Anxiety is usually described as a feeling of unease, nervousness, and worry about a specific event or circumstance. Anxiety and related disorders have been found to be more common than depression among pregnant and postpartum women.1 As many as 15.8%1 of pregnant women, and up to 1 in 52 women in the postnatal period will experience diagnosable levels of anxiety.
Perinatal Mood and Anxiety Disorders (PMADs) can impact people of any culture or socioeconomic class. While these disorders can surface at any time, there is a heightened risk during the perinatal period. Perinatal Anxiety, Panic Disorder, Perinatal Obsessive-Compulsive Disorder, Postpartum Post-Traumatic Stress Disorder, and Postpartum Psychosis make up the anxiety disorders of the PMADs.
The perinatal period is defined as the period of time during pregnancy through the year following birth. This is a time of great uncertainty and change from a physical, mental, and social perspective. Thus the early identification of signs and triggers for anxiety during this time period allows for the most appropriate and successful interventions.
What Is Anxiety?
The symptoms of Generalized Anxiety Disorder include:
- Excessive anxiety and worry
- Difficulty controlling worry or ruminating on persistent thoughts
- Irritability and/or agitation
- Restlessness or inability to sit still
- Feeling on edge
- Poor concentration
- Sleep disturbances including difficulty falling asleep or staying asleep
- Physical symptoms can include a racing heart-beat at rest, shortness of breath, and GI distress
There are characteristically symptoms of Perinatal Anxiety Disorder that can differ from Generalized Anxiety Disorder in the general population. Excessive worry can be focused on the personal health of the mother or it can be specific to the baby’s health. Safety of a new baby is an area of heightened focus for women who are experiencing anxiety in the postpartum period.
Many moms find it hard to admit that they are struggling with anxiety because there are such high expectations for this to be a time of great joy. The pressure to embrace the transition into motherhood can result in more stress.
Signs of Anxiety While Pregnant: What It Looks Like
Some anxieties during pregnancy are normal, and even helpful, to ensure that there is attention on the health and wellness of the pregnant mom. Thinking about planning for the arrival of a new family member, maintaining overall health, following healthcare professionals’ orders, and planning for the birth can all yield some expected and normal level of anxiety and nervousness.
Women who have experienced infertility or losses related to pregnancy are at higher risk for experiencing anxiety during subsequent pregnancies. Many moms have a hard time staying connected with friends and family following these types of losses. There is difficulty in accepting the loss of how things are supposed to work, and excessive stress is placed on relationships.
Many women feel a sense of unease throughout the pregnancy due to memories from past traumatic experiences. There are resources available, support groups, and professionals who specialize in this type of anxiety during the perinatal period.
Symptoms of Anxiety While Pregnant
For many, the signs of anxiety while pregnant can also be confused with pregnancy symptoms. Lack of sleep, shortness of breath, and heartburn could all be symptoms of pregnancy as well as anxiety. It is a good idea to let your healthcare provider know about any symptoms that you experience to rule out physical causes. If other health related causes can be ruled out, it is possible that anxiety is to blame.
The symptoms of anxiety during pregnancy and the postpartum period might include but are not limited to:
- Constant worry about your health or your baby’s health
- Racing thoughts
- Hypervigilance
- Physical symptoms like dizziness, racing heart, and nausea
- Sleep Disturbances
- Changes in diet
- Inability to sit still
- Worrying that something bad is going to happen
Is My Anxiety Affecting My Baby?
The impact that anxiety can have on a mother as well as her baby is significant. During pregnancy, the mother’s internal environment plays a big part in the development of her baby. When a mother is experiencing high levels of stress and anxiety regularly, there is an increase in cortisol production. Studies have shown that untreated anxiety can have implications resulting in preterm births4 as well as increased activation of fight or flight responses in babies.5
21% of women tested positive for PMADs in prenatal screenings.3 Of that group, 66% with Major Depressive Disorder (MDD) also had anxiety, most commonly Generalized Anxiety Disorder (GAD). Despite the high numbers reported in existing studies, these disorders are often underdiagnosed and undertreated. Many times this is due to the stigma attached to seeking help for mental health or a lack of linkage to appropriate resources. Screening and early detection can provide protective interventions for the mother, baby, and family.
In the postpartum period, anxiety can arise in the weeks following birth, or anytime thereafter. A common time for elevated risk is approximately three months after birth. Emotional and physical attachment between a mom and her baby is something to pay attention to. Oftentimes, a baby’s response to their own anxiety or feelings of threat are regulated by their caregiver. If the caregiver is not able to regulate their own anxiety and stress, they may have difficulties addressing the baby’s emotional needs.
Breastfeeding is also impacted by high stress levels due to the pressures and demands of the process which can include frequent feedings, varying milk supply, problems with latching, and overall exhaustion. Seeking support and education can help to reduce the stress associated with breastfeeding.
Causes & Triggers of Perinatal Anxiety
There are a number of evidenced-based risk factors for perinatal anxiety disorders. The causes and triggers for anxiety are related to physical and social components contributing to their onset. According to Emily J. Fawcett in her article, “The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period,” “Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.”6
Some causes of anxiety in the perinatal period include:
- Personal or family history of PMADs, or other diagnosed mental illness
- Symptoms during pregnancy can be an indicator for postpartum symptoms
- History of significant reaction to hormonal changes (Puberty, PMS, PMDD, hormonal birth control, etc.)
- Endocrine Dysfunctions (diabetes, thyroid imbalance, fertility challenges)
- History of miscarriages, loss, fertility challenges
- Lack of sleep
- Physical pain or discomfort
- Relationship stress
- Financial stress
- Childcare stress
- Breastfeeding complications
Treatment of Anxiety While Pregnant
Many moms find themselves putting the needs of their baby before their own. Taking care of yourself is a form of taking care of your baby. If you are suffering from a perinatal anxiety disorder, it is likely that it will impact the way that you care and interact with others, including your baby.
Therapy
Talking with a therapist is a great way to start taking care of yourself. There are various types of therapies used to treat anxiety disorders.
Some evidence based treatment models specific to treating perinatal anxiety include:
Cognitive Behavioral Therapy (CBT)
CBT is a therapeutic technique that focuses on understanding a person’s cognitions or thoughts and how they impact their behavior. Learning about dysfunctional patterns of thinking can result in mood and behavioral changes when these cognitions are challenged. A common goal of CBT is to recognize anxiety as an alarm of sorts. This helps the individual to recognize and understand their personal needs and react appropriately with coping skills and tools.
Interpersonal Therapy (IPT)
IPT is based in attachment theory and can help a mom to find her voice. The strategies include improving communication skills, developing a social network, and role playing. The concerns are targeted from a “past, present, and future perspective” to address role changes, new stressors, and strengthened ability to advocate for needs.
Lifestyle Changes
Take some time to look at your lifestyle during pregnancy. Are there ways to reduce stress? What supports could help you shift to a lifestyle that is recovery focused?
Some possible ways of decreasing perinatal stress could be to:
- Carve out time in your day for self care
- Be intentional about talking with your partner (or a trusted friend or family member) about your mental health needs
- Focus on exercise and dietary needs
- Talk with your employer about modifying work hours or responsibilities
- Implement a sleep routine that promotes rest
These lifestyle changes can shift your focus from worry to wellness and promote healing.
Medication
Finding a prescriber who is also up to date on perinatal mental health issues is important due to the unique role of treating both the mother and the baby. These prescribers can include psychiatrists, psychiatric nurse practitioners, medical doctors, and any other medical professional with a license to prescribe psychotropic medications.
When it comes to medications, there are often concerns regarding the implications on the health of both the mother and the baby. In a study on prescribed medication use during pregnancy and lactation it was shown that “exposure always occurs, be it to treatment or illness.”7 In other words, there are several perspectives to explore including the risk of treatment versus the risk of untreated psychiatric illness.
The two main groups of medications typically prescribed in the perinatal period are Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). It is very important to note that if you are currently prescribed medication and become pregnant, it is best to contact your prescriber to discuss your options. Sometimes the benefits of staying on a medication outweigh the risks of discontinuing and a possibility of relapse in symptoms.
There are resources listed below which discuss medication interactions and recommendations in the perinatal period.
How to Get Help for Someone Suffering From Anxiety While Pregnant
If you notice that a loved one does not seem to be acting like themself or is struggling during pregnancy or the postpartum period, it can be helpful to talk with them about seeking professional help. Creating an open and non-judgemental space for sharing is a great first step to getting the help that they need. There are many benefits to early intervention including a decrease in the severity of symptoms and quicker recovery rates.
Women and families who are at risk for anxiety in pregnancy and in the postpartum period can benefit from planning ahead. Encourage your loved one to get adequate sleep, exercise regularly, and focus on good nutrition. Identify social supports to help with the transition into parenthood such as support groups or therapeutic services. Providing services to assist with household and/or childcare duties can help to decrease stress and allow greater time for self care.
Create a postpartum coping and support plan which includes access to professional services such as a therapist, postpartum doula, lactation consultant, pelvic floor specialist, and support groups (both general or specific).
7 Ways to Manage Perinatal Anxiety Symptoms
Most pregnant women are already involved in healthcare and have access to resources available to meet their needs. If you have been screened as positive for perinatal anxiety by a healthcare professional, there are some actions you can take to start taking care of yourself. Working with providers who have training in the field of perinatal mental health can ensure that the therapies and treatments are appropriate for both the mother and the baby.
1. Therapy
Therapy will provide a safe space to share about the struggles that you are facing. Sometimes talking about anxiety in pregnancy and the postpartum period is difficult. Loved ones may not understand and you may feel embarrassed to admit that you are having a hard time. A therapist who is trained in issues related to perinatal mood and anxiety disorders will help you to work through your anxiety, get you the appropriate care, and use evidence based techniques to treat the symptoms. Learn more about finding and choosing a therapist here.
2. Find a Support Group
Parents need support. The type of support that is needed during this time includes empathy, access to updated and useful information, and access to resources for women and their families. For many pregnant women and moms who are struggling with anxiety and related disorders, it is comforting to hear from others that are going through similar struggles. These groups help to eliminate loneliness and stigma, while promoting overall well being and healing.
3. Rest and Relaxation
Take some time to think about how you have been sleeping and if you are as rested as you need to be. Is there something getting in the way? If so, take the time to ask for help, improve your sleep hygiene, and start to make sleep a priority. For many people the importance of sleep is underestimated. The impact that lack of sleep has on mental wellness is immense.
Some tips to help with sleep are to:
- Avoid caffeine
- Set a consistent bedtime
- Create a ritual before bed that relaxes you
- Avoid using electronics at least 30 minutes before the intended bedtime
- Be gentle with yourself as you adjust to a new sleep routine
It is suggested for new moms to sleep when the baby sleeps, or when you have someone else watching the baby. If you find that even with help you are unable to sleep or relax, talk to your healthcare provider as this may be a symptom of anxiety in the postpartum period.
4. Meditation and Mindfulness Techniques
Although it may seem like a daunting task to practice meditation and mindfulness when you are feeling anxious, there are various forms of these techniques that could be helpful even when it is difficult to relax.
When you’re feeling anxious, you might try:
- Placing your hand on your belly while breathing slowly in and out
- Going for a mindful walk
- Taking time to get in touch with your five senses
- Focusing on positive affirmations and statements about you and your baby
- Using an app for short guided meditations are all examples of these techniques
Seeking help from a therapist, yoga instructor, or mindfulness group can also be a great way to learn about how to use mindfulness or meditation techniques in your life.
5. Prenatal Yoga
Prenatal yoga classes are intended to provide a safe space to stretch, breathe, and promote relaxation. The techniques used in prenatal yoga can help assist with anxiety, pregnancy wellness, and preparation for birth and the postpartum period.
6. Exercise
There are many benefits to exercise in the perinatal period, especially for women who are experiencing anxiety. Improved sleep, release of stress, strengthening physical health in preparation for birth or for postnatal recovery, and improved moods are some examples of these benefits. It is always important to consult with your treatment team when determining the right exercise modalities for you.
7. Perinatal Massage Therapies
Working with a provider who specializes in massage for pregnancy and postpartum allows for special attention to those needs. Massage has been proven to reduce stress hormones in the body and loosen muscles. Some other benefits of massage in the perinatal period include reduction in joint and back pain, reducing symptoms of anxiety and depression, improved sleep, improved circulation, and minimizing frequent headaches.
Perinatal Anxiety Statistics
Many people are familiar with the term postpartum depression however the stigma attached to mental health diagnosis, especially in the perinatal period, can lead to a lack of information and silence due to a fear of being judged.
The following statistics illustrate the prevalence of anxiety disorders in the perinatal period:
- Anxiety and related disorders were found to be more common than depression among pregnant and postpartum women.1
- As many as 15.8%1 of pregnant women and up to 20%2 of women in the postnatal period will experience anxiety.
- 21% of women tested positive for PMADs in prenatal screenings3
- Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder6
After the Birth
After birth, new moms go through a huge hormonal shift as the estrogen and progesterone levels that have increased during pregnancy fall quickly following birth. Due to this hormonal change and sleep deprivation, 60-80% of new moms will experience baby blues. Baby blues lasts for up to two weeks following birth. Some anxiety is expected during this time as it is a natural response for a parent to protect their newborn.
Postpartum Anxiety
If you notice that you are excessively worrying about the health or safety of your baby, or are worrying in an irrational way, you may be suffering from postpartum anxiety. Some common themes include worrying about driving in the car with a new baby, not allowing others to hold the baby, and a fear of walking up and down stairs with the baby. If you notice that you are struggling to participate in everyday tasks as a result of anxiety, it may be time to seek professional help.
There can also be exacerbating factors for anxiety following childbirth as well as things that parents can’t plan for in pregnancy. When expectations do not match your reality in regards to the childbirth experience or early postpartum period, there can be feelings of loss and stress related to feeling a lack of control. If the birth was traumatic in any way, or if there was real or perceived danger to the mother or baby, there is a higher chance of developing a PMAD.
Next Steps
Whether or not this is your first baby, transitioning into the role of being a parent of an infant comes with many changes. It can be helpful to recognize the psychological and social changes that are taking place in your life. Are there new coping skills or types of support that you need in order to adjust more effectively? Are your expectations matching up with your reality? Are your needs being met on a physical, mental, emotional, social, and spiritual level? Taking a regular inventory of how you are adjusting can be helpful in identifying any concerns and needs you have.
There are many resources for a new mother and her family. Some supportive resources include mental health providers, postpartum doulas, support groups, lactation consultants, faith communities, healthcare providers, home bound supports, and crisis hotlines. Each community differs in the availability of services, and many services are offered virtually.
If you find that you are suffering from anxiety in pregnancy or the postpartum period, the most important thing to know is that it is not your fault that you are feeling this way and you can get help and guidance to feel better again!
Additional Resources for Anxiety While Pregnant
If you or a loved one is struggling with perinatal anxiety, the following resources may be of help:
- Postpartum Support International (PSI): Provides support, local resources, and information for perinatal mood and anxiety disorders.
- PSI Helpline: 1800-944-4773 (4PPD)
- The Postpartum Stress Center: Premier treatment and professional training center for prenatal and postpartum depression and anxiety.
- MothertoBaby: Information about medications during pregnancy and breastfeeding.
- MGH Center for Women’s Mental Health: Reproductive Psychiatry Resource and Information Center.
