anxiety in pregnancy

Pregnancy is always an emotional time and having some worries is normal. Whether you’re a first-time parent or are adding to your family, just getting pregnant can be stressful, then the nine months of pregnancy throws up all sorts of concerns. You may wonder: Is my bump too small? Is it too big? Is the baby not kicking enough?… the questions you ask yourself are endless. How will I get through labour? Will I be a good mother? Will I bond with my baby? These are all normal worries, and very much part of the experience for most first-time mothers. The reality is a little bit of anxiety, worry and hesitation about pregnancy, childbirth and parenting is par for the course. However, we are now living through a pandemic in which pregnant women are classified as high risk. Naturally, anxiety levels have gone up and suddenly feeling anxious has become the new norm.

 

What is Anxiety?

Anxiety is a natural, adaptive response we experience when we feel unsafe or threatened. These perceived “threats” could be specific, like how do I get products that are out of stock, or they can be general feelings that something bad will happen. It can even be something completely imagined in our heads, without any rationale for thinking it. Overwhelming anxiety occurs when feelings of being anxious and stressed don’t go away, can’t be controlled easily, and come on without any particular reason. This is when you should seek help.

 

What is Antenatal Anxiety?

The chances of developing anxiety are greater when pregnant, but signs are sometimes missed or ignored. In fact, the early symptoms are often dismissed as being down to hormonal changes, but these changes can actually affect the chemicals in your brain and cause anxiety.

Antenatal anxiety might involve developing one or more of the following conditions during pregnancy:

  • Generalised anxiety  - you feel anxious most days.
  • Panic disorder - you have panic attacks, when you feel overwhelmingly anxious and have physical symptoms such as shortness of breath, chest pain and dizziness.
  • Agoraphobia - a fear of open or public spaces.
  • Obsessive-compulsive disorder - you are compelled to carry out certain behaviours or rituals.
  • Post-traumatic stress disorder (PTSD) - your anxiety is related to a past traumatic event, and you have bad dreams, flashbacks and find it hard to relax and sleep.
  • Social phobia - you’re worried about being criticised or humiliated in public

If you already have an anxiety disorder or you are someone who worries a lot, you may be at greater risk of developing anxiety during pregnancy. Factors that could increase the chances of you experiencing anxiety during pregnancy include:

  • History of high anxiety and/or depression
  • Striving for perfectionism
  • History of miscarriages
  • High-risk pregnancy
  • Major life stressors (such as the coronavirus pandemic and it’s impact)

It’s time to talk to a healthcare provider if you’re experiencing any of these issues or don’t enjoy things that used to make you happy. If you think you may be at risk of developing antenatal anxiety, it’s important to seek professional help and treatment early on in your pregnancy to make sure you and your baby receive the right care.

 

What are the signs and symptoms to look out for?

  • In your body - increased heart rate, stomach pains, tight chest and throat, shallow breathing, loss of appetite, difficulty falling or staying asleep, muscle tension eg. grinding teeth, neck and shoulder pain, back pain, muscle twitching…
  • In your mind - racing thoughts about the future; imagining the worst-case scenario; constantly worrying, obsessing or feeling on edge; difficulty concentrating and focusing; forgetfulness; finding it hard to stay calm…
  • In your behaviour - avoiding certain situations, activities, places, or people; over-controlling; asking others for constant reassurance; checking things repeatedly; being extra careful and vigilant of danger; demonstrating irritability, having panic attacks …

These symptoms can develop gradually, or you may experience them suddenly and intensely. They can get worse over time if they’re not treated.

 

How common is pregnancy anxiety?

Anxiety in pregnancy is more common than many of us realise – and it can affect men too. Some parents experience mental ill health for the first time in pregnancy. Vulnerability is a common feeling in pregnancy, particularly for first time parents, which is understandable when dealing with new feelings and changes never experienced before. If this feeling is left unchecked, it can grow and escalate into anxiety, and even depression.

If you have had severe mental ill health in the past, or have it now, you are more at risk of it returning during pregnancy or in the year after giving birth than at other times in your life. It’s important to remember there is plenty of support available, so it’s helpful to keep an eye out for the signs.

Tell your midwife or GP if you have experienced anxiety before even if you aren’t feeling anxious right now. The more they know about your mental health history the better they can support you during your pregnancy.

The midwife or doctor won’t criticise you or judge you for having these feelings. They know this happens to many pregnant women, and they will focus on finding the right treatment to help you recover.

If you find anxiety difficult to talk about, you could write down how you feel before your appointment or take someone with you for support.

 

What’s the difference between antenatal anxiety and antenatal depression?

Up to half of people with antenatal anxiety also have antenatal depression. Antenatal depression involves feeling low, numb and hopeless, losing confidence, being emotional or angry, not being able to sleep or eat properly, losing concentration and not being interested in people or activities you normally like.

There are safe ways to treat both anxiety and depression at the same time during pregnancy.

 

How is pregnancy anxiety treated?

Anxiety is treated with psychological therapies such as relaxation training, cognitive behavioural therapy or using mindfulness. (Anxiety, phobias and panic attacks are usually treated using self-help treatments based on cognitive behavioural therapy CBT). 

You might also be encouraged to modify your lifestyle to reduce stress, exercise and eat healthily.

In more severe cases, your doctor might prescribe medication. They will discuss with you what medicines are safe to take during pregnancy

Remember, anxiety during pregnancy is common – it’s nothing to be ashamed of – but without treatment, it can get worse. You should talk to your doctor or midwife to get on top if it as soon as you can.

 

How can I manage my anxiety?

1. Get plenty of sleep. Catch more zzzs. Some research has found that lack of sleep could exacerbate anxiety, so aim for seven to eight hours a night whenever possible.


2. Eat whole and fresh foods. Brazil nuts contain selenium, which may help to improve your mood. Fatty fish, such as salmon, mackerel, sardines, trout, and herring, are high in omega-3 known to fight depression and anxiety. Other foods thought to be beneficial are eggs, pumpkin seeds, dark chocolate, turmeric, chamomile and yoghurt.

eat healthy to help with anxiety

Some people find that a healthy diet helps them to manage their anxiety. This may be because highs and lows in blood sugar can affect mood. It's also important to stay away from stimulants such as caffeine, alcohol and cigarettes. Apart from being bad for your baby, they can contribute to panic attacks and make it harder for you to control your anxiety in the long term.


3. Stay active. Even five minutes of aerobic exercise can begin to stimulate anti-anxiety effects but it’s recommended you do 30 minutes or more of exercise a day for three to five days a week to significantly improve depression or anxiety symptoms. Being pregnant is not the time to significantly increase your exercise. Always check with your doctor before starting any new activities.
Under the current lockdown restrictions you could practise walking or running, while maintaining your social distance. There are lots of videos and advice on practising yoga, pilates etc. at home, but it’s recommended that you only take classes where the instructor can see you and provide you with corrective postures and techniques. Whatever works for you, keep doing it through pregnancy. It’s your chance to focus on something different, and it’s great for you and your baby’s health. A surge of endorphins, or stress-relieving stretches, can help you feel good and sleep better.

stay active in pregnancy to help with feelings of anxiety


4. Arm yourself with knowledge. Understanding the facts about anxiety and how to help yourself, will in itself help ease your anxiety. The charities anxietyuk, mind and no panic offer lots of information and support on anxiety, and of course the NHS is a fantastic source of knowledge for all things health related.
Keeping a diary may help you to identify any triggers for your anxiety and to manage your symptoms. Perhaps you often get anxious at a particular time of day, or when facing a particular challenge or activity. A diary can also help you keep track of times when you've successfully controlled your feelings, so you learn what works.


5. Build a support network. Family and friends can be your mainstay in dealing with anxiety. Talking to someone you trust and who understands you is invaluable. If you aren't able to open up to someone close to you, the Samaritans and Anxiety UK both run helplines that you can call to talk to someone. Also building your network to include a self-help group is a great way to learn techniques and strategies you need to take control of the disorder. There are plenty of resources available to help you with your anxiety, from meditation videos to online courses and books. Your midwife or GP may be able to make a recommendation, or you can just search online or have a look in your nearest bookshop.


6. Schedule time in your day to relax. Try learning about simple relaxation techniques and practise them regularly. Whether it be hypnobirthing, exercise, breathing techniques or mindfulness. One great way to join body and mind together in relaxation is through yoga. There have been some studies done of the effect of yoga on mental health and the research discovered it can enhance mood and may even be as effective as antidepressant drugs in treating depression and anxiety. Source

practise yoga to relax in pregnancy
Controlling your breathing can help counter some of the physical sensations of anxiety and help you to relax. And many mums find meditation and breathing techniques help them relax in pregnancy and manage the pain of labour. A meditation technique called mindfulness may help. As you breathe try to focus on the sights, sounds and smells around you. If a negative thought comes into your head, don't fight it. Just let it pass by without judgement. It’s difficult at first but gets easier with practice.

breathing techniques for dealing with anxiety in pregnancy

7. Try shifting your focus. If you're feeling constantly anxious, focus on something small, like the details of a picture or the texture of something you're wearing. If you can, try to keep your thoughts entirely on this one thing, really taking in all the small details. This can help you take a moment to calm down. And do not feel guilty or embarrassed about feeling anxious. There is nothing wrong with feeling like this. Acknowledging your anxious feelings is the most important first step in your journey to feeling better.


8. Treat yourself to some pampering.  Why not buy a treat for every month of your pregnancy? Something small like a candle or a manicure could be enough to give you some “me time”. It will give yourself something to look forward to, away from your thoughts of your pregnancy.


9. Find ways to connect to your baby. Mothers have told us that focusing on the baby for a short time each day helped them feel better about their pregnancy. Simply taking some time to put your hands on your tummy when the baby is kicking. This can help you feel closer to your baby and start building your bond.  Thinking about my baby, rather than everything else that is going on around you, gives you that reassurance and calm that your main priority is okay.


10. Ask for help and talk to your midwife. It can sometimes be difficult to know whether your feelings are manageable or a sign of something more serious. Trust yourself. You are the best judge of whether your feelings are normal for you. Talk to your midwife or GP if you are feeling low for more than two weeks.

 

Will anxiety affect my baby?

It is very unlikely that your baby will be affected by your anxiety, particularly if you get the right treatment and support. So try to focus on asking for help and finding ways to manage your symptoms. Be confident that you are doing everything you can to take care of your baby. The last thing you need is to feel anxious that your anxiety is affecting your baby, as this could create a vicious circle of thoughts.

Early treatment is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you will start to feel better.

 

Will I feel less anxious after the birth?

There are generally fewer cases of anxiety in women after the birth than during pregnancy. If you didn't have any mental health problems before you became pregnant, it's likely you'll start to feel better after the birth.

If you continue experiencing anxiety when your baby is born, talk to your midwife, health professional or GP as soon as possible. They'll probably reassure you that your feelings are normal and offer some advice to manage your symptoms. But if there is more to it, it's good to get help as early as possible.

Further reading:

Awake at 3 a.m.: Yoga Therapy for Anxiety and Depression in Pregnancy and Early Motherhood

The Little Book of Self-Care for New Mums

The Positive Birth Book: A New Approach to Pregnancy, Birth and the Early Weeks

The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions and Compulsions

anxiety in pregnancy

Pregnancy is always an emotional time and having some worries is normal. Whether you’re a first-time parent or are adding to your family, just getting pregnant can be stressful, then the nine months of pregnancy throws up all sorts of concerns. You may wonder: Is my bump too small? Is it too big? Is the baby not kicking enough?… the questions you ask yourself are endless. How will I get through labour? Will I be a good mother? Will I bond with my baby? These are all normal worries, and very much part of the experience for most first-time mothers. The reality is a little bit of anxiety, worry and hesitation about pregnancy, childbirth and parenting is par for the course. However, we are now living through a pandemic in which pregnant women are classified as high risk. Naturally, anxiety levels have gone up and suddenly feeling anxious has become the new norm.

 

What is Anxiety?

Anxiety is a natural, adaptive response we experience when we feel unsafe or threatened. These perceived “threats” could be specific, like how do I get products that are out of stock, or they can be general feelings that something bad will happen. It can even be something completely imagined in our heads, without any rationale for thinking it. Overwhelming anxiety occurs when feelings of being anxious and stressed don’t go away, can’t be controlled easily, and come on without any particular reason. This is when you should seek help.

 

What is Antenatal Anxiety?

The chances of developing anxiety are greater when pregnant, but signs are sometimes missed or ignored. In fact, the early symptoms are often dismissed as being down to hormonal changes, but these changes can actually affect the chemicals in your brain and cause anxiety.

Antenatal anxiety might involve developing one or more of the following conditions during pregnancy:

  • Generalised anxiety  - you feel anxious most days.
  • Panic disorder - you have panic attacks, when you feel overwhelmingly anxious and have physical symptoms such as shortness of breath, chest pain and dizziness.
  • Agoraphobia - a fear of open or public spaces.
  • Obsessive-compulsive disorder - you are compelled to carry out certain behaviours or rituals.
  • Post-traumatic stress disorder (PTSD) - your anxiety is related to a past traumatic event, and you have bad dreams, flashbacks and find it hard to relax and sleep.
  • Social phobia - you’re worried about being criticised or humiliated in public

If you already have an anxiety disorder or you are someone who worries a lot, you may be at greater risk of developing anxiety during pregnancy. Factors that could increase the chances of you experiencing anxiety during pregnancy include:

  • History of high anxiety and/or depression
  • Striving for perfectionism
  • History of miscarriages
  • High-risk pregnancy
  • Major life stressors (such as the coronavirus pandemic and it’s impact)

It’s time to talk to a healthcare provider if you’re experiencing any of these issues or don’t enjoy things that used to make you happy. If you think you may be at risk of developing antenatal anxiety, it’s important to seek professional help and treatment early on in your pregnancy to make sure you and your baby receive the right care.

 

What are the signs and symptoms to look out for?

  • In your body - increased heart rate, stomach pains, tight chest and throat, shallow breathing, loss of appetite, difficulty falling or staying asleep, muscle tension eg. grinding teeth, neck and shoulder pain, back pain, muscle twitching…
  • In your mind - racing thoughts about the future; imagining the worst-case scenario; constantly worrying, obsessing or feeling on edge; difficulty concentrating and focusing; forgetfulness; finding it hard to stay calm…
  • In your behaviour - avoiding certain situations, activities, places, or people; over-controlling; asking others for constant reassurance; checking things repeatedly; being extra careful and vigilant of danger; demonstrating irritability, having panic attacks …

These symptoms can develop gradually, or you may experience them suddenly and intensely. They can get worse over time if they’re not treated.

 

How common is pregnancy anxiety?

Anxiety in pregnancy is more common than many of us realise – and it can affect men too. Some parents experience mental ill health for the first time in pregnancy. Vulnerability is a common feeling in pregnancy, particularly for first time parents, which is understandable when dealing with new feelings and changes never experienced before. If this feeling is left unchecked, it can grow and escalate into anxiety, and even depression.

If you have had severe mental ill health in the past, or have it now, you are more at risk of it returning during pregnancy or in the year after giving birth than at other times in your life. It’s important to remember there is plenty of support available, so it’s helpful to keep an eye out for the signs.

Tell your midwife or GP if you have experienced anxiety before even if you aren’t feeling anxious right now. The more they know about your mental health history the better they can support you during your pregnancy.

The midwife or doctor won’t criticise you or judge you for having these feelings. They know this happens to many pregnant women, and they will focus on finding the right treatment to help you recover.

If you find anxiety difficult to talk about, you could write down how you feel before your appointment or take someone with you for support.

 

What’s the difference between antenatal anxiety and antenatal depression?

Up to half of people with antenatal anxiety also have antenatal depression. Antenatal depression involves feeling low, numb and hopeless, losing confidence, being emotional or angry, not being able to sleep or eat properly, losing concentration and not being interested in people or activities you normally like.

There are safe ways to treat both anxiety and depression at the same time during pregnancy.

 

How is pregnancy anxiety treated?

Anxiety is treated with psychological therapies such as relaxation training, cognitive behavioural therapy or using mindfulness. (Anxiety, phobias and panic attacks are usually treated using self-help treatments based on cognitive behavioural therapy CBT). 

You might also be encouraged to modify your lifestyle to reduce stress, exercise and eat healthily.

In more severe cases, your doctor might prescribe medication. They will discuss with you what medicines are safe to take during pregnancy

Remember, anxiety during pregnancy is common – it’s nothing to be ashamed of – but without treatment, it can get worse. You should talk to your doctor or midwife to get on top if it as soon as you can.

 

How can I manage my anxiety?

1. Get plenty of sleep. Catch more zzzs. Some research has found that lack of sleep could exacerbate anxiety, so aim for seven to eight hours a night whenever possible.


2. Eat whole and fresh foods. Brazil nuts contain selenium, which may help to improve your mood. Fatty fish, such as salmon, mackerel, sardines, trout, and herring, are high in omega-3 known to fight depression and anxiety. Other foods thought to be beneficial are eggs, pumpkin seeds, dark chocolate, turmeric, chamomile and yoghurt.

eat healthy to help with anxiety

Some people find that a healthy diet helps them to manage their anxiety. This may be because highs and lows in blood sugar can affect mood. It's also important to stay away from stimulants such as caffeine, alcohol and cigarettes. Apart from being bad for your baby, they can contribute to panic attacks and make it harder for you to control your anxiety in the long term.


3. Stay active. Even five minutes of aerobic exercise can begin to stimulate anti-anxiety effects but it’s recommended you do 30 minutes or more of exercise a day for three to five days a week to significantly improve depression or anxiety symptoms. Being pregnant is not the time to significantly increase your exercise. Always check with your doctor before starting any new activities.
Under the current lockdown restrictions you could practise walking or running, while maintaining your social distance. There are lots of videos and advice on practising yoga, pilates etc. at home, but it’s recommended that you only take classes where the instructor can see you and provide you with corrective postures and techniques. Whatever works for you, keep doing it through pregnancy. It’s your chance to focus on something different, and it’s great for you and your baby’s health. A surge of endorphins, or stress-relieving stretches, can help you feel good and sleep better.

stay active in pregnancy to help with feelings of anxiety


4. Arm yourself with knowledge. Understanding the facts about anxiety and how to help yourself, will in itself help ease your anxiety. The charities anxietyuk, mind and no panic offer lots of information and support on anxiety, and of course the NHS is a fantastic source of knowledge for all things health related.
Keeping a diary may help you to identify any triggers for your anxiety and to manage your symptoms. Perhaps you often get anxious at a particular time of day, or when facing a particular challenge or activity. A diary can also help you keep track of times when you've successfully controlled your feelings, so you learn what works.


5. Build a support network. Family and friends can be your mainstay in dealing with anxiety. Talking to someone you trust and who understands you is invaluable. If you aren't able to open up to someone close to you, the Samaritans and Anxiety UK both run helplines that you can call to talk to someone. Also building your network to include a self-help group is a great way to learn techniques and strategies you need to take control of the disorder. There are plenty of resources available to help you with your anxiety, from meditation videos to online courses and books. Your midwife or GP may be able to make a recommendation, or you can just search online or have a look in your nearest bookshop.


6. Schedule time in your day to relax. Try learning about simple relaxation techniques and practise them regularly. Whether it be hypnobirthing, exercise, breathing techniques or mindfulness. One great way to join body and mind together in relaxation is through yoga. There have been some studies done of the effect of yoga on mental health and the research discovered it can enhance mood and may even be as effective as antidepressant drugs in treating depression and anxiety. Source

practise yoga to relax in pregnancy
Controlling your breathing can help counter some of the physical sensations of anxiety and help you to relax. And many mums find meditation and breathing techniques help them relax in pregnancy and manage the pain of labour. A meditation technique called mindfulness may help. As you breathe try to focus on the sights, sounds and smells around you. If a negative thought comes into your head, don't fight it. Just let it pass by without judgement. It’s difficult at first but gets easier with practice.

breathing techniques for dealing with anxiety in pregnancy

7. Try shifting your focus. If you're feeling constantly anxious, focus on something small, like the details of a picture or the texture of something you're wearing. If you can, try to keep your thoughts entirely on this one thing, really taking in all the small details. This can help you take a moment to calm down. And do not feel guilty or embarrassed about feeling anxious. There is nothing wrong with feeling like this. Acknowledging your anxious feelings is the most important first step in your journey to feeling better.


8. Treat yourself to some pampering.  Why not buy a treat for every month of your pregnancy? Something small like a candle or a manicure could be enough to give you some “me time”. It will give yourself something to look forward to, away from your thoughts of your pregnancy.


9. Find ways to connect to your baby. Mothers have told us that focusing on the baby for a short time each day helped them feel better about their pregnancy. Simply taking some time to put your hands on your tummy when the baby is kicking. This can help you feel closer to your baby and start building your bond.  Thinking about my baby, rather than everything else that is going on around you, gives you that reassurance and calm that your main priority is okay.


10. Ask for help and talk to your midwife. It can sometimes be difficult to know whether your feelings are manageable or a sign of something more serious. Trust yourself. You are the best judge of whether your feelings are normal for you. Talk to your midwife or GP if you are feeling low for more than two weeks.

 

Will anxiety affect my baby?

It is very unlikely that your baby will be affected by your anxiety, particularly if you get the right treatment and support. So try to focus on asking for help and finding ways to manage your symptoms. Be confident that you are doing everything you can to take care of your baby. The last thing you need is to feel anxious that your anxiety is affecting your baby, as this could create a vicious circle of thoughts.

Early treatment is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you will start to feel better.

 

Will I feel less anxious after the birth?

There are generally fewer cases of anxiety in women after the birth than during pregnancy. If you didn't have any mental health problems before you became pregnant, it's likely you'll start to feel better after the birth.

If you continue experiencing anxiety when your baby is born, talk to your midwife, health professional or GP as soon as possible. They'll probably reassure you that your feelings are normal and offer some advice to manage your symptoms. But if there is more to it, it's good to get help as early as possible.

Further reading:

Awake at 3 a.m.: Yoga Therapy for Anxiety and Depression in Pregnancy and Early Motherhood

The Little Book of Self-Care for New Mums

The Positive Birth Book: A New Approach to Pregnancy, Birth and the Early Weeks

The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions and Compulsions