Why is no one talking about antenatal anxiety?

Editor’s note: In October 2018 Yahoo Canada published a series on anxiety, which is currently the leading mental health issue in Canada. We’re re-running several stories for Bell Let’s Talk Day to help raise awareness and funds for mental health initiatives across Canada.

When it comes to the topic of mental health and pregnancy, the conversation is largely focused on the postpartum experience, particularly postpartum depression. While raising awareness about postpartum depression has undoubtedly helped destigmatize mental health, we have failed women by not discussing another serious and debilitating disorder: antenatal anxiety, or anxiety during pregnancy.

Although women are twice as likely to suffer from anxiety disorders, not much research or attention has been given to anxiety during pregnancy (antenatal and perinatal anxiety). While women with a history of anxiety and depression are at an increased risk of developing antenatal anxiety, many women develop diagnosable anxiety for the first time during and following pregnancy.

According to a 2017 study, more than 20 per cent of women self-report feelings of anxiety such as panic attacks, restlessness, irritability and obsessive thoughts while pregnant. While it’s completely normal to experience feelings of anxiety prior to giving birth (it is a major life change after all) antenatal anxiety is widely regarded as underdiagnosed, and under-represented in research. Many women who report symptoms of anxiety are dismissed, with their feelings as either the product of nerves or hormones.

When my sister Carrera Danks became pregnant with her first child in 2011, our family was overjoyed. She had conceived on her first try — just a month after her picture-perfect wedding complete with a poofy princess-like ball gown, blinged-out centrepieces and a friendly bartender who faithfully obliged my requests for more tequila.

The excitement of a new baby overshadowed any fears we may have had about my sister’s mental health. Like me, Danks had been diagnosed with both anxiety and depression in her early teens and had been taking antidepressants ever since. When she announced that she was going to stop taking medication during her pregnancy, she was nervous, but convinced that it was the safest option for the baby. What followed was nine arduous months of anxiety, exacerbated by her being diagnosed with gestational diabetes, followed by severe postpartum depression.

ALSO SEE: Is anxiety curable? Why that’s the wrong question to ask

From her home in Guelph, Ont., Danks admits that despite her medical history, she was surprised by the severity of anxiety and depression she experienced.

“I’ve always wanted to be a mother for as long as I can remember,” she said. “It was something that we had wanted and planned for. I thought, surely anxiety and depression wouldn’t be a problem because this is the one thing that I’ve always wanted.”

Doctors dismissed her anxiety as jitters. Friends and family (myself included) resounded in a chorus of “Everything is going to be fine!” whenever she voiced her concerns. The warning signs were there – restlessness, panic, obsessive thoughts and worrying, but it wasn’t until after the baby was born that our family took action.

With counselling and a return to medication, Danks slowly improved, but was left with an intense fear of a similar experience should she ever get pregnant again.

According to Dr. Simone Vigod, a psychiatrist and clinical researcher in pregnancy and postpartum mental health at the Women’s College Hospital in Toronto, many expectant and new mothers suffer in silence.

“Anxiety can be extremely debilitating,” Vigod tells Yahoo Canada. “One of the most heartbreaking things is when a woman who’s nine or ten months postpartum comes to see me and it’s obvious that she’s been struggling for months, but never thought it was OK to seek care.”

Vigod helps run the Reproductive Life Stages program, dedicated to supporting women with mood and anxiety issues related to the menstrual cycle, pregnancy and postpartum period and problems that develop during menopause.

“There are some women’s brains who are sensitive to the hormonal fluctuations that occur during these times,” she explained. “Part of what’s happened is that ‘postpartum depression’ has become a really important code word in the public. Postpartum depression and anxiety have different symptoms but can be conceptualized along the same spectrum of issues.”

While some women present with clear anxiety disorders such as Generalized Anxiety Disorder (GAD) Vigod says there’s evidence to suggest that the vast majority of postpartum depressions are very “anxious depressions.” Along with the symptoms of depression, many women are feeling agitated, rather than slowed down, and consumed with worry that something will be wrong with the baby or will go wrong during labour.

“If an anxious thought occurs and a woman can’t let it go, or it prevents her from doing the things that she would normally do, like interact with people, leave the house, or feel confident to take care of the baby on her own, then there may be a problem.”

Through her work with in reproductive mental health, Vigod helps women at all stages of pregnancy (planning, antenatal and postpartum) transition into parenthood through group therapy and private treatment. Vigod says the goal is to help patients develop mindfulness based skills and relaxation skills to help reduce anxiety symptoms, which can negatively impact the health of the baby. High levels of stress during pregnancy have been linked to preterm birth and low birth weight, which are markers for illness throughout the child’s lifetime.

“Anxiety disorders are very treatable,” Vigod said. “There’s strong evidence that shows that psychological treatments like Cognitive Behavioural Therapy (CBT) does help.”

While proactive treatment and talk therapy is undoubtedly helpful, for some women continuing medication during pregnancy is the safest course of action for both mother and child.

ALSO SEE: Nearly half of all Canadians suffer from anxiety — and many believe there’s no cure

“The vast majority of medications used to treat anxiety are antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs),” Vigod explained. “These are relatively low risk medications, but you can never say that they’re completely risk free.”

For my sister, the decision to have another child after experiencing antenatal and postpartum anxiety and depression required careful consideration and a revised game-plan. For her second pregnancy in 2017, she continued taking antidepressants and enlisted the help of midwives for additional support.

“I was more inclined this time around to say, ‘Something’s not right and I need help,’” Danks said. “I had a better understanding of my feelings, and I didn’t want my daughter to see me in a state that would worry her as well. I wanted her to know that some days may be harder than others, but that we can all get through it. It’s nobody’s fault.”

Like Danks, many women are motivated by their children to seek treatment for anxiety. Dr. Vigod notes that many of her patients who are suffering postpartum are eager to improve the trajectory of their family, which starts with putting their mental health first.

“I have a lot of respect for the people I see who are doing such an incredible job as mothers, but suffering so much inside,” Vigod said. “This is a time in life when we have a huge opportunity to intervene not only with one person, but with a family as well. We can make improvements for multiple people across generations.”

The Reproductive Life Stages program is structured to help restore a sense of community and support for women who are otherwise shamed into silence by the stigma surrounding their feelings and the overwhelming desire to be the “perfect” mother.

“We do a lot of group work,” Vigod explained. “Sometimes women are hesitant to go into groups because they feel ashamed or they feel like nobody else will understand. It’s extremely powerful to be in a group with other women and hear. ‘Yes, I felt that too – and we’ll get through this together.’”

Although we know that anxiety is the most common form of mental illness, and that women are at an increased risk for experiencing anxiety disorders, the research surrounding antenatal and perinatal anxiety is still in its infancy. By elevating anxiety during pregnancy to the same level of public consciousness as postpartum depression, we can hopefully encourage more women to seek medical intervention when the problem arises, and rid ourselves of the myth that treatment is only safe and necessary after giving birth.

Phone calls with my sister, including the one for our interview, involve several interruptions from my nieces. Their curious little voices derail our conversations as my sister tries to corral her daughters between activities and wrestle with a teething toddler.

Still, despite the chaos, I can hear that my sister is in a good place emotionally, and that she’s raising happy kids.

“These days I see my family and I know that I can do it because I wouldn’t want to not do it. I love my children more than anything in the entire world,” she said. “But some days all I can do is love them, feed them, clean them, cuddle them and that’s OK. It’s just about making sure all of our needs are met physically and an emotionally — that’s a win most days.”

During the month of October, Yahoo Canada is delving into anxiety and why it’s so prevalent among Canadians. Read more content from our multi-part series here.

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Abacus Data, a market research firm based in Ottawa, conducted a survey for Yahoo Canada to test public attitudes towards anxiety as a medical condition, including social stigmas and cultural impacts. The study was an online survey of 1,500 Canadians residents, age 18 and over, who responded between Aug. 21 to Sept. 2, 2019. A random sample of panelists were invited to complete the survey from a set of partner panels based on the Lucid exchange platform. The margin of error for a comparable probability-based random sample of the same size is +/- 2.53%, 19 times out of 20. The data was weighted according to census data to ensure the sample matched Canada’s population according to age, gender, educational attainment, and region.