Treatment options and self-help tips for pregnancy anxiety

How common is pregnancy anxiety?

Anxiety in pregnancy affects around 1 in 10 women. Biologically we are designed to protect our children as mothers, and so the vast majority of women will find anxiety increases in general in pregnancy. It enables us to make safer choices, to eat more healthily, to question our activities and life choices. It helps us to protect our growing babies. Anxiety is essentially our fight and flight response. We see a potential threat (the worry or concern) and we either fight it or run away from it – essentially changing our behaviours and modifying or avoiding the potential threat.

But the problem with anxiety in pregnancy is the impact it has on women and birthing people in everyday life. Anxiety is crippling for many. It can impact on work, relationships, on physical health and wellbeing. It is when the anxieties in pregnancy have increased to a degree where it is impacting on everyday life that this requires treatment.

Women who have untreated anxiety and stress in pregnancy are more likely to go on to experience the following:

• postpartum depression
• a baby who is unsettled after birth
• a baby with colic
• a baby whose fetal heart rate changes in labour
• a baby with restricted growth
• a premature birth
• bonding and attachment issues with their baby after birth

None of these risks mean that they will definitely happen, but from the research available, untreated pregnancy anxiety does increase all these risks. Nobody can avoid stress in pregnancy – life continues to go on. BUT the recognition, treatment and management is what is important because by lowering maternal cortisol levels (the stress response) then the amount of cortisol transferred to the baby is reduced, therefore promoting healthy growth, healthy fetal heart rate patterns and also improving oxytocin release in both the mother and baby.

Treatment options for pregnancy anxiety

Firstly, speaking to your midwife is the most important element in speaking up and seeking support. You should be asked about your mental health at booking, at 36 weeks, on discharge from the hospital or when your community midwives leave from your home birth and on discharge to the health visitor. This is at the very minimum. Most midwives will ask routinely at each contact, however.

Each area has different mental health support services in place. These are called different things depending on where you live, and it can be a postcode lottery. Some areas offer pregnancy specific mental health support – others offer generic mental health support. This can range from counselling to cognitive behavioural therapies and techniques.

In some areas, additional midwife visits will be provided, and sometimes antenatal education programmes tailored to women with additional support needs such as mental health concerns. By speaking to your midwife early, you will be able to ask for the support which is needed for you. Mental health issues which are treated and managed, and which do not impact on your ability to care for yourself or other children, is not a safeguarding issue. Please never be afraid to speak up and ask for help. There is nothing to be ashamed of, and it is so common.

Medication can be another option, particularly for women who were on these prior to pregnancy. It’s a risk / benefit analysis and totally up to the individual person as to what is right for them. Some medications are safer than others in pregnancy, and usually if a low dose is commenced at the beginning of pregnancy, then a medication review will be needed as the pregnancy continues as the metabolism of medications can change in pregnancy, so sometimes need to increase with the advancing pregnancy. This is unique to the woman or birthing person and works best in collaboration with your GP to manage your medication. For those with severe anxiety, referral to perinatal mental health teams will be recommended in pregnancy for the highest level of support.

Self help techniques for pregnancy anxiety

• Massage in pregnancy has been shown to lower cortisol levels, reduce the chances of premature birth, small or gestational age babies and reduce neonatal cortisol salivary levels after birth.
• Mindfulness, meditation and yoga are all great ways of relaxing, rewinding anxieties and reducing stress and cortisol levels in pregnancy. Pregnancy is a great way of bonding with baby antenatally too. The calm app and headspace app are great to download for wellbeing.
• Exercise of any sort is a great way of boosting endorphins which help to improve mental wellbeing. This is also a great way of switching off and ‘clearing your head’.
• Speaking out loud to family, friends, partners is so important too. People who listen, do not judge and people who know they don’t need to ‘fix’ your anxieties but are there to support you is what is most important.
• If the anxieties are related to birth and labour, then hypnobirthing is a great way to reduce and manage these anxieties. A good hypnobirthing programme which explores all varieties of birth, which applies the techniques to any birth and explores all the choices and options available is the most ideal programme available. A programme just centred around spontaneous vaginal birth is not so ideal when 1 in 4 women have a caesarean birth, 2 in 5 women have an induction of labour and 1 in 5 women have an instrumental birth in the UK. Realistic hypnobirthing programmes are the most ideal. The breathing techniques, affirmations, reframing and other techniques can help many women in pregnancy as well as during their birth of their baby.

My own experience of pregnancy anxiety

I have had a history of work anxiety in the past following an event which led to me having PTSD. I had three months of CBT which has given me the techniques to manage the anxieties I have had in this pregnancy. Anxieties in pregnancy increase for a number of reasons and this is something I have had more of this time round having my second child.

In my first pregnancy, I was working in a low risk birth centre: I watched some incredible women birth their babies with some magical births surrounded by birthing partners. I would care for hundreds of women a year and catch 70-80 babies a year (the others were handed over with shift changes or transferred to the labour ward if concerns arose).

But this time, I work in a mixed job, part clinical but with a third of my time spent in risk management. I help review the tiniest proportion of babies who enter neonatal units unexpectedly, are sadly miscarried late or are stillborn. As you can imagine, I arrive home with sadness and anxieties some days which need addressing so as not to impact on my mental health, nor my pregnancy or birth choices. I know these aren’t my stories, I know many of them have risk factors, smoke, have complex social or medical needs – but there are always the few where none of these factors apply and every case, regardless of history, leaves me feeling the injustice of life and emotional for these families.

Because of my job, I worry hugely about so many things but especially ultrasound scans. My 10 and 11 week scans, I was full of anxiety, worried I’d be told there was no heartbeat. With my 20 week scan coming up, I have no excitement: just anxiety that there will be an anomaly found. I’ll be excited when I know all is okay. It’s the same for midwife appointments too: what if something is found in my wee or my blood pressure is raised? Sometimes knowing too much is a curse.

Finally, it sounds mad but knowing what we are having has made me even more anxious. We didn’t find out with my first, but I have known this time since 12 weeks. Already, I am picturing what they will be like together, making plans full of hope, bonding on a whole different level to what I did with a surprise baby. I almost feel the closer I feel to this baby, the more anxious I am, and worried that something will happen.

I spend my evenings listening to hypnobirthing tracks, breathing techniques and ensuring I exercise and swim once a week. I utilise my CBT techniques to rationalise these experiences everyday, in order to reduce these anxieties and I come home and talk about this with my husband, family and friends. Keeping it inside increases the anxieties and it is so important to speak openly about them.

So if you are feeling anxious and reading this, know you aren’t alone. Pregnancy can cause so many women or pregnant people to feel anxious. Speak up, speak out and find ways to help reduce or manage these anxieties in pregnancy. Let’s talk openly about anxieties in pregnancy.