You’ve no doubt heard about postnatal depression but you many not be aware of how common anxiety in pregnancy is. So common in fact, it’s often dismissed as a normal symptom of expecting a baby by loved ones. However, anxiety in pregnancy can be  all encompassing and debilitating for mothers, sucking out the pleasure of moments and experiences they would love to enjoy. 

Anxiety during pregnancy affects one in every five pregnancies and shows up in numerous ways. From generalised worry, specific fears, panic attacks and even new onset of obsessional compulsive disorders. Getting the heads up if you are at risk of developing antenatal anxiety during pregnancy can go a long way to ensure you take steps to minimise the disruption that anxiety can cause during your pregnancy and after having a baby. 

1. Pregnancy Hormones and Mood

A well known reason for emotional ups and downs in pregnancy are your rapidly changing hormones. The two main influences are the hormones called estrogen and progesterone.

During the first trimester of pregnancy estrogen and progesterone levels soar. These rapid changes in your hormone levels are very important to pregnancy but also affect neurotransmitters, the brain chemicals that regulate your mood, like serotonin, the happy hormone. If you’re experiencing an emotional roller coaster, such as anxiety. irritability, tearfulness, fatigue and sadness for no apparent (and often irrational) reasons. Hormones are probably prime suspects. For example at 28 weeks my daughter had a full on tearful meltdown over her dad stealing a spoonful of a yoghurt she had been looking forward to. She could see how irrational her reaction was and was laughing, crying and displaying range of emotions that I can’t even describe. 

Pro-tip: Appease hormonal swings by consuming nutritious food, regularly hydrating with water, taking gentle exercise and engaging in health promoting behaviours; such as getting outside in natural sunlight, meditating and having plenty of rest. 

2. Having a history of anxiety 

One of the biggest factors to predict anxiety in new and pregnant mothers is a history of anxiety. Simply put, if you have had anxiety problems in the past, you may be more vulnerable to these feelings resurfacing during pregnancy.

You may be genetically predisposed to worry and anxiety or you may have been subject to a stressful event or both in the past. Many factors like low self-esteem, anger, pessimistic ruminating thoughts or a tendency to be nervous, worried or shy can contribute to feeling that too many thing are out of your control in pregnancy. This feeling of uncertainty can cause a relapse and, trigger new worries often about perceived risks to the pregnancy and babies health. 

It is not unusual for women on prescriptions for a mental health condition to be told to stop, or to be reluctant in continuing with these medications. Their worry about medication, along with stopping effective treatment at a time of hormonal inbalance and big life event may further impact anxiety in pregnancy. 

Pro tip: Having a proper medication review with a perinatal specialist is important as soon as you find out you are pregnant to assess the risks and benefits of either stopping or continuing to take medication. Ask your doctor to make a referral for you. 

3. Perfectionism 

A little known factor related to vulnerability to anxiety in pregnancy is perfectionism.

Perfectionism is the desire to be a perfect or flawless person in various aspects of one’s internal or external life. Usually involving very high standards that one sets out to achieve and a belief that being “perfect” should be strived for. But, in pregnancy this can have both positive and negative consequences. One the encouraging side perfectionism can motivate you to practice self care, seek out classes or courses, and get fully prepared. 

Unfortunately in pregnancy, these traits often succumb to a downside; googling relentlessly, comparing and scrutinising experiences of others and setting up standards that are high, inflexible and self critical. Seeking to constrain unpredictable forces of nature into a neat todo list and organised calendar is exhausting! It can lead to increased feelings of anxiety, dissatisfaction, and difficulty coping for pregnant women with perfectionism personality traits.   

Pro tip: Create any plans with built in flexibility and stay away from google for your research. Google will send you down unreassuring rabbit holes of information with likely, no relevance to you or your pregnancy at all. Instead, make a list of things you’d like more information on, and ask your midwife or obstetrician. They know you, your pregnancy and your specific risks and needs. This makes them the best choice to reassure or if needed, make a personalised plan for you.

4. Life experiences 

Many studies have shown that adverse events in life and high perceived stress during pregnancy play an important role in the onset of anxiety in pregnancy.

Adverse events can show up in life at any time, or as some research suggest may even come from generational trauma before you were born! If adversity happens in childhood or as an adult, being exposed to these events, such as domestic violence or emotional, physical or sexual abuse, has a considerable impact on a woman’s mental health in pregnancy.

If she is exposed to domestic violence before or during pregnancy (particularly, if the abuse comes from her partner), having a history of abuse, or if she has experienced a sexual assault. These are all high risk factors for the development of anxiety in pregnancy. 

Pro tip: Domestic violence and history of abuse have been shown to be some of the strongest independent predictors of anxiety in pregnancy, and carries high risk to the safety of mother and baby. If someone is being abusive or violent towards you please, please, google your local women’s refuge and ask for advice and help. You are not alone and will be supported. 

5. Previous pregnancy and birth experiences 

Unsurprisingly the idea of birth causes varying levels of anxiety. But women with previous complicated or traumatic deliveries, and even first time mothers who have been affected by awareness of negative experiences, both are highly vulnerable to anxiety in pregnancy. Especially as the pregnancy begins to show and the due date approaches. This particular type of anxiety is called tokophobia and it means a severe fear, or phobia, of childbirth. 

Any unexpected loss of pregnancy can be a hugely traumatic event and can lead to high level of anxiety and depression that can persist into subsequent pregnancies and become severe as the gestational anniversary of loss approaches. 

Pro tip: If you have experienced trauma with previous pregnancies, ask your midwife and doctor to refer you for specialist psychological support. Having a few sessions with a specialist perinatal therapist can make an enormous difference to the way you feel. Ask them to give your obstetrician a psychologically informed birth plan and put a copy in your notes. This will help to limit retelling your story over and again. 

6. High risk pregnancies 

Women with medically high-risk pregnancy may experience anxiety, worries, and depressive symptoms, along with a sense of powerlessness and stress. Between 15-20% of pregnancies are high-risk, wherein the pregnancy is complicated by one or more serious conditions that affect the mother or the baby. Unsurprisingly, having a high risk pregnancy may increase the stress and, thereby further increase anxiety and risk in a negative feedback loop. Women with high-risk pregnancies are highly vulnerable to anxiety in pregnancy.

Pro tip: If your pregnancy is medically high risk, you may need more emotional support. Hiring a dedicated birth professional such as a doula, who is trained to provide emotional support during pregnancy and birth, may provide the extra reassurance you need. 

7. Social situations

Adverse events and experiences can come in a multitude of forms; a lack of partner or of social support, unplanned or unwanted pregnancy, isolation, bereavement, poverty, housing issues, involvement of social services, asylum and refugee status, addiction, poor health – I could go on but you understand my point I’m sure. That life can be stressful. Even at the best of times and especially if there is a baby on the way! 

But, when you are pregnant or thinking of having a baby, reducing this stress as much as possible will add a protective element towards reducing anxiety.

Pro tip: There’s certainly something in the saying ‘a problem shared is a problem halved’ and your first action is talking to someone in a position to help you. This could be your midwife, doctor or charity specific to your situation – they can all help you put a plan in place and make you feel less alone with your worry. 

The takeaway about anxiety in pregnancy

Anxiety in pregnancy is very common, it is actually more common than depression. Although you may not hear a lot about it, many, many women suffer from anxiety in pregnancy. Some is universal, it would be unusual for you to not be anxious during this time! But, for many women, this acceptable level of anxiety escalates, causing great distress or interfering with their ability to function at home or work. Knowing if you may be vulnerable to developing anxiety in pregnancy will provide an opportunity to access early support and protect against the risk. 

It’s important to trust and feel heard by your midwife or doctor. Health-care professionals should always ask about your mental health at every appointment but I understand from feedback these questions doesn’t always take priority. I would recommend, even if you have to start the conversation, to always have a meaningful conversation with your midwife or doctor about how you’re feeling and ask if you feel extra support would help.

Some prescription medications can safely be used to treat anxiety during pregnancy and the benefit of taking medication may outweigh the risk of stopping. Which is why a medication review with a perinatal specialist is important.

Targeted therapy with a perinatal specialist can help enormously with anxiety, particularly for people with past trauma or who have experienced pregnancy loss in the past. Even if you are not pregnant yet, seeking out pre-emptive therapy will stand you in good stead for future pregnancies. 

What’s most important to remember is that anxiety during pregnancy is not something you have to live with. If it happens, you can and will get better. The first step is asking for help.