However, when anxiety is interfering with functioning, causing distress, and persistent a women might be experiencing a Perinatal Mood and Anxiety Disorder (PMAD). In fact, PMADs are the most common medical complications of childbearing. They are under screened for and under treated worldwide.
Estimated rates from past studies found up to 1 in 5 (or 20%) of women experience a PMAD; understandably, these rates have started to be documented as even higher in the pandemic. Recent studies suggest significantly higher rates of depression, anxiety, posttraumatic stress symptoms, as well as feelings of isolation and loneliness for perinatal women during the pandemic. Anxiety in pregnancy has also been a predictor of postpartum depression. It is important that women are identified and provided the support needed.
The United Nations Children’s Fund estimates that there were 116 million births in the first ten months after the COVID-19 was declared a pandemic by the World Health Organization (WHO) (March 2020). Rates for PMADs remain high. When mood and anxiety disorders are not treated during pregnancy, there are adverse outcomes for the mother, child, and family. For mothers this might include increase in substance use, smoking, lack of medical care. Infants are more likely to be preterm, lower birth weight. The relationship, attachment and bonding between a mother and her infant can be significantly affected. It can affect spouse or partner relationships and family functioning. Yet, there are research supported “evidence-based” treatments to help significantly reduce symptoms of anxiety and depression during the perinatal period (conception to one year after birth).
One such approach that aims to treat anxiety during pregnancy is Cognitive Behavioral Therapy (CBT). CBT focuses on the inter-connection between thoughts, feelings, and behavior. It is based on the view that how you think affects how you feel. To feel better a person needs to think “better” or in a more balanced and realistic way. The focus is on increasing awareness of thoughts and how they affect feelings and behavior. This is not ignoring or dismissing feelings. The goal is to build awareness of automatic thoughts and thought patterns that are inaccurate, overly negative, unproductive or unhelpful. It helps a person replace unhealthy and anxious thinking with more helpful and accurate thoughts.
With CBT, pregnant women with anxiety learn calming and relaxation strategies (Diaphragmatic breathing, Progressive Muscle Relaxation, Mindfulness, Guided Imagery) and cognitive coping strategies to identify, examine, and modify thoughts. Techniques to evaluate and change negative, inaccurate, or unhelpful thoughts or thinking errors are taught and practiced. Typical unhelpful cognitive distortions or thought patterns for anxiety include catastrophizing (“what if” thinking for the 1% uncertainty), predicting the future, jumping to conclusions without all the information, dismissing the positive and focusing on the negative. These are also connected to deeply held beliefs about the world, self, and interpretations about situations. It intends to help build skills to effectively manage and reduce anxiety symptoms. Self-care, practice goal setting, and support are also essential for helpful treatment pregnancy women in therapy. When loss or trauma has been experienced, women need additional grief processing and support.
If you or someone you know is experiencing a PMAD, please reach out for help and support. The earlier the better. Cognitive Behavior Therapy (CBT) is one “evidence-based” treatment; providers who are certified or advanced trained in EMDR and Interpersonal Therapy (IPT) are also excellent resources for depression and birth trauma and loss. Training providers can be found in the provider directory at the Postpartum Support International website https://www.postpartum.net/get-help/provider-directory/. When symptoms are not helped with therapy, medication might we warranted and safely prescribed by psychiatrist trained to support Maternal Mental Health (MMH).
If you have questions or concerns, please reach out to a provider trained in MMH, talk with your OBGYN, pediatrician, primary care provider, or contact us to discuss how you can access support. Taking care of yourself is taking care of your baby. There are both formal therapy and informal support groups that can help. You are not alone. Please know that there are effective options for treatment and providers who can support you during pregnancy.
Resources and References:
Postpartum Support International: https://www.postpartum.net
Anxiety During Pregnancy: Options for Treatment By MGH Center for Women's Mental Health https://womensmentalhealth.org/posts/anxiety-during-pregnancy-options-for-treatment/How you can mange anxiety during pregnancy: https://www.health.harvard.edu/blog/how-can-you-manage-anxiety-during-pregnancy-202106252512
What is Postpartum Depression https://www.therapistaid.com/therapy-worksheet/what-is-postpartum-depression
Anxiety Coping Skills: https://www.therapistaid.com/therapy-worksheet/coping-skills-anxiety
CBT Training for Therapists: https://beckinstitute.org/training/