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Dec. 18, 2000 -- Pregnancy should be a joyous time, but for some women it's marked by fear and anxiety -- about the medical procedures they might be subjected to, about the pain they might face in delivery, about their baby, sometimes about the very state of being pregnant itself. This distress can cause women to skip or delay important medical appointments and, in a worst-case scenario, endanger the health of both mother and child.
Most medical experts say that as women learn about the changes they'll experience while pregnant -- and about the necessary medical procedures they must undergo -- they become more comfortable with the process. However, some women can't overcome their fears without help from a psychiatrist or psychologist. A study published recently in the journal Psychosomatics describes one particularly severe case -- and its successful treatment through psychotherapy.
In the paper, authors Gretchen Brenes, PhD, of the department of public health sciences at Wake Forest University in Winston-Salem, N.C., and Karen Milo, PhD, of the department of psychiatry and behavioral medicine at the University of South Florida in Miami describe the case of a 23-year-old woman whose fears of pregnancy were causing her nightmares and hyperventilation. The woman sought psychiatric treatment in her 29th week of pregnancy because she was so afraid of needles and the impending delivery -- and afraid, too, of the fetus inside her, she reported -- that she was unable to discuss her pregnancy, or her anxiety about it, with others.
"She stated that she felt 'weird' about having a baby living inside her, and her anxiety increased whenever she felt the fetus move, saw the heartbeat of the fetus on the ultrasound, or was otherwise reminded of her pregnancy," the researchers wrote.
Brenes and Milo sought to decrease the woman's anxiety so that she would comply with recommended medical procedures. They taught her breathing, muscle-relaxation, and guided-imagery techniques to help her control her emotional and physical responses.
For instance, she was shown that by redirecting her thoughts of the fetus inside her body to a vision of the child outside her body, she could help relieve her fear of delivery, and she was taught communication and assertiveness skills to help her express her concerns to medical personnel and her family.
While it's not uncommon to have fears during pregnancy, especially for first-time mothers or those who have had miscarriages or other past problems, few women experience such catastrophic feelings as the woman described in this paper. But even garden-variety anxieties can be relieved with education, says John McNabb, MD, an obstetrician and gynecologist at Baylor University Medical Center, in Garland, Texas.
For instance, he says, 15 or 20 years ago, many women worried that sonograms, which screens for some problems while the fetus is in the uterus, might harm the mother or the child. Educating an expectant mother about the proven safety of this procedure can help erase any misplaced fears she might have picked up along the way. Another source of needless anxiety, he says, are oft-repeated horror stories about painful deliveries. An update on modern techniques to control pain can go a long way toward easing those fears.
"Some women do have problems coping with the pregnancy right from the beginning, and the stress of the 9 months of carrying the baby makes it even more difficult," says Tracy Papa, DO, a perinatologist at Harris Methodist Fort Worth Hospital (Texas), who is used to dealing with anxious moms. She specializes in treating women who have high-risk pregnancies either because of a chronic illness or because of a chance of a genetic abnormality in the baby. "It's not uncommon for us to start them on antidepressants; there are a number of that are safe to take during pregnancy," she tells WebMD.
McNabb says he has never had a patient whose anxiety was so severe that she needed psychiatric counseling to get through the pregnancy, but all the experts interviewed by WebMD say it's important for the obstetrician to carefully evaluate and educate their patients about what to expect during pregnancy and delivery. Once that's done, if the expectant mother still shows signs of serious distress, then psychological or psychiatric treatment may very well be the best option.