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Pregnancy can be a really beautiful thing, but it’s also a very emotional time. Teixeira Murray looks at what happens when worry turns into anxiety.
Anxiety is just one of the many feelings a pregnant woman may experience and it isn’t unexpected, considering all the changes a woman’s body goes through during this time. However, if you’re feeling more anxious than normal, more often than not, it can be helpful to understand more about anxiety and how it can manifest during pregnancy.
The Wits University-based clinical psychologist, Dr Katherine Bain explains that while postnatal depression (PND) is now better understood, pregnancy anxiety (PrA) has only recently become recognised as a distinct condition.
“Pregnancy anxiety can be characterised by pregnancy-specific fears and worries that cause significant emotional and physical distress and interfere with daily functioning. There are usually excessive negative thoughts relating to foetal health, potential foetal loss, complications during childbirth, and the difficulties of parenting,” she says.
Of course, most women do feel some anxiety during pregnancy, because having a baby is a time of great physical and psychological transition. All women tend to worry about the health of the baby and how it’s developing, while others worry about their birth plans and whether everything will run according to plan.
As the pregnancy progresses and the birth date looms, many more anxious thoughts are invested in the lifestyle accommodations that will be required once baby arrives. But all of these can be normal within limits. It’s when these anxious thoughts consume the woman and affect her daily function that there is cause for concern.
Nurse and midwife Henny De Beer says family and friends may find it difficult at first to identify if a woman is suffering from anxiety because many of the concerns or fears can be validated. However, there are certain things they can look out for.
“Antenatal anxiety or depression can manifest itself in various ways, and forms anything from road rage to being extremely short-tempered, she says. “I have found that many women who suffer will find themselves unable to complete tasks that were previously normal, and may even look for excuses to stay home from work, even if there is no physical reason preventing them from going.
“These woman may neglect self-care and obsessively talk themselves down, and speak about negative stuff all the time. Often they deliberately avoid people, friends and family, and create distance in their relationships. Insomnia and nightmares plague them, as well as bad eating patterns – either too little or too much.
“The difficult thing is that pregnancy is a huge, life-changing event, and no amount of preparation is going to protect you from being nervous or from sleep-deprived anxiety attacks. You can’t be protected. But you can have help to put the moments in perspective: if your response is out of perspective, then professional help must be sought.”
Understanding who is at risk for pregnancy anxiety is just as important as treating the condition and so Bain has helped to identify several types or reasons why some women may be more susceptible to pregnancy anxiety.
“Pregnancy anxiety has been found to be higher in younger mothers, in first-time pregnancies, where abuse is present and or where the pregnancy was unplanned. The risk is also very high in cases where there are more risks for complications in pregnancy and birth,” she says.
“It is also more prevalent in women living in stressful circumstances, such as women who feel financially insecure, unsupported, or who have recently experienced stressful life events. These women may feel like they have less control during pregnancy.”
Bain suggests that it’s imperative to seek help for your pregnancy anxiety as early as possible because it allows for important intervention opportunities. Research before and during pregnancy is good but it can be counterproductive as it can scare the mother, whereas antenatal classes that equip women with knowledge and allow them to feel more prepared for childbirth have been shown to decrease levels of pregnancy anxiety.
“It is important to seek treatment for pregnancy anxiety, as it has been linked to increased nausea, higher risk of pre-term birth, low birth weight, and related developmental challenges for the baby,” says Bain. “It is also considered a risk factor for future PND. Higher perceived levels of emotional and practical support also help, so women should try to ask their families and friends for what they feel they need.
“In cases where the anxiety feels excessive, more formal intervention may be required. In these cases, consultation with a psychologist and/or psychiatrist may be helpful. Where available, consultation with a mental health professional who specialises in perinatal mental health is recommended.”
Having great support during pregnancy and thereafter is vital, but becomes a necessity when faced with pregnancy anxiety. Once concerns about anxiety have been raised, women should be encouraged to seek help, and this can come in many forms.
De Beer believes that midwives and doulas already go a long way towards helping mothers deal with difficult moments during pregnancy, but finding psychological help where excessive anxiety is identified is crucial.
“As a midwife I always suggest that pregnant couples do homework early in the pregnancy if the mother has previously suffered from some form of anxiety. Some mothers will be fine with certain relaxation techniques such as hypnobirthing and mindfulness, as well as increased communication. But where I have identified negative patterns, I always suggest psychological help.”
As a psychologist, Bain believes that treatment should help to identify the origins of the anxiety and the factors that are currently maintaining and exacerbating it. “As psychologists we need to help with the management of the anxiety through the interruption of maladaptive coping strategies, and the development of a healthier emotional regulation capacity,” she says.
“A psychiatrist can assist with the provision of medication to manage the anxiety, and is most qualified to weigh up the risks to the foetus with regards to the effects of the medication. While it is not possible to test the safety of medications during pregnancy, in some instances, not medicating can be more dangerous.”