Most women experience moments of worry throughout their pregnancy and after having a baby. It’s very common and quite normal. After all, growing, birthing and caring for a little human is an intense experience that opens the door to a whole host of emotions. However, for some women these worries take on a life of their own, insidiously taking over their day-to-day life. The worries become constant and crippling, stealing away peace and joy. These aren’t your run-of-the-mill worries; this is perinatal anxiety.
In a study of 310 Canadian women, BC Psychologist Dr. Nichole Fairbrother and colleagues (2016) found anxiety and related disorders affected more than 15% of pregnant and postpartum women. Anxiety and related disorders were found to be even more common than depression among the women studied.Perinatal Anxiety: Anxiety During Pregnancy and Baby’s First Year – Anxiety Canada
Despite perinatal anxiety being more common than once believed, it’s often not talked about or screened for by health care professionals. In an effort to demystify perinatal anxiety, and to shed light on this struggle, I want to share my own lived experience with perinatal anxiety along with helpful strategies for managing this common mood disorder. This is a long article so feel free to use the table of contents below and jump between sections.
Very important! If you are having thoughts of self-harm, harm to your baby or harm to someone else please reach out for help immediately. Tell someone you trust and make an urgent appointment with your family physician. If you feel unsafe please call a mental health helpline, call 911 or visit your local emergency department.
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Defining perinatal anxiety
Anxiety during pregnancy and after having a baby (postpartum) is called perinatal anxiety.
Perinatal means the time during pregnancy (prenatal) and the time after pregnancy (postpartum). Some women will only experience perinatal anxiety during pregnancy, or only postpartum, and some will experience it during pregnancy and postpartum.
Anxiety is a feeling of fear or threat by a real or imaginary situation. Anxiety can affect the way someone thinks, feels and acts. Some common symptoms of anxiety include feeling scared, irritable or on-edge, having upsetting thoughts, and experiencing restlessness, shakiness, bowel discomfort, dizziness, a fast heart rate, shortness of breath and fatigue.
My lived experience with perinatal anxiety
I’ve experienced a degree anxiety of during and after each of my five pregnancies, although it wasn’t until my third baby that I discovered I was suffering from perinatal anxiety. After my third baby was born, I was screened for postpartum depression (PPD). I passed the test with flying colours, but something didn’t feel right. I was on edge. I felt nervous and stressed all the time. One night I woke up and my arms felt numb. I gasped for breath and the weirdest tingling sensation rolled through my body I thought I was dying or going crazy. This was the first of many panic attacks I would experience in the months to come.
As my anxiety worsened I started feeling numb and dissociated with day-to-day life. I even became too scared to leave my house. Two months after my third baby was born, my mother-in-law convinced me to come with her to do a little shopping. Desperate not to disappoint her, I agreed to go. I don’t remember much from that shopping trip other than having a panic attack in the change room at Le Chateau. It was awful. It felt like anxiety had taken me hostage and I needed someone to save me. ..
When my anxiety was at it’s worse I was convinced I was dying. Dr. Google was constant advisor and it got to the point that I had even convinced my husband I was deathly ill. Thankfully he took a step back and encouraged me to get help. He didn’t know anything about anxiety but he knew something wasn’t quite right. He had access to an online counselor through his work so I contacted the counselling service. This was before the days of Zoom. Yes, I’m that old! The counselor could sense that I was far gone and urged me to see our family doctor. I was so anxious about that visit! I trembled in the waiting room but my doctor was lovely. He was patient and compassionate. It was exactly what I needed. To get me started, my doctor urged me to lean into my extended family for help. At this point in my life I was terrible at asking for help! Whether it was because of guilt or pride, probably a mix of both, I never asked other people for help. My husband ended up making the call and I stayed with my in-laws for a few weeks while my husband was traveling for work.
Slowly my postpartum anxiety became a bit more manageable. It was around this time we moved away from family for a new job opportunity. I still can’t believe we made that move given the state I was in. We had three young children (ages 4, 2 and newborn) and were moving 800 km away from all of our family and friends. I bawled the entire move down. However, it was there, in our new city, that my new doctor referred me to a psychiatrist. That psychiatrist was the best thing that happened to me. She referred me to a weekly cognitive-behavioral therapy (CBT) support group where I learned many of the helpful tools I still use to this day for managing my anxiety. Two years after the birth of my third child I was finally finding my way out of perinatal anxiety. It took me that long!
Almost eight years later my husband and I decided to grow our family. When I was young I knew I wanted a BIG family but my struggles with perinatal anxiety made me second guess that choice. I didn’t want to make myself go through crippling perinatal anxiety again. However, after eight years I knew that I was stronger, both mentally and physically. We had our fourth child in 2020 and our fifth and final baby at the end of 2022. During my fourth and fifth pregnancies I did experience perinatal anxiety; however, it was much more mild. During both pregnancies I pre-emptively connected with a counselor and used various strategies to manage my thoughts and feeling. When my anxiety started to worsen towards the end of my fifth pregnancy I opted to start taking anti-anxiety medication. I was determined not to slide back into the abyss of crippling anxiety, and I didn’t!
If you are struggling with anxiety while pregnant or after your baby is born, don’t loose heart. This condition is very treatable and by taking quick action it can resolve in a relatively short period of time (not years like me!). Below I’ve listed the many strategies I have used for managing perinatal anxiety over my five pregnancies. I hope you find them helpful.
Strategies for Managing Anxiety while Pregnant and After Having a Baby
It took me two years to find my way out of perinatal anxiety. It took me that long because I lacked knowledge and awareness of this common condition and the strategies for managing it. I want you to know that if you are struggling with anxiety in your pregnancy or after having your baby, you don’t have to suffer silently for months on end. The good news is that perinatal anxiety is very treatable. By using the key strategies listed below you can rediscover the joy of this special time in your life.
Help and Support
The very first thing you should do if you are struggling with anxiety while pregnant or after having a baby is to seek out help and support. Below is a list of people that can provide help and support.
Midwife, Obstetrician and Family Physician
If you are currently pregnant or just recently had your baby and experiencing anxiety, I strongly recommend you start by talking to your midwife or obstetrician and your family physician about your anxiety. Yes, both. Each health care professional will have different ideas and resources for you to explore. If you are postpartum and no longer under the care of a midwife or obstetrician, start with your family doctor. If you don’t have a family doctor, please go to your local walk-in medical clinic or hospital to seek help.
My story: I have talked to several different doctors and midwives about my perinatal anxiety over the years, and thankfully all of my interactions have been very positive. Occasionally I’ve had to ask for resources or connections if they weren’t offered. I’ve learned that it’s important never to leave an appointment with a clear plan of action and to advocate for myself if I don’t feel like I’m getting the support I need.
Here are some tips for that first conversation with your midwife/obstetrician and doctor:
- Be prepared by jotting down a list of feelings, thoughts, and physical symptoms that you have been experiencing.
- Mention any family history of mood disorders or other conditions that can mimic mood disorders like thyroid problems.
- Ask for a longer appointment to have time to discuss your concerns and not feel rushed.
- Don’t be afraid to be honest. Health care professionals have heard it all and won’t be shocked or surprised by what you tell them.
- Advocate for yourself! Make a plan of action and a follow-up appointment before leaving the appointment.
Most health care professionals will recommend counseling as part of your treatment for perinatal anxiety, and I couldn’t agree more! Counseling plays a key role in developing greater awareness around anxiety and learning tools for managing it. I suggest finding a psychologist or counselor with specific training and experience with perinatal mental health and cognitive-behavioral therapy (CBT) (more about CBT below). Counseling can be in-person or virtual. I prefer in-person therapy sessions but depending on where you live and who is available virtual therapy sessions are effective too.
A psychiatrist is a doctor specializing in treating mental illness. Here in Canada you need a physician’s referral to access a psychiatrist; however, you can access a counselor, psychologist or social worker without a referral and most employee benefits provide some coverage of the cost.
If you are experiencing anxiety during pregnancy especially relating to childbirth, consider hiring a doula. A doula is a birth companion that provides care and support during the birthing process as well as support leading up to the birth and shortly afterwards. I’ve had two births without a doula and three births with a doula. Hands down, my births with a doula were much more positive experiences.
My story: I had quite a bit of anxiety towards the end of my fifth pregnancy and yet it was my most positive birthing experience. I chalk it up to having a really supportive birth team, midwife, doula and husband, that were fully aware of my anxiety and worries and did everything to support me through the birthing process. It made a world of a difference.
There are also postpartum doulas that provide physical and emotional support during the weeks following birth. From light housekeeping to breastfeeding support, a postpartum doula can help ease the transition to being a new parent and provide resources if you are struggling with postpartum anxiety.
Family and Friends
You don’t have to do this alone. If you are struggling with anxiety while pregnant or after having a baby it’s important to be open about it with those you trust. I used to try and hide my perinatal anxiety from my family and friends. Sometimes I would seem flaky or perhaps unkind because I’d cancel a commitment at the last minute or avoid certain things. Eventually I started being honest about my struggles and I was humbled by the kindness and compassion I received.
The truth is most family and friends want to help and it’s important to lean into that help. As I write this I’m breastfeeding my four week old baby while my mother-in-law is washing the dishes in the kitchen. Two of my older children are staying at a friend’s home and my eldest is helping make supper. Because of all the help I’ve received the last few weeks, I’ve had very minimal postpartum anxiety since the birth of my fifth baby.
Here are some ways friends and family members can help if you are struggling with perinatal anxiety:
- Ask for someone to watch your older children so that you can rest, exercise or get to important appointments.
- Have a trusted friend or family member drive you to appointments or even sit in on your appointment and take notes if you’re struggling with remembering things.
- Ask for healthy meals to be delivered to your home.
- Have a friend or family member help with light housekeeping tasks like laundry or tidying.
A Note about Partners
If your partner has never experienced and managed anxiety, your partner may find it very difficult to understand and support you. Your partner might invertedly do things to make your anxiety worse. To help your partner better understand and support you during this time have them come to appointments with you, if possible, and read this helpful resource.
Sometimes family and friends are busy and can’t provide you with all the help you need. If this is the case, and you can afford it, consider hiring help. This can look like hiring a part-time nanny, mother’s helper (a young teen) or babysitter to help with your toddler or a house cleaner to come by weekly. If your budget is tight, reach out to your fellow mom community and see if you can swap or trade help.
It’s normal for anxiety to make you feel incredibly tired. It’s also normal for anxiety to make you feel keyed up and cause insomnia. Being pregnant or having a newborn doesn’t help the sleep situation either. One important strategy for managing perinatal anxiety is getting enough sleep. Easier said than done, I know! Ultimately different strategies work for different mamas. If you get more rest co-sleeping with your baby, do it (safely)! If you sleep better when putting your baby in a crib in a separate room, do that! If you can nap while you baby naps do that too.
Here are more tips for helping with sleep:
- Develop a relaxing bedtime ritual around the same time each night.
- Rest when your baby sleeps or when your toddler naps.
- Make your bedroom a place of rest (dark, quiet, cool and comfortable).
- Use a white noise machine, app or Spotify playlist.
- Avoid social media and news before bedtime.
- Listen to a relaxing audiobook, music or meditation before bed.
- If you can’t fall asleep, change the environment, try sleeping on the couch.
- Get some exercise during the day.
Eating wholesome meals can be a big challenge while pregnant (hello morning sickness!) and after having a baby, but perinatal anxiety makes it even more difficult. It’s common to lose your appetite when highly anxious. This is a normal bodily response. Not many people would sit down to a nice meal if a bear was chasing them. The same idea goes with anxiety. It’s hard to have an appetite when you feel impending doom. However, eating nutritious food helps manage anxiety because it stimulates the parasympathetic system of the body, also known as the rest and digest system.
Here are some strategies for getting good nutrition:
- Have a stash of healthy, easy to grab snacks: dried fruit, apple, cheese, crackers, granola bars, nuts, veggie sticks and hummus.
- Have a bottle or cup of water close by at all times.
- Drink caffeine free teas.
- Take prenatal vitamins, even after your baby is born.
- Ask a friend or family member to help with making a meal plan and pick up groceries.
- Contact a nutritionist.
- Ask a friend to set up a meal train.
If you’re pregnant or just had a baby and you’re dealing with anxiety, exercise might be the last thing on your mind. That’s fair. Towards the end of my fifth pregnancy I was hugely pregnant, going through a significant bout of perinatal anxiety and it was winter. I didn’t want to exercise but I knew it would reduce my stress and help me sleep. I forced myself to go on a short ten minute walk every day. I’m confident that getting a bit of exercise along with the other strategies I was using helped me a lot. By the end of my pregnancy I was in a much better state and I went on to have a very positive birth experience.
When you’re feeling anxious movement helps to reduce those jittery feelings that come with being anxious. It can also help boost your mood and energy levels if you’re feeling fatigued. Exercising outdoors has the added benefit of connecting with nature which also reduces stress.
If you haven’t been exercising throughout your pregnancy or just had a baby, make sure to clear physical activity with your doctor or midwife first. It takes time to heal from having a baby, especially if you’ve had a c-section. Once you’ve been given the “ok” start small, stay consistent and choose an activity that you enjoy.
- Go for a walk outside and bring your baby along in a stroller or carrier.
- Try a specifically designed prenatal or postpartum program at the gym or online.
- Find a friend to exercise with to keep it fun and social.
Medication can help by rebalancing brain chemicals and reducing the symptoms of anxiety. While medication doesn’t fully get rid of anxiety, it can provide enough relief to allow you to pursue other anxiety reducing strategies more easily. With any type of medication there are side effects and some types work better than others. Thankfully there are options available even if you’re pregnant or just had a baby. I should also mention that some anxiety medication can take weeks to feel the full effect, so that is something to consider.
My story: Near the end of my fifth pregnancy my family physician suggested I take anti-anxiety medication. Despite using all the tools in my tool belt, my anxiety was getting worse and worse. I fretted over the decision. I worried about how it would impact my unborn baby and the possible side effects. In the end I decided to take it and it was one of the best decisions I made for my mental health.
Taking medication to help manage perinatal anxiety does not mean you’re broken or you’ve failed. It means that you recognize that you need help and you’re taking steps to get better. This is a good thing!
To explore options for anti-anxiety medication please talk to a physician or psychiatrist.
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of therapy that helps to change thinking patterns and behaviours. It’s a very useful strategy for managing and reducing anxiety. I highly recommend finding a counselor with experience using CBT. If that isn’t an option here is a free app for trying CBT on your own: Mindshift CBT app. There are also helpful books on CBT listed in the last section of this article.
Mindfulness and Meditation
Practicing mindfulness and meditation are two effective strategies for managing anxiety. They help you focus on being in the present moment and teaching your body how to relax. Sometimes these strategies can increase anxiety at first, but don’t let that scare you away. With some consistency these strategies can be very helpful.
A few favourite mindfulness and meditation resources:
- Daily journaling
- Expectful app
- Headspace app
Books and More Resources
While there aren’t many books about perinatal anxiety, you can still find some great books and resources about anxiety and many of the strategies and ideas from these books can be helpful.
Coping with anxiety during pregnancy and following the birth: A cognitive behaviour therapy-based self-management guide for women and health care providers
A free resource put together by the BC Mental Health & Addiction Services.
Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety, Panic, and Worry by Catherine M. Pittman PhD and Elizabeth M. Karle MLIS
The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions by Pamela S. Wiegartz , Kevin L. Gyoerkoe , et al.
I hope this guide to managing preinatal anxiety helps you rediscover a sense of peace in your day-to-day life. If you have any questions about this common mood disorder feel free to leave a comment below or contact me.