Sage Advice From The Experts On How To Manage Your Anxiety Around Miscarriage & Pregnancy

“In the beginning, most women would have anxiety around delivery because they know that was going to happen one way or another,” Lindemann says. “There are, however, causes that can arise during pregnancy — for example, if your screening tests are abnormal, if your blood pressure goes up, if you have preeclampsia, if you develop diabetes or other health problems. Many women will worry about the amount of fetal movement, with justification.

“Since first-time moms enter pregnancy with tabula rasa, meaning no previous experience or knowledge, they worry about the one thing they know for certain is going to happen, and that is labor and delivery, pain, an epidural, and who will do her delivery.”

Women who have suffered a miscarriage understandably have more anxiety around pregnancy.

“This is a special and unfortunate group,” Lindemann says. “Most of them actually do have something to worry about. Certainly, most moms and dads would worry about the other shoe dropping. In theory, first-trimester miscarriages are common, and if you count the miscarriages that occur before or around the time of the first missed period, you would be looking at about 40% of pregnancies.”

We know that stress and anxiety are never helpful to a pregnancy, and Lindemann says, “They can be associated with babies which are small for gestational age, depression, suicide, and even homicide. I strongly recommend anxiety be treated effectively, whether it’s by antidepressant medications, antianxiety medications, counseling, or all three.”

For these expectant women, Lindemann says, “First of all, we need to carefully track all the signs of a standard, routine pregnancy. This includes weight gain, maternal age, history of miscarriages, history of a term pregnancy, history of preterm pregnancies, history of pregnancy loss, diabetes, smoking, infections of the baby, the amniotic fluid, the umbilical cord, the cervix, the uterus, the vagina, and routine and indicated lab tests.”

“Then comes a complicated conversation about possible causes of pregnancy loss,” Lindemann explains. “We used to say that an infertility workup could not begin until three early, consecutive spontaneous pregnancy losses occurred. In my experience, this is adding insult to injury. I believe that a real discussion needs to occur even after one pregnancy loss, particularly if it is after you have a normal fetal heartbeat at 11 or 12 weeks.”

“I would divide repetitive pregnancy loss into three groups,” Lindemann says. “There is the autoimmune group where you have blood clotting disorders, either before or during pregnancy, such as MTHFR or Factor V Leiden. Second, you have congenital anomalies with chromosome defects such as Down syndrome. Thirdly, you have an infection.”

Providing hope against pregnancy anxiety around a previous miscarriage, Lindemann says, “Beginning in about 1980 and going through the next two decades I had many patients come to see me who had had previous pregnancy loss, many of them due to previous infections. I treated the infections, and most of these patients went from having a previous stillborn to delivering living babies, although not everyone carried their babies at 40 weeks. My advice to anyone having a miscarriage is to look for all possible causes.”

Dr. Lindemann shares tips to help reduce anxiety during pregnancy:

“Journaling helps promote self-esteem and is an excellent technique to help you manage your anxiety and depression at home,” Lindemann says. “You may want to keep two journals: an everyday journal with your private thoughts and a second journal for issues you want to bring up with your therapist or OB-GYN.”

For your private journal, Lindemann says, “Think gratitude. Gratitude affirms goodness and helps you know that the source of goodness can be outside of yourself. This helps you build a healthy, holistic view of yourself.”

In your public journal, Lindemann advises, “Your second journal will help you prioritize the concerns you plan to share with your therapist or your obstetrician. Getting answers to the tough questions early on helps establish a feeling of safety with your pregnancy. Keep your list to three or five concerns — this allows your doctor to concentrate on your biggest problems, given their time restraints.”

“Although journaling is very constructive, it doesn’t take the place of a counselor,” Lindemann says. “If you get a referral to a counselor from your physician, don’t be shy about seeking help.”

“Yoga and mindfulness meditation have both been shown to reduce anxiety in pregnant women. Walking has been shown to reduce anxiety, with the CDC recommending at least 150 minutes of exercise a week, such as brisk walking, for healthy pregnant or postpartum women,” Lindemann says. “This can be broken down into about 30 minutes a day for five days. Even the 30 minutes can be broken down into smaller segments.”

“Enlist the help of your partner with creating and maintaining a calm pregnancy environment,” Lindemann says. “Consider decluttering, adding a few plants, and maybe introducing aromatherapy to your home.”

“Taking anxiety medications during pregnancy does carry some risks to your baby, depending upon the medication, including cleft lip and ‘floppy baby syndrome’ — i.e., hypothermia, lethargy, poor respiratory effort, and feeding problems,” Lindemann says. “Your infant may also suffer from withdrawal from certain medications. Be sure to consult with your prescribing physician and understand all the risks before making your decision.”