancy is left untreated, there are clear risks to the developing fetus including low birth weight, intrauterine growth restriction, prematurity and maternal preeclampsia. What’s more, experiencing anxiety during pregnancy greatly increases the likelihood that you will experience it postpartum.
Whether you are experiencing a few worries or are coping with intense symptoms of anxiety, it is incredibly important to care for your mental health during pregnancy.
This starts with radical acceptance. It may sound counterintuitive to practice acceptance in the face of anxiety or any uncomfortable emotion. Your impulse may be to push it away, ignore it or fight it. If you’ve tried any of these strategies, you already know that they are largely ineffective and, in fact, tend to worsen anxiety. As previously mentioned, anxiety is a normal, human experience. As hard as we may try, we can’t get rid of it and we can’t ignore it. Our job is to learn to live and cope well in the face of anxiety, rather than trying to get rid of it.
Taking a stance of radical acceptance, acknowledging the emotional experiences we are having as they are, not as we wish they were, helps foster self-compassion and tends to turn the temperature down on the experience. You can start by saying to yourself “I’m having a hard time right now” or placing your hand on your heart in a gesture of compassion. Remind yourself this is a normal part of being a human and an expected part of pregnancy.
Mindfulness is also an incredibly powerful tool to help manage anxiety. While anxiety is very much about future worry, getting caught in spiraling thoughts and feeling unable to tolerate distress, mindfulness is about slowing down and paying careful, non-judgmental, attention to the present moment. Mindfulness can help us unhook from anxious thoughts, feel safer in the present moment and reduce catastrophic thinking.
One of my favorite ways to teach mindfulness is to have clients pick a task they do every day, such as brushing teeth or drinking coffee, and do it slowly, focusing on each of the five senses. I encourage clients to observe and describe what they notice about this process, and how it can feel different each time they practice. When we practice daily mindfulness in this way, we are working our “mindful muscles” and are much better able to utilize mindfulness to support us in a moment of intense anxiety or distress.
I also recommend breathing techniques that are designed to activate the parasympathetic nervous system, the “rest and digest” network of nerves in the body, which serve to calm our nervous systems after a period of anxiety or distress. A simple yet very effective breathing technique for anxiety is to elongate your exhales. I often tell clients to practice inhaling for a count of two and exhaling for a count of four. As with mindfulness, practice this daily so you are better able to utilize this skill during times of distress.
Radical acceptance, self-compassion, mindfulness and breathing techniques are powerful tools to help manage anxiety, but they may not be enough for everyone. Whether your anxiety feels severe or you would just like some additional support, working with a therapist or psychiatrist during pregnancy is a great option and a nice way to shore up your mental health before your baby’s arrival.
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Perinatal Mood and Anxiety Disorders