Why am I so anxious in pregnancy after a traumatic birth or loss?
Pregnancy after a traumatic birth or loss can bring a lot of anxiety. This can happen after a difficult birth, miscarriage, termination for medical reasons, stillbirth or the death of a baby after birth.
Sometimes the current pregnancy is going very smoothly. The scans are reassuring and there is no particular indication that the previous experience will be repeated, but you still feel frightened. At other times, you might be told that you need some medication, additional scans or monitoring. Although the medical situation may be very different from last time, your mind goes straight to: Here we go again.
In my work with women after birth trauma and pregnancy loss, I often hear: I know this is a different pregnancy. Why am I still panicking?
There are a few different reasons why this can happen.
Your brain is using the experience it already has
Anxiety and hypervigilance are common responses to trauma. Your brain learns from what has happened before and uses that information to predict what might happen next.
The difficulty with pregnancy and birth is that the number of experiences we have is usually very limited. The personal “data set” is small. If the main experience your brain has to draw on involved danger, helplessness, trauma or loss, it is likely to return to that experience when trying to predict the outcome of this pregnancy.
It can begin to feel as though the fact that something terrible happened before makes it likely to happen again. The mind is particularly alert to anything that seems similar: the same stage of pregnancy, a scan, a bodily sensation, a hospital appointment or a familiar medical phrase.
Even a small change can bring back memories. You might be told that your baby needs another growth scan, that you need to take medication or that something should be monitored more closely. The actual reason may have very little in common with the previous experience, but emotionally it can feel like the beginning of the same story.
Asking maternity questions and tolerating uncertainty
If you are worried about something medical, it is fine to call your midwife or maternity team and ask. That is part of their job. I would much rather somebody asked the question than sat at home panicking, Googling or asking a partner for reassurance about something they are not medically qualified to answer.
Sometimes the worries can feel quite far-fetched when you say them aloud, but they still feel frightening. You might think:
I had a viral infection a week before the loss. Did that cause it?
Is there something wrong with my body that makes this more likely to happen?
Did I exercise too much?
Was it something I ate?
How likely is it that the same complication will happen again?
These can be turned into questions for a midwife, obstetrician or another relevant medical professional. Sometimes information is an important part of feeling safer. It may clarify whether two events were connected, what is known about the chance of recurrence and whether anything different is recommended in this pregnancy.
Pregnancy is a limited period of time. If you need more contact with your midwife, or additional checks that have been agreed with maternity, that may help you through it. You do not need to feel guilty for asking questions or needing reassurance.
At the same time, reassurance may only last until the next thought or sensation arrives. Every pregnancy involves tolerating some uncertainty, and anxiety tends to ask for 100% certainty. It wants somebody to answer the question: Can you guarantee that my baby will be safe?
Nobody can give that guarantee. Part of managing anxiety in pregnancy is gradually learning to sit with the uncertainty that remains. We can talk about this in therapy and use different strategies to make that uncertainty more tolerable, so you are not continually chasing a level of certainty that is unavailable.
Why am I blaming myself?
As a society, we often carry an idea that good things happen to good people and bad things happen to bad people. We know, when we stop and think about it, that this is not how life works. Terrible things happen to innocent children and to people who have done nothing to cause them.
After trauma, however, the mind tries very hard to make sense of what happened. Sometimes people minimise the experience and think: Maybe it was not really that traumatic. Why am I feeling like this? I should be coping better.
At other times, they accept that something terrible happened but conclude that it says something about them: There must be something wrong with me. Maybe I am cursed. Maybe I am being punished. Perhaps it was somehow my fault. If one bad thing happened, it can also feel as though another one may be waiting, so you need to stay extremely careful and vigilant in case you miss it.
Other common thoughts include:
My body failed me.
I should have realised something was wrong.
I should have asked more questions.
I should have advocated for myself more.
I should not have trusted what I was being told.
Hindsight bias is very common here. Looking back, you have information that was not available to you at the time. A symptom, decision or moment that was unclear then can appear obvious afterwards.
Perfectionism and the idea that we can control the outcome
I work with many highly educated, perfectionistic women who have put a great deal of effort into pregnancy and birth. They have read books, completed courses, researched their choices and tried very hard to do everything correctly.
All this preparation can be helpful, but it can also leave us with the impression that if we take the right actions, we can produce the right outcome. If the birth then becomes complicated, it is easy to search for the thing we should have done differently.
A breech baby is one example. Someone may later blame herself for not moving enough, using a birthing ball enough or trying the right position. However, research has not shown that adopting a particular sitting or lying position will turn a breech baby. By 36 or 37 weeks, most babies have moved into a head-first position naturally; others remain breech, which is why medical options and interventions exist.
Many maternity professionals describe their role as monitoring and managing nature. Nature and biology play a very large part in pregnancy and birth, and they are often difficult to predict.
In therapy, we can begin to dissolve some of the myths about control and work with the self-blame. We might use a responsibility pie chart to look more realistically at everything that contributed to what happened. Sometimes we liaise with maternity to ask questions about the previous birth or loss and understand it more fully. Sometimes the work involves unpacking the negative conclusions and looking at the evidence available to you at the time.
We may eventually arrive at a difficult truth: sometimes very unfortunate things happen. What happened was not a judgement on your character, your worth or how much you deserved your baby. In some cases, as self-blame reduces, anger about the care you received becomes clearer. Giving feedback or making a complaint can feel important. Some people also find meaning in supporting organisations campaigning for better maternity care.
What if I have experienced other trauma before?
A traumatic birth or pregnancy loss can be even more difficult when it connects with earlier experiences. You may already carry beliefs such as the world is unfair, I am not good enough, people are cruel, I cannot trust other people or nobody helps me when I need them.
What happened during maternity care can then feel like more evidence for those beliefs, particularly if you felt ignored, dismissed, powerless or badly treated.
It can be useful to talk about those earlier experiences and, at times, to process them in therapy too. The work can improve more than the anxiety around this pregnancy. It may change how you feel about yourself, other people and the world going forward.
Worry can feel protective
Worry often has a purpose. You might feel that worrying keeps you vigilant, prepares you for the worst or stops you from being caught off guard. Some people also hope that worrying will somehow buffer them from the pain if something goes wrong.
Unfortunately, worrying cannot make future pain hurt less. It creates a great deal of anxiety in the here and now and can take you away from the life you are living during this pregnancy.
In therapy, we can look at what the worry is trying to achieve and whether it is actually helping. We might work on catastrophising, predicting the future, mind reading, or separating facts from anxious opinions. There are also different ways of managing worry, including letting go of it, postponing it and deciding whether there is a practical action or question underneath it.
Mindfulness and attention training can help you notice when your attention has become completely absorbed by danger and bring it back to the present. Self-compassion can also be important, particularly when your usual response is to criticise yourself for being anxious or for not coping “better”. Compassion can feel unfamiliar and uncomfortable at first, so this may be something we build gradually.
Working with avoidance
Some people avoid preparing for the baby because it feels too frightening. You might avoid buying things, reading information, discussing the birth or imagining bringing the baby home. After a loss, preparing for another baby can feel like tempting fate. It can also bring up grief and memories of the baby who died.
We can use gradual exposure or behavioural experiments to help you approach these things at a manageable pace. The aim is for anxiety to have less control over what you are able to do. Excitement may or may not come.
Liaising with maternity to support trauma-informed care
Therapy can also help you think about how this pregnancy and birth could be different. We can identify what happened before, what is likely to trigger you and what would help you feel safer and more involved in your care.
This might include:
how you would like procedures and changes to be explained
being asked for consent before examinations or touch
words, situations or medical procedures that are particularly difficult
what happens when you panic, freeze or struggle to speak
how a partner or another trusted person can support you
how you would like to be included in decisions
your preferences, as well as what you would want if circumstances changed
We can work on assertiveness and how to advocate for yourself. With your consent, I can also liaise with maternity to explain the trauma response and advocate for trauma-informed care. This can help the professionals involved understand your needs and support you to remain part of decisions about your care.
Processing the traumatic birth or loss
Sometimes it is helpful to process the previous experience during pregnancy. Trauma-focused CBT and EMDR can both be used for trauma connected with birth and pregnancy loss.
Trauma-focused CBT may involve going through what actually happened. This could include talking through the experience, writing a birth or pregnancy narrative, or recording it and listening back. We can unpack the difficult meanings attached to it, particularly thoughts involving self-blame, failure, guilt, responsibility or trust.
There may be unanswered medical questions. Perhaps you do not fully understand why something happened or why a particular decision was made. I can help you identify those questions and, with your consent, liaise with maternity services to try to get the missing information.
EMDR also involves identifying the memories and current symptoms we need to work on, developing grounding strategies where these are helpful, and then processing the memories using bilateral stimulation, such as guided eye movements.
People often find that the memory becomes less immediate and less preoccupying. They may develop new interpretations or insights. For example, somebody who felt that she failed may begin to feel less responsible or recognise the strength it took to survive what happened. Sometimes people begin to feel proud of themselves in a way that had not been possible before.
If the recent experience has reinforced earlier trauma, some of those memories and beliefs may also become part of the work. The overall aim is to improve your life going forward. That can include far more than enduring the next appointment or getting through the birth.
NICE guidance supports trauma-focused CBT or EMDR when post-traumatic stress disorder develops following a traumatic birth, miscarriage, stillbirth or neonatal death.
Getting support
There is a lot that can be done to help with anxiety after a traumatic birth or pregnancy loss. You can speak to your midwife or GP if anxiety is becoming difficult to manage. Continue to contact maternity services about any new medical concerns or changes in your baby’s movements.
I offer specialist CBT and EMDR for traumatic birth, pregnancy loss and anxiety during a subsequent pregnancy. Appointments are available face to face in Chapel Allerton, Leeds, and online across the UK. I currently have some availability for therapy. Please contact me if you would like to discuss whether I may be able to help.
Further information and evidence
You can read more about my approach to birth trauma therapy in Leeds and online, including the use of trauma-focused CBT and EMDR.
If fear of the birth itself has become overwhelming, you can also read more about therapy for fear of childbirth and tokophobia.
This article provides general information and is not a substitute for individual medical or psychological assessment.
Anna Selassie is a BABCP-accredited Cognitive Behavioural Psychotherapist and EMDR therapist specialising in perinatal mental health, birth trauma and pregnancy loss. She offers face-to-face therapy in Chapel Allerton, Leeds, and online across the UK.
