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What is maternal anxiety?

“Maternal anxiety is anxiety that affects women during pregnancy, birth and the first post-natal year”, says Dr Green. “There are lots of different forms of anxiety, from anxiety about unwanted, intrusive thoughts, specific phobias that are relevant to this period, like vomiting or needle phobia, anxiety after trauma, uncontrollable worry or panic attacks.

“The typical themes in maternal anxiety tend to be worrying that something bad is going to happen, either to you or your baby, during pregnancy, or postnatally, or perhaps during the birth, or that there'll be some aspects of parenting that you won't manage to cope with or tolerate.

“We know anxiety is a normal human emotion. It's nothing to be ashamed about, all of us experience it. But for some women, it can be more problematic, and that's when it gets more intense, more preoccupying. It stops you from doing things, sucks the joy out of things. That's when it can become really distressing.”

Dr Green says she experienced maternal anxiety herself following the birth of her daughter in 2015.

“The first sign of trouble for me was on the postnatal ward. When my daughter cried, I just felt this overwhelmingly intense panic. It was a really physical feeling. I felt utterly overwhelmed that I didn't know what to do, that I didn't know how to stop her crying, that everybody around me would be annoyed, angry with us, or about to tell us off. It was so intense. Lots of people were saying, ‘Just relax, enjoy your baby, you're just exhausted’. And I thought, ‘OK, I'll get better when I get home’, and it didn't. I was really consumed with fear about leaving the house or about having visitors over.”

So if you think you’re experiencing maternal anxiety, what should you do?

1. Talk to your GP, midwife or health visitor about how you’re feeling

“What I would really encourage women to do is if you notice that you're feeling anxious, and that anxiety is persistent, and it's preoccupying... please do go and talk to your GP, talk to your midwife or your health visitor, and explain to them how anxious you're feeling and the effect that it's having on you”, says Dr Green.

“We've got decades of research that show that cognitive behavioural therapy (CBT), which is a certain type of talking therapy, is incredibly effective for anxiety difficulties.

“Every area in the UK has access to free talking therapy services. We also have new specialist perinatal mental health services if you're struggling more significantly, and if you are pregnant, or you have a baby under one, you should be prioritised for psychological treatments, in line with NICE guidelines. So that's what I would encourage people to be asking for.”

Apart from seeking advice from your GP, midwife or health visitor, there are other things that you can do to tackle your maternal anxiety, says Dr Green. Keep reading to find out more.

2. Get to know your anxiety and how it works for you

“The reason for getting to know your anxiety is because you can't start solving any problem without clearly identifying it and defining it. So when you notice yourself feeling anxious, pay attention- what situations is it popping up in? What sorts of thoughts are going through your mind, the frightening pictures in your mind? How does that affect you in terms of your emotions, in terms of what's happening in your body? And how do you then respond, so what sorts of things do you tend to do to cope?

“The more you can get to know the patterns in your own thinking, the patterns in your behaviour, that's the first step to making sense of how the problem works for you, and then taking steps to work your way out of it.”

3. Remember that anxious thoughts are just thoughts, not facts

“The third tip, which I think is really important, is to remember that anxious thoughts, whether that's in the form of a verbal thought, an image, or a worry, they're products of your mind, they're not facts,” says Dr Green. “So even though you might feel in danger, it doesn't mean that you are. Our emotions are helpful, but they're not always a reliable guide to what's going on in the world.”

4. Get outside of your head

“Being stuck in your head, churning worry over and over or running through lots of worst-case scenarios continuously is never helpful,” says Dr Green. “It keeps you focused on negative outcomes. It doesn't make you any safer. It doesn't usually make people feel more in control, or more sure, it just churns up more doubt.

“So if you notice yourself stuck in your head, try and think about how you can give your mind a bit of a rest, how you can give the worry a bit less airtime. We talk in the book a lot about shifting the focus of your attention, so trying to get out of your head and into the task in the moment. The idea is to shift focus away from unproductive worry to something that's more meaningful and matters to you.”

5. Test out your anxious predictions

“If you have got anxious predictions about something that you think is going to go wrong in a particular situation, can you think about how you can put that to the test, bearing in mind that our thoughts aren't always reliable?’ says Dr Green. “Can you think about small ways you could challenge yourself to get out into the real world and find out how it works for you?

“So for me, one day I decided to challenge myself. My friend was coming to visit me and she was coming into the station, which is about a five-minute walk from my house. And I was like, ‘Right, I'm just going to try and go from home to meet her and come back again. And I'm going to try and go without over-preparing. And if she cries, I'm just going to see what happens. And I'm going to try and pay attention to what other people are paying attention to’, because I'd often just keep my head down and not be wanting to look up or see if people were glaring at me. And I did manage that. It was terrifying but I did it. She didn't cry on the way there, she was a bit grisly on the way back, but no one really paid that much attention.

“So that small step gave me the confidence then to do that again, to go to the shop to get a pint of milk, or to buy myself a magazine or some chocolate, or to have someone over to the house and to let them hold her and just go with the flow a bit more.”

6. Keep an eye out for the ‘seeking certainty trap’

“Anxiety really likes to con us into thinking that we can and should be 100% certain and 100% sure of stuff before we do it, or before we can move on from something,” says Dr Green. “That's an impossible task. We can't really be 100% certain or sure of most things in life. The more you try to be sure, usually what happens is the more doubtful and anxious you get.

“So what we try and encourage people to do is think about the task and not seek certainty. It's to tolerate uncertainty, and it's to build up gradually your acceptance of uncertainty and sitting with that.”

7. Be more compassionate with yourself

“Dial down self-criticism because no one ever criticises themselves into feeling less anxious or more confident - it just doesn't work,” says Dr Green. "It’s a really common habit that women in general, I think, and mums can get stuck in, and it's not helpful, it's not fair. And it can add shame to anxiety. Have a careful think about: Are there ways you can take a bit more of a compassionate approach, or start to focus on the things you've managed to do? Even if they're small things, because achieving small things in the face of absolute exhaustion, pain, or trying to get on with day-to-day life, or you're heavily pregnant, those are things to celebrate.”

You can listen to Dr Green talking about maternal anxiety with Emma Barnett by heading to ´óÏó´«Ã½ Sounds and listening to the Woman’s Hour episode from 15 November. Join the conversation on Twitter and Instagram @bbcwomanshour.

For more information and support about maternal anxiety, head to the ´óÏó´«Ã½ Action Line website.