When my husband and I decided we were ready to start “trying” for a baby, I braced myself for the many things that could go wrong and the taxing pregnancy symptoms I could experience along the way. I knew a handful of women who had struggled to conceive, and others who had endured heartbreaking miscarriages. Then there were the actual symptoms associated with the first trimester of pregnancy, like nausea and extreme exhaustion. It didn’t sound fun, but we were as ready as we ever would be to start a family, so why wait?
I took a pregnancy test on an unseasonably warm Tuesday morning in February after waiting seven long days for my period to arrive. The word “pregnant” blinked back at me almost instantaneously, and I was in complete disbelief: After worrying that I would have a hard time conceiving, it had happened in the first month. And maybe even more confusing, I didn’t have any physical symptoms. No breast tenderness, no nausea, and I had enough energy to run a half-marathon. That night, I was happy. Maybe this whole pregnancy thing would be a breeze!
Everything was “perfect,” the doctors assured me over and over again—I didn’t believe them.
The next day, something shifted. Surely the fact that I didn’t have any of the common symptoms associated with pregnancy was a bad thing, right? I turned to Doctor Google, who told me that a symptomless first trimester could be harmless, but it could also indicate that hormone levels weren’t rising and that my body was getting ready for a miscarriage. I started spending hours on the internet every day, combing through message boards with glazed-over eyes, reading every comforting and horrifying story I could find.
I’ve never been a particularly calm person—I do live in New York, after all—but in the following weeks I experienced an almost unimaginable level of anxiety. My thoughts were circular and obsessive, and focusing on work was next to impossible. By the time my first prenatal visit rolled around at nine weeks, I had completely lost my appetite, and not because of morning sickness. I was just that anxious.
Despite what I thought my lack of physical symptoms could mean, my pregnancy was viable. As I closed out my first trimester and moved into my second, the fetus growing inside me was tested for every possible abnormality, and everything came back negative. Everything was “perfect,” the doctors assured me over and over again, but I didn’t believe them. I continued to move through each week on a wave of the most debilitating anxiety I’d ever experienced in my life, forcing down food and obsessively thinking about all of the things that could still go wrong.
For many women—like me—pregnancy is the first time they experience anything approaching such a high level of anxiety.
As it turns out, my experience with what I now know is called antenatal anxiety is a much bigger deal than the normal jitters associated with pregnancy, and it isn’t that unheard of. “The ‘official’ number of women who struggle with extreme anxiety in pregnancy is around 10%, but I think it’s actually one of the most underreported pregnancy symptoms out there,” says Karen Duncan, M.D., assistant professor at the department of obstetrics and gynecology at NYU. “So many women suffer in silence.”
Some women are more likely to experience antenatal anxiety than others—if you have a previous history with anxiety, for example, or past traumas around pregnancy, you’re at a higher risk. But for many women—like me—pregnancy is the first time they experience anything approaching such a high level of anxiety.
“There are many patients without a history of anxiety that begin to experience symptoms during pregnancy,” explains Kimberly Magna, M.D., assistant director of education for the Columbia Women’s Program. “Anxiety is often prompted by perceived lack of control and life transitions. Women may begin to have health-related fears, preoccupation with physical symptoms of pregnancy with or without significance, and feelings of incompetence. They may not be reassured by physicians or loved ones’ attempts to comfort.”
Your experience is valid, and you shouldn’t have to suffer in silence.
Pregnancy is a trifecta of anxiety triggers: On top of the major life transition and lack of control, one of the biggest factors to blame for antenatal anxiety is hormones. As Duncan explained it to me, everyone’s hormones affect them differently. So while I may not have been taking naps in the middle of the day or struggling with morning sickness as some women do, my rising hormone levels were presenting themselves in the form of anxiety. “Hormones affect the levels in the brain that control a woman’s mental status,” she said. “They can make us feel more depressed, happier, or more anxious. In the first trimester when the hormones are shooting up as the pregnancy is growing rapidly, women can be incredibly anxious. And it doesn’t help that the miscarriage risk is higher [in the first trimester].”
If you think a wave of pregnancy-induced anxiety might be a possibility, it’s helpful to make a plan to treat it with your doctor before you get pregnant, says Stephanie Mclellan, M.D., chief medical officer at the women’s healthcare platform Tia. “This type of pregnancy-specific anxiety can affect the quality of the pregnancy and even be impactful on the life of the baby and that baby’s baby, via epigenetic signaling,” she explains. So even before trying to conceive, find a mental health professional you trust. Consider cognitive behavioral therapy, and work on busting day-to-day stress through lifestyle shifts like regular exercise, high-quality sleep, adequate nutrition, acupuncture, journaling, meditation and mindfulness.
If you didn’t see your antenatal anxiety coming, though, don’t beat yourself up—there’s still plenty of time to take action during your pregnancy. According to Duncan, the most important thing you can do is let your doctor know what’s going on right away.
“Whether or not you think what you’re experiencing is normal, it’s important to say something so you can be screened for anxiety and depression,” she says, adding that women who experience anxiety and depression in pregnancy or more likely to suffer from postpartum depression and anxiety. “Your OB-GYN can refer you to a counselor, and they can help you come up with an action plan. Lifestyle tweaks and talk therapy can help, and in some cases there are medications we use to help calm those anxiety-like symptoms and panic attacks, but risks and benefits need to be weighed. This should always be done under the supervision of a doctor.”
My advice to anyone struggling with antenatal anxiety? Don’t wait to tell someone what’s going on. Your experience is valid, and you shouldn’t have to suffer in silence. Make sure to let your doctor know, and talk to other women about it—more people struggle with it than you probably think.
Leigh Weingus is a New York-based freelance writer covering health and wellness, women’s issues, entertainment, and more. Follow her at @leighweingus.
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