by Ngaire Stirling
Anxiety Disorder is a blanket term for a selection of mental health issues widely believed to be caused by a deficiency in a neurotransmitter known as GABA and abnormal activity in the amygdala (flight or fight section of the brain) hypothalamus and cerebellum. Anxiety Disorders tend to be genetically pre-determined to some extent but are also triggered by stress and worry. This makes pregnancy and early parenthood a key period for anxiety symptoms in women.
Anxiety in Pregnancy
Around 10%* of women experience anxiety or depression in pregnancy and up to 40% in women diagnosed with fertility issues. Previous anxiety issues, poor coping skills, changed living arrangements, violence or abuse, poverty, discrimination, life changes such as giving up work, feelings of isolation, low self-esteem and unplanned pregnancy can all contribute to the likelihood of developing an ante natal anxiety disorder. Treatment of anxiety disorders includes a number of pharmaceuticals including SSRI anti-depressants however these are not recommended in pregnancy. Cognitive Behaviour Therapy is recommended for women who wish to avoid medication during pregnancy.
Anxiety Disorders in Early Parenthood
Diagnosis with post-natal depression often includes any one of many Anxiety Disorders. This can, unfortunately, leave women who aren’t depressed believing that feelings of panic and extreme anxiety are part of motherhood. Around 16%* of women are diagnosed post-natal depression in the first year after the birth of their baby and triggers include adjusting to this major life change, sleeplessness, coping with the day to day stresses of motherhood and concerns about baby development.
How Anxiety Disorders manifest during Pregnancy and Early Parenthood
Pregnancy Specific Anxiety
Pregnancy Specific Anxiety is measured by a questionnaire that determines the level and classification of the anxiety disorder. It’s been examined in depth as acute anxiety has been proven to have ongoing effects on the child, including pre-mature birth, difficulty concentrating and lower density grey matter. Major triggers have been identified as fears of birth, fertility issues bearing a disabled child, marital problems, pregnancy complications, negative impact on career and being a younger mother to be. Pregnant women can be assessed for the level of anxiety they’re experiencing and counselling may be recommended.
Generalised Anxiety Disorder
This is the most common diagnosed anxiety condition and is common in both pregnancy and early motherhood. It manifests in excessive worry about the birth, living arrangements and parenting issues. Symptoms may include lack of concentration, appearing “short tempered”, fatigue, insomnia and muscle tension.
Panic disorders can manifest in nausea, confusion, dizziness, racing pulse, extreme emotional state and difficulty breathing. As some of these symptoms can also be attributed to pregnancy itself, women can feel panicked and be unaware of an underlying disorder. Panic disorder is generally triggered by acute stress or fear making pregnant women especially vulnerable.
Post-Traumatic Stress Disorder
Post Traumatic Stress Disorder is surprisingly common in women who have had difficult births or a birth that did not go to plan. Symptoms include “flashbacks”, panicked feelings, breathlessness and feeling faint when recalling various aspects of the birth.
Situational Anxiety is the most common form of anxiety issue and is a direct response to a stressful situation – from a day to day situation to a major life change. Most people experience situational anxiety at some point in their lives and early parenthood is one of the most reported periods. A therapist may help identify periods where the anxiety is at its worst and recommend ways to manage it.
Social Anxiety Disorder
Social Anxiety Disorder is where the woman has an intense fear of public scrutiny or elevated levels of attention. As pregnancy tends to increase a woman’s exposure to medical scrutiny and involves activity perceived as “humiliating” (such as constant weighing and invasive exams) it can heighten the symptoms of this disorder. Similarly, a woman suffering post natal anxiety may feel as though she is being judged for her mothering skills. This can lead to women withdrawing and isolating themselves, which can, in turn, lead to depression.
Compulsive behaviour triggered by repetitive obsessions (intrusive and distressing thoughts and mental images) results from acutely stressful situations. This is common after the birth of a child where a mother becomes fixated on preventing harm to the child. The mother may experience “flashes” of disturbing images where her child is hurt or harmed and will compensate with a repetitive behaviour. Early motherhood can trigger compulsive cleaning behaviours.
Phobias including Agoraphobia
Because of the “medical” nature of pregnancy and birth, the most common phobia is a fear of medical interference, bodily fluids and of course, the pain of childbirth. In the early parenthood period, irrational fears may become overwhelming, especially those related to safety of the child. Visualising “worst case scenario” consequences of contact with the object of fear can trigger extreme panic in mothers with acute phobias.
Agoraphobia is a fear of being in a situation where she cannot escape and result in avoidance behaviours such as staying at home or avoiding specific locations. Agoraphobics may experience a panic attack in such a situation. This is more common towards the end of pregnancies where women are overcome by fear of labour and shortly after birth where a simple trip with a baby seems overwhelming and fraught with danger.
Anxiety is an extremely common mental health issue and pregnancy issue. It’s a leading trigger of pre and post-natal depression and can impact greatly both the mother and the child. It’s vital for parents who need help to seek it immediately.
Image Credit: Trevor Bair