If you are just finding out you are pregnant you may be experiencing a rollercoaster of emotions. This post with cover how to deal with anxiety in the first trimester of pregnancy. If you missed it, you can check out how to deal with pregnancy anxiety while you’re trying to get pregnant and more to come on trimester two and three coming soon.
Once you become pregnant, it’s normal to have occasional worries about maintaining your pregnancy. The risk of miscarriage is highest early in the first trimester. The risk drops with each week that goes by, declining to 4-5% after the fetal heartbeat has been confirmed, and to less than 1% by week 14. Your own personal risk might be higher or lower depending on several other factors, including your age, lifestyle, and past pregnancy history.
What if you have had a positive pregnancy test and have seen and heard the heartbeat, but are still worried? What can you do while you’re waiting for the 11-13 week ultrasound? It is particularly difficult during the first trimester to feel confident that your body is doing everything it needs to do to sustain your pregnancy. And it’s hard to wait when you are anxious. As a result, some women begin to scan their bodies to see whether they still “feel pregnant.”
A patient of mine, “Nicole”, was a healthy 34-year-old woman who had been trying to conceive for over a year and had experienced two miscarriages. She came in for treatment 17 weeks into her third pregnancy. Genetic screening, ultrasounds, and fetal heart rate all indicated that the fetus was healthy and developing normally. Nicole thought she would feel better when she entered her second trimester, but was very worried about miscarrying.
She spent a great deal of time monitoring her body for signs of pregnancy. On the days she felt at her best physically, she felt worse emotionally, and often felt convinced that she was miscarrying. Nicole made constant trips to the bathroom to check for bleeding. She would push on her abdomen to check for cramping and then become uncertain as to what was causing the twinges of discomfort. She went into her doctor’s office on three unscheduled occasions to have the nurse check the fetal heartbeat. She begged her cousin, an ultrasound technician, to let her come in for a “quick look” at the baby.
She worried that her family thought she was crazy. She frequently called her mother to ask for reassurance; those calls typically ended with Nicole crying that her mother “didn’t know what she was talking about because she’s not a doctor!” The more people tried to reassure her that she was “just anxious,” the more upset she became. She was starting to feel like nothing she could do made her feel better.
This is probably the only time in your life when feeling sick will actually make you feel better. Still nauseous? Great! Do your breasts feel tender? What a relief. Are you still tired? I am so happy for you!
The problem is that pregnancy symptoms ebb and flow. It’s healthy and normal for symptoms to begin to dissipate. However, if you are anxious, you might not take the alleviation of these symptoms as a sign that your pregnancy is progressing. Rather, you will jump to the conclusion that you are miscarrying or no longer pregnant.
This is called catastrophic thinking. When you catastrophize, you expect the worst possible outcome, usually involving loss (e.g. loss of health, loss of job, loss of love, loss of life, etc.). Catastrophic thinking can have a dramatic impact on your mood.
The fantasies of something bad happening can inject as much stress and anxiety in your life as if those possibilities were really occurring. Because of the mind-body connection, your body has a very difficult time understanding that you are just thinking about a loss, but not actually experiencing one. We live through many more negative and anxiety-provoking experiences in our minds than real life actually brings. This leaves you feeling so bad that you become more convinced that something bad is happening, and the spiral continues.
Next, you will want to do something to reassure yourself; you may even feel like you have to have this reassurance. Seeking medical reassurance is tricky. One the one hand, you want to get the input of your doctor; on the other, you may fear that you’re becoming annoying. You might worry about calling too often. Some patients begin to fear that their doctor might “fire” them.
While I have never known a patient to be fired for asking too many questions, I have seen the relationship with their doctors become tense. I have also known patients to switch doctors if they cannot convince their OBGyn to order tests or see them as often as they would like to be seen.
The question is not whether your doctor provides the medical care you would like, but whether they provide the care you need. If you think you need more tests and appointments than are typically recommended, that might not be a good sign.
Don’t let your vision or medical choices become blurred by anxiety.
Here are some steps you can take to manage worries about miscarriage:
- Ask yourself: “Where did this worry come from?” Were you experiencing physical symptoms that caught your attention? Did you suddenly begin cramping? Did you find blood in your underwear? If so, a call to your doctor might be reasonable. BUT, if you were pushing on your side to see if it hurt, or if you just heard a story about miscarriage that prompted a worry, or if the worry came to your mind “from out of nowhere,” recognize that this is anxiety, not a medical emergency.
- Do not purchase additional pregnancy tests or special equipment to monitor the heartbeat to reassure yourself.
- Do not call your doctor with slightly different versions of the same question. One of my favorite responses from an OBGyn with whom I work closely is: “Asked and answered.” Asking repeatedly, or in slightly different ways, is a form of reassurance seeking. Reassurance seeking is a difficult pattern to break, and it will only make you feel better in the short run. In the long run, you will need more and more of it, and still never be satisfied.
- Begin to look for resources that will help you manage your anxiety more effectively. You could probably benefit from learning relaxation strategies to reduce physical tension and anxiety symptoms within your body. You might also want to learn more about how to manage the thought patterns that create or maintain anxiety. Cognitive behavioral therapy (CBT) is the most effective form of therapy available for managing anxiety. Read, view Ted Talks, explore credible videos on YouTube, and perhaps set up a consultation with CBT therapist.
- Do not emotionally disconnect from your pregnancy. Some women decide that they will not allow themselves to think about their baby or begin to brainstorm names or think about baby gear. This is most common for women who have experienced loss previously and who do not want to get “too attached.” This strategy does not work. No one has experienced less pain because they tried not to be attached, and this can set the stage for difficulties with attachment once your baby arrives.
For many women, anxiety about pregnancy loss diminishes once they’re publicly pregnant. This typically occurs near the end of the first trimester: the time when risk for miscarriage decreases, when you have heard the heartbeat at a few appointments, and likely had an ultrasound. When you share your news, you open yourself to celebration and cheer and the hope of others. The positive reactions they share help to balance your worries. Until then, don’t wish to feel worse than you do. Try to feel confident that your body is doing what it needs to do to support the well-being of your child.
About the Author
Dr. Jill Sullivan is a licensed clinical psychologist with more than fifteen years of specialized training and expertise in Cognitive Behavioral Therapy (CBT). She is also the co-founder of CBT Specialists of Chicago. Dr. Sullivan graduated summa cum laude with a degree in Psychology from the University of Michigan and completed her Ph.D. in Clinical Psychology at the University of Minnesota. She completed her clinical internship and post-doctoral fellowship at Northwestern Memorial Hospital, where she also served as a staff psychologist for three years. She is an Assistant Clinical Professor in the Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine. From 2003 through 2011, Dr. Sullivan practiced with a multidisciplinary group focused on women’s health, including family planning, pregnancy loss, mood management during pregnancy, postpartum adjustment, and the transition to motherhood. She maintains a full-time private practice in Chicago. Additional information about the Anxiety-Free Pregnancy Series can be found at https://www.anxietyfreepregnancy.com/.
Looking for more on how to SURVIVE your first trimester of pregnancy? Check this post out for tips and tricks.