Identifying Perinatal Anxiety
Many people experience anxiety during pregnancy and the early years of parenting. However, when worry becomes persistent, overwhelming, or begins to impair daily functioning, individuals may be experiencing perinatal anxiety (PNA).
PNA is the most prevalent perinatal mental health condition, occurring more frequently than depression1. Despite this high prevalence, PNA is frequently under-recognised. Clinical information and screening, and public awareness tend to focus predominantly on postnatal depression (PND), resulting in lower recognition and understanding of PNA. Moreover, many individuals report distress patterns more characteristic of anxiety than depression, but these symptoms are often normalised or dismissed as typical perinatal experiences. Consequently, individuals may struggle to identify or articulate their psychological symptoms.
1Fairbrother et al., 2016
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Persistent, unjustified general worry
- Constant wide-ranging worry
- Frequent “what if” thoughts and catastrophic expectations
- Feeling overwhelmed, stressed, or out of control
- Recurring concerns about pregnancy or family life (e.g., finances, work, relationships)
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Persistent, unjustified worry about parenting
Attachment/bonding
- Feeling disconnected from the pregnancy or baby
- Doubting love or feeling indifferent or uneasy towards the pregnancy or baby
Parental confidence
- Feeling unprepared or inadequate as a parent
- Overthinking and/or repeatedly questioning decisions
- Over-researching or striving for perfection
- Persistent feelings of doing things “wrong”
- Guilt or shame related to thoughts about the baby
- Feeling pressured to enjoy parenting when this is not the case
Perceived lack of support
- Feeling isolated or unsupported by partner, family, or friends
- Anticipatory worry about coping without help
- Resentment toward others who appear to have more support
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Worry about Baby’s safety or health
- Persistent fear that something is wrong with the baby
- Excessive information-seeking or reassurance-seeking
- Worry about developmental milestones
- Repetitive checking of breathing, heart rate, or other signs of wellbeing
- Fears of unintentionally harming the baby
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Childbirth-related worries
Before birth
- Fear of pain, complications, or death
- Anxiety about losing control or the birth not going to plan
- Nightmares or intrusive thoughts about labour
- Repeatedly questioning decisions about birth preferences
After birth
- Avoidance of places, people, or reminders associated with birth
- Emotional detachment from or avoidance of the baby
- Nightmares, flashbacks, or distressing memories related to the birth
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Emotional and identity changes
- Feeling that having a baby was a mistake
- Fears about loss of identity
- Missing work or pre-pregnancy lifestyle
- Feeling judged or inadequate
- Resentment, feeling trapped, or a sense of losing control
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Concerns About Changes to Appearance
- Worry about weight, body image, or attractiveness
- Distress over physical changes related to pregnancy or birth (e.g., varicose veins, skin changes, scars, breast changes)
- Frequent comparison with others
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Irritability
- Increased irritability or reduced patience
- Mood swings, anger, or emotional instability
- Throwing or breaking objects during moments of overwhelm
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Intrusive thoughts
- Unwanted images or thoughts involving harm, accidents, or illness
- Preoccupation with doing the “right” thing
- Disturbing or violent intrusive thoughts
- Persistent concerns about germs or contamination
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Checking or repetitive behaviours
- Excessive monitoring of the baby’s health or behaviour
- Over-cleaning or repetitive rituals to reduce anxiety
- Frequent reassurance-seeking from professionals
- Attending numerous classes or consuming excessive parenting information
- Logging feeds, nappies, or movements far beyond what is necessary
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Difficulty concentrating or ‘brain fog’
- Problems with focus, memory, or decision-making
- Intrusive thoughts interrupting cognitive processes
- Feeling confused, disorganised, or scattered
- Difficulty completing tasks or sustaining conversation
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Sleep or Relaxation Difficulties (Not Attributable to Pregnancy-Related Discomfort or Infant Care)
- Difficulty initiating or maintaining sleep due to worry or intrusive thoughts
- Early-morning waking with panic and inability to resume sleep
- Persistent hyperarousal, preventing relaxation
- Restlessness, constant activity, or inability to slow down
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Panic Symptoms (Psychological and Physical)
- Intense fear, dread, or a sense of impending harm
- Hypervigilance and constant scanning for threats
- Feeling detached from reality
- Palpitations or irregular heartbeat
- Breathlessness, rapid breathing, or dry mouth
- Sweating, chills, or hot flashes
- Nausea, gastrointestinal discomfort, or butterflies
- Dizziness or blurred vision
- Muscle tension, tremors, or weakness
- Tingling or numbness in extremities
- Exhaustion following heightened anxiety
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Avoidance and birth trauma
- Avoidance of reminders or discussions about birth
- Substance use to suppress intrusive memories
- Flashbacks or nightmares related to:
- Childbirth
- Pregnancy complications
- Miscarriage or perinatal loss
- Previous reproductive losses
- IVF treatment
- Other traumatic perinatal events
Experiencing occasional symptoms is common. However, when multiple symptoms are present simultaneously or begin to disrupt daily functioning – such as self-care, bonding with the baby, completing routine tasks, social engagement, or maintaining relationships – this may indicate that additional assessment or support is warranted.
You can find out more about measuring perinatal anxiety below.