Experiencing fear and anxiety during pregnancy

Written by: Dr Karen Joash
Published: | Updated: 30/11/2018
Edited by: Top Doctors®

Pregnancy can be an emotional rollercoaster. It’s a major life event and can bring lots of worries about relationships, work and money to the surface, as well as concerns about your baby’s health and your own. It is normal to experience anxiety during pregnancy but 95% of women will be able to cope with the right support. At the same time, health professionals need to be on the lookout for the symptoms of anxiety and depression.

Our London-based Top Doctors expert gynaecologist, Dr Karen Joash, discusses some of the disorders that pregnant women may face and explains how they can be managed…

Post-traumatic stress

Some women suffer from unresolved post-traumatic stress from a previous pregnancy where things didn’t go to plan - it’s important that women who have been through these experiences get appropriate counselling or therapy.


Some women have a deep-seated fear of pregnancy and giving birth called tokophobia, sometimes it is based on something they heard as an adolescent such as an experience of a relative or sometimes their own previous experience of birth. Symptoms can include panic attacks and psychosomatic symptoms. They need to have directed psychological therapy to address and resolve their fears and anxieties during pregnancy.

Depression during pregnancy

You’re more prone to depression during pregnancy if you’ve suffered from depression before, including post-natal depression and PMS-type monthly depression which has a hormonal basis. These women usually experience anxiety during pregnancy about taking anti-depressants because they are concerned about the effect it will have on their baby, but most types are safe to use in pregnancy, plus it’s better to treat the symptoms earlier than later. Equally, if women want to come off their medication that may be fine too in most cases, so long as they are supported with counselling and medical supervision.

Post-natal depression

Post-natal illness affects up to 10 per cent of women who have recently given birth, so it’s by no means uncommon. It usually starts in the days and weeks after giving birth; the symptoms can vary but include women becoming increasingly despondent, tearful, feeling miserable for no apparent reason, tense and snappy. They may also develop concentration problems, sleeping difficulties and sometimes obsessional and inappropriate thoughts about harming their baby. If you have these sorts of feelings it’s important to mention them to your doctor, midwife or health visitor and get appropriate help. This can include counselling and cognitive behavioural therapy techniques which can help women change the negative feelings they may experience.

Post Puerperal Psychosis (PPP)

PPP is a severe form of mental illness that affects 0.1 per cent of women who have just given birth. Each district maternity hospital will usually have one case a year and the symptoms include mania/high mood, depression, confusion, hallucinations and delusions. PPP can affect women who have never suffered from depression before. It is regarded as a psychiatric emergency and needs urgent treatment by specialists. If left untreated it can sometimes lead to suicide and/or infanticide.


Preventing these serious cases is another reason why it’s so important to monitor the mental health of women during pregnancy and those who have recently given birth. These problems are, treatable, nothing to be ashamed of, and are best treated as early as possible.

By Dr Karen Joash
Obstetrics & gynaecology

Dr Karen Joash is one of London's leading and most dedicated obstetrician and gynaecologists. She is known for her empathy, communication and personal approach to her patients and has been working in the field for over ten years. Practising at various of top clinics in the capital, including Portland Hospital, she aims to deliver care which is tailored to the needs of each individual woman. She is Director of Medical Education at Imperial College and has a track record of leading change and progression.

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