Did you know that anxiety is one of the most common side effects of pregnancy? If you are pregnant and struggling to deal with feelings of worry and anxiousness, you are not alone! In this article, we will address the differences between typical worrying versus what presents as an anxiety disorder. We will give you tips to lessen your anxiety during pregnancy, including tools for self-advocacy.
- Worry is the work of pregnancy
- Identifying anxiety
- How to advocate for yourself
- Practical steps for coping with anxiety
- Mindfulness exercises
- Social support
- Professional Help
Worry is the work of pregnancy
According to Dr. Lewis Mehl, a psychologist specializing in perinatal mental health, "Worry is the work of pregnancy." Certainly all pregnant people feel worry to varying degrees, and this worry can be used to guide you as you prepare emotionally and physically for giving birth and for the challenges of early parenthood.
Much of the worry that pregnant people experience is a fear of the unknown. How can I make sure I'm eating foods that are safe for my growing baby? What will labor feel like? What will it be like to get an epidural? What if I end up needing a cesarean birth?
By taking tangible steps toward self-education, including utilizing trusted web resources (such as Evidence Based Birth and kellymom), reading recommended books (we love anything by Penny Simkin), taking prenatal education classes, and joining a support group, you can begin to relieve some of your fears and prepare mentally for different scenarios.
Creating a birth plan can help you identify useful questions to ask your care provider and help you feel prepared and ready to be an active decision-maker in your health care. It will also allow you to envision your ideal birth scenario, while giving you the tools to strategize dealing with unforeseen complications, should they arise.
As you work through the normal worries of pregnancy, try this exercise from Birthing From Within:
- Write down all of your secret worries. Some may seem trivial, but pay attention to those that you are purposefully trying to minimize, and those that cause physical tension in your body
- Share each of your worries with a trusted listener. This could be your partner, but you might find you benefit from the guidance of a pregnancy health expert, such as your doula, midwife, or OB
Use the following questions to work through your worries with your trusted listener:
- What would you do if this worry/fear actually happened?
- What do you imagine your partner (or birth attendant) would do/say?
- What would it mean about you if this happened?
- How have you faced crises in the past?
- What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What’s keeping you from doing it? If there is nothing you can do to prevent it, how would you like to handle the situation?
Exploring your fears and concerns through this exercise, especially the ones you are hesitant to open up about, can help shift your thinking from feeling frozen by fear to feeling prepared with coping strategies and solid back-up plans. You will also find that sharing your worries helps you feel more supported by your chosen birth team, or may encourage you to seek out a more supportive team if you feel your worries are not addressed with seriousness and compassion.
20-25% of people experience mood and anxiety disorders during the perinatal period, which is defined as the time from conception up through two years postpartum. We hear a lot about perinatal depression, but perinatal anxiety is just as common, and tends to reach its most severe levels in the last trimester of pregnancy.
How can you tell if what you are experiencing is typical worries that come with the major life change of welcoming a baby into the world, or if what you are experiencing is a generalized anxiety disorder that will benefit from the help of mental health professionals?
A generalized anxiety disorder is defined as excessive and uncontrollable worrying that affects your ability to function normally day to day. For the prenatal period this may present as:
- Anxiety or fear that interrupts your thoughts and interferes with daily tasks
- Panic attacks - outbursts of extreme fear and panic that are overwhelming and feel uncontrollable
- Persistent worries that keep coming into your mind
- Constantly feeling irritable, restless or “on edge”
- Having tense muscles, a “tight” chest and heart palpitations
- Finding it difficult to relax and/or taking a long time to fall asleep at night, fatigue
- Anxiety or fear that stops you going out or engaging in activities you would otherwise enjoy
Some of these symptoms can be difficult to separate from normal pregnancy symptoms, such as insomnia, restlessness, and general fatigue, but the key factor to consider is whether your anxiety symptoms make daily life feel difficult. It may also be helpful to know that anxiety disorders in pregnancy often center around concerns over the health of the baby, concerns over your own health (particularly during delivery), and concerns that something may happen to your partner or your relationship.
Risk factors that make you more likely to develop prenatal anxiety include:
- Personal or family history of mental health problems or current mental health problems
- Pregnancy complications
- Past experience with pregnancy loss (miscarriage, stillbirth or termination)
- Current or past history of physical, psychological, or sexual abuse
- Predisposition to perfectionism and anxiety
- Lack of support from family and friends
- Stressful life events
- Continuing lack of sleep or rest
- An unplanned pregnancy
- Having multiples
Because it can be difficult to separate typical pregnancy-related worry from an anxiety disorder that requires professional intervention, anxiety in pregnancy is often underdiagnosed. If you believe you are experiencing an anxiety disorder while pregnant, it is important for you to advocate for the help you need.
Here are a few tools you can bring with you to your next prenatal appointment that can help you discuss your anxiety and additional support you need with your care provider:
Additionally, the Seven Starling emotional mapping tool is available to our members to help them keep track of their mood shifts, and identify if they are having more bad days than good days. If the bay days outnumber the good, it may be time to seek help.
Practical steps for coping with anxiety
There are simple changes you can make to your daily life to help reduce the symptoms of your anxiety during pregnancy:
- Eating well. When we are stressed we tend to crave sweets and carbs, which in turn cause spikes in our blood sugar, which can lead to mood swings and emotional instability. Focusing on balanced nutrition, including frequent servings of protein, and avoiding junk food (even if that’s what you’re craving), can help keep your blood sugar levels stable, and also help keep your mood stable. Try not to go too long between meals to avoid a blood sugar crash.
- Avoiding caffeine. One to two small cups of coffee a day is generally acceptable during pregnancy, but if you find you are struggling with anxiety try cutting out caffeine completely. Caffeine can exacerbate symptoms of anxiety by making you feel jittery and restlessness, and can interfere with sleep.
- Physical activity. Getting even just a few minutes of brisk activity every day is a proven way to boost your mood and lower stress levels. Try taking a short walk during your lunch break, or decompress with a few sun salutations at the end of your work day. If you find you lack the motivation to exercise, you can ask a support person to encourage you and exercise with you.
- Get outside. If exercising feels too overwhelming, try simply getting outside! We love this recommendation from Beyond the Blues: “When you’re depressed or anxious, the four walls feel as if they’re closing in. The world feels darker and smaller...To counter this, go outside your home, look up at the sky, stand up straight, put your arms at your sides, and breathe. You don’t have to actually go anywhere. Just go outside once a day, even if this means standing outside of your front door in your bathrobe.”
- Control your environment. Be aware of factors that trigger your anxiety and think of ways to eliminate or lessen them. That might mean avoiding news on TV or the radio, deleting apps from your phone that lead to doomscrolling, and avoiding social media accounts that you find triggering. It’s also a good idea to avoid watching shows and movies that are scary, suspenseful, violent, or tragic. Try to avoid overstimulation, and if your workplace has a lot of background noise, try using noise-cancelling headphones.
- Enhance your environment. Along with avoiding external sources of stress and anxiety, you can focus on creating an environment that is soothing. Try playing calming music in the background as you work or clean or exercise. Open blinds and curtains to let natural sunlight into your space. Burn candles or diffuse essential oils with relaxing scents.
- Don’t push yourself. Be kind to yourself at this time. Your body is experiencing great emotional, physical, and hormonal changes, and you might find that you are now overwhelmed by activities that used to feel routine. It’s okay to say no — to cancel plans, to ask for a rain check, to reschedule appointments.
- Take breaks. It’s also okay if you need more frequent breaks from work and other activities than you did before you were pregnant. If you find yourself feeling stressed and anxious, try stepping away from your desk and taking a few deep breaths, taking a pause to focus simply on breathing in and out. Take breaks at least every two hours to stretch, hydrate, and snack. If it’s possible, stop work for the day if you feel overly anxious or tired.
A growing body of research suggests that mindfulness exercises during pregnancy are an excellent way to reduce anxiety.
The term “mindfulness” is a meditation technique that involves being present in the moment, tuning in to our body’s sensations and thoughts in that moment, and accepting whatever we are feeling or sensing with gentleness and grace.
Mindfulness can be as simple as acknowledging when you feel happy or at peace, like the great author Kurt Vonnegut suggested, “...please notice when you are happy, and exclaim or murmur or think at some point, 'If this isn't nice, I don't know what is.’”
Mindfulness can also mean allowing yourself to sit with difficult thoughts and feelings, acknowledging them without self-critique. Not to dwell, but to accept the feeling instead of struggling against it, and see acceptance as part of the process of letting go. This is how you are feeling at this very moment, but the feeling will not last forever.
Here are some mindfulness exercises you can start to incorporate into your daily routine:
- Journaling. Try keeping a brief bullet-style journal to keep track of your thoughts and feelings. Check in with yourself twice a day, and jot down how you are feeling in that moment, both physically and mentally.
- Baby movement check-ins. As your pregnancy progresses and your baby’s movements become more pronounced, use them as a reminder to pause and check in with yourself. Take a moment to take a few deep breaths, sending love and oxygen down to your baby through your breath, and then pay attention to your physical sensations. How are you feeling, what emotions are present with you? Take another deep breath and release any anxiety and tension you are feeling from your body with your exhalation. Let your baby help you remember to be in the moment.
- MyLife App. This app can be used to guide you through mindfulness exercises including breathing exercises, yoga videos, and journaling prompts.
- Body Scan exercise. Use this exercise to scan your body one area at a time for places where you might be holding tension. Often we carry tension that we aren’t even aware of, which contributes to the physical symptoms of anxiety. Pay particular attention to your jaw, brow, and shoulders. Those muscle groups are where anxiety likes to hide.
- Breathing exercise. This 15 minute breathing exercise can help calm you before or after a stressful situation. It is a great introduction to the practice of meditation, and encourages you to focus on your breath and redirect wandering thoughts.
- Tense and release exercise. This exercise helps you rid your body of tension by first tensing a muscle group, noticing how it feels to hold the muscle tense, and then letting it go, paying attention to how your muscle feels when it is relaxed.
Finding a group of expecting parents who are going through the same life changes will help you feel less alone on your journey. Social support is pivotal to maintaining your mental health, and at Seven Starling we have a passion for building community. When you join our Full Circle membership, you will be paired with 5-10 other families with similar due dates. In your group you can lean on each other for support, ask for advice, and share the highs and lows. You can also connect with other pregnant people experiencing anxiety to learn what therapies or exercises have worked from them, and get one-on-one advice about managing anxiety from your expert Doula.
Support from your partner is also very important at this time, but they may be struggling with how to help you. We have written an article just for them. [link]
If you find that self-help techniques like taking frequent breaks, monitoring your environment, and mindfulness exercises aren’t enough to lessen your symptoms of anxiety, consider reaching out to a mental health professional. Studies have shown that cognitive behavioral therapy (CBT) can be effective in treating perinatal anxiety and is the recommended first course of action, but there are also pharmacological options that are safe for pregnancy, including SSRIs.
Look for a mental health professional that has special training in perinatal mood and anxiety disorders? You can find local providers through the Postpartum Support International Directory.
Birthing From Within by Pam England, CNM, MA & Rob Horowitz PhD
Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety by Soshana Bennett, PhD & Pec Indman, EdD, MFT
Perinatal Generalized Anxiety Disorder: Assessment and Treatment
Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study
ADAA: Perinatal Mood Disorders
Four Reasons to Practice Mindfulness During Pregnancy