For my May 2024 Blog, I decided to research a topic I’ve been interested in for close to two decades. If you tally up my internship year, my time working in community mental health, and my two years in private practice, I’ve been completing intake assessments for nearly eighteen years!

An intake assessment or “intake” refers to the initial session and paperwork at the start of treatment. Among other things, this documentation includes the client’s presenting issues, their family, social and mental health history, a complete risk assessment, current symptoms, diagnosis, and treatment recommendations.

· “Do you recall unusually high stress levels during your pregnancy?”

· “Did you experience excessive anxiety or distress during your pregnancy or shortly after the birth?”

· “Did you have a period of the blues after your child was born? Were you diagnosed with Postpartum-Depression?”

I’ve undoubtedly asked these types of questions hundreds of times to new mothers and to the biological parents of youth clients. I further gathered this information, when privy to birth history, from adoptive parents, caregivers, foster parents and DCYF assigned Social Workers. Gathering this information was a required part of our community mental health intake documentation. I believe it falls under Washington Administrative Code (WAC), 246-341-0640, which states that behavioral health agencies are responsible for intakes that consider “the individual's relevant behavioral and physical health history...”

I might not have been aware of precise details, but I knew excess anxiety in pregnancy can have detrimental outcomes on the pregnancy and fetal development. For instance, women in high stress occupations have a higher risk of preterm delivery. When anxiety is high, cortisol and adrenaline are released, and naturally, that would affect a growing fetus. If the fetus was continually exposed to high levels of these hormones, it would likely predispose them to mental health and/or other behavioral health conditions in childhood and potentially also throughout their life.

In all my years practicing in community mental health, the implications of stress and anxiety during pregnancy was not always addressed. While the information was dutifully collected, it was not frequently acknowledged. This was particularly true in childhood and adolescent cases.

After having a pregnancy where I was affected by high anxiety myself, I began contemplating these questions even more. I noticed feeling differently when asking them during intakes and I realized I was feeling both “mom-guilt” and shame. I was harboring fear that I had hurt my son during his fetal development—that I could or should have done more to protect him.

Mom-guilt is a lingering feeling of inadequacy or doubt experienced by mothers often stemming from not meeting personal expectations regarding parenting. It can be incredibly overwhelming and persistent, affecting a mother’s mental and emotional well-being. While it is called “mom-guilt,” this feeling regularly includes both guilt (I’ve failed or I’ve done something wrong) and shame (I’m flawed, unworthy, or defective).

My son turned five-years-old in March 2024. I have apprehensively avoided this topic for far too long. Let’s finally delve into the research:

Anxiety during pregnancy is a common experience for many expectant mothers, but when anxiety levels are consistently high, it can have significant implications for both the mother and the developing fetus. Understanding the effects of maternal anxiety before and after pregnancy is crucial for promoting maternal and child health.

Before and During Pregnancy:

1. Conception & Early Development: Research suggests that maternal anxiety even before conception can affect fetal development. High levels of stress hormones in the body can disrupt the delicate hormonal balance necessary for conception. Additionally, anxiety before pregnancy may contribute to irregular menstrual cycles, which can impact fertility.

2. Epigenetic Changes: Studies have shown that maternal stress and anxiety can result in epigenetic changes, altering the expression of genes involved in stress regulation and emotional development in the fetus. These changes can have long-lasting effects on the child's susceptibility to anxiety and mood disorders later in life.

3. Prenatal Programming: The prenatal environment plays a crucial role in programming the fetus for life outside the womb. Maternal anxiety can lead to increased levels of cortisol, the stress hormone, which can cross the placenta and affect fetal development. This may result in altered brain development, impaired immune function, and an increased risk of behavioral and emotional problems in childhood.

4. Impact on Fetal Development: High levels of maternal anxiety during pregnancy have been linked to adverse outcomes such as low birth weight, preterm birth, and developmental delays. Chronic stress during pregnancy can also lead to alterations in the fetal stress response system, potentially predisposing the child to anxiety and mood disorders later in life.

Early Postpartum:

1. Maternal-Infant Bonding: Maternal anxiety can affect the quality of the mother-infant bond, influencing the baby's emotional development and attachment patterns. Mothers who experience high levels of anxiety may have difficulty bonding with their infants, leading to insecure attachment styles and potential emotional problems for the child.

2. Postpartum Mental Health: Maternal anxiety doesn't necessarily dissipate after childbirth; in fact, it may persist or even intensify in the postpartum period. Postpartum anxiety can interfere with maternal-infant interactions, breastfeeding, and overall maternal well-being, impacting the child's emotional and cognitive development.

Delayed Postpartum and After:

1. Childhood Development: The effects of maternal anxiety can extend into childhood and beyond. Children born to mothers who experienced high levels of anxiety during pregnancy may be at increased risk of anxiety disorders, attention deficits, and behavioral problems.

2. Parenting Style: Maternal anxiety can influence parenting styles, with anxious mothers often displaying overprotective or controlling behaviors. This can affect the child's autonomy, self-esteem, and ability to regulate emotions.

Okay—all of this research spells out virtually exactly what I expected. So, my next question is, where is the silver lining in all of this? Because, today, there is absolutely nothing I can do about my pregnancy and postpartum anxiety five years ago! There is a quote I like by an unknown author that reads, “You can’t go back and change the beginning, but you CAN start where you are and change the ending.”

Let’s now look into research on what parents/caregivers can do to help recondition and support healthy brain development in children.

Now we know that maternal anxiety during pregnancy can have a profound impact on both the mother and the unborn child. The research does suggest that high levels of maternal stress can influence fetal development and may even affect the child's long-term emotional and cognitive well-being. However, once the child is born, there are steps parents/caregivers can take to mitigate the effects of maternal anxiety and foster a nurturing environment for their little one.

1. Seek Support: Acknowledge that maternal anxiety is common and seeking support is essential. Surround yourself with understanding family members, friends, and healthcare professionals who can provide guidance, empathy, and assistance.

2. Practice Self-Care: Remember that taking care of yourself is crucial for both you and your child. Engage in activities that promote relaxation and reduce stress, such as meditation, gentle exercise, deep breathing exercises, or pursuing hobbies you enjoy.

3. Bonding and Attachment: Building a strong bond with your child is vital for their emotional development. Spend quality time with your baby through cuddling, skin-to-skin contact, and engaging in soothing activities like singing or reading to them.

4. Promote Stability: Establishing a predictable routine can provide a sense of security for both you and your child. Create a consistent schedule for feeding, sleeping, and playtime, as it helps regulate your baby's internal clock and reduces stress for both of you.

5. Healthy Communication: Be mindful of the way you communicate with your child. Offer reassurance, comfort, and positive affirmations regularly. Avoid expressing anxiety or stress in front of your child, as they can pick up on your emotions and may become anxious themselves.

6. Create a Calm Environment: Surround your child with a peaceful and nurturing environment. Keep noise levels low, minimize exposure to screens and stimulating activities, and create a cozy and safe space for your baby to rest and play.

7. Practice Mindful Parenting: Stay present and attentive to your child's needs. Respond to their cues with sensitivity and empathy, and practice active listening during interactions. Mindful parenting promotes a secure attachment and helps regulate your child's emotions.

8. Seek Professional Help if Needed: If you're struggling to cope with maternal anxiety or notice concerning signs in your child's behavior, don't hesitate to seek professional help. Therapy, support groups, or counseling can provide valuable resources and strategies for managing anxiety and promoting your child's well-being.

Conclusion:

There are two types of anxiety, necessary anxiety, and unnecessary anxiety. Necessary anxiety serves a purpose by alerting us to potential threats or challenges, motivating us to take appropriate action. For example, feeling anxious before an important presentation may prompt us to prepare thoroughly. Unnecessary anxiety, on the other hand, is excessive and disproportionate to the situation. It may not serve any productive purpose and can interfere with daily functioning. This type of anxiety may arise from irrational fears or worries about hypothetical or unlikely scenarios, leading to unnecessary distress and impairment in various areas of life.

It would be easy for me to rationalize my pre and postnatal anxiety as entirely necessary anxiety. Yet, if I’m being entirely honest with myself, portions of my anxiety were unnecessary. I could have made a choice to ease my distress. But, as many would say, “hindsight is 20/20.” I was doing my best, at that moment in time, with the information I had then.

Research provides valuable data and correlations, but it’s important to recognize that it often doesn’t offer absolute proof of causation; instead, it suggests relationships and trends based on the numbers collected. Blaming yourself for something without concrete evidence of causation can be unproductive, especially when the outcome is beyond your control. It’s important to focus on what you can influence and learn from the situation rather than dwelling on self-blame.

While prenatal anxiety can potentially affect brain development, there's evidence to suggest that supportive environments, early interventions, and positive experiences post-birth can help support healthy brain development in children. Strategies such as providing nurturing care, engaging in enriching activities, and fostering secure attachments can all contribute to mitigating the effects of prenatal anxiety on a child's development. Additionally, seeking guidance from healthcare professionals specializing in child development can offer tailored support and interventions.