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Treating Postpartum Depression
Postpartum Depression: Diagnosis and Treatment

Section 9
Untreated Anxiety in Pregnant Women

CEU Question 9 | CEU Test | Table of Contents | Depression
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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In the last section, we discussed panic and depression.  This included panic disorder; panic attacks and pregnancy; and panic vs. depression, which comes first?

In this section, we will continue our discussion of anxiety.  This will include untreated anxiety, when a child is truly at risk, and ghosts in the nursery.

Awareness of the frequency with which anxiety disorders can accompany pregnancy may enable the diagnosis to be made sooner, thereby reducing the woman’s emotional distress and preventing further complications for both mother and child not only during pregnancy but also after birth. 

♦ Untreated Anxiety
First, let’s discuss untreated anxiety.  Postnatal anxiety is a frequent occurrence, it often overlaps with symptoms of depression, and it also increases the likelihood of postpartum depression.  Failure to diagnose or treat the anxiety, therefore, poses a significant risk to both the mother and her baby.

Tessa’s story illustrates just how serious that dual risk can be.  Tessa had a history of panic attacks and had been taking antidepressant medication to control her illness.  When she became pregnant, however, she immediately stopped taking her medication because she wrongly believed, as so many do, that her pregnancy would protect her from the anxiety. 

For the first two or three weeks she did feel better.  But at about nine weeks she began to feel that her baby was somehow deformed, and the panic attacks returned.  Still, Tessa refused to go back on her medication.  Tessa was going to yoga classes, taking long walks, and using relaxation techniques, and although her symptoms continued throughout her pregnancy, she was able to control them well enough to make her life reasonably livable.

When Tessa’s son was born, however, things went from bad to worse.  Tessa had a difficult time breast-feeding and was self-conscious because friends kept questioning her about her inability to nurse.  Every time she looked at her baby she began to feel anxious, to the point where she could barely bring herself to touch the infant or to establish any kind of positive feeling toward him.  Because she felt that the baby himself had triggered her panic attacks in utero, and because she’d visualized him as being deformed, once the child was actually born she couldn’t shake the anxiety toward him that had become so firmly entrenched. 

In the end, I used cognitive behavior therapy with her in order for her to be able to love her son without being panicked by him.  To do this I ask her to focus on various parts of the baby’s body, for example the forehead or arm or toe and notice how perfectly the part was formed.  This focused attention on the reality of her baby’s lack of deformity coupled with statements using positive terms like beautiful, soft, glowing, etc. decreased her panic.

Even before her baby was born, however, Tessa may well have been putting him as well as herself at risk by allowing her anxiety to go untreated.  Many studies have shown that increased anxiety during pregnancy is often associated with conditions including pre-eclampsia, preterm labor, and even miscarriage, as well as changes in fetal blood circulation and behavior.

♦ When a Child is truly at Risk
Second, let’s discuss when a child is truly at risk.  Sometimes a baby’s health is truly compromised and that, too, can trigger panic in the mother.  If a baby has a serious medical condition, it would seem only normal for the mother to be anxious.  At times, however, anxiety can cross the bounds of normalcy into a clinical psychiatric condition, and because of all the sophisticated prenatal testing, any chromosomal abnormality in the baby is diagnosed during pregnancy.

Serena, age 18, was referred to me by her pediatrician because of the uncontrollable panic attacks she’d been experiencing ever since her child was diagnosed with a severe lung disorder in the third trimester of her pregnancy.  After Serena gave birth, as her child underwent a series of medical workups, her panic increased and she became more and more certain he would die.  Serena began to experience severe night sweats and chest pains, and she slept in the baby’s room night after night, convinced that he wouldn’t survive.

In another, similar case a mother was told at twenty-one weeks of gestation that her baby had a serious kidney disease, and even though she had no previous history of anxiety, she began to experience breathlessness and the sensation that she was actually choking.

♦ Ghosts in the Nursery
Third, in addition to untreated anxiety and anxiety when a child is truly at risk, let’s discuss ghosts in the nursery.  When a baby’s life is in danger, the mother’s fear, whether or not it is accompanied by clinical anxiety, is very much in the present, but experiences in the past, or even long forgotten, can also lead to panic during pregnancy.  "Ghosts in the nursery" refers to adverse childhood experiences by the mother that have not been explored or resolved and which may therefore trigger severe anxiety with relation to impending motherhood.

While ghosts in the nursery may be a unique variation on panic disorder, other symptoms, like Tessa’s, are not unlike the intrusive thoughts that plague women with another form of anxiety disorder, obsessive-compulsive disorder to be discussed in the next section.

In summary, in this section we have discussed anxiety.  This has included untreated anxiety, when a child is truly at risk, and ghosts in the nursery.

Peer-Reviewed Journal Article References:
Brandão, T., Brites, R., Pires, M., Hipólito, J., & Nunes, O. (2019). Anxiety, depression, dyadic adjustment, and attachment to the fetus in pregnancy: Actor–partner interdependence mediation analysis. Journal of Family Psychology, 33(3), 294–303.

Dellagiulia, A., Lionetti, F., Pastore, M., Linnea, K., Hasse, K., & Huizink, A. C. (2019). The Pregnancy Anxiety Questionnaire Revised-2: A contribution to its validation. European Journal of Psychological Assessment. Advance online publication.

Incollingo Rodriguez, A. C., Tomiyama, A. J., Guardino, C. M., & Dunkel Schetter, C. (2019). Association of weight discrimination during pregnancy and postpartum with maternal postpartum health. Health Psychology, 38(3), 226–237.

Whisman, M. A., Davila, J., & Goodman, S. H. (2011). Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period. Journal of Family Psychology, 25(3), 375–383.

Online Continuing Education QUESTION 9
Why does failure to treat a mother’s anxiety pose a significant risk to the mother and the baby? To select and enter your answer go to CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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