To the Expectant Mom with a Million Questions and Worries

“Have a little faith in your ability to handle whatever’s coming down the road. Believe that you have the strength and resourcefulness required to tackle whatever challenges come your way. And know that you always have the capacity to make the best of anything. Even if you didn’t want it or ask for it, even if seems scary or hard or unfair, you can make something good of any loss or hardship. You can learn from it, grow from it, help others through it, and maybe even thrive because of it. The future is unknown, but you can know this for sure: Whatever’s coming, you got this.” ~Lori Deschene

As an obstetrician in Manhattan, I see the following scene often…

A woman who is newly pregnant walks into my office, her eyes wide, her fingers clutched around her phone or a notebook and pen.

She has just come from her first ultrasound and is now looking at me in total fear and anxiety. Not because she was told she has had a miscarriage—there is a beautiful heartbeat noted. Not because she has been told something looks abnormal with the baby—the baby looks healthy, like a little jumping peanut, as they all do early in pregnancy. Not because she has medical complications that make her pregnancy extremely high risk.

Instead of taking a deep breath and feeling relief that the ultrasound showed a healthy pregnancy, her mind immediately goes to the million things she needs to get right and understand and process to ensure that she does everything right. To ensure that she receives an A+ in pregnancy and growing a healthy baby.

Her look is a reflection of her inner emotions related to the unpredictable nature of pregnancy. She is scared to death because she realizes that she is no longer in control. She can do everything perfectly and still something bad may happen.

This may be the first time in her life she has ever felt this way. So she desperately wants to control every bit of the process and soak in every detail she can in regards to statistics, testing, the effects of her diet, exercise, stress, work environment, and household and dietary toxins.

She is clinging to any bit of power she has, to make everything turn out alright. To make sure she has a good pregnancy, an uneventful birth, and goes home with a healthy baby that will flourish and go to the top schools and become a happy and successful person.

She also wants to maintain control of herself, the self she has cultivated for years and involves her career that she has worked hard for, her body that she has meticulously cared for, and her ability to work hard and be successful in everything she does.

Now that all medical records and patient notes are available for the patients to see, a colleague of mine has coined a code word to add to such patient’s notes so that everyone who sees them understands they will need double the standard time for these appointments to answer the long list of questions that will inevitably arise.

They should be prepared for questions on everything from birth plans to whether or not they should do invasive testing for Down’s syndrome even if the very sensitive screening tests return normal to what their chances are of getting gestational diabetes to whether it is safe to paint their nails and color their hair.

They often bring a bag full of the supplements they have been taking and the makeup and skin products they have been using and ask the doctor to review and comment on each and every one and the safety and risks and benefits of each in pregnancy. If we do not have a good enough answer based on the available data, they want to know what we personally would do, as uncertainty and lack of direction is not an option.

These moms require a little extra gentleness and support from their doctors; however, it can be difficult, as often no matter how many questions I answer and how well I try to ease their fears, I know that they may never be fully satisfied with my responses.

The information I give them involves many responses that reflect a lack of a complete knowledge of all of the answers to their questions.

I cannot definitively tell them how the face cream they used before knowing they were pregnant may affect their growing baby. I may not know how likely their fibroid is to cause preterm contraction or pain compared to women who have fibroids in other locations or of different sizes

I can try to reassure them that even if they can only tolerate bread due to extreme nausea, their baby will get the nutrients they need; however, they may never fully believe me and feel that they have already done something wrong that is causing irrevocable harm.

What I want to tell them, but often don’t due to my concern for their response and thinking that I do not take them seriously or provide the level of support and intensity they need, is this:

Pregnancy is scary because most things that happen are beyond our control. Life, and everything about life, is also beyond our control; however, pregnancy is often the first time we come face to face with the fact that we really just have to let it be and accept what comes. 

This is terrifying. We want to feel that we can influence the outcomes—the harder we work, the healthier we are, the better we follow all of the rules, the better our outcome will be. But just as someone can eat healthy, exercise every day, and get hit by a car crossing the street, a mom can follow every rule and recommendation and end up with a baby with a heart defect or have cervical insufficiency and lose the pregnancy. 

The more we can accept the unpredictable nature of life and death, the more we can just be during the pregnancy and not live in perpetual fear of possible negative outcomes. 

The truth is, worrying about it does not lessen the pain if a bad outcome occurs. So spending our time worrying about what may be is not helping us in any way and is actively preventing us from fully living in the present.

This is the first lesson of being a parent, and an important lesson for everyone in life, no matter if you desire to be a parent or not: You cannot control your children; you can only do your best to be present and conscious and support them so they can flourish and grow into their own authentic selves. 

Do the same for yourself during pregnancy and in life in general. Try to be present in the moment instead of focused on all of the ways that things could go wrong. Be conscious of how you treat your body. Provide yourself with nourishment, rest, exercise, and self-care so you can thrive during the pregnancy and beyond.

Oftentimes pregnancy provides a window of time when women will actually focus on themselves more instead of on taking care of everyone else, as they understand that their well-being inextricably affects the well-being of the baby growing inside of them.

If you notice yourself becoming very anxious or stressed, take some quiet time to sit with these emotions. You may intuitively discover what is causing them, and often it will be your lack of control and the uncertainty that is inevitable during pregnancy.

Try meditation, yoga, or other mindfulness activities to re-center and get into the present moment. Be grateful for how your body is supporting you and your growing baby. Journaling and talking to a therapist, alone or with your partner if you have one in this pregnancy, may also help uncover the underlying programming and conditioning that lead to your current emotional state.

Oftentimes there are roots going back to our own childhood and feelings of inadequacy, low self-worth, or invalidation that make us feel we will somehow mess up or not be a good enough parent. We become very anxious or worried that we will either make the same mistakes our own parents did, or that we cannot live up to the standards we have set for ourselves if we have placed our own parent(s) on a pedestal.

We may have become a perfectionist at a young age to emotionally cope with the dynamics in our own families. We may even have avoided risks or failure during our adult life so that we never had to deal with the sense of not being good enough.

Pregnancy brings all of these emotions and more into focus. It can become a time where we are either forced to turn inward and address our personality traits that developed in our own childhood or risk becoming very anxious, stressed, and depressed.

During my own pregnancy I went to an extreme. I detached from my pregnancy, as the thoughts of all of the negative outcomes I have seen in my professional experience were too much to bear.

I did not have the proper tools or self-awareness to explore it and heal myself. Rather than face the crippling anxiety and work through it, I dissociated from the pregnancy and did not allow myself to connect or bond with my daughter until she was born.

I always was very relaxed and nonchalant at my own obstetric visits and sonogram appointments because I had forced the emotions so deep inside that no one could even see them. I eventually developed severe postpartum anxiety and depression that stemmed from this lack of confronting my true feelings and understanding where they came from so that I could heal them.

I was completely unaware that I was even suffering from severe anxiety and depression for almost two years after the birth of my daughter. This was how deep the schism was between my emotional response to pregnancy and having a baby was and my ability to process and understand these emotions.

Not everyone who is anxious or depressed during pregnancy or postpartum has similar feelings to my own. However, I have noticed that women who come into the pregnancy already very anxious and worried are more likely to develop worsening of these symptoms during pregnancy and postpartum.

It may be related to the fact that initially the concern is over having a normal healthy pregnancy, but as birth looms closer they realize that the birth is also out of their control, and then as going home with the baby looms closer they realize that breastfeeding, soothing the baby, and the temperament and health of their baby is also out of their control.

We go from facing a finite period—we just have to get through this pregnancy—to an infinite period,  parenthood, in which the older our child gets the less control we have. This is terrifying to someone who is naturally a perfectionist, type A, someone who has learned through life that the more they do and the harder they work, the better the outcome will be.

Instead of struggling and succumbing to the toxic, negative emotions and fears, we have to learn to acknowledge them and then let them go. We must learn to just be. To sit with the uncomfortable nature of the unknown. 

This does not mean you should not ask questions. This does not mean that you will never worry or feel anxious. But it means that you can also let in moments of calm and relaxation. Moments where you trust your body to do what it innately knows how to do without our conscious interference.

Your doctor or midwife cannot and will not be able to fully reassure you and hold your hand and tell you everything will be okay. We will do our best to answer all of your questions and support you in a nonjudgmental and compassionate way; however, no matter how many notes you take we cannot release you from the anxiety that comes from a feeling of lack of control. Only you can do that.

I recommend trying to avoid the triggers that will make it worse, avoiding pregnancy apps where other women write comments that are often not based in science, and limiting the amount of books and classes you digest during your pregnancy and parenthood.

There are whole industries created that exist and profit off of our desires and needs to feel perfect and in control. The truth is that perfection does not exist, and the future is never predictable.

Instead of allowing fear and anxiety to control me and close me off from all of the wonderful, deep emotions that come from embracing vulnerability and the unknown, I now choose every day to consciously work to uncover my anxieties when they appear.

I thank my inner self for showing me I still have work to do, and then bring myself back into the present moment and back to the gratitude for what I have right now, no matter how messy or imperfect it may be.

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