Two-Minute Shrink

Practical psychiatry articles for people seeking strategies, solutions, and healing now—not years from now.

Treating Anxiety in Pregnancy Without Psychotropic Drugs

Restructuring thought patterns, one aspect of CBT, can be highly effective.

Part I of this two-part series on treating anxiety in pregnancy deals with one component of cognitive-behavioral therapy approach: restructuring thought patterns. Part II deals with using relaxation/hypnosis coupled with guided imagery.

For a woman who wants to have children, the news that she's pregnant is usually exhilarating—at first. But that initial moment of happy anticipation is sometimes soon replaced by feelings of anxiety. A question I often hear is: "What will I do about maternity leave?"

Currently in the US, the Family Medical Leave Act allows certain employees to take up to 12 unpaid weeks of leave to care for newborns or family members. While this might be great for some women (and men), taking time off without pay is not an option for many.

In fact, a recent study by the Pew Research Center showed that a record 40% of all US households with children under 18 have mothers who are either the only source of income for the family or the primary source. In other words, a large percentage of households depend on the mother's income.

Bottom line, pregnancy makes many women feel they have to choose between their baby and their job.

Maternal Anxiety and Fetus Health

The angst caused by these income pressures brings unnecessary stress to our pregnant patients, which in turn can lead to adverse effects for the fetus as well as the mother. One review of 13 studies published from 1966 to 2006 found that in 8 of the studies, anxiety during pregnancy was tied to prematurity and low birth weight.

An Alternative to Psychotropic Medications

The potential risk of psychotropic medications to both the mother and the fetus remains controversial. Recent studies showing adverse health effects on the newborn suggest there's wisdom in providing a nonmedical alternative, if it's effective. I have stayed away from prescribing medications for pregnant patients suffering from anxiety, and have had positive results with a nonmedical alternative. My approach has been to treat these disorders using cognitive-behavioral therapy (CBT) and relaxation/hypnosis, coupled with guided imagery.

Helping the Patient Change Thought Patterns

Pregnant women with anxiety tend to ruminate about the future and "what will be" on a number of issues. These concerns become more excessive and intense in their minds when the baby is born into an economically challenging financial situation to a mother with limited or no maternity leave. Using the CBT approach for such patients offers a new and lasting perspective on thoughts driving the anxiety, allowing for negative thoughts to be challenged, changed, and channeled into more here-and-now thinking, with an emphasis on focusing the patient on taking the best care of herself today.

Anxiety and future worries can play tricks on the patient's thinking. The key is to get the patient to live "where her feet are" and avoid the frightening thoughts of "what ifs" tied to the future. This allows the patient to shift away from negative "all or nothing" or "this or that" thinking.

The clinician allows the person to stay more in the moment with a new and broader perspective on the issues facing her and to think about the beauty of childbirth. This shift in thinking that occurs with CBT, which reduces anxiety, will allow the patient to tap into clearer thinking and into her strength, to develop a better idea about the future, including how much time she will be able to free up for child care. Reducing worry makes her better able to determine what types of plans, including financial planning, can be developed after childbirth.

Maternal Leave Is a Mental Health Issue

We regularly speak of the importance of mental health. However, when it comes to the mental health of expectant mothers (and fathers), we have failed to provide what most industrialized countries accept as normal: freedom from financial anxiety during pregnancy, and a financially secure year to heal from giving birth, and to nourish and nurture the newborn child.

A recent report by the Institute for Women's Policy Research says that the United States is the only high-income country that does not mandate paid maternity leave for employees. The Family and Medical Leave Act 2012 survey estimates that about 35% of employees work for companies that provide paid maternity leave, and about 20% work for companies that provide paid paternity leave as well. Of course, lower-paid employees are least likely to work for companies that offer paid leave.

We must encourage mental health advocacy organizations and politicians to put more emphasis on addressing this important issue.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

Robert London, M.D., has been a practicing physician/psychiatrist for more than three decades.

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