Is it normal to feel anxious in pregnancy?

By?definition, anxiety is a feeling of worry, nervousness or unease about something with an uncertain outcome.?

This pretty much sums up pregnancy, right??

When pregnant, we don’t have complete control over pregnancy outcomes or the changes happening in our body (or our emotions!) and we can’t predict what the birth will look like, how we will feel or what our baby will be like. We can be prepared, sure, but we can’t plan for everything.?

In many respects, anxiety?is?normal in pregnancy.?

Origins of anxiety

Anxiety is necessary because it protects us from danger. Anxiety activates our fight/ flight/ freeze response when we are threatened by something. Our body sends out the stress hormone cortisol which prepares us to respond and avert danger. This is the system that kicks in when we’re about to cross the road and out of our periphery we see a car. Anxiety is what makes us jump back onto the curb. It’s important for our survival.?

Mild to moderate levels of temporary anxiety can energise us, improve our thinking and motivate us. Like studying for an exam or preparing for a job interview. If anxiety wasn’t present it’s unlikely we’d study or engage in any job prep. There would be no concern about the outcome.?

And that’s what anxiety is at it’s core, right? We want things to work out, and if they aren’t going to work out well then we want to be prepared. We don’t want to be blindsided.?

We carry these ancient survival responses within our bodies and yet we no longer live in the stone age. There aren’t physical threats or predators at every turn. Anxiety, which used to protect us from physical danger, is now on the lookout for psychological and emotional threats.?

This tends to be more easily triggered in people who have experienced trauma and grief (though it can absolutely affect anyone). When something is experienced in the present moment and anxiety is activated, this is likely due to something that has happened in the past. Our body has remembered the threat (or something that looks a lot like this threat) and it prepares our body to react.?

However, the survival tactics we may have used in childhood to navigate difficult situations aren’t always helpful in adulthood. And when anxiety persists, it can take a serious toll on the body and mind and can diminish our ability to cope with change and interfere with daily life.?

How does anxiety manifest in pregnancy??

There is no single cause for pregnancy anxiety, rather, it is a combination of biological, psychological and social factors. Hormones are considered a factor in the development of anxiety and depression in the perinatal period.?

Pregnancy anxiety can occur in response to:

·??????Fear of miscarriage/ infant loss

·??????Prenatal diagnosis (e.g. congenital disorders)

·??????Obstetric complications (e.g. gestational diabetes, blood pressure)

·??????Insecurity over work or money

·??????Coping with multiple children

·??????Fear of birth, how they will cope during birth or something happening to self or baby

·??????Fear of change to relationship dynamics with partner or other children

·??????Weight gain and body image

·??????Social issues e.g. finances, relationship instability, housing instability etc.?

·??????The pregnancy was unplanned

·??????PTSD triggers

·??????Feeling out of control

·??????Concerns about how they will cope postnatally

·??????Concerns about whether they will love their baby or feel connected

·??????A pre-existing anxiety disorder

·??????A family history of anxiety or depression

Many worries may swirl through the mind of a pregnant woman. And with so much uncertainty, it comes as no surprise that 1 in 5 women in Australia will experience perinatal anxiety (in pregnancy or postpartum).?

Symptoms of pregnancy anxiety

While there are different categories of anxiety disorders, women who develop an anxiety disorder in pregnancy may experience:?

·??????Physical symptoms: increased heart rate, sweating, slowing down of digestion, trembling, shaking, cold clammy hands, feeling sick/ nauseas, tight feeling in the chest.?

·??????Psychological symptoms:?ruminating about one or more concerns, sleep difficulties, appetite changes, preoccupation with baby’s or own health, panic attacks, intrusive thoughts, alertness.?

·??????Emotional symptoms:?low mood, irritability, restlessness or feeling “on edge”

·??????Behavioural symptoms:?avoidance of feared situations or triggers

When does anxiety become a problem??

When anxiety stems from irrational fears, or perceived (not?real) danger, and/ or it impacts on daily functioning, relationships and self-care- then it becomes a problem.

It’s important to note that not all anxiety is irrational. Many women experience reality-based fears due to their lived experience. Fear of pregnancy loss because this was their previous experience. This is understandable. But what happens when it preoccupies a woman’s every thought? What happens when it impacts their functioning, their relationships, their health? This is when anxiety passes the threshold from within the norm to something of a clinical nature. Of course complicated grief and trauma play a role here too, but professional support can help a woman navigate this and manage anxiety symptoms.?

What’s more, antenatal anxiety can affect the developing foetus and the quality of the infant-caregiver relationship. Early detection and treatment benefits both mum and bub.?

Assessing pregnancy anxiety

The Edinburgh Postnatal Depression Scale (EPDS) is a screening tool designed to identify possible anxiety and depression symptoms in the antenatal and postnatal period. It is a 10-item, self-reporting measure that asks women to reflect on how they have felt over the preceding 7 days. If a perinatal woman scores 13 or more on the scale, further assessment via clinical interview is required to assess for anxiety and depression. This would be a good time to chat to the woman about accessing professional help to manage symptoms of anxiety in pregnancy.?

Tips on providing support to women with pregnancy anxiety

·??????Listen and validate her feelings. Dismissing worries is not helpful.?

·??????Provide psychoeducation on pregnancy anxiety

·??????Encourage the woman to consult with their GP or qualified health professional

·??????Support the woman to activate her emotional and practical supports and resources

·??????Encourage the woman to have?a plan to support her emotional wellbeing?in the postpartum period.?

Recap

There is no doubt that pregnancy is a time of uncertainty and on some level, anxiety is both normal and expected at some point. But persistent pregnancy anxiety symptoms can impact functioning, relationships and lead to depression and attachment difficulties after birth. This is why early intervention is key.?

This article first appeared on Lauren Keegan Psychology. To get articles like this direct to your inbox, join my mailing list here. Weekly clinical tips and resources for clinicians working with perinatal women and their babies.