Overcoming Pregnancy Paranoia

Pregnancy tends to be a major, life-changing event, so it can be natural for people to experience stress and worry related to becoming pregnant, giving birth, and having a child. However, what people call “pregnancy paranoia” often goes above and beyond normal worries and, in some cases, falls under the categorization of an anxiety disorder. If you’re experiencing persistent worries related to pregnancy, consider talking to your doctor or a licensed therapist for support.

What is pregnancy paranoia?

Rather than an official diagnosis, pregnancy paranoia can be seen as a colloquial term people often use to describe anxiety related to pregnancy. Among those who would prefer not to become pregnant, pregnancy paranoia can describe a fear of becoming pregnant, sometimes even if the person has used contraception or has not had intercourse. Among those who are pregnant, pregnancy paranoia often centers on fears of miscarriage, death during childbirth, or the potential negative significance of normal pregnancy symptoms.

In this article, we delve into both types of pregnancy paranoia — the extreme anxiety sometimes experienced by people who don't want to become pregnant, as well as the extreme anxiety sometimes experienced by people who already are pregnant — and answer questions commonly asked by people experiencing it. 

When should I take a pregnancy test?

Both people who are anxious to become pregnant and those anxious because they do not want to become pregnant may find themselves tempted to take pregnancy tests earlier or more often than necessary to reduce their anxiety. However, compulsively taking pregnancy tests generally won't help the situation or bring about any new information if they are taken excessively or at the wrong time. 

In this instance, pregnancy testing may become a form of "checking behavior." Checking behavior typically describes an action a person takes to provide themselves reassurance that something they fear hasn't happened. While engaging in a checking behavior may reduce anxiety in the short term, it is thought to perpetuate it in the long term.

Are home pregnancy tests accurate?

Home pregnancy tests can identify if a person is pregnant with nearly 100% accuracy when taken after one day of a missed menstrual period. In order to know when your first day of menstruation is expected, you usually need to know when you last menstruated, as well as how long your cycles normally last. There are many menstrual cycle tracking apps available that can calculate estimated period dates automatically as long as you enter the dates when you have your period each cycle.

Some home pregnancy tests advertised as “early pregnancy tests” can identify pregnancy up to five days before the expected first day of menstruation. While this may appeal to someone with pregnancy-related anxiety, the accuracy of such a test tends to be less consistent because it depends on the level of hormonal changes a person is experiencing, and these can vary from person to person. Because of differences in hormonal levels in the days prior to a missed period, negative early pregnancy tests don't always provide useful information.

What is beta-human chorionic gonadotropin (beta-hCG)?

Beta-human chorionic gonadotropin (beta-hCG) is the hormone usually measured in pregnancy testing. Beta-hCG levels usually double every 48 hours in the early stages of pregnancy. Beta-hCG can be measured through home pregnancy tests, which check urine for its presence. They can also be measured through blood tests, which are usually done at a doctor's office rather than at home.

Can I get pregnant on birth control?

People who do not want to become pregnant may use birth control yet continue to experience stress over whether they are going to have an unplanned pregnancy anyway. While birth control can effectively prevent pregnancy for most people, there are some cases in which a person becomes pregnant while using contraceptives. Different types of birth control typically have different levels of effectiveness.

What types of birth control are most effective?

There are a wide variety of contraceptives available that range from over 99% effective to less than 80% effective. Often, the effectiveness of a contraceptive is dependent on how closely a person uses it compared to instructions. People who are fearful about becoming pregnant may want to choose contraceptives with a high effectiveness rate or use two types of contraceptive methods at once to allay their anxieties.

It's best to talk to your doctor about which contraceptive type is best for you. Talking openly about your pregnancy fears with your doctor may help you identify a plan that helps you feel more comfortable about remaining sexually active and having intercourse without constantly fearing pregnancy. 

Contraceptive options include combined hormonal contraceptives, which come in the form of pills, patches, and vaginal rings. These are usually over 99% effective with perfect use. Other options include progestin-only hormonal contraceptives, which are available in pills, injections, implants, and intrauterine devices (IUDs). These are also over 99% effective with perfect use but may become much less effective with imperfect use. 

Non-hormonal options are also available, like the copper IUD, condoms, diaphragms, and behavioral methods, like withdrawal and avoiding intercourse during fertile time periods. It can be important to note that these two behavioral methods tend to be much less effective than other contraceptive options.

What are common pregnancy symptoms?

Pregnancy symptoms commonly occur during the first trimester of pregnancy. People who fear becoming pregnant may worry they're experiencing pregnancy symptoms when they are not. People who want to become pregnant may also be on high alert for pregnancy symptoms, albeit for different reasons. Those who are already pregnant may monitor their symptoms and worry that they are abnormal. See the most common symptoms and the percentage of pregnant people who experience them below.

• Nausea: 80% to 88%
• Vomiting: 35% to 40%
• Pelvic or lower back pain: 20% to 65%
• Vulvar itching: 19% to 50%
• Vaginal bleeding: 17% to 50%
• Itchy skin: 17%
• Leg cramps: 10%
• Varicose veins: 3%

When you experience worry about physical symptoms, it may be difficult to discern whether that worry is reasonable or excessive. If you are pregnant, having a discussion with your doctor about which symptoms are normal and expected and which could be cause for concern may help you become more confident. You could also tell your doctor about your specific worries to see if they have any advice. They have likely worked with many pregnant people in the past and, in addition to giving recommendations, may help you identify whether you are experiencing the normal worries of pregnancy or something that might require more attention.

If you are not pregnant but consistently interpret normal physical sensations as pregnancy symptoms, you may want to consider seeking treatment for anxiety. An extreme fear of pregnancy or giving birth may be linked to an anxiety disorder, depression, past trauma, or another psychiatric concern.

Trusting your healthcare provider

Sometimes, pregnancy worries can manifest as a lack of trust in one's doctor or health team. Finding a healthcare provider you trust and then learning to let go and trust them may reduce these worries. A person may feel less anxious about a healthcare provider if they read positive reviews of their doctor or hospital. Speaking directly to people who had positive experiences with the same healthcare team may also provide reassurance that they are experts who know what they're doing.

If you have very specific worries related to your healthcare team or pregnancy plan, it's okay to bring these up and directly discuss them with your doctor. You are not the first pregnant person to be worried about something going wrong, and speaking with your doctor might alleviate your fears.

Tips for maintaining mental health during pregnancy

If you sense your pregnancy-related worries are compromising your mental health, there are additional steps you can take to feel calmer.

Learn about women's health and pregnancy

Sometimes, people are anxious about pregnancy because they've never experienced it before and aren't knowledgeable regarding what to expect. When they have certain symptoms or experiences, they may go on high alert, thinking these symptoms signal a problem simply because they haven't learned what is normal and what isn't. 

While you generally don't want to obsessively research every symptom you have or call your doctor excessively, it can be a good idea to educate yourself on women's health and pregnancy. Read articles and books on what to expect during pregnancy. Ask questions of people you know who have been pregnant before. Speak up at your doctor’s appointments if you have concerns. Consider joining pregnancy or parenting groups for support and assurance from people going through similar experiences.

Promote good physical health

Promoting good physical health can improve mental health during pregnancy and otherwise. The Centers for Disease Control and Prevention (CDC) recommend that pregnant people continue to engage in moderately intense activity for 150 minutes per week. Examples of moderately intense activity include walking, less strenuous yoga, bicycling, and water aerobics.

Eating nutritious food can always be important, but it may be especially important during pregnancy. While many people tend to think they need to eat much more than usual during pregnancy, maintaining a healthy weight can still be vital. A pregnant person usually only needs to eat more than they used to during their second and third trimesters. According to the American College of Obstetricians and Gynecologists, an extra 340 calories may be needed per day in the second trimester, which generally comes out to about half a sandwich and a glass of skim milk.

Identify and treat anxiety disorders

Research has found that 20% or more of pregnant people may experience anxiety disorders. Identifying and treating anxiety disorders during pregnancy can be particularly important, not only for the person with the disorder but also for their unborn child. Anxiety during pregnancy can increase a person's risk of miscarriage, preeclampsia, early delivery, and a low birth weight. Children born to someone with anxiety tend to be more likely to develop behavioral problems, attention-deficit/hyperactivity disorder (ADHD), and cognitive challenges.

While worry and fear can be natural parts of pregnancy, anxiety typically becomes a disorder when it is excessive, severe, or negatively impacts your daily life. Talking to your doctor, a therapist, or both can help you identify whether you're experiencing the normal worries of pregnancy or something more serious.

When to seek therapy for pregnancy paranoia

If you’re experiencing frequent worry about getting pregnant or about the health of your pregnancy, therapy may help. Remote therapy generally allows you to meet with a therapist and discuss your worries without having to leave the comfort of home or the location of your choice. BetterHelp is a remote therapy platform that can connect you with a qualified therapist.

A 2018 systematic review of five research studies concluded that more research on anxiety during pregnancy is urgently needed. However, the study authors also noted that anxiety symptoms during pregnancy appear to improve with treatment. Therapy and medication are the two most common treatments for anxiety during pregnancy. 

While more research is needed, it seems likely that therapy can help people with their pregnancy-related fears, and studies suggest that online therapy is usually just as effective as in-person therapy.