Essential reads & resources

Clinically Reviewed by Brandy Chalmers, M.A., LPC, NCC

‍

Did you know that anxiety is one of the most common side effects of pregnancy and postpartum? If you are pregnant or gave birth in the last 24 months and are struggling to manage feelings of worry and anxiousness, you are not alone! In this article, we will address the differences between typical worrying versus what presents as an anxiety disorder. We will give you tips to reduce your anxiety during pregnancy and postpartum, including tools for self-advocacy.

Worry is the work of pregnancy

According to Dr. Lewis Mehl, a psychologist specializing in perinatal mental health, "Worry is the work of pregnancy." It is also a biological drive that helps new mothers respond proactively to their babies cries, needs, and serves as a form of protection for new babies. 

Much of the worry that pregnant or new mothers experience is a fear of the unknown. How can I make sure I'm eating foods that are safe for my growing baby? What will labor feel like? What will it be like to get an epidural? Am I burping my baby correctly? Is this baby shampoo safe for my baby? Is my baby warm enough?

By taking tangible steps toward self-education, including utilizing trusted web resources (such as Evidence Based Birth and kellymom), reading recommended books (we love anything by Penny Simkin), taking childbirth and parenting education classes, and joining a support group, you can begin to relieve some of your fears and prepare mentally for different scenarios.

If you’re pregnant, creating a birth plan can help you identify useful questions to ask your care provider and help you feel prepared and ready to be an active decision-maker in your health care. It will also allow you to envision your ideal birth scenario, while giving you the tools to strategize dealing with unforeseen complications, should they arise.

As you work through the normal worries of pregnancy and postpartum, try this exercise from Birthing From Within:

• Write down all of your secret worries. Some may seem trivial, but pay attention to those that you are purposefully trying to minimize, and those that cause physical tension in your body
• Share each of your worries with a trusted listener. This could be your partner, but you might find you benefit from the guidance of a pregnancy health expert, such as your doula, or a mental health expert, such as a counselor.  Seven Starling, a digital platform making high-quality mental healthcare more accessible for new mothers and caregivers, is certainly an option to consider. With specialized therapy, peer support, and in-app exercises, Seven Starling uses the most effective, proven methods to treat common perinatal mood disorders like perinatal anxiety during pregnancy and postpartum.

Use the following questions to work through your worries with your trusted listener:

• What would you do if this worry/fear actually happened?
• What do you imagine your partner (or birth attendant) would do/say?
• What would it mean about you if this happened?
• How have you faced crises in the past?
• What, if anything, can you do to prepare for, or even prevent, what you are worrying about? What’s keeping you from doing it? If there is nothing you can do to prevent it, how would you like to handle the situation?‍

Exploring your fears and concerns through this exercise, especially the ones you are hesitant to open up about, can help shift your thinking from feeling frozen by fear to feeling prepared with coping strategies and solid back-up plans. You will also find that sharing your worries helps you feel more supported or may encourage you to seek professional help.

Identifying anxiety

20-25% of people experience mood and anxiety disorders during the perinatal period, which is defined as the time from conception up through two years postpartum. We hear a lot about perinatal depression, but perinatal anxiety is just as common, and tends to reach its most severe levels in the last trimester of pregnancy.

How can you tell if what you are experiencing is typical worries that come with the major life change of welcoming a baby into the world, or if what you are experiencing is a generalized anxiety disorder that will benefit from the help of mental health professionals?

A generalized anxiety disorder is defined as excessive and uncontrollable worrying that affects your ability to function normally day to day. For the prenatal period this may present as:

• Anxiety or fear that interrupts your thoughts and interferes with daily tasks
• Panic attacks - outbursts of extreme fear and panic that are overwhelming and feel uncontrollable
• Persistent worries that keep coming into your mind
• Constantly feeling irritable, restless or “on edge”
• Having tense muscles, a “tight” chest and heart palpitations
• Finding it difficult to relax and/or taking a long time to fall asleep at night, fatigue
• Anxiety or fear that stops you going out or engaging in activities you would otherwise enjoy

Some of these symptoms can be difficult to separate from normal pregnancy or postpartum symptoms, such as insomnia, restlessness, and general fatigue, but the key factor to consider is whether your anxiety symptoms make daily life feel difficult. It may also be helpful to know that anxiety disorders in pregnancy or postpartum often center around concerns over the health of the baby, concerns over your own health, and concerns that something may happen to your partner or your relationship.

Risk factors that make you more likely to develop prenatal anxiety include:

• Personal or family history of mental health problems or current mental health problems
• Pregnancy complications
• Past experience with pregnancy loss (miscarriage, stillbirth or termination)
• Current or past history of physical, psychological, or sexual abuse
• Predisposition to perfectionism and anxiety
• Lack of support from family and friends
• Stressful life events
• Continuing lack of sleep or rest
• An unplanned pregnancy
• Having multiples

Getting professional support

If you feel that you may have a generalized anxiety disorder or could benefit from professional support, we encourage you to seek help right away. At Seven Starling, we offer online therapy for expecting and new parents. Therapy is a powerful way to get support for common conditions like Anxiety and Depression. Seven Starling therapists are experts in the perinatal period and are here to help support you. Get started here to book a free consult with a Care Coordinator.

Self-Advocacy

Because it can be difficult to separate typical perinatal-related worry from an anxiety disorder that requires professional intervention, anxiety in the perinatal period is often underdiagnosed. If you believe you are experiencing an anxiety disorder while pregnant or in postpartum, it is important for you to advocate for the help you need.  

Practical steps for coping with prenatal anxiety

There are changes you can make to your daily life to help reduce the symptoms of your anxiety during the perinatal period:

• Eating well. When we are stressed we tend to crave sweets and carbs, which in turn cause spikes in our blood sugar, which can lead to mood swings and emotional instability. Focusing on balanced nutrition, including frequent servings of protein, and avoiding junk food (even if that’s what you’re craving), can help keep your blood sugar levels stable, and also help keep your mood stable. Try not to go too long between meals to avoid a blood sugar crash.
  
  
• Avoiding caffeine. One to two small cups of coffee a day is generally acceptable during the perinatal period, but if you find you are struggling with anxiety try cutting out caffeine completely. Caffeine can exacerbate symptoms of anxiety by making you feel jittery and restlessness, and can interfere with sleep.
  
  
• Physical activity. Getting even just a few minutes of brisk activity every day is a proven way to boost your mood and lower stress levels. Try taking a short walk during your lunch break, or decompress with a few sun salutations at the end of your work day. If you find you lack the motivation to exercise, you can ask a support person to encourage you and exercise with you.
  
  
• Get outside. If exercising feels too overwhelming, try simply getting outside! We love this recommendation from Beyond the Blues: “When you’re depressed or anxious, the four walls feel as if they’re closing in. The world feels darker and smaller...To counter this, go outside your home, look up at the sky, stand up straight, put your arms at  your sides, and breathe. You don’t have to actually go anywhere. Just go outside once a day, even if this means standing outside of your front door in your bathrobe.”
  
  
• Control your environment. Be aware of factors that trigger your anxiety and think of ways to eliminate or lessen them. That might mean avoiding news on TV or the radio, deleting apps from your phone that lead to doomscrolling, and avoiding social media accounts that you find triggering. It’s also a good idea to avoid watching shows and movies that are scary, suspenseful, violent, or tragic. Try to avoid overstimulation, and if your workplace has a lot of background noise, try using noise-canceling headphones.
  
  
• Enhance your environment. Along with avoiding external sources of stress and anxiety, you can focus on creating an environment that is soothing. Try playing calming music in the background as you work or clean or exercise. Open blinds and curtains to let natural sunlight into your space. Burn candles or diffuse essential oils with relaxing scents. 
  
  
• Don’t push yourself. Be kind to yourself at this time. Your body is experiencing great emotional, physical, and hormonal changes, and you might find that you are now overwhelmed by activities that used to feel routine. It’s okay to say no — to cancel plans, to ask for a rain check, to reschedule appointments.
  
  
• Take breaks. It’s also okay if you need more frequent breaks from work and other activities than you did before you were pregnant. If you find yourself feeling stressed and anxious, try stepping away from your desk and taking a few deep breaths, taking a pause to focus simply on breathing in and out. Take breaks at least every two hours to stretch, hydrate, and snack. If it’s possible, stop work for the day if you feel overly anxious or tired. 
  

Mindfulness exercises

A growing body of research suggests that mindfulness exercises during the perinatal period is an excellent way to reduce anxiety.

The term “mindfulness” is a meditation technique that involves being present in the moment, tuning in to our body’s sensations and thoughts in that moment, and accepting whatever we are feeling or sensing with gentleness and grace.

Mindfulness can be as simple as acknowledging when you feel happy or at peace, like the great author Kurt Vonnegut suggested, “...please notice when you are happy, and exclaim or murmur or think at some point, 'If this isn't nice, I don't know what is.’”

Mindfulness can also mean allowing yourself to sit with difficult thoughts and feelings, acknowledging them without self-critique. Not to dwell, but to accept the feeling instead of struggling against it, and see acceptance as part of the process of letting go. This is how you are feeling at this very moment, but the feeling will not last forever.

Here are some mindfulness exercises you can start to incorporate into your daily routine:

Journaling. Try keeping a brief bullet-style journal to keep track of your thoughts and feelings. Check in with yourself twice a day, and jot down how you are feeling in that moment, both physically and mentally.‍‍

‍Body Scan exercise. Use this exercise to scan your body one area at a time for places where you might be holding tension. Often we carry tension that we aren’t even aware of, which contributes to the physical symptoms of anxiety. Pay particular attention to your jaw, brow, and shoulders. Those muscle groups are where anxiety likes to hide.‍

Breathing exerciseThis 15 minute breathing exercise can help calm you before or after a stressful situation. It is a great introduction to the practice of meditation, and encourages you to focus on your breath and redirect wandering thoughts.‍

Tense and release exercise. This exercise helps you rid your body of tension by first tensing a muscle group, noticing how it feels to hold the muscle tense, and then letting it go, paying attention to how your muscle feels when it is relaxed. 

Social Support

Finding a group of expecting parents who are going through the same life changes will help you feel less alone on your journey. Social support is pivotal to maintaining your mental health, and at Seven Starling we have a passion for building community. Some of our treatment plans includes peer support, which has been proven to be an effective component of treatment for perinatal mood and anxiety disorders. Get started here to book a free consult with a care coordinator.

Support from your partner is also very important at this time, but they may be struggling with how to help you. We have written an article just for them here.

Sources:

‍Bennett, S. S., & Indman, P. (2019). Beyond the blues: Understanding and treating prenatal and postpartum depression & anxiety. Untreed Reads, LLC.

England, P., & Horowitz, R. I. (2007). Birthing from within. Souvenir.

Four reasons to practice mindfulness during pregnancy. Greater Good. Retrieved May 19, 2022, from https://greatergood.berkeley.edu/article/item/four_reasons_to_practice_mindfulness_during_pregnancy 

Perinatal mood disorders. Perinatal Mood Disorders | Anxiety and Depression Association of America, ADAA. (n.d.). Retrieved May 19, 2022, from https://adaa.org/find-help-for/women/perinatalmoodisorders

Pilkington, P., Milne, L., Cairns, K., & Whelan, T. (2016). Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study. BMC psychiatry, 16, 23. https://doi.org/10.1186/s12888-016-0721-0