Anxiety in pregnancy

If you have trouble coping with anxiety, or you just need a little reassurance, you don’t need to suffer in silence. Feeling very anxious for a long time isn’t good for you or your baby (Bea et al 2005, Kurki et al 2000). Fortunately, there’s plenty of help available, as well as self-help techniques you can try yourself.

Is it normal to worry in pregnancy?

Yes. Pregnancy is a life-changing event, so it's only natural for you to feel scared or uneasy sometimes (McLeish 2007, NHS Choices 2014c). The hormone changes that pregnancy brings can also play havoc with your emotions, making you more vulnerable to worry (NHS Choices 2015). You may find yourself worrying about:

• your pregnancy symptoms and what they mean
• how your baby's developing
• your relationship with your partner
• money

Low mood and worries in pregnancy usually resolve themselves (McLeish 2007). However, it is a good idea to discuss any concerns you have with your midwife. She can reassure you, and she may offer extra support to prevent your anxious thoughts from getting worse.

When does worry become a more serious problem?

Worry becomes a problem when you find it difficult to control your thoughts, or when it starts to interfere with your daily life (NHS Choices 2014c). For example, you may be avoiding public places because crowds make you feel nervous or because you worry what people think of you.

If this is the case, or if your anxiety's making you feel miserable or depressed then you may have clinical anxiety. This is also known as generalised anxiety disorder.

The main symptoms of clinical anxiety are:

• feeling nervous, anxious or on edge a lot of the time
• not being able to stop or control your anxious thoughts
• worrying lots about a range of different things
• finding it difficult or impossible to relax
• feeling restless and finding it hard to keep still
• being irritable and short-tempered
• feeling afraid, or thinking that bad things will happen
  (Thomas 2010)

You may also experience physical symptoms, such as:

• racing heartbeat and rapid breathing
• dizziness
• excessive sweating
• tension, pain or trembling in your muscles
• a numb or tingling feeling in your fingers, toes or lips (Ryan 2013)

Sometimes, these symptoms can come on quickly and intensely for no obvious reason. This is known as a panic attack.

If you think you may have clinical anxiety, it is important that you see your GP, who can confirm the diagnosis and recommend treatment (Ryan 2013, NHS Choices 2014c).

How will my anxiety be treated?

When you see your GP about your anxiety, she'll discuss the risks and benefits of different treatments with you. Try to be as honest as possible about how you're feeling so she can recommend the right treatment.

As long as your symptoms are not severe, she's more likely to suggest talking therapies rather than medication to avoid any unnecessary risks to your baby (NICE 2014). Talking therapies offer practical advice to help you manage your feelings.

If you were already taking medication for anxiety before becoming pregnant, your GP may advise that you switch to therapy instead (NICE 2014). However, you should never stop taking medication without talking to your GP first.

If your GP does think that you'll benefit from a talking therapy, she may refer you to a service that specialises in cognitive behavioural therapy (CBT) (NICE 2014a).

Evidence shows that CBT is an effective way of treating anxiety (McLeish 2007). The aim is to recognise how your brain and body respond to stress, and learn how to change those reactions. It helps you to focus on what you're feeling now, and what you can do to feel better again (BABCP 2012).

Depending on your circumstances, and how severe your anxiety is, your therapist may offer CBT in one of the following ways:

• Self-help. Your therapist will give you book recommendations, leaflets or access to online courses, which will enable you to try CBT for yourself. She'll support you with this, either face-to-face or over the phone, and will answer any questions you may have.
• Therapist-led. This form of CBT is more intensive as you will have regular, face-to-face sessions with a therapist. She'll work with you to find out what's triggering your anxiety, and help you develop ways to minimise and manage your anxious feelings.
  (NICE 2014a, McLeish 2007)

Another kind of psychological treatment that can help with anxiety is applied relaxation. A therapist will teach you how to relax your muscles properly, and give you a trigger word that should help you to calm yourself when you start feeling anxious. Applied relaxation usually involves an hour-long session every week for a few months (NHS Choices 2014c).

These treatments are usually offered on the NHS by a specialist mental health service. But depending on your local area, your GP may recommend a private provider such as a charity. Charities often run reduced-cost counselling for people on low incomes.

Is there anything I can do to relieve my anxiety?

Whether you have the occasional worry or clinical anxiety, there are plenty of techniques you can learn to help manage your symptoms.

Use relaxation techniques

Try to set aside a moment for relaxation every day, or even a few times a day if you can. You may find it easier to calm yourself when you're next feeling anxious if you practice how to relax when you're feeling good.

You could simply sit still and focus on your breathing, taking deep breaths in through your nose and out through your mouth. Or try visualising a happy place or listening to some music. This relaxation audio is a great place to start.

Some people find it helpful to deliberately tense and then relax all of the muscles in their body. Start with your toes and finish with the muscles in your face (Mind 2013b).

A meditation technique called mindfulness may also help. As you breathe try to focus on the sights, sounds and smells around you. If a negative thought comes into your head, don't fight it. Just let it pass by without judgement. This can be difficult at first, so you may find it helpful to find a mindfulness course in your local area (NHS Choices 2014d).

Find a self-help book or online course

There are plenty of resources available to help you with your anxiety, from meditation videos to online courses and books (NHS Choices 2014a). Your midwife or GP may be able to make a recommendation, or you can just search online or have a look in your nearest bookshop.

Most libraries are signed up to a scheme called Reading Well Books on Prescription, which recommends self-help books on common mental health problems (Reading Agency nd, NHS Choices 2013). Ask at your local library for more information.

Exercise regularly

Gentle exercise isn't just great for keeping your body healthy while you're pregnant – it can also help your mind. This is because exercise prompts your brain to release feel-good chemicals that can boost your mood and help to relieve anxiety (NHS Choices 2014b).

Walking, swimming, yoga and Pilates are great options. Or you could see if your local gym has any classes designed for pregnant women.

Eat sensibly

Some people find that a healthy diet helps them to manage their anxiety (Mind 2015). This may be because highs and lows in blood sugar can affect mood (NHS 2014b, Mind 2010).

Read more on how to enjoy a balanced diet in pregnancy.

It's also important to stay away from stimulants such as caffeine, alcohol and cigarettes. Apart from being bad for your baby, they can contribute to panic attacks (NHS Choices 2014b) and make it harder for you to control your anxiety in the long term (Mind 2015). You should not be smoking or drinking any alcohol at all while you are pregnant.

Talk about how you're feeling

Sharing your concerns with someone you trust may help you to feel more positive (Mind 2015). Try telling your partner how you feel, or even a friend or family member. You could also look up local support groups (NHS Choices 2014c).

Keep a diary

This may help you to identify any triggers for your anxiety and to manage your symptoms. Perhaps you often get anxious at a particular time of day, or when facing a particular challenge or activity. A diary can also help you keep track of times when you've successfully controlled your feelings, so you learn what works (Mind 2015).

Try complementary therapies

There's not much evidence to support the use of complementary therapies during pregnancy (NICE 2008) but many women find them helpful. You may like to try:

• massage
• reflexology
• hypnotherapy
  (Mind 2015)

Aromatherapy, herbal treatments and flower remedies can sometimes help with anxiety (Mind 2015). However these aren't always safe in pregnancy, so check with your midwife or GP first (NHS Choices 2014f).

Will I feel less anxious after the birth?

In general, there are fewer cases of anxiety in women after the birth than during pregnancy (McLeish 2007, NCCMH 2014). If you didn't have any mental health problems before you became pregnant, it's likely that you'll start to feel better after your baby is born (McLeish 2007, Andersson 2006).

If you still find it difficult to control your mood after the birth, talk to your midwife, health visitor or GP as soon as possible. They'll probably reassure you that your feelings are normal and offer some advice to stop your symptoms becoming worse. But if there is more to it, it's good to get help early on.

Read about the baby blues and postnatal depression.

Where else can I get help with anxiety?

• The charity Mind specialises in helping people with anxiety, depression and other mood disorders.
• The National Childbirth Trust can help put you in touch with a support group near you.
• This tool from the British Association for Counselling and Psychotherapy lists registered therapists in your area who may be able to help.
• You can also find support in the BabyCentre community from other pregnant women and mums coping with anxiety.

If you find that your emotions are unpredictable, read our article on mood swings in pregnancy.