Anxiety and panic attacks in pregnancy

Having some level of anxiety and stress when you are pregnant is fine and normal.

Pregnancy can be a time of heightened anxiety and stress for many reasons. Anxiety in pregnancy only becomes a problem when it’s out of control and you feel anxious all the time (called ‘Generalised Anxiety Disorder’) or you get sudden intense bursts of anxiety (‘panic attacks’).

If your anxiety gets too intense, or goes on for too long, it can really affect your pregnancy. There is also a risk that it will have an effect on your developing baby.

The fear of childbirth - known as tokophobia - is also classed as a kind of anxiety.

“My anxiety was very much a ‘black dog’, always in the background, niggling away. It felt like an unknown risk, an uncontrollable fear that would catch me unaware.” Amber, mum of one. Read more...

Does anxiety affect my growing baby?

Some anxiety in pregnancy is normal and usual, but chronic (continual) anxiety or stress can sometimes affect the way an unborn baby grows and develops.

Read more about whether anxiety affects the baby 

Do I have anxiety in pregnancy?

Sometimes, you can tell that something isn’t right and you are unwell. Other times, if your feelings started gradually, you may find it hard to tell where the line is between ‘normal’ difficult feelings and being unwell. Generally if you are feeling sad and anxious more than you are feeling happy then you should seek help.

Anxiety symptoms can include:

  • Feeling over-anxious all the time and not able to control it
  • Worrying about a number of events and activities - in pregnancy this could play out as constant worry about your baby
  • Unable to concentrate, mind going blank
  • Feeling irritable
  • Sleeping badly
  • Tense muscles

Panic attacks have the same symptoms. They start suddenly and are at their worst up to ten minutes later. The extra symptoms of panic attack are:

  • Feeling you can’t breathe
  • Thinking you’re going crazy
  • Being afraid you are going to die or something else terrible is about to happen.

The physical symptoms of anxiety and panic attacks can make you think you have a serious physical disease or that you’re having a heart attack, which can make you even more anxious.

“I was doing  well, and then at 24 weeks it hit me like a ton of bricks that maybe this pregnancy was a bad idea. I was so anxious…but all the stops were pulled out for me, and as well as the midwives I saw a health visitor who helped me.” Simone, mum of one

How common is anxiety in pregnancy?

Very common. More than one in ten pregnant women experience anxiety. Do not feel like you are a failure because you feel like you are not coping.

What should I do if I have anxiety in pregnancy?

Tell your midwife or doctor if you have experienced anxiety in the past.

Talk to your midwife or doctor also if:

  • you feel anxious most of the time for more than two weeks.
  • anxiety is making you feel physically ill with fast heartbeat, fast breathing, sweating, feeling faint, feeling sick and diarrhoea.
  • you have panic attacks.
  • you have unpleasant thoughts that keep coming back and you can’t control them.
  • you find yourself repeating an action (like washing, checking, counting) to feel better.
  • you are so afraid of giving birth that you don’t want to go through with it.

Just as extra care is needed in pregnancy to make sure you are physically healthy, the same applies to your mental health. Describing your symptoms can help your healthcare team make sure you get the right care for you and your baby.

You may feel very distressed or guilty at feeling anxious or panicky at a time when everyone expects you to be happy, but anxiety is not your fault.

The midwife or doctor won’t criticise you or judge you for having these feelings – they know this happens to many pregnant women, and they will discuss and organise treatments so you can get better.

It can be difficult to talk about your thoughts and feelings.  You may want to write down what you want to say first, or you may want to have someone with you.

The important thing is to let someone know so that the right help can be found as soon as possible. 

Your midwife or doctor should ask you a range of questions that have been designed to let them find out your level of anxiety. The treatment will depend on the outcome.

Have a look at our ideas for coping with stress and top tips for looking after your emotional wellbeing.

What are the risk factors for developing anxiety?

Anyone can develop anxiety, but there are some things that make it more likely:

  • Family members have anxiety or panic attacks
  • You have had anxiety or panic attacks in the past
  • You have experienced a traumatic event (this is linked to post-traumatic stress disorder)
  • Using some illegal drugs
  • You have depression
  • You are under extra stress.

What’s the treatment for anxiety in pregnancy?

Generalised anxiety disorder and panic attacks are usually treated with using guided self-help techniques based on Cognitive Behavioural Therapy (CBT). If you have mild anxiety you may not need treatment. Your doctor will discuss the options with you.

"I didn't think CBT would work but I found it so helpful. I had a little guide book so if I was feeling anxious at work or at home, I could refer to it for tips and pointers to get me through certain situations.” Katie, mum of one. Read more...

If you were already on medication for anxiety before you became pregnant, your doctor will discuss any risks that the medication might have for your baby.

They will talk to you about potentially stopping the medication and moving to psychological treatment, such as CBT, or moving to another medication that is lower-risk but still works.

How can I prevent anxiety in pregnancy?

You could also try a self-help book. The Royal College of Psychiatrists recommends these ones:

  • Overcoming Anxiety by Helen Kennerley
  • Overcoming Anxiety, Stress and Panic: A Five Areas Approach by Chris Williams
  • Feel the Fear and Do It Anyway by Susan Jeffers
  • Overcoming Panic and Agoraphobia by Derrick Silove and Vijaya Manicavasagar
  • Panic Attacks: What They Are, Why They Happen and What You Can Do About Them by Christine Ingram
  • An Introduction to Coping with Phobias by Brenda Hogan

Is anxiety linked to depression?

Some people can also start suffering from depression in pregnancy as a result of having anxiety.

More information and support

Anxiety UK: Helpline: 08444 775 774. Organisation run by people with anxiety disorders, offering information, support and therapies for people experiencing anxiety.

No Panic: Helpline: 0800 138 8889.  Online and telephone support for people suffering from panic attacks, phobias, Obsessive Compulsive Disorder, and anxiety disorders.

MIND Helpline: 0300 123 3393. Mental health charity providing information, support, local groups and an online chatroom.

Read our guide to antenatal depression to find out more

Other resources

Sources

  1. Glover V (2015) Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. Advances in neurobiology 2015;10:269-83. doi: 10.1007/978-1-4939-1372-5_13
  2. American Psychiatric Association (2013) DSM-5: Diagnostic and Statistical Manual of Mental Disorders; 5th Edition
  3.  NICE (2014) Antenatal and postnatal mental health: clinical and service management guidance, clinical guideline 192, National Institute for Health and Care Excellence.  London, P 4: Available at: http://www.nice.org.uk/guidance/cg192
  4.  Royal College of Psychiatrists (2013) Anxiety, Panic, Phobias. Available at:http://www.rcpsych.ac.uk/mentalhealthinfo/problems/anxietyphobias/anxiety,panic,phobias.aspx April 2013. Due for review April 2015.
  5. NICE (2014) Antenatal and postnatal mental health: clinical and service management guidance, clinical guideline 192, National Institute for Health and Care Excellence.  London, P 4: Available at: http://www.nice.org.uk/guidance/cg192
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Last reviewed on February 1st, 2015. Next review date February 1st, 2018.

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