Anxiety During Pregnancy: Causes And Coping Mechanisms

Pregnancy can be an exciting time for expecting parents, but it may also come with worries and anxieties that can cause significant distress for the person carrying the child. Fear of birth, fear of the unknown, and daily problems that can arise from the physical and hormonal changes of pregnancy often lead to a constant sense of concern over the baby's health and their ability to manage future parenting responsibilities. The individual can further develop anxiety about childbirth and postpartum care.

Perinatal anxiety or anxiety while pregnant is a common problem, with around 1 out of 5 women being diagnosed with an anxiety disorder during this time. Anxiety during pregnancy can be managed with mindfulness meditation, prenatal massage therapy, exercise, prenatal classes, prenatal yoga, and Lamaze breathing classes. It’s often helpful to work with a licensed therapist online or in person as well.

Feeling anxious

Anxiety during pregnancy can be a natural reaction to the many changes that are likely occurring, such as increased hormone levels, upcoming life changes, and the physical effects of pregnancy. Some people who have a pre-existing anxiety disorder or manage other mental health conditions have varying responses to pregnancy, with some feeling more at ease and others noticing a steep increase in their anxiety levels. Every person tends to be unique, including their physiological body, and thus, each pregnancy can also be unique and may vary in its effects and symptoms.

Research suggests that untreated anxiety or panic attacks during pregnancy can lead to more complications before and after giving birth. For example, high levels of anxiety during pregnancy are associated with a range of complications, including low birth weight, preterm birth, and smaller head circumference.

Healthcare providers will generally check in during prenatal appointments regarding an expectant parent's mental health and any symptoms of an anxiety disorder. It can be important to address all concerns during appointments to ensure the best possible care and resolution (or at least reduction) of symptoms.

Early trimester

Perinatal anxiety generally refers to the anxiety that may arise throughout pregnancy. Early pregnancy can be an exciting time for many parents-to-be. It also may come with fear and apprehension, especially for those who have had a history of traumatic pregnancies or miscarriages. 

Miscarriages primarily occur within the first trimester and can be traumatic for many people. While some may be able to manage the loss of the embryo without major emotional or psychological effects, others may react very strongly to the loss. In these cases, severe depression, anxiety, and post-traumatic symptoms (especially in cases of recurrent loss) may follow the miscarriage. If left untreated, they may morph into anxiety disorders, post-traumatic stress disorder, or even obsessive-compulsive disorder. If you have experienced a loss of pregnancy, do not hesitate to reach out for professional help.

The first trimester is a time when there is generally a greater risk of spontaneous abortion. This time can also be stressful for those who are concerned that their actions while unknowingly pregnant may have negatively affected their unborn child. For example, some people who do not know they are pregnant may drink, smoke, or take certain medications, and they may be worried they unknowingly damaged the growing fetus. Ultrasound and blood tests typically monitor the fetus during the pregnancy to confirm that it is developing healthily and has not been affected by substance use or medications taken before confirming pregnancy. 

With unexpected pregnancies, the first few weeks may be stressful as expectant parents usually need to plan for the future by looking at their finances, family, and other areas of life that will likely be impacted by a baby. They also may be thinking about the future. It can be common to worry about how employment will be affected and how to plan for parental leave (and if it will be paid). Especially with single parents or those in low-income situations, these fears can be real concerns and often lead to a significant amount of stress.

Middle and late trimester

During the second and third trimesters of pregnancy, the risk of a miscarriage usually decreases, and parents can typically expect to have a viable fetus.

Genetic testing and bloodwork can be done to rule out most abnormalities or fetal health conditions that need to be addressed either before birth or immediately after the child has been delivered. These tests can trigger anxiety as the parent or parents await news regarding the future of their unborn child. Once these tests have been done and come back with no signs of any problems, the positive news often relieves a great amount of stress. In the cases where the tests come back showing complications, however, this is often an unexpected and fearful discovery for the parents. The fears of an unhealthy pregnancy (depending on the diagnosis) and the worries of caring for a child and providing them with the highest quality of life after birth can become significant sources of anxiety. 

Not all parents may have the means to care for children with severe impairments or lifelong health conditions, which can increase overall worry and impact numerous aspects of a family's future. Some children may even be found to have conditions so significant that doctors may inform the family of a shortened life expectancy after birth. This can be one of the most devastating things a parent can hear about their unborn child. In the worst-case scenario, there may also be health concerns that may require a medical termination of the unborn child or confirmation to expect a stillbirth. 

In less extreme cases in which the fetus is proven to be healthy and growing without problems, parental concerns are usually focused on preparing for the future. For instance, if this is your first child, you may be worrying about your ability to handle parenthood and the approaching childbirth.

The second trimester is generally the period when an expectant mother gets a few short weeks of energy and feels the best before the exhaustion and physical pains of carrying a child typically take over for the last three months. The third trimester is generally when the fetus is growing rapidly, and the mother’s body is changing to get ready for childbirth. Exhaustion is a factor that can greatly impact an expectant parent’s ability to manage physical and emotional stress. The size of the baby often begins to affect the quality of sleep as it is frequently difficult to find a comfortable position. Furthermore, the uterus is typically preparing for childbirth at this point and may begin to contract irregularly (Braxton-Hicks contractions) at any time. These contractions are often painful and can increase anxiety for both parents as the inevitability of labor approaches. 

This is also a period when the parents generally need to pay very close attention to the progression of pregnancy and report any remarkable changes to their doctor. Dizziness, high blood pressure, and edema (swelling) can indicate a serious condition known as pre-eclampsia. These symptoms usually need to be reported to the obstetrician to make sure the mother and fetus are safe. Most obstetricians respond quickly when they recognize the symptoms and provide treatment as soon as possible. 

All necessary tests will normally be done to ensure the mother and baby are healthy with no imminent complications. The parents may then be informed of any changes they may need to make for the healthiest possible pregnancy.

Panic attacks

Panic attacks during pregnancy can be a common mental health problem, affecting many women with an increased risk if there is a family history of panic disorder. An individual with a panic attack during pregnancy may experience symptoms such as a sudden onset of intense fear, difficulty breathing, rapid breathing, and a racing heartbeat. 

Labor

Labor can cause a great amount of anxiety, no matter how many pregnancies a parent has been through. Parents who have given birth may experience anxiety because they know what to expect and may be aware of the unpredictable nature of childbirth. New mothers are usually apprehensive and fearful of the unknown and the inevitability of childbirth, whether through vaginal birth or a Cesarean section. There are typically many classes, as well as online information, available to help parents understand the birthing process, what to expect, and how to best prepare themselves.

Postpartum

Identifying and treating prenatal anxiety and depression can be incredibly important for the overall health of the mother, as well as the development of the unborn child. This vigilance for the mental health of new parents normally should not end when the baby is born.  

Appearing sometimes as severe postpartum anxiety, postpartum depression (PPD) can be an extremely serious mental health condition that may affect new parents and caregivers soon after the birth of the baby. While the focus of PPD in the past was typically on the person who gave birth, non-birthing parents and caregivers may also experience this depressive disorder after labor and delivery are over. Postpartum hormone changes and sleep deprivation can lead to higher rates of PPD in women after birth. However, non-birthing parents may also experience anxiety and depressive symptoms and may not reach out due to social stigma related to heterosexism and cisgenderism. 

Postpartum depression can strike at any point after childbirth, whether during the first few days of the postpartum period or even weeks or months later. Symptoms of postpartum depression may include:

• Intense anger
• Depressive mood
• Difficulty bonding with the baby
• Irritability
• Fatigue
• Disordered sleep
• Self-harm compulsions or thoughts of hurting the baby
• Not feeling “like yourself”

Many parents and caregivers may choose to hide their depression from their friends, family, and physicians for several reasons, potentially including shame and the preconceived notion that this can be a normal response to this period of life. This may lead to a person not receiving the help that they need, and they may experience heavy emotional distress that can be left untreated. The exhaustion, isolation, and overwhelming responsibility of being a new (or even repeat) parent is generally not something that should be taken lightly. If you, your partner, or someone you know is showing any of these symptoms, please seek professional help as soon as possible to intervene with the progression of the disorder and relieve the symptoms that may be affecting their quality of life. 

Coping with an anxiety disorder while pregnant

The following section introduces healthy ways for you to manage stress and anxiety through relaxing techniques such as mindfulness meditation, exercise, and massage therapy. Before trying any of the following, check with your healthcare provider to make sure the suggestions are safe for you and your unborn baby. Do not try new medications or supplements, exercise, or relaxation therapy without speaking with your healthcare provider first. 

Meditation and mindfulness practice

A safe and non-invasive technique to relieve stress and anxiety throughout the mind and body may be meditation and mindfulness relaxation techniques. Mindfulness meditation is generally believed to have been derived from Buddhist meditation practices that typically focus on accepting and drawing attention to the present moment. This practice of being mindful is usually intentional and may allow oneself to focus on emotional responses, sensations, and thoughts of the present moment in a nonjudgmental way. Mindfulness meditation can improve worry, anxiety, and depression in pregnant women while helping to increase self-compassion. 

Lifestyle changes

Adding certain lifestyle changes to daily routines may help reduce worries and other common symptoms of anxiety in pregnancy. For example, a calming bedtime routine may help support staying asleep to improve mental well-being and other pregnancy outcomes, such as reduced stress levels and improved mood control. Remembering to find support and spend time with friends or family members may also help prepare women mentally for giving birth and the period after the baby arrives. 

Prenatal massage therapy

Similarly, finding a professional who provides prenatal massage can be another option to relax an expectant mother. A pregnant woman is usually unable to receive traditional forms of massage therapy, as it can be unsafe and may trigger labor. A massage therapist who specializes in prenatal massage can relieve tension safely and provide significant pain relief and relaxation. Furthermore, massage therapy can improve circulation, enhance general well-being, improve mood, and relieve muscle aches and joint pain. 

Exercise

Exercise, if possible, can also be a good form of relaxation and may prepare the body for the birthing process. Not everyone who is pregnant may be physically capable of excessive physical activity, but even a short 30-minute walk a few times per week can lead to a significant improvement in both physical and mental symptoms. It is always advised to avoid any heavy lifting while pregnant, so generally, some light form of cardiovascular exercise is best for expectant mothers.

Prenatal classes

Prenatal yoga

Prenatal yoga can be viewed as a type of mind-body relaxation exercise that is typically modified to be safe for pregnant women. In prenatal yoga, the person generally performs a series of poses and stretches while practicing breathing techniques. This type of yoga must generally be taught by a trained professional who knows what is safe for the pregnant body and can guide parents through modifications. This movement and meditation practice often carries many benefits, potentially including relaxation, alleviation of stiffness or discomfort, and preparation of the body for labor and delivery. 

Lamaze breathing classes

Finally, one of the best ways to cope with the apprehension of labor and delivery, as well as the process itself, may be Lamaze breathing techniques. These are very commonly taught in classes available at pregnancy resource centers, as well as in hospitals themselves. This may allow a mother to focus on her breathing, calming herself despite the circumstances, while providing the brain and body with more oxygen. 

Resources to support parents

There are often pregnancy resource centers that assist expectant parents in receiving the care and support they need, including programs like WIC (Special Supplemental Nutrition Program for Women, Infants, and Children). These resource centers may provide blood tests and ultrasounds for those without insurance, and they may also provide expectant parents with information to help them become recipients of government assistance. These are typically medical care and food benefits, which can be extremely useful in providing a proper diet for the mother while pregnant and providing formula and solid baby foods once the child has been born. 

Many also have parenting classes available that teach about fetal development, breastfeeding, and parenting babies and young children. You can also ask these pregnancy resource centers if they offer specialized services for pregnant women with anxiety disorders, panic disorders, or other mental health issues that may become more prevalent during pregnancy. They may have low-cost or free options for cognitive behavioral therapy available for you to use.

The importance of seeking help for anxiety disorders

If you are unable to manage the symptoms of anxiety or simply want to talk to a therapist for support, it’s generally recommended to seek the assistance of a licensed mental health professional to guide you through the coping and healing process. Your therapist can help you understand why you are anxious and give you strategies to improve your response to stress. Getting professional help can be one of the best options for identifying and reducing symptoms and their triggers, both while pregnant and in one's daily life outside of pregnancy.

If you are pregnant and your feelings of anxiety are becoming a significant concern, notify your doctor, mental health professional, and even your OB-GYN specialist of any psychological changes or concerns you may have. Do not hesitate to choose the course of treatment that is most effective and comfortable for you.

Seek guidance and treatment at any local mental health center or practice as soon as possible if you feel like something is amiss. If an on-site visit is not possible due to your health or caring for a newborn or young child, you might reach out for help or further information via an online therapy platform. 

Online therapy can be a convenient and cost-effective option that may empower you to get the support you need from the comfort of your own home. Furthermore, online therapy can be as effective as in-person therapy, with people generally showing improved symptoms from depression and anxiety with regular talk therapy sessions. Do not hesitate to set up a session with a therapist, especially if you feel like you cannot manage it on your own.