Prenatal anxiety: Tips and treatment

I have always been an anxious person.

As a kid, I remember lying awake whenever my parents were out past my bedtime, waiting for the sound of the garage door to signal that they had returned home. I couldn’t drift off until I was sure they were back, safe and sound. I hoped I’d outgrow this someday — it was exhausting — but that level of anxiety has always been present in my life. By the time I was 28, and pregnant with my daughter, it was clearer than ever that the worry monster was still lurking.

From the moment that second line appeared on the stick, I could feel the tension mounting. I struggled to control my anxious thoughts and feelings, obsessing over the bean in our ultrasound photo, unable to stop myself from googling potential complications. I worried about the big stuff — finances, how having a baby would change my marriage, if I would learn the ropes of motherhood quickly enough — but mostly, I was consumed by obscure medical conditions and their symptoms. After I noticed I had strangely itchy palms for two days, I moved up my next prenatal appointment so that the doctor could confirm I didn’t, in fact, have a rare liver condition I’d read about. When I finally admitted to my obstetrician that I no longer felt the joy of pregnancy, only the dread of the “what ifs,” she referred me to a psychiatry clinic specializing in prenatal and postpartum anxiety and depression.

Ariel Dalfen, a perinatal psychiatrist and head of the Maternal Infant Program and Perinatal Psychiatry clinic at Mount Sinai hospital in Toronto, says some degree of anxiety during pregnancy is normal, given the huge life changes ahead. “But,” she says, “it gets into the pathological range when it starts to become the major focus of what you’re going through, rather than just a sidebar. If the anxiety impacts your ability to function in day-to-day life, or if you feel you can’t control or put a lid on it, it’s excessive.”

Symptoms of antenatal anxiety range from compromised sleep and an inability to concentrate, to physical manifestations such as tightness in the chest, dizziness or heart palpitations. Prescribed treatment depends on the severity of symptoms. Minor levels of anxiety can be managed with talk therapy, says Dalfen. “It could be as simple as talking through your concerns with someone, or it could be more formal, like cognitive behaviour therapy. Exercise and yoga are also good ways to handle lesser anxiety.” More serious anxiety may require medication, she says.

One technique that worked for me was keeping an anxiety journal. List your anxious thought, how it makes you feel, and the evidence for the worry (for me, it was symptoms I was experiencing) and against (I allowed myself to look at reputable health websites only — just the facts). Seeing my concerns mapped out on paper made them seem less scary. Dalfen calls this “walking yourself back to the middle.”

Women who have a history of anxiety should be extra careful to monitor their mental health during pregnancy. “While it’s possible that someone who has never experienced anxiety before will develop it during pregnancy, people who have anxious personalities, or who are perfectionists, are at higher risk,” Dalfen says. She reports that women usually return to their baseline postpartum.

This was (mostly) true for me. While I still stress about the health and development of my now-19-month-old daughter, Sophie, I’ve learned to cope with the “what ifs” along the way. Now I worry that if I don’t stop worrying I’ll miss out on the best parts of her life. And that’s a double negative if I’ve ever heard one.

A version of this article appeared in our June 2013 issue with the headline "Anxious and expecting," pp. 73.

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