Supporting Mental Health During Pregnancy
Strategies for Managing Stress and Anxiety

Women usually experience a mixture of intense happiness, pride and relief after bringing a baby into the world. However, the process of giving birth can also be very distressing if everything does not go according to plan. Additionally, hormonal changes and the risk of medical issues can add to the stress of having a baby.

As such, a pregnant woman may experience mental health concerns, and it's important to address these concerns for the well-being of both mother and baby.

Why is mental health important during pregnancy?
Mental health encompasses any psychological condition or emotional disorder which disrupts a person’s normal thoughts, emotions or behaviour.

Since pregnancy is a major life event for reproductive-age women supplemented by hormonal changes, it represents an increased risk for mental health challenges like depression, anxiety and self-harm.

This is because the process of childbearing is usually accompanied by unpredictable feelings of anxiety and exhaustion. As such, pregnant women may be prone to poor mental health due to uncertainties like if:

• the baby will arrive late or early (premature) and may need to stay in neonatal intensive care.

• there may be complications during pregnancy.

• they do not feel supported or acknowledged.

• there may be problems with their baby’s health.

Unfortunately, poor mental health in pregnant women is associated with poor foetal growth and premature delivery. And in some instances, infants may be more vulnerable to later infections, and more frequently admitted to the hospital.

For instance, some research studies found that some babies are more likely to have low birth weight if the mother experienced depression during pregnancy. So, untreated mental illness may affect a baby's natural development.

As such, providing good social and emotional support for pregnant mothers to improve mental health may reduce risks and prevent pregnancy complications, and in turn, prevent adverse obstetric and fetal birth outcomes.

Risk factors of poor mental health during pregnancy
Pregnant women are highly prone to developing mental health problems due to different factors like financial hurdles, relationship issues and social factors.

The most common mental health problems pregnant women may experience are depression and antenatal anxiety. The latter is characterised by excessive worrying and fear about the childbirth process, the infant’s health, and future parenting roles. 

Depression is particularly characterised by:

• Symptoms of depressed mood

• Loss of appetite

• Feelings of worthlessness

• Low self-esteem

• Loss of interest

• Irritable mood

• Feelings of fatigue

• Poor concentration

So, if not effectively managed, depression and antenatal anxiety may lead to pregnancy complications and postnatal mental health problems. Here are some risk factors that could trigger poor mental health episodes:

Violence and abuse
Domestic violence during pregnancy may lead to increased depression and anxiety, especially as the pregnancy progresses. As a result, the expectant mother who may have experienced domestic violence may have difficulty bonding with the baby, or feel anxious about how to create a safe environment for the child.

Rape
Rape may affect a pregnant woman’s mental health. As such, women who conceive due to sexual violence are more likely to experience conditions such as depression and anxiety. Furthermore, women with poor mental health are sometimes more vulnerable to this type of abuse from their partners due to a lack of interest in sex.

Adolescent pregnancy
According to research, adolescent mothers are twice as likely to experience depression and anxiety in contrast to pregnant adults. This may, unfortunately, lead to miscarriage, preterm birth, or giving birth to an underweight baby.

HIV/AIDS
HIV-positive mothers may experience more mental health challenges than women who are HIV-negative. This may be exacerbated when a pregnant woman learns of their HIV status for the first time during the pregnancy.

Additionally, the process of adjusting to this sudden news and disclosing it to family and friends could result in guilt, shame, stigma and rejection by partners or family. The lack of community support or an unstable family situation may also aggravate mental health problems during pregnancy.

Substance use
Pregnant women with a history of substance use may experience frequent episodes of anxiety and depression due to body withdrawal symptoms.

Death and financial issues
Stressful events such as the death of a loved one or financial setbacks are common triggers for mental health issues in pregnant women.

Other common stressors include:

• Being overburdened with responsibilities at home (e.g., caring for kids).

• Feeling overwhelmed by life events (e.g., having an ongoing illness prior to pregnancy).

Taking care of mental health during pregnancy
Stress and anxiety can be more challenging to cope with when you're pregnant because your body is under constant stress from the demands of childbirth (which will happen at some point).

In fact, one’s body is working hard to grow a baby, so there are many things happening at once. Thus, it can be more challenging to cope with stress during this time than at any other period in your life.

In addition to general physical health, a woman’s social situation (lack of family support, or financial difficulties) and her medical history may play a part in determining whether or not she experiences stress or anxiety during pregnancy.

Fortunately, there are some things one can do both physically and mentally to help better cope with anxious feelings during pregnancy.

How to control stress and anxiety during pregnancy?
Here are some effective strategies for managing stress and anxiety during pregnancy for expectant mothers.

Self-care practices
Self-care is essential when you’re pregnant. By taking care of yourself, you’re taking care of the baby in your womb. Thus,

• Take time to relax.

• Get enough sleep.

• Eat healthy food, avoiding junk food and sugary drinks as much as possible, especially during the first trimester.

• Get regular exercise (walking or jogging outdoors is ideal).

• Occasionally take deep breaths to get extra oxygen into your body.

Join a support group for pregnant woman
Consider joining a pregnancy support group. Pregnancy support groups are safe spaces - people aren’t intruding on your privacy but still understand what it's like for you emotionally at this stage in your life.

Generally, joining a support group can provide dedicated help and guidance for pregnant women.

Talking about it
Talk to someone you trust about your pregnancy concerns or worries. You may find it helpful to talk to your partner about the transition, so that he or she understands why you may not be feeling like yourself right now.

If possible, try to figure out ways for both of you to discuss these worries without making either person feel judged or criticised by the other person's response (or lack thereof).

Your family members should also be on board with working through any issues that arise during pregnancy, because they can help you feel more confident in yourself and in the relationship.

Stress and anxiety management techniques
Managing stress and anxiety may help increase the likelihood of a full-term pregnancy and reduce the risk of health complications for both mother and baby.

Different strategies for coping with stress during pregnancy may include mindfulness-based practices like deep breathing, and getting sufficient sleep and exercise.

Getting enough sleep
Practising healthy sleep habits may help minimise stress levels during the day. The average pregnant woman should aim for at least 7 to 9 hours of sleep per night. They should also avoid caffeine close to bedtime and foods that can cause indigestion, like fatty or fried meals, citrus fruits, and carbonated beverages.

Journaling the pregnancy
Since pregnancy comes with unexplainable emotions, journaling may come in handy to help you express and process those emotions and feelings.

Social support
Getting social support may improve individuals' positive interactions to reduce depression, stress, and anxiety. And thus, reducing the risk of adverse pregnancy and birth outcomes.

Social support (emotional, instrumental, affectionate, and/or tangible social support) may also provide an additional suitable coping mechanism for pregnant women to handle stressful events.

Does insurance cover mental health during pregnancy?
Many pregnant women experience stress, depression and anxiety and may need to seek help from a mental health professional as soon as possible.

Depression is often treated using medication combined with therapy sessions (or both). While this approach works well for some women who experience mild symptoms of depression, others need more intense treatment before they fully recover.

Fortunately, insurance coverage for mental health is available with companies like Prudential to help pregnant mothers get adequate therapy.  Additionally, pregnancy insurance can help expectant mothers ease their worries about finances if anything unforeseen were to happen.

Conclusion
Pregnancy is a time of joy and excitement but it can also be challenging. The stresses of everyday life can make it harder for you to cope with feeling stressed or anxious during pregnancy. While many strategies can help manage stress during pregnancy, it's important to get professional help if you have an ongoing mental illness such as depression or anxiety disorder.

Depression can be a serious mental illness, and one that affects millions of people worldwide. However, it's important to know that depression is treatable, and it's not just something you have to live with during pregnancy or afterwards.

In fact, there are many ways you can help yourself manage your stress and anxiety while pregnant or after birth without medication or therapy—and we hope the aforementioned strategies may help you prevent maternal and postpartum depression.

Related reading:
Mental Health in Malaysia: Overcoming Stigma & Improving Care 

Prudential also offers a comprehensive critical illness plan, PRUAllCare, which includes mental health insurance & benefits.