Pregnancy can bring excitement and anticipation, but it can also bring uncertainty, worry and fear. Sometimes all of these feelings occur at the same time.
You may find yourself worrying about your baby’s health, whether the pregnancy is progressing normally, giving birth, becoming a parent or how life is going to change. If this is your first baby, almost everything can feel unfamiliar. If you have had a difficult pregnancy, birth or loss before, a new pregnancy may bring its own particular anxieties.
There is no rule that says you have to feel happy and relaxed throughout pregnancy. Feeling worried does not mean that you are doing pregnancy badly, and it does not mean that you will not enjoy becoming a parent.
For some people, however, ordinary worries begin to become persistent, difficult to control and exhausting.
Anxiety in pregnancy is common
If you are experiencing anxiety during pregnancy, you are certainly not alone.
Estimates vary depending on how anxiety is measured. A large systematic review involving more than 220,000 women found that around 15% met criteria for an anxiety disorder during pregnancy. When researchers looked more broadly at anxiety symptoms, the figures ranged from around 18% in the first trimester to almost 25% in the third trimester (Dennis et al., 2017).
Pregnancy can also be the first time someone experiences significant anxiety, while for others it can mean the return or worsening of anxiety they have experienced before.
When does normal worry become anxiety?
Some worry during pregnancy is completely understandable. Anxiety becomes more of a concern when worrying begins to feel difficult to control or starts interfering with everyday life.
You might notice that you:
- worry repeatedly about your baby, your health or the birth
- find it difficult to switch off from worrying
- constantly check for signs that something might be wrong
- feel tense, restless or unable to relax
- struggle to concentrate
- become irritable or agitated
- notice physical symptoms such as a racing heart, dizziness or muscle tension
- struggle to sleep because your mind will not settle
- experience sudden episodes of intense fear or panic.
These are also consistent with symptoms highlighted by the NHS in its guidance on anxiety during pregnancy.
One of the difficulties with anxiety is that it can create its own cycle.
You notice a sensation or have a worrying thought. You begin to wonder whether it means something is wrong. You become more anxious, which makes you notice even more sensations and thoughts, and these in turn seem to confirm that there is something to worry about.
You may even start worrying about the fact that you are worrying:
Shouldn’t I be enjoying this?
Why can’t I just relax?
Is worrying this much normal?
That additional layer of self-criticism rarely helps. Pregnancy does not have to be a continuously joyful experience.
What can help with anxiety during pregnancy?
There is no single technique that works for everyone. What helps will depend on what you are anxious about, how much it is affecting you and what may be keeping those worries going.
Talk about how you are feeling
Anxiety can become harder to manage when you are dealing with it alone.
Talking to your partner, a friend or family member can help, but it is also worth talking to your midwife or GP if your anxiety is persistent or affecting everyday life.
You do not need to wait until things become unbearable before asking for help. Support is available during pregnancy, and your midwife or GP can help you decide whether additional psychological or perinatal mental-health support would be useful.
Keep moving, if you are able to
Walking, swimming, pregnancy-appropriate yoga or another form of activity you enjoy may help both physical and psychological wellbeing.
A systematic review and meta-analysis found that physical activity interventions during pregnancy were associated with reductions in prenatal anxiety scores, although there was considerable variation between studies (Sánchez-Polán et al., 2021).
Follow the advice of your maternity team about the type and amount of exercise appropriate for your pregnancy.
Learn to respond differently to anxious thoughts
Anxiety often encourages us to treat thoughts as though they are predictions.
There is an important difference between:
“Something could go wrong.”
and:
“Something is going wrong.”
Cognitive behavioural approaches can help you notice these patterns, look at how you are interpreting uncertainty and develop more balanced ways of responding.
This does not mean forcing yourself to think positively or reassuring yourself that everything will definitely be fine. Pregnancy contains genuine uncertainty.
Instead, it can mean learning that having a frightening thought does not make that thought a fact.
There is good evidence for psychological approaches to perinatal anxiety. A systematic review and meta-analysis of 26 studies found psychological interventions reduced anxiety symptoms, with evidence supporting cognitive, behavioural and mindfulness-based approaches. The authors reported particularly strong effects for CBT (Clinkscales et al., 2023).
NICE recommends psychological interventions, including CBT, as an initial treatment option for women with anxiety disorders during pregnancy and the postnatal period.
Preparing for birth when you feel anxious
For some women, anxiety becomes particularly focused on childbirth.
You might worry about pain, losing control, medical interventions, something going wrong or simply not knowing what labour will be like.
I am trained in hypnobirthing, and one of the things I value about good birth preparation is that it can give women practical skills to use during labour. These might include breathing, relaxation, focused attention, imagery and mental rehearsal. These skills can help you prepare for the unpredictability of childbirty by helping you understand what is happening, consider your choices, develop coping strategies and feel better equipped to respond if things do not happen exactly as you imagined.
That distinction is important. Hypnobirthing can help you to understand that successful births can involve discomfort, being worried, needing analgesia or medical interventions. In fact hypnobirthing does not mean you will not want or need pain relief during labour, but it does contribute to a more positive birth experience.
My particular interest in pregnancy-related anxiety
Pregnancy-related anxiety is an area that is especially important to me professionally.
My PhD research focused on anxiety during pregnancy, including how thinking about and imagining future pregnancy-related experiences can influence how women feel.
Pregnancy naturally involves a great deal of thinking ahead.
You may imagine giving birth, picture bringing your baby home or wonder what it will feel like to become a parent. Sometimes these thoughts and images are reassuring. At other times, the mind can repeatedly rehearse frightening versions of what might happen.
This is one of the reasons I am particularly interested in the use of imagery within psychological therapy.
We often think of anxiety as being about thoughts, but sometimes the mental pictures we create of the future can be just as powerful.
Where does cognitive behavioural hypnotherapy fit?
My approach combines my psychological background and research into pregnancy-related anxiety with my training in hypnobirthing and cognitive behavioural hypnotherapy (CBH).
CBH does not simply involve putting someone into hypnosis and suggesting that they will feel calm.
We can first look at the particular thoughts, predictions, images and behaviours associated with the anxiety.
For example, someone approaching childbirth might repeatedly think:
“I won’t be able to cope.”
Simply replacing that with:
“My birth will be calm and easy.”
may not be particularly convincing or helpful.
A more realistic therapeutic goal might be:
“I don’t know exactly what my birth will be like, but I can prepare, use the skills I have learnt, communicate what I need and cope with difficult moments.”
Hypnosis and guided imagery can then be used to help mentally rehearse that different response.
Similarly, someone anxious about becoming a parent might work towards:
“I don’t have to know exactly what everything will be like. I can learn and adapt as I go.”
The goal is not necessarily to remove every anxious thought.
It is to help those thoughts feel less threatening and to increase confidence in your ability to cope with uncertainty.
Bringing research and therapy together
For me, this is where my different areas of experience fit particularly well together.
My research background gives me an understanding of pregnancy-related anxiety and the importance of the way we anticipate future events. My hypnobirthing training provides practical experience of using imagery, relaxation and focused attention around childbirth. Cognitive behavioural hypnotherapy adds a framework for understanding the thoughts and behaviours that may be maintaining someone’s anxiety.
Most importantly, the approach does not depend on repeatedly telling someone:
“Everything will be fine.”
For an anxious mind, the immediate response is often:
“But what if it isn’t?”
A more useful question can be:
“Even though I can’t know exactly what will happen, what would help me feel better able to cope with it?”
You don’t have to struggle on your own
Anxiety during pregnancy is common, and effective help is available.
If worry is becoming difficult to control, affecting your sleep or everyday life, causing panic attacks, or taking away much of your enjoyment of pregnancy, speak to your midwife or GP.
Hypnobirthing and hypnotherapy can provide useful skills for some women, but they should complement rather than replace appropriate maternity or mental-health care.
Pregnancy inevitably contains uncertainty. Feeling anxious about some of that uncertainty is human.
The aim does not have to be to experience pregnancy or childbirth without ever feeling worried. A more realistic goal may be to understand your anxiety, develop ways of responding to it and feel increasingly confident in your ability to cope with whatever comes next.
References
Catsaros, S. & Wendland, J. (2023). Psychological impact of hypnosis for pregnancy and childbirth: A systematic review. Complementary Therapies in Clinical Practice, 50, 101713. DOI: 10.1016/j.ctcp.2022.101713.
Clinkscales, N., Golds, L., Berlouis, K. & MacBeth, A. (2023). The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis. Psychology and Psychotherapy: Theory, Research and Practice, 96(2), 296–327. DOI: 10.1111/papt.12441.
Dennis, C-L., Falah-Hassani, K. & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315–323. DOI: 10.1192/bjp.bp.116.187179.
National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance (CG192).
NHS. Anxiety in pregnancy.
Sánchez-Polán, M., Silva-Jose, C., Franco, E., Nagpal, T. S., Gil-Ares, J., Lili, Q., Barakat, R. & Refoyo, I. (2021). Prenatal anxiety and exercise: Systematic review and meta-analysis. Journal of Clinical Medicine, 10(23), 5501. DOI: 10.3390/jcm10235501.
Yaqoob, H., Ju, X-D. & Jamshaid, S. (2024). Hypnobirthing training for first-time mothers: Pain, anxiety and postpartum wellbeing. Psychology Research and Behavior Management, 17, 3033–3048. DOI: 10.2147/PRBM.S465361.