- Anxiety is an expected and understandable part of chronic illness pregnancies.
- Anxiety in chronic illness pregnancies is treatable when it is better understood.
- Treating anxiety in chronic illness pregnancies is an important piece of prenatal care.
Living with chronic illness affects every aspect of life, including reproduction. Chronic illness complicates pregnancy, labor, delivery, and the postpartum period. The specter of these complications may cause chronically ill pregnant people to experience heightened anxiety. As part of appropriate prenatal care, this anxiety needs to be acknowledged and treated.
Increased risks create increased anxiety.
Many chronic illnesses reduce fertility and increase the risk of complications during pregnancy and birth (Ghorayeb et al., 2018). Complications can include exacerbation of disease symptoms for the mother and health risks for the developing fetus (Tyer-Viola & Lopez, 2014). Because of these dangers, many pregnancies in chronically ill people are considered “high-risk” and are followed with a higher level of medical supervision and care (Ralston et al., 2021).
In making reproductive decisions, then, people with chronic illnesses are faced with difficult questions from the outset Will I be able to get pregnant? Will pregnancy worsen my symptoms and/or the course of my disease? Will my compromised body be able to nurture a healthy fetus? Understandably, a heightened level of maternal anxiety exists in these pregnancies (Ralston et al., 2021).
Anxiety contains a multitude of feelings.
Anxiety is often experienced as a crippling and overwhelming effect. It’s beneficial to approach anxiety with non-judgmental curiosity. One might ask: What difficult thoughts and feelings is the anxiety expressing? Maternal anxiety in chronic illness pregnancies often contains several underlying feelings, including fear, guilt, anger, and sadness.
Fear: From the moment a chronically ill person even thinks of becoming pregnant, they are concerned about how their illness will interact with their pregnancy. Will pregnancy worsen chronic illness symptoms? Will chronic illness affect pregnancy? Pregnancy is experienced by chronically ill people less as a joyful time of anticipation and more as a “constant underlying worry about what [could] happen to them and their infants” (Tyer-Viola & Lopez, 2014, p. 31).
Guilt: Chronically ill people often wonder if they are being “selfish” by undergoing a high-risk pregnancy (Ralston et al., 2021). Will their body be able to sustain a growing fetus? Will they pass on their illness to their baby? Further, does the difficulty of pregnancy foreshadow the negative effect that chronic illness will have on their ability to parent a child? That is, will their child be short-changed by having a parent who lives with illness (Ghorayeb et al., 2018)?
Anger: Part of living with chronic illness is grappling with the thwarted wish to feel normal. For many chronically ill people, this wish to “be like everyone else" is particularly strong during pregnancy (Tyer-Viola & Lopez, 2014). Feelings of isolation and envy of people with “normal” pregnancies are common.
Sadness: Chronic illness creates multiple losses, including the loss of being able to count on one’s body as reliable. The loss of a “normal pregnancy” evokes memories of other losses caused by illness and also fuels anticipatory grief over illness-related losses that likely will occur in the future. The difficulty of a high-risk pregnancy may feel like a precursor to challenges in caring for one’s infant. Breastfeeding, for example, may be compromised by the mother’s chronic illness symptoms and/or treatment.
Coping with anxiety in a chronic illness pregnancy:
An important part of coping with illness-related pregnancy anxiety is accepting it as understandable. One's body, already taxed by chronic illness, is going to be further challenged by pregnancy. Most people living with chronic illnesses are used to a certain level of health-related anxiety. This baseline level is going to increase with pregnancy.
The pain of anxiety increases when one tries to run from or fight the feeling. Instead of moving away from the feeling, try moving toward it. To say, “I am anxious, and it makes sense that I am anxious,” is a necessary move toward tending to oneself with self-compassion.
Making room for anxiety will allow you to sort out risks and manage them. You will want to have conversations with your medical providers in which risks are addressed and strategies for managing them are outlined. Give yourself the time and space to ask all of the “what if” questions churning in your mind. Make sure you understand and are satisfied with your providers’ explanations.
Making room for anxiety will also propel you to care for yourself as you tend to it. You’ll want to take care of your mind and body, not only to support a healthy baby but also to support a healthy you. Are you getting enough rest and nutrition to support your healthy mind? Are you reducing stressors that are in your control in order to create a greater sense of calm? Are you engaging in activities that reduce anxiety, such as mindfulness and gentle exercise? Are you cultivating relationships that are supportive and authentic? Do you have a space where you can talk about and process the anxiety associated with being pregnant and chronically ill? Of course, partnering with a mental health professional is always recommended in treating anxiety during pregnancy.
Pregnancy is different for those of us living with chronic illnesses. Honoring these differences with compassionate attention goes a long way toward improving both the process and the outcomes of our pregnancies.
Ghorayeb, J., Branney, P., Selinger, C.P., & Madill, A. (2018). When your pregnancy echoes your illness: transition to motherhood with inflammatory bowel disease. Qualitative Health Research, 28(8), 1283-1294.
Ralston, E., Smith, P., Chilcot, J., Silverio, S.A., & Bramham, K. (2021). Perceptions of risk in pregnancy with chronic disease: a systematic review and thematic synthesis. PLoS One, 16(7), 1-15.
Tyer-Viola, L.A. & Lopez, R.P. (2014). Pregnancy with chronic illness. JOGNN, 43, 25-37.