Thanks to movie and TV representations of childbirth, most people are familiar with the more "traditional" signs of labor — water breaking, back pain, contractions. But is increased anxiety a sign of labor? The answer, it turns out, is complicated.
"It's not in the textbooks," Dr. Karen Duncan, an OB-GYN and assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health, tells Romper via phone. Duncan does think there may be more to this than what we currently recognize, though, and says that many of the mental symptoms of labor are overlooked or ignored.
"[Anxiety is] not a classic sign of labor, but I think it's likely that when women are getting into really early labor they do have some anxiety and heightened awareness," she says. "And it's probably the subconscious recognition of something going on in your body, maybe before you even mentally realize you're having cramps or you're having some back pain. It could be one of the earliest signs of something going on."
Of course, having a sense of worry during pregnancy, particularly as labor approaches, is common. "Many people about to deliver a baby are anxious about labor and new parenthood, and many feel anxious as they approach delivery," Amanda Tinkelman, a Brooklyn-based psychiatrist and certified perinatal mental health specialist, tells Romper. Most parents could probably talk about a time during their pregnancy where they became more anxious than usual — some don't feel ready, or feel ready but fear for the worst from a medical point of view. Tinkelman says this kind of increased anxiety is typical.
"There's a lot of unknowns," Duncan confirms. "Labor itself is a complete lack of control... Not knowing when you're going into labor alone... is extremely anxiety provoking for some women."
Most pregnant people's anxiety will not reach the level of an anxiety disorder, in which troubled or worried thoughts affect one's quality of life by becoming persistent, inconsolable, and/or irrational. But both Duncan and Tinkelman agree that anxiety disorders in pregnancy have historically been under-reported.
The more we talk about it, the more we de-stigmatize it.
"In the past, people would be more aware of postpartum depression as a potential complication of pregnancy," Tinkelman explains. "Now, we are beginning to appreciate that many people develop symptoms during pregnancy, not just postpartum, and many develop anxiety symptoms, and not just depressive symptoms. For this reason, the currently preferred term to identify these most common complications of childbearing is perinatal mood and anxiety disorders, abbreviated PMADs."
Both Tinkelman and Duncan say that while those with a pre-existing anxiety disorder are at heightened risk of anxiety (and worsened anxiety) during pregnancy, the development of an anxiety disorder during this time is not uncommon and multi-factorial. Changes in sleep patterns, psycho-social stresses about motherhood, adjusting to bodily changes, past trauma(s), and hormones, may all contribute.
"Hormones add to [anxiety]," explains Duncan, which is why she says women with a personal or family history of anxiety disorders should be aware of their risk during pregnancy. She also says those who are suffering from increased or new anxiety should talk to their care provider. "There is help. You don't have to suffer in silence."
Duncan also says that optimizing sleep, gentle exercise, yoga, acupuncture, talk therapy, childbirth classes, support groups for pregnant people, and medication are all treatments that can help. "There's definitely not a one-size-fits-all solution," she continues, "but there are a lot of possible solutions."
There's a lot even experts don't understand about anxiety, particularly during pregnancy and including, yes, whether that increasing sense of dread you're feeling as your due date nears is a sign of labor, or if it's the thought of labor that's fueling your anxiety. But based on what is known, either is possible. And, fortunately, we're learning more every day thanks, in no small part, to the fact that we're talking about it.
"There's been a bit of a stigma attached to... anxiety, but there shouldn't be," says Duncan. "The more we talk about it, the more we de-stigmatize it."
If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.