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Anxiety in the perinatal period

Anxiety is something we all experience from time to time. It includes both physical sensations and emotional reactions. Anxiety is a response to a situation we might see as a threat to us or a situation we feel we have no control over, for example moving house, being in a difficult relationship or giving birth. In these situations it's understandable to be worried and you may even find it hard to sleep, concentrate or eat for a brief period. These feelings of worry usually stop when the situation has resolved.

What you need to know

What helps?

We know that manageable levels of anxiety can be helpful in certain situations such as in emergencies or when we need to meet a deadline; we all have different tolerance to stress/anxiety. However if your feelings of anxiety are very strong or last a long time you need to access help to learn how to deal with it.

Perinatal anxiety is anxiety experienced during pregnancy or in the year after childbirth. You might hear it called:

  • prenatal or antenatal anxiety if you experience anxiety during pregnancy
  • postnatal anxiety if you experience it after giving birth
  • some women may have severe anxiety around childbirth also known as tokophobia
  • you may experience panic attacks
  • if your anxiety leads you to experience unwelcome thoughts, images, urges or doubts, or there are repetitive activities that you feel you have to do you may have Obsessive Compulsive Disorder.

Many women experience anxiety during the perinatal period. The National Institute for Health and Care Excellence (NICE) suggests that 13% of women experience anxiety during pregnancy, this is higher than figures for depression. Perinatal anxiety is less well known about, but far more prevalent that we had first thought.

Some of the symptoms to look for in perinatal anxiety are listed below:

How you might feel?

  • Anxious
  • Frightened
  • Worried
  • Stressed/on edge
  • Unsettled
  • Detached
  • Strange (not feeling yourself)
  • Feel numb

How you might think:

  • Racing thoughts
  • Unable to concentrate
  • Constant worrying
  • Thinking the worst case scenario
  • Doubting yourself
  • Going over the same worries/thoughts
  • That other people know your are anxious and are watching you

What are some the physical signs you may experience?

  • Headaches
  • Unexplained aches and pains
  • Decrease in appetite
  • Difficulty sleeping
  • Sweating
  • Stomach churning
  • Tight chest

Some of the things you might start doing:

  • InabilityHaving difficulties getting off to sleep or staying asleep
  • Unable to sit and relax
  • Constantly on the go/pacing
  • Find it difficult to finish off one thing
  • Eat less (or more)
  • Being snappy/increased irritability

Need help right now?

Call NHS 111 or contact Samaritans

If you are booked at Winchester or Basingstoke hospitals and are struggling with anxiety / depression during pregnancy, please ask your midwife about referral to the LEAP wellbeing programme.

Want to talk to someone?

We know that talking about how you are feeling can often be very difficult, however there is help out there, you do not have to feel like this. We hear that women often worry that they will be judged or seen to be 'not coping', this is a common misconception. Health professionals are aware of how common anxiety is during the perinatal period, and are able to support you and your family.

  • Pandas (Pre and Postnatal depression advice and support) have a free helpline from 9am to 8pm every day 0808 1961 776

Want to find support on social media and apps?

  • Baby Buddy is an app designed to look after you and your baby’s physical and mental health. You can download it online, or from Google Play or the App Store.
  • Pandas offers online support and information as well as a helpline
  • Want to talk to other women and families who have been through this?
  • To find your local peer supports group click here.  
  • Pandas support and information for people coping with pre and postnatal mental illness, as well as their families, friends and carers.

Want to read more about it?

  • For information from the Royal College of Psychiatry Click here
  • For information from MIND Click here

Content adapted from MIND

Websites

Links list

Apps

Podcasts

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When should you worry?

Newborn

NEWBORN

Contact your health visitor or GP if your baby is newborn and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own 
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
  • Are often startling and you cannot understand why
  • Move one side of their body more than the other, for example:
    • Rarely moves one of their arms compared to the other arm
    • Rarely moves one leg compared to the other leg
    • When your baby startles, one side moves or looks different from the other

6-8 weeks 

6-8 WEEKS

Contact your health visitor or GP if your baby is 6-8 weeks and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs 
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

2-3 months

2-3 MONTHS

Contact your health visitor or GP if your baby is 2-3 months and they…

  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy, or have floppy arms or legs when awake
  • Move their arms and legs in repetitive jerky movements, or writhing movements
  • Have not started to bring both their hands to their face, or do not move their arms much
  • Keep their hands fisted, and you find it difficult to open their hands
  • Can’t lift their head when lying on their tummy
  • Move one side of their body more than the other, for example:
    • Mostly moves one arm or mostly brings one hand to their face
    • Rarely kicks or moves one leg compared to the other leg

3-4 months

3-4 MONTHS

Contact your health visitor or GP if your baby is 3-4 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when awake
  • Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Still need you to support their head, or can’t lift their head when lying on their tummy 
  • Have very tight fists and it’s hard to open their hand
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other

4-6 months

4-6 MONTHS

Contact your health visitor or GP if your baby is 4-6 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky, or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys 
    • Rarely kick one leg compared to the other
  • Are unable to roll, or can roll in one direction but not the other
  • Find it difficult to reach their arms out. For example, they do not reach for toys
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
  • Still need you to support their head

6-9 months

6-9 MONTHS

Contact your health visitor or GP if your baby is 6-9 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms or legs in repetitive, jerky or strange ways
  • Move one side of their body more than the other, for example:
    • Rarely use one of their arms to pick up toys, or eat and drink
    • Rarely kick one leg compared to the other
  • Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
  • Still have their early reflexes, like the startle reflex and grasp reflex
  • Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
  • Still need you to support their head
  • Still need you to help turn their head when lying on their back
  • Can’t crawl, or find it hard, for example, drags one of their legs behind them
  • Find it difficult to stand, for example:
    • Can’t stand with support 
    • Doesn’t try to pull themselves up to stand
  • Can’t move a toy from one hand to the other
  • Doesn’t use both hands to hold larger things

9-12 months

9-12 MONTHS

Contact your health visitor or GP if your baby is 9-12 months and they…

  • Have lost skills which they could do before
  • Feel very stiff, for example:
    • Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
    • Find it difficult to change their position on their own 
    • You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
  • Feel very floppy when they are awake
  • Move their arms and legs in repetitive, jerky, or strange ways
  • Use one side of their body more than the other, for example:
    • Lean to the side when they sit
    • Use one arm to pull to stand more than the other
    • Rarely use one of their arms to pick up toys, or eat and drink. 
    • Rarely kick one leg compared to the other 
  • Find it difficult to sit, for example:
    • Only sit with support
    • Lean on their hand when sitting
    • When they sit their back is very curved
  • Can’t move a toy from one hand to the other
  • Don’t use both hands to hold larger things
  • Don’t point to objects
  • Can’t crawl, or find it hard, for example, drags one leg behind them
  • Find it difficult to stand, for example:
    • Can’t pull themselves up to stand
    • Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
    • Can’t stand with support

2 months

Your Baby By Two Months

Social/Emotional Milestones

  • Calms down when spoken to or picked up
  • Looks at your face
  • Seems happy to see you when you walk up to her
  • Smiles when you talk to or smile at her

Language/Communication Milestones

  • Makes sounds other than crying
  • Reacts to loud sounds

Cognitive Milestones (learning, thinking, problem-solving)

  • Watches you as you move
  • Looks at a toy for several seconds

Movement/Physical Development Milestones

  • Holds head up when on tummy
  • Moves both arms and both legs
  • Opens hands briefly

4 months

Your Baby By Four Months

Social/Emotional Milestones

  • Smiles on his own to get your attention
  • Chuckles (not yet a full laugh) when you try to make him laugh
  • Looks at you, moves, or makes sounds to get or keep your attention

Language/Communication Milestones

  • Makes sounds like “oooo”, “aahh” (cooing)
  • Makes sounds back when you talk to him
  • Turns head towards the sound of your voice

Cognitive Milestones (learning, thinking, problem-solving

  • If hungry, opens mouth when he sees breast or bottle
  • Looks at her hands with interest

Movement/Physical Development Milestones

  • Holds head steady without support when you are holding him
  • Holds a toy when you put it in his hand
  • Uses his arm to swing at toys
  • Brings hands to mouth
  • Pushes up onto elbows/forearms when on tummy

6 months

Your Baby By Six Months

Social/Emotional Milestones

  • Knows familiar people
  • Likes to look at self in a mirror
  • Laughs

Language/Communication Milestones

  • Takes turns making sounds with you
  • Blows “raspberries” (sticks tongue out and blows)
  • Makes squealing noises

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts things in her mouth to explore them
  • Reaches to grab a toy she wants
  • Closes lips to show she doesn’t want more food

Movement/Physical Development Milestones

  • Rolls from tummy to back
  • Pushes up with straight arms when on tummy
  • Leans on hands to support herself when sitting

9 months

Your Baby By Nine Months

Social/Emotional Milestones

  • Is shy, clingy, or fearful around strangers
  • Shows several facial expressions, like happy, sad, angry, and surprised
  • Looks when you call her name
  • Reacts when you leave (looks, reaches for you, or cries)
  • Smiles or laughs when you play peek-a-boo

Language/Communication Milestones

  • Makes a lot of different sounds like “mamamama” and “bababababa”
  • Lifts arms up to be picked up

Cognitive Milestones (learning, thinking, problem-solving)

  • Looks for objects when dropped out of sight (like his spoon or toy)
  • Bangs two things together

Movement/Physical Development Milestones

  • Gets to a sitting position by herself
  • Moves things from one hand to her other hand
  • Uses fingers to “rake” food towards himself
  • Sits without support

1 year

Your Baby By One Year

Social/Emotional Milestones

  • Plays games with you, like pat-a-cake

Language/Communication Milestones

  • Waves “bye-bye”
  • Calls a parent “mama” or “dada” or another special name
  • Understands “no” (pauses briefly or stops when you say it)

Cognitive Milestones (learning, thinking, problem-solving)

  • Puts something in a container, like a block in a cup
  • Looks for things he sees you hide, like a toy under a blanket

Movement/Physical Development Milestones

  • Pulls up to stand
  • Walks, holding on to furniture
  • Drinks from a cup without a lid, as you hold it
  • Picks things up between thumb and pointer finger, like small bits of food
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Self care and Prevention

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