The Worry Machine That Never Shuts Off
Everyone told you that pregnancy would be "the happiest time of your life." And maybe parts of it are. But right now, at 3 AM, you are wide awake, staring at the ceiling, running through a mental checklist of everything that could go wrong.
Is the baby moving enough? Was that food safe? What if something happens during delivery? What if you are not a good mother? What if something is wrong and nobody has caught it yet?
Your heart is racing. Your chest is tight. You cannot sleep even though you are exhausted. And the guilt makes it worse, because you feel like you should be grateful and excited, not paralyzed with dread.
This is perinatal anxiety. It is one of the most common complications of pregnancy and the postpartum period, affecting an estimated 15% to 20% of women. It is at least as common as perinatal depression, yet it receives a fraction of the attention.
At MomDoc, we screen for it, we name it, and we treat it.
Anxiety vs. "Normal Pregnancy Worry"
Every pregnant person worries. That is the human brain doing its job, protecting the vulnerable. The line between normal worry and clinical anxiety is not about the content of your thoughts; it is about intensity, duration, and impairment.
Signs That Your Anxiety May Be Clinical
- You cannot control the worry. You try to stop, and you cannot. It loops endlessly.
- Physical symptoms dominate. Racing heart, shallow breathing, chest tightness, nausea (beyond morning sickness), muscle tension, headaches, dizziness.
- Sleep is destroyed. You cannot fall asleep or stay asleep even when the baby is sleeping, even when you are safe, even when everything is objectively fine.
- You are avoiding things. Avoiding driving, avoiding being alone with the baby, avoiding reading about pregnancy because it triggers more fear.
- Intrusive thoughts. Unwanted, vivid mental images of harm, accidents, illness, or death. These thoughts feel foreign and terrifying.
- Irritability and anger. Snapping at your partner, your older children, or yourself for reasons that feel disproportionate.
- Compulsive behaviors. Excessive Googling, repeatedly checking the baby monitor, obsessive cleaning, needing constant reassurance.
The Biology of Perinatal Anxiety
Perinatal anxiety is not a personality flaw or a sign that you are "not handling things well." It has biological roots:
- Hormonal shifts: The dramatic fluctuations in estrogen, progesterone, cortisol, and thyroid hormones during pregnancy and postpartum directly affect the brain's anxiety-regulating neurotransmitter systems.
- Sleep deprivation: Sustained sleep loss dysregulates the amygdala (your brain's fear center), making you more reactive to perceived threats.
- Prior anxiety or trauma: A personal or family history of anxiety, panic disorder, OCD, or PTSD significantly increases vulnerability.
- Pregnancy-specific triggers: High-risk diagnoses, prior pregnancy loss, fertility struggles, and traumatic birth experiences.
Screening at MomDoc
ACOG Clinical Practice Guideline No. 4 (2023) now explicitly recommends screening for anxiety alongside depression during the perinatal period [1]. MomDoc uses validated screening tools:
- GAD-7 (Generalized Anxiety Disorder scale): A 7-question self-report measure of anxiety severity.
- EPDS (Edinburgh Postnatal Depression Scale): Though designed for depression, it captures anxiety symptoms (particularly items about panic and worry).
- PHQ-9: Used for depression screening; combined with GAD-7 for a comprehensive picture.
Screening occurs at:
- The initial prenatal visit
- At least once later in pregnancy (typically around 28-32 weeks)
- At the postpartum visit (6 weeks)
- At any visit where you express concerns
Treatment: Getting Your Brain Back
Psychotherapy (First-Line for Mild to Moderate Anxiety)
- Cognitive Behavioral Therapy (CBT): The gold standard for anxiety. Teaches you to identify, challenge, and replace anxious thought patterns with evidence-based reasoning. Highly effective for intrusive thoughts and compulsive behaviors.
- Exposure and Response Prevention (ERP): A specific form of CBT particularly effective for perinatal OCD-type symptoms.
- Interpersonal Therapy (IPT): Focuses on relationship dynamics and role transitions (becoming a parent) that fuel anxiety.
Medication (For Moderate to Severe Anxiety)
ACOG Clinical Practice Guideline No. 5 (2023) provides clear guidance on pharmacotherapy during pregnancy and lactation [2]:
- SSRIs (sertraline, escitalopram): First-line. Well-studied in pregnancy with a favorable risk profile. The risks of untreated severe anxiety (preterm birth, low birth weight, impaired bonding) generally outweigh the medication risks.
- SNRIs (venlafaxine): Second-line for patients who do not respond to SSRIs.
- Benzodiazepines: Used sparingly and short-term for acute panic. Not first-line due to dependency risk and neonatal considerations.
- Buspirone: A non-addictive anxiolytic sometimes used as an adjunct.
Self-Management Strategies
These are complementary, not substitutes for professional treatment:
- Structured breathing exercises: 4-7-8 breathing, box breathing. These activate the parasympathetic nervous system and can interrupt a panic spiral in real time.
- Progressive muscle relaxation: Systematic tensing and releasing of muscle groups.
- Sleep hygiene: Establishing the preconditions for rest, even when rest feels impossible.
- Limited reassurance-seeking: Counterintuitively, constantly Googling symptoms or seeking reassurance from your partner reinforces the anxiety loop. CBT teaches healthier coping alternatives.
Myth Busting: "Anxiety During Pregnancy Is Just Hormones. It Will Pass."
Some cases of mild anxiety do resolve as hormones stabilize. But clinical perinatal anxiety frequently does NOT spontaneously resolve, and untreated anxiety during pregnancy is a strong predictor of postpartum depression and anxiety. Dismissing it as "just hormones" risks allowing a treatable condition to escalate into a crisis.
Treatment works. Early treatment works best.
Emergency Resources
If anxiety is causing thoughts of self-harm, panic attacks that feel like medical emergencies, or an inability to care for yourself or your baby:
- MomDoc Triage: 480-821-3601
- Postpartum Support International: 1-800-944-4773 (call or text)
- Maternal Mental Health Hotline: 1-833-943-5746 (24/7, free)
- 988 Suicide & Crisis Lifeline: Call or text 988
You Are Not Losing Your Mind
You have a medical condition with a biological basis and effective treatments. Call MomDoc at 480-821-3601 or book a virtual visit. You can start feeling better much sooner than you think.
This content is for informational purposes only and does not replace professional medical advice. Always consult your MomDoc provider regarding your specific mental health needs.