But for some people, that worry becomes so strong that it overpowers the entire pregnancy experience. That's when it morphs into anxiety. Perinatal generalized anxiety disorder is medically defined as excessive and uncontrollable worry during pregnancy. "It's natural to feel worried or some anxiety during pregnancy, but when it reaches the point to interfering with your day-to-day life, that's when it requires professional help," says Sarah Allen, PhD, a psychologist specializing in maternal mental health.
Besides seeing a therapist, Dr. Allen says there's a lot that pregnant people can do to quell their anxiety and feel more peace. Knowing exactly what causes anxiety during pregnancy and what actions can help minimize it can make this wild time in your life a bit easier to manage.
What causes anxiety during pregnancy?
Before you start troubleshooting, it helps to know the root causes of anxiety during pregnancy. Of course, not all pregnancies are the same, and different people can experience anxiety for different reasons. "Women who have pre-existing anxiety or other mental health conditions are more likely to experience anxiety during pregnancy," Dr. Allen says, citing one potential factor.
Licensed therapist Nahomie Guillaume, LMFT, agrees, though she also says having a previous diagnosis for anxiety does not mean it will return. One reason it does resurface, she says, is that so much is out of a person's control during pregnancy, and this can bring up feelings from a similar time in the past. Often, she says, people do not make this connection until working with a therapist.
Both therapists say this feeling can be exacerbated if the pregnancy was unwanted or unexpected. But the lack of a support system can also contribute. "Anxiety is rooted in fear," Dr. Allen says. "If someone is fearful of how she will handle the responsibilities of being a mom because she feels she will be on her own to do it, that can certainly lead to feeling more anxious."
"Anxiety is rooted in fear." —Sarah Allen, PhD
This is exactly why, Guillaume says, people of a lower socioeconomic status are more likely to experience anxiety during pregnancy. Affording the baby's basic needs, continuing to work, and securing child care are all more difficult for people in these communities. "There are so many cultural and social layers that come into play before you even consider how hormones are affecting how someone feels," she says. (More on this in a moment.)
Guillaume adds that fears about childbirth and the baby's health can also snowball into anxiety—especially in terms of what this will look like during a pandemic. For Black women, who are more than twice as likely to die in pregnancy than white women in the United States, this feeling is not unfounded. Both experts also say that people who have experienced loss often worry obsessively until the baby is safely in their arms. "Experiencing a miscarriage or stillborn birth can be extremely traumatic," says Dr. Allen. "I do always recommend women seek therapy while pregnant to cope with the anxiety that can resurface."
And there's the hormone factor. Guillaume explains that women start producing more cortisol and estrogen during pregnancy, which sometimes causes irritation, fatigue, and, yes, anxiety. During the first trimester, both progesterone and estrogen rise to new levels and a new hormone, gonadotropin, is produced. She explains that the rise in cortisol and progesterone, in particular, can cause mood to change. "This is often how someone knows they are pregnant in the first place; they just feel like something is 'off,'" she says. Hormone levels level out a bit in the second trimester, often making this part of pregnancy less of a roller coaster (at least hormonally), but estrogen and progesterone peak to new levels in the third trimester, at 32 weeks.
Pregnancy is a time when literally everything is changing. For all these reasons, anxiety can increase during pregnancy. But fortunately, there's a lot you can do to get it under control.
How to feel more peaceful during pregnancy
Remember how anxiety is often rooted in feeling like everything is out of control? That's exactly why it can be helpful to focus on what you can control. Taking steps like setting up the nursery, stocking up on diapers, and figuring out what your maternity plan will look like are all actions that are in your control.
Here's another important step that both experts say is important: Identify your support system and don't be afraid to ask for help when you need it. If you are experiencing pregnancy without a partner, this support system could include parents, siblings, and friends. "Virtual support groups and Facebook groups can also be helpful as a way to connect with other expecting parents who are experiencing many of the same fears," Dr. Allen says.
"Remind yourself that everything is fine right now. In this moment, there's no need to worry." —Dr. Allen
She says one time when it can be especially beneficial to lean on your support system is during particularly important doctor's appointments—especially if you have experienced a miscarriage in the past. "For these women, it can also be helpful to focus on the present, not the future," she says. "Remind yourself that everything is fine right now. In this moment, there's no need to worry."
Guillaume says it's also important to trust and feel heard by your doctor, especially for BIPOC people who are worried about their safety during pregnancy and birth. Working with a doula can often be beneficial in voicing concerns or requests of how you would like the birthing experience to go.
While health-care providers should broach the topic of anxiety during prenatal care, experts recommend telling your doctor how you're feeling—even if you have to volunteer that information. Some prescription medications can safely be used to treat anxiety during pregnancy. If you are overburdened by financial stress, a doctor can also connect patients to patient advocates, who can suggest resources (including government support and subsidized daycare). Of course, both experts reiterate that therapy can help as well, particularly for people with past trauma or who have experienced pregnancy loss in the past.
What's most important to remember is that anxiety during pregnancy is not something you have to live with. It can and will get better. The first step is asking for help.
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