If you’re pregnant, you’ve probably been feeling joyful and excited as you dream about your new little one. But there’s a flip side as well: Fear and anxiety can also creep in, as you start to accept the idea that you’re growing a tiny person inside your body, and that your life is about to completely change. Plenty of moms-to-be find themselves feeling overwhelmed with worry—and it’s completely understandable. You’re suddenly in charge of another life, and the thought of anything harming your child can be terrifying.
“It’s scary not to know what’s going to happen, how your body will change, whether or not the baby be healthy, and how having a child will alter your life and identity overall,” says Perri Shaw Borish, MSS, LCSW, BCD, a psychotherapist and founder of Whole Heart Maternal Mental Health in Philadelphia.
It’s also important to note that some women have risk factors that make them more likely to develop prenatal depression or anxiety, such as a history of depression or anxiety, a previous pregnancy loss, a family history of mood disorders or factors like the recent loss of a loved one, living in poverty or limited social support. The American College of Obstetricians and Gynecologists recommends that physicians screen pregnant women for depression and anxiety, and if you’re having concerns about your own mental well-being, you should mention them to your doctor.
The good news? There are lots of coping strategies and lifestyle changes that may help alleviate anxiety. In fact, pregnancy is a great time to experiment and figure out what kind of self-care routine works for you, so you’ll have it in place for the postpartum period as well. Here’s what the experts recommend.
“Rather than being up in your head, try to get back into your body, even if it’s just doing something simple like stretches at home,” says Brooklyn-based psychotherapist Rachel Magida, MPH, LCSW. Pregnancy-specific workouts are great for this and are often easy to do from the comfort of your living room, but even a simple walk can boost your heart rate and do wonders for your mood. “Even if it’s not formal exercise, just getting outside in the fresh air and sunlight can really help, whatever movement you can get,” says Borish.
She also suggests scheduling exercise breaks in your calendar, the same as you would your doctor’s appointments or work meetings. “Planning for exercise will help it become part of your recipe for success,” says Borish. Besides providing a distraction from upsetting thoughts, exercise releases endorphins, which are brain chemicals that can enhance your sense of well-being.
2. Learn to Breathe Properly
Pregnant women may already find themselves feeling a little short of breath, since by the second trimester they’re inhaling and exhaling 30 to 40 percent more air. (This is due to the hormone progesterone, which stimulates the lungs.) Of course, anxiety can also cause people to feel breathless, which doesn’t help. Both Magida and Borish recommend a technique called square breathing (also called box breathing or controlled breathing). Begin by slowly exhaling completely, then inhaling for four seconds, holding your breath for a count of four, exhaling for four seconds and holding your breath again for the same count before repeating. As you do it, imagine a square and that your breath is traveling up one side, across the top, back down and around the bottom. “Try practicing this when you aren’t feeling anxious, so when do you start to feel stressed, it will be one of your go-to tools,” says Borish, who adds that it can be especially helpful if you’re having trouble falling asleep.
It may help to write your fears down on paper to help get them out of your head. “If you’re having what I call ‘ongoing spiraling,’ sit down for 10 or 15 minutes, maybe at the beginning of the day, and write down what’s bothering you in a journal or notebook,” says Magida. “Then close the book and set it aside, although if you have another worry later in the day, go back and add it.” If it helps, you can run through the list with your doctor and get the lowdown on what is and isn’t a real cause for concern.
Borish suggests keeping a pen and paper on your nightstand, so you can jot down anxious thoughts if they strike overnight. “I’m not talking about your phone, but an actual pen and paper—so if you get woken up and start worrying, jot your thoughts down, and know that they will be there for you the next morning,” she says. Borish also suggests patients set boundaries and give themselves what she calls “a set worry time” each day and once it’s over, try to put their unsettling thoughts aside.
Whether you choose a therapist, your partner or a few friends, having someone to act as a sounding board can be invaluable. But if you choose to confide in a pal, Magida warns, “Make sure you pick the right kind of friend, meaning someone who can just listen, and sit with you in your anxiety and hold that for you, not necessarily giving you advice like ‘here’s what happened to me when I was pregnant,’ but say things like, ‘I know this is so hard for you, I get it, and I’ve got your back.” Borish also recommends finding an expectant moms’ group, either online or in person. “Sharing resources, worries and feelings with others who are experiencing the same thing can be so helpful during pregnancy,” she says.
5. Practice Sleep Hygiene
Although getting restful sleep can already be tough when you’re dealing with heartburn and an ever-growing belly, there are certain things you can do to help stack the deck in your favor. “It’s important to have a consistent bedtime as well as a bedtime routine,” Borish says. “Keep the lights off, turn off the TV and leave the phone in another room, and make sure the temperature is just right for a comfortable sleep environment. You also shouldn’t be using your bedroom to work or study—it’s just for sleep and sex.”
Other suggestions include avoiding caffeine late in the day and skipping naps if you find they make it hard for you to conk out at bedtime. That said, if you find that anxious thoughts are consistently keeping you awake, it might be time for some more support. “If you can’t fall asleep due to anxiety or depression, it’s a clear red flag that you can’t manage it on your own and you should seek help,” Borish says.
6. Ground Yourself with Calming Words
If your mind is brimming with anxious thoughts, take a moment to center yourself. “Sit somewhere, plant your feet on the ground, look around the room and name the different things you see, like pillow, chair, couch, lamp,” says Magida.
If you can, try to focus on the present moment. “When you’re pregnant, staying present can be hard because there’s so much thinking about the future,” says Borish. “You have all these dreams and fantasies that you’re putting on the baby, but for some women, it can cause anxiety due to the lack of control.” Remind yourself that anxiety is just a feeling. “It might mean your brain is signaling that you need to pay attention, but it doesn’t mean there’s actually a threat or a danger,” Borish says.
When you’re pregnant, it can be tempting to type in search terms every time you feel a strange new twinge, but if you’re already experiencing anxiety, this can just worsen it. “I tell my patients, you are not allowed to Google, because you can find anything to support anything,” Borish says. “Try to get your information only from your provider or trusted sources.”
As a mom-to-be, you’re balancing a ton of stuff at once, so treat yourself as you would a good friend—with compassion. “A lot of women are super-hard on themselves and are perfectionists, and there’s a sense that you need to get it all done,” says Borish. “Give yourself permission to do what you can and just be good enough, and be patient with yourself.”
So take a deep breath, mama—and know that you’ve got this. We’re right here with you.
Perri Shaw Borish, MSS, LCSW, BCD, is the founder of Whole Heart Maternal Health, a group practice in Philadelphia specializing in perinatal mood and anxiety disorders, infertility, grief and loss. She is a licensed clinical social worker and also holds a master’s degree in social science.
Rachel Magida is a psychotherapist in private practice in Brooklyn, New York, specializing in new mothers, young adults and life transitions. A licensed clinical social worker, she also holds a master’s degree in public health.
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