Anxiety and panic attacks in pregnancy

It’s natural to have some feelings of anxiety when you are pregnant. But if you are feeling anxious most of the time and find it difficult to relax you may need help.

What is anxiety?

Anxiety is a feeling of unease, worry or fear, that can be mild or severe. Everyone feels anxious sometimes, but some people find it hard to control their worries. Some people with anxiety also have panic attacks, which can be very frightening.

Some pregnant women feel distressed or guilty about feeling anxious or panicky when everyone expects them to be happy. But anxiety is a mental health condition and not a sign of weakness, something that will go away on its own or that you should just ‘snap out of’.

Anxiety symptoms can include:

  • feeling anxious all or most of the time and not able to control it
  • restlessness
  • feeling very worried (for example, in pregnancy you may feel constantly worried about your baby)
  • feeling a sense of dread
  • being unable to concentrate, or feeling like your mind goes blank
  • feeling irritable
  • feeling constantly on edge
  • difficulty falling or staying asleep.

Panic attacks can come on very quickly and for no apparent reason. Symptoms can include:

  • a racing heartbeat
  • a feeling of dread or fear of dying
  • chest pain
  • shortness of breath
  • dizziness
  • sweating
  • feeling faint
  • shaky limbs
  • tingling
  • a churning stomach.

Most panic attacks last for between 5 and 20 minutes. They can be very frightening, but they are not dangerous.

Some people can also have depression in pregnancy because of anxiety.

“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?

Anxiety in pregnancy is very common. More than 1 in 10 pregnant women have it. Do not feel like you are a failure because you feel like you are not coping.

Pregnancy can be a very emotional experience and it can sometimes be difficult to know whether your feelings are manageable or a sign of something more serious. Trust yourself. You are the best judge of whether your feelings are normal for you. If you feel anxious a lot or have panic attacks during pregnancy it’s important to ask for help.

What causes anxiety?

 Anyone can develop anxiety, but you are more likely to have it if you have: 

  • a family history of anxiety or panic attacks
  • had anxiety or panic attacks in the past
  • experienced a traumatic event or abuse
  • used some illegal drugs
  • depression
  • a long-term or painful condition
  • been under extra stress due to things like relationship problems, money worries or unemployment.

Pregnancy-specific anxieties and phobias

You may feel a bit anxious about or afraid of giving birth. This is very common. Pregnancy and childbirth are major life events, so don’t be hard on yourself for having these feelings. Talking to your midwife and doing some positive things to prepare for labour  may help.

A phobia is an overwhelming and debilitating fear of something. It is rare, but some women are so afraid of giving birth that they don’t want to go through with it, even if they really want to have the baby. A severe fear of childbirth may also affect their decision on how to give birth to their baby. This is called Tokophobia.

Some women develop a fear of childbirth because they have had a traumatic birthing experience, miscarriage or neonatal death. In this case, they may have post-traumatic stress disorder.

A needle phobia may also cause problems in pregnancy because it can cause some women to avoid having important blood tests or treatments.

If you are having overwhelming feelings of anxiety or terror about anything to do with your pregnancy or that may affect your pregnancy, it’s very important to talk to your midwife or GP. This needs to be treated by a mental health specialist.

 “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 baby?

Being concerned about whether anxiety or stress will affect your baby is understandable, but it can also create a vicious circle of thoughts. You may be feeling anxious during your pregnancy, then begin to worry if it this is affecting your baby and so become even more anxious.

It is very unlikely that your baby will be affected by your anxiety, particularly if you get the right treatment and support. So try to focus on asking for help and finding ways to manage your symptoms.

Be confident that you are doing everything you can to take care of your baby.

Find out more about stress and your baby.

What should I do if I have anxiety in pregnancy?

Talk to your midwife or doctor if you:

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

Tell your midwife or GP if you have experienced anxiety before even if you aren’t feeling anxious right now. The more they know about your mental health history the better they can support you during your pregnancy.

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 focus on finding the right treatment to help you recover.

If you find anxiety difficult to talk about, you could write down how you feel before your appointment or take someone with you for support.

What’s the treatment for anxiety in pregnancy?

Your midwife or GP will talk to you about all your options and the pros and cons of each treatment. What’s best for you will depend on things like:

  • how bad your symptoms are
  • what has help you in the past (if you’ve had anxiety before)
  • what services are available locally.

Anxiety, phobias and panic attacks are usually treated using self-help treatments based on cognitive behavioural therapy (CBT). 

"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 need more help you may be referred to a specialist mental health team for pregnant women. You may also be offered therapy, such as cognitive behavioural therapy, mindfulness  and applied relaxation with a professional therapist. You may also be offered medication, such as antidepressants.

Find out more about treatment and support for mental health.

How can I prevent or manage anxiety in pregnancy?

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

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

More information and support

Anxiety UK

No Panic

MIND 

 
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Sources

NHS Choices. Generalised anxiety disorder in adults. https://www.nhs.uk/conditions/generalised-anxiety-disorder/ (Page last reviewed: 01/02/2016. Next review due: 01/02/2019)

NHS Choices Panic Disorder https://www.nhs.uk/conditions/panic-disorder (Page last reviewed: 15/08/2017. Next review due: 15/08/2020)

Howard L et al. (2018) Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. The British Journal of Psychiatry

Clinical Knowledge Summaries (Oct 2017) Generalised anxiety disorders https://cks.nice.org.uk/generalized-anxiety-disorder

Hofberg K and Ward M R (2003) Fear of pregnancy and childbirth Postgraduate Medical Journal 2003;79:505-510 doi:10.1136/pmj.79.935.50 

NHS Choices Phobias https://www.nhs.uk/conditions/phobias/ (Page last reviewed: 14/01/2016. Next review due: 01/01/2019)

McAllister N et al (2021) Pregnancy outcomes in women with severe needle phobia. European Journal of Obstetrics, Gynecology and reproductive biology. 2012 Jun;162(2):149-52. doi: 10.1016/j.ejogrb.2012.02.019. Epub 2012 Mar 23.

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

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Last reviewed on October 19th, 2018. Next review date October 19th, 2021.

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