Almost 1 in 5 birthing people experience a mental health condition in pregnancy. One of the most common is anxiety, with one study showing it impacts up to nearly 30% of pregnant people.
But many pregnant people with anxiety are not properly diagnosed and do not receive treatment. It’s clear: pregnant people don’t just need support, they need answers and long-term solutions.
A new study into the treatment of pregnancy-related anxiety echoes this sentiment. It reveals a collaborative approach to mental health care may be more beneficial than stand-alone treatment. Plus, psychological interventions, such as mindfulness, motivational interviewing, and supportive counseling, are more effective in reducing anxiety during pregnancy compared to standard prenatal care.
“People want to not just get help but really understand why they feel anxiety and they want coping skills to manage their anxiety more effectively,” explains Heidi Cox, PhD, PMH-C, a licensed clinical psychologist and founder and director of The Centered Space Psychology Group, who was not part of the research.
Some experts like Dr. Cox believe strongly in a collaborative care model for perinatal anxiety. Here’s what that entails and the benefits.
Breaking Down Collaborative Care for Anxiety
Collaborative care is a team-based approach that involves simultaneous support from multiple health professionals, such as psychologists, obstetricians, midwives, and nurses.
“Standard care is currently either therapy or medication, sometimes both, if the person is lucky enough to have their anxiety recognized,” Dr. Cox says. “Anxiety is a persistent fear or worry in everyday situations, so when the whole team understands the perinatal anxiety picture they can provide better support and care because they have a fuller picture of the situation.”
This approach may be more important than ever as rates of pregnancy-related anxiety continue to rise. That is due to a combination of psychological, social, and systemic factors, that have intensified for many after the COVID-19 pandemic, points out Misty Richards, MD, MS, a psychiatrist and assistant clinical professor at the David Geffen School of Medicine at UCLA, with a joint appointment in the UCLA Division of Child and Adolescent Psychiatry and Department of Obstetrics and Gynecology.
Generally, hormonal and neurological shifts experienced in the body during pregnancy can make anxiety symptoms feel more pronounced. “For example, increased levels of estrogen, progesterone, HCG, and other hormones during pregnancy, can affect mood and stress levels,” says Dr. Cox. “Sleep is also affected during pregnancy and loss of sleep can increase anxiety as well.”
Another study looked into risk factors for depression and anxiety in pregnancy, revealing a history of previous depression or anxiety, abuse, and marital problems were among the most common.
Treating anxiety in pregnancy is crucial as it can increase the risk of premature birth, low birth weight, and delivery complications. Anxiety can also contribute to postpartum depression, poor parent-infant bonding, and emotional or behavioral issues in children.
Bringing obstetric, mental health, and primary care providers together can help ensure anxiety is addressed early and prevent it from leading to negative outcomes.
“This team-based approach has been shown to improve maternal mental health, enhance birth outcomes, and reduce barriers to care, especially for those from marginalized communities,” says Dr. Richards.
Anxiety Symptoms in Pregnancy
Key anxiety signs to look out for include:
- Constant worrying
- Racing thoughts
- Trouble sleeping, even when tired
- Rapid heartbeat
- Nausea
- Sense of dread that something will go wrong with the pregnancy or baby
If you, or a loved one, needs support, reach out to your care provider for assistance.
Why Is Collaborative Care Successful?
A big reason for its success is pregnant people often feel more at ease discussing their mental health with care providers they already know. It’s also more convenient.
“Mental health care that is delivered within the obstetric clinic setting, where patients already feel comfortable, reduces barriers like stigma, scheduling, and transportation—especially crucial for pregnant individuals balancing many appointments,” says Marika Toscano, MD, MS, an OB-GYN specializing in maternal-fetal medicine and the assistant professor of maternal fetal medicine at Johns Hopkins University.
Treating anxiety is also largely about educating pregnant people about their own emotions and parental transitions, Dr. Cox says. “Education about the anxiety cycle is very important, as is understanding your own anxiety cycle and noticing it in your body so that you know how to identify it and respond differently,” she says.
Many pregnant people benefit from learning about “matrescence,” or the process of becoming a mother. “Once perinatal patients see their anxiety in the context of a larger process it helps to reduce anxiety as well,” says Dr. Cox.
What About Cognitive Behavioral Therapy?
The study also suggests that cognitive behavioral therapy (CBT), often considered the gold standard in mental health treatment, isn’t enough to treat anxiety in pregnancy alone. CBT seeks to recognize and challenge false and distressing beliefs often through intensive treatment that requires “homework” between sessions. While CBT can be beneficial for treating anxiety, demands on pregnancy may call for a gentler approach.
“Beginning with supportive therapy, motivational interviewing, and mindfulness (when appropriate), disarms and engages a patient, helping them feel validated and held during an incredibly vulnerable and challenging time,” explains Dr. Richards, who is also the co-founder and medical director of the Perinatal Psychiatry for the Maternal Outpatient Mental Health Services (MOMS) Clinic at UCLA Health.
Dr. Richards points out that new mothers are often sleep deprived and struggle with feelings of inadequacy.
“Perhaps what you are looking for, in addition to more sleep, is someone who will listen to you, validate the challenges you are facing, help you back to regulation, and encourage you to take the next simple, reasonable step in the right direction,” she explains.
Once a patient starts feeling better, and trust has been established, “then you can begin to challenge cognitive distortions, create thought-feelings-behavior journals, and begin the process of cognitive restructuring that often involves homework,” says Dr. Richards.
But it’s important to note that collaborative care may not work for everyone. Pregnant people who are experiencing symptoms of anxiety should speak with their health care provider about what may work best for them.
