What is Prenatal Anxiety?

Every little cramp sends your mind racing. Your Google search history is one long string of pregnancy-related search terms. You find yourself dreading prenatal appointments; the rising tide of dread diminishes for a moment after each appointment, then builds again as the “what ifs” and worries increase. You wake up at 2 AM, mind racing, convinced that something is wrong with your baby, and then start to wonder, “Is this normal? Is there something wrong with me?”

While pregnancy is naturally a time of heightened concern it is possible to move from a reasonable level of worry, into anxiety that interferes with day-to-day life. How do you know if what you’re experiencing is normal or has crossed that threshold?

What is prenatal anxiety?

Prenatal anxiety is not necessarily different from other kinds of anxiety but refers to significant symptoms associated with an anxiety disorder during pregnancy. If anxiety symptoms start to interfere with your ability to function, they may be severe enough to be classified as an anxiety disorder.

A distinguishing factor of prenatal anxiety is that the focus is usually on pregnancy-related topics: childbirth, role as a mother, pregnancy health, etc. Some of the most common symptoms of prenatal anxiety are:

• Constant worrying and rumination (overthinking)
• Restlessness
• Muscle tension
• Hypervigilance
• Difficulty sleeping because of worry (not due to general pregnancy discomfort)
• Unexplained feelings of dread

One of the things that can make distinguishing normal pregnancy symptoms from prenatal anxiety so difficult is that pregnancy is a time of so much physical and hormonal change. Especially for a first-time mother, there may not be a baseline of normal vs. abnormal symptoms to alert them to seek additional support.

Another complicating factor is that some of the most commonly used screening tests are not very effective at diagnosing prenatal anxiety. However, this does not mean it is not common, with an estimated one in five women suffering from some sort of anxiety disorder during pregnancy. The emerging research suggests that prenatal anxiety may be more common than depression, even though prenatal depression is more consistently screened for.

Is this more than prenatal anxiety?

Prenatal anxiety is an umbrella term that can also encompass other manifestations of anxiety disorders. Some women may experience symptoms of Obsessive-Compulsive Disorder, panic attacks, or symptoms of Post-Traumatic Stress Disorder. This is especially likely if a woman has struggled with any of these anxiety disorders in the past.

During the vulnerable time of pregnancy, women are confronted with emotions, themes, and body sensations that can dredge up past experiences and activate past trauma. For example, if a woman has suffered from a previous loss, extensive medical treatments for infertility, sexual abuse or trauma, or medical trauma, it makes perfect sense that pregnancy and the requisite medical care could trigger post-traumatic stress symptoms.

Similarly, the heightened stress of pregnancy can make it a time when it’s more likely that someone who has suffered from Obsessive-Compulsive Disorder (OCD) may use those thought loops to cope with the uncertainty of pregnancy. Research suggests that pregnant and postpartum women are 1.5-2 times more likely to experience symptoms of OCD.

However, regardless of the exact type of anxiety one experiences, certain things will remain true for best practices in diagnosis and treatment.

Does prenatal anxiety mean I lack faith?

Anxiety can be a tricky concept to deal with in Christian circles. You might wonder, “does all my worrying mean I lack faith?” The Bible presents us with many verses that speak to anxiety:

Be anxious for nothing, but in everything, by prayer and supplication, with thanksgiving, let your requests be made known to God, and the peace of Christ which surpasses all understanding, shall guard your hearts and minds in Christ Jesus. – Philippians 4:6-7

Faith can be an especially important part of dealing with anxiety as you learn to present all your worries and anxieties to God, trusting that He does promise peace. However, what this verse and others like it should not do is condemn you for not being able to handle anxiety without support. God is not a merciless judge. Hebrews 4:15-16 presents this encouragement:

For we do not have a high priest who is unable to sympathize with our weaknesses, but one who in every respect has been tempted as we are, yet without sin. Let us then with confidence draw near to the throne of grace, that we may receive mercy and find grace to help in time of need. – Hebrews 4:15-16

Jesus has suffered through the entire range of human experience, only without sin. Trust that He has known suffering and pain and is ready to comfort and companion you no matter what you face. There is biblical precedent for seeking wise counsel and for taking care of our physical bodies.

If anxiety is impairing your ability to function it is both the loving and wise response to seek additional support. In a world without sin and suffering, anxiety, along with every other health concern, would not be an issue. But in all the brokenness of this world, it is unsurprising that our minds and bodies experience that brokenness too.

Practical Steps

You might be thinking, “Okay, I’m pretty sure I have prenatal anxiety, so now what do I do?” There are a number of options. One of the most basic things you can do, that will benefit you even when you are not pregnant, is to develop a practice of diaphragmatic breathing. Diaphragmatic breathing sends a “calm down” signal to your nervous system that tells your body it is safe.

One of the simplest methods to remember is “box breathing.” Inhale through your nose for four counts, hold your breath without for four counts, exhale through your mouth for four counts, pause without inhaling for four counts. Repeat this several times in a row.

Breathing exercises like this one are most effective when you first practice them when you don’t need them, so when you are experiencing heightened anxiety, you have a familiar and easy-to-access resource.

Do I Need Counseling?

If basic steps like regular breathing, exercise, more rest, and limiting media are not giving you enough relief, it can be a good idea to seek counseling. When untreated, prenatal anxiety can have negative health effects on your developing child. Prenatal anxiety is connected with preterm birth, lower birth weights, and other complications.

This should not be cause for more anxiety, but it should underscore the importance for both you and your child of doing what you can to minimize your distress. It is understandable for a woman to need support during one of the most stressful times in her life.

Untreated prenatal anxiety also significantly increases a woman’s risk for postpartum depression, so establishing care with someone who knows you during pregnancy can also prove immensely helpful in the prevention and early treatment of postpartum mood disorders. Counselors are equipped with tools that are evidence-based and proven to help.

Especially during a time when the safety of some pharmaceutical interventions is contested, it’s great to have other tools to work with. Cognitive Behavioral Therapy (CBT) can help with generalized anxiety, EMDR and brainspotting are both amazing tools for processing trauma and therapists have many other resources to develop a plan that will work for you. If you are struggling, please reach out to us, we want to help.