I promise my next post will be more lighthearted; but, today I want to write about anxiety and depression during pregnancy. I hope that all of the readers of this blog will go and talk to someone else about this topic so that we may begin to understand and normalize these experiences like we have started to see happen with discussions of postpartum depression. I have decided to talk about this now because at the moment about 80% of my current clients are dealing with anxiety. Many of them had anxiety before pregnancy and many of them didn’t.
Finding out that you are expecting a baby may come with a mix of emotions ranging from excitement to worry to downright dread. Worrying about the health of yourself and your baby, concerns about how you will afford to raise a child, and fear of the unknown are just a few common thoughts among many. Does this mean that because you have these thoughts that you have anxiety? No, not at all. However, if these thoughts consume a large portion of your time and begin to influence your ability to work, play, love, and experience happiness, please know you are not alone and you definitely are not without help.
Since this topic inherently comes with questions best left for clinical care providers, I have decided to pull in my favorite mental health care provider on the planet for this post- my own Mom. Dr. Laura Renbaum has been professionally balancing motherhood to two (pain in the ass) daughters and her career in Psychiatry for over 30 years. Her practice focuses on individualized therapy and treatment.
On not being alone:
When I started considering writing this post, I started digging into the literature for numbers. A paper in Obstetrics and Gynecology found that more than one half (54%) and more than one third (37.1%) of the women had antenatal anxiety and depressive symptoms, respectively, at some point in pregnancy. Post-traumatic stress disorder, generalized anxiety, obsessive-compulsive disorder, and panic disorder are all commonly experienced in the perinatal period and may have been present before pregnancy or started during pregnancy. There’s also an association between anxiety and depression during pregnancy and postpartum depression.
The effects of prenatal anxiety on the developing baby.
I am sure many of you have seen the news regarding how women of color are at greater risk of premature labor and adverse outcomes as a result of the microaggressions that they experience daily. It turns out that stress hormones (particularly cortisol) released in pregnancy may contribute to premature labor and delivery and nearly all of us produce it, especially under stress and anxiety. Catecholamines released by our bodies under stress and anxiety can result in maternal constriction of blood vessels, thereby causing increased blood pressure and may ultimately limit the flow of important blood and nutrients to the placenta. Thus, long-term stress may have some effect on baby’s development. You may be asking yourself: “Oh, great! So now I have to have anxiety about what my anxiety may be doing to my baby?!?”
Here’s what Dr. Renbaum has to say:
“We should probably think of Big “A ” Anxiety vs the normal nervousness, worrisomness that comes with being a mother-to-be. Of course there are things to be worked out, plans to make, all sorts of “what-ifs?” that pop in and out of your mind from time to time throughout your pregnancy. In general the latter type of anxiety is annoying and no cause for concern for your baby. There is some evidence that chronic high levels of the kind of stress hormones and substances produced in the severely stressed and anxious are not good for gestation and the fetus; but, even then the effects are difficult to measure. We recommend if you are experiencing ongoing high level of symptoms that interfere with functioning; sleeping, eating, enjoying, socializing, working, etc. that you seek professional support.”
Q: So what can I do to help myself and when is it time to seek professional help?
A: “Some of the best things that you can do in pregnancy to reduce anxiety are the things you would normally do to help with reducing stress – minus the margaritas of course! I put exercise highest on the list (assuming this is discussed with your OB/midwife) along with a healthy diet. Exercise calms your adrenal glands and can give relief in the moment but also better benefits over time. Also, cut back on stressful activities and maybe try relaxation/meditation techniques like prenatal yoga or mindful breathing and use your support networks. Not being alone in a literal sense is one of the best things you can do to alleviate some of the anxiety. Keeping up with hobbies, friends, and meaningful duties also may provide a helpful distraction from our natural tendency to ruminate.””
Q: Referring back to “Big A Anxiety” vs. nervousness, how are you to know when to seek professional help?
A: “Big A Anxiety,” especially that which comes from untreated active OCD, PTSD, Adjustment disorder, Panic Disorder, or Generalized Anxiety Disorder (GAD) are usually managed sucessfully with professional help. As for depression, sadness or inability to enjoy that is accompanied by suicidal thoughts is very urgent and one should get help immediately. Otherwise consider seeking help if the mood problem lingers weeks rather than days.
Q: Do all providers have experience in perinatal treatment or do you have suggestions on how to find someone who does?
A: First ask your Midwife, OB, or doula if they have networked with mental health providers who have shown a special interest or training in treating anxiety in pregnancy. Part of psychiatric training involves issues of pregnancy including the use of medications . There are providers who are more interested and experienced than others . If they don’t have this as part of their profile I would just phone them and ask. The most interested /experienced would welcome your inquiry.
Q: Anything else everyone should know about prenatal anxiety and depression?
A: Pregnancy is about 9 (maybe more like 10) months duration. Life doesn’t go “on hold” during this time. Meaning that you will expect the usual ups, downs, worries and preoccupations that go with your life in addition to some new ones. In general, symptoms that start to interfere with biological functions and relationships and don’t go away as one normally expects them to should be addressed more proactively.