Pregnancy-Related Anxiety

Theory, Research, and Practice

Rachel Dryer, Robyn Brunton, Rachel Dryer, Robyn Brunton

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000472257
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book provides a collective examination of the theoretical, empirical, and clinical perspectives of pregnancy-related anxiety. Pregnancy-related anxiety is a distinct form of anxiety that is experienced by pregnant women and is characterized by pregnancy-specific fears and worries. This form of anxiety has been associated with a range of negative obstetric, neonatal, and maternal outcomes. There has been increased research interest in this form of anxiety, particularly over the last 15 years.
The content is organized in three sections. The first section provides a thorough understanding of pregnancy-related anxiety, ranging from its historical development, evidence of its distinctiveness to the antecedents and outcomes of this anxiety for the mother and child. The second section examines key clinical issues around diagnosis and treatment specifically, current diagnosis/screening for this anxiety and approaches for intervention and treatment. The final section considers emerging areas of research such as pertinent issues around culture and acculturation which are key issues in an increasingly multicultural world. Moreover, the effects of pregnancy-related anxiety on the woman's broader psychosocial functioning are considered with specific chapters on body image and sexual abuse, two key areas of concern.
A seminal resource, this book provides a broad examination of the topic from multiple frameworks and perspectives which sets this book apart from other books in print. This book intends to inform and stimulate future research studies, as well as increase awareness and understanding of pregnancy-related anxiety. It is a must-read for researchers, educators, clinicians, and higher education students who care about delivering better support and services to pregnant women, particularly those who are vulnerable and distressed.

Part I

Understanding pregnancy-related anxiety

1 What is pregnancy-related anxiety?

Christine Dunkel Schetter and Carolyn Ponting

DOI: 10.4324/9781003014003-3

What is pregnancy-related anxiety?

The term pregnancy-related anxiety is now common in the literature on pregnancy. It appears in nursing, psychological, psychiatric, and obstetrics publications among others. Yet it does not have one agreed-upon definition. Slightly different terms in the literature refer to overlapping yet distinct concepts. For example, pregnancy anxiety, pregnancy-specific anxiety, pregnancy distress, and pregnancy concerns are all terms that are used. Moreover, these terms are not always well defined. Researchers have too often designed assessment tools and then created a title for the instrument, not always accurately reflecting the content assessed. In our own research, we prefer the term pregnancy anxiety. Therefore, in this chapter, we will use the term pregnancy anxiety when describing the development of our scales and related studies. In all other aspects, the term pregnancy-related anxiety will be used for consistency in terminology throughout this book. Pregnancy-related anxiety is most often conceptualized as an affective state consisting of any combination of concerns about one’s pregnancy, baby, self, hospital and health care, childbirth, and future parenting (Dunkel Schetter, 2011).

The difficulty in coming to agreement on the definition of pregnancy-related anxiety is readily apparent in several systematic reviews published since 2011 on anxiety and stress during pregnancy (Evans et al., 2015; Nast et al., 2013; Sinesi et al., 2019). Some of the reviews focus on clinical screening for anxiety symptoms and clinical disorders during pregnancy (Meades & Ayers, 2011). Others focus more broadly and include at least some measures of pregnancy-related anxiety. For example, Sinesi et al. (2019) reviewed anxiety scales used in pregnancy and reported on 22 relevant studies, 11 of which use instruments that measured “general worries” experienced during pregnancy, whereas 3 studies involved instruments measuring pregnancy-specific worries, distress, or anxiety. Similarly, Evans et al. (2015) conducted a systematic review of anxiety instruments in pregnancy in which 4 of 17 scales were on pregnancy-related anxiety, while 3 more were on pregnancy distress that is broader. Similarly, Nast et al. (2013) systematically reviewed instruments measuring psychosocial stress in pregnancy, finding 11 anxiety scales and 6 scales measuring pregnancy-specific stress. In that review, some of the scales classified under anxiety were actually on pregnancy-related anxiety, but others were more general, exemplifying the ongoing confusion about the concepts involved.

In sum, there are a plethora of measures of anxiety and stress used in pregnancy research, as well as a number of instruments developed to assess pregnancy-related anxiety and pregnancy stress. The large number of instruments and their assessment of various interrelated concepts together contribute to the absence of an agreed-upon definition of pregnancy-specific anxiety (Brunton et al., 2015) and to lack of agreement on the adoption of common assessment tools.

History of research on pregnancy-related anxiety

The earliest published work on pregnancy-related anxiety or distress was conducted by Pleshette, Asch, and Chase who in 1956 reported that half to two-thirds of women feared pain and injury during delivery, losing their baby, or fetal abnormality. Later, Light and Fenster (1974) created one of the first inventories on pregnancy-related anxiety with 62 items on maternal concerns during pregnancy, including those about the baby, birth, self, family, medical care, and finances. At about the same time, Burstein et al. (1974) also developed a dichotomous (true/false) 25-item pregnancy anxiety scale (PAS) that captured psychosomatic concerns regarding a woman’s pregnancy and concerns about hers and the baby’s health, including the postpartum period. In later work (Glazer, 1980), researchers found that 94% of a sample of 100 women in a Midwestern region of the United States were concerned about whether the baby would be healthy and normal, 93% about the baby’s condition at birth, 91% about her appearance as an expecting mother, and 89% about unexpected events during birth. Standley et al. (1979) and Lederman (1984) were also pioneers in this area of research conducting interviews to assess a woman’s acceptance of her pregnancy, parenting confidence, and concerns over her relationship with the baby’s father.

Since then, others around the world have developed concepts, measures, and programmatic research on pregnancy-related anxiety. Research teams in the United Kingdom, Belgium, Australia, and various parts of the United States continue to push this work forward. Notably, Van den Berg, Huizink, and colleagues have a large program of work on pregnancy-related anxiety, based on the Pregnancy-Related Anxiety Questionnaire (PRAQ) that is translated into many languages, including Spanish and German (Huizink et al., 2004, 2016; Sikkema et al., 2001; Van den Bergh, 1992).

What is pregnancy-related anxiety and what isn’t it?

Bayrampour et al. (2016) have added to our understanding of pregnancy-related anxiety by differentiating it from other forms of distress. Reviewing qualitative and quantitative data from 38 studies, these researchers conducted a concept analysis based on the premise that pregnancy-related anxiety is a distinct concept from general anxiety and depression. Their systematic approach to clarifying the concept resulted in the following definition: “nervousness and fear about the baby’s health, the mother’s health and appearance, experience with the health care system, social and financial issues in the context of pregnancy, childbirth and parenting that are accompanied by excessive worry and somatic symptoms” (p. 121). This definition is similar to how we have defined these phenomena in our work, as “fears about the health and well-being of one’s baby, the impending childbirth, of hospital and health care experiences (including one’s own health and survival in pregnancy), birth and postpartum, and of parenting or the maternal role” (Dunkel Schetter, 2011, pp. 534–535; Guardino & Dunkel Schetter, 2014).

Worries or concerns about one’s pregnancy occurring during a specific pregnancy are a central component of pregnancy-related anxiety. It is important to distinguish this component from worries about becoming pregnant and from symptoms of generalized anxiety. Pregnancy anxiety is distinct from the concepts and measures of general state and trait anxiety, and from current or past anxiety disorder diagnoses. That is, pregnancy-specific anxiety is more than just general anxiety assessed during pregnancy. Huizink and colleagues (2004) demonstrated that generalized anxiety and depressive symptoms contributed just 17% of the variance in pregnancy-related anxiety, a finding replicated across early, mid, and late pregnancy by a study in Australia with a much larger sample size (n = 1209) (Brunton et al., 2019).

Pregnancy-related anxiety may vary over the course of pregnancy, as may the specific worries a woman experiences. For example, there is maternal worry early in pregnancy associated with unplanned pregnancies (Grussu et al., 2005). In addition, we know that women are often anxious during their first trimester about possible pregnancy loss and as they acclimate to pregnancy-specific physical symptoms and anticipate further changes (Rubertsson et al., 2014). In addition, women who experience high-risk conditions during pregnancy are likely to have concerns about the well-being of their baby (McCoyd et al., 2020). Toward the end of pregnancy, women worry more about impending labor and delivery (Madhavanprabhakaran et al., 2015; Mudra et al., 2020). They also may worry about their own health and even surviving childbirth, especially if they lack confidence in prenatal and maternity care in their health care setting (Davis, 2019; Engle et al., 1990; Backes et al., 2020). Finally, pregnant women worry about being a good mother, and about meeting any cultural expectations associated with pregnancy and motherhood. For example, some cultural groups expect women to be happy and emotionally steady during pregnancy for the baby’s sake (Kieffer et al., 2002). Thus, a range of pregnancy-related concerns may arise over the course of pregnancy under the umbrella term of pregnancy-related anxiety.

When researchers describe pregnancy concerns, they appear to be referencing many of these pregnancy-related worries, however, not all concerns that occur in the context of pregnancy should be considered pregnancy-related anxiety. Women who are worried about paying rent or buying food during pregnancy are likely to have worried about these issues before becoming pregnant and will continue to worry about them after pregnancy. These chronic worries are not usually specific to pregnancy, although they may be exacerbated due to prenatal nutrition concerns, but the issues are captured more effectively by other measures in the literature (e.g., Tallis et al., 1994). Social and financial sources of concern reflect stress-related concepts that are clearly distinguishable from anxiety in general or pregnancy-related anxiety. For example, concepts such as financial strain and relationship stress have separate measures and literatures (Dunkel Schetter et al., 2013; Pierce, 1994; Ross et al., 2019). Thus, these need not be confounded with assessments of pregnancy-related anxiety. In contrast, worrying specifically about whether the baby is getting sufficient nutrients and is growing normally is specific to a pregnancy and is what many existing pregnancy-related anxiety measures or scales are design...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Dedication
• Contents
• List of figures
• List of tables
• List of contributors
• Foreword
• Acknowledgments
• List of abbreviations
• Introduction
• Part I Understanding pregnancy-related anxiety
• Part II Implications for practice
• Part III Future directions
• Index