I must begin by saying that this is a long one; clearly anxiety was a very big deal in PAL! I must also say that this post doesn’t go into what I did to manage my anxiety, as I want to do that justice elsewhere. This is just me trying to make sense of what it really meant to feel the fear of PAL and how it manifested for me personally.
I would estimate that about 99% of the clients I have worked with throughout my career experience some form of anxiety, whether that be by itself or alongside depression and / or other mental health difficulties. I feel confident in talking about the origins and functions of anxiety, ways in which to understand and manage the symptoms using some basic strategies, as well as some more complex and exploratory therapy techniques. I had anxiety in the bag.
And then I experienced pregnancy after loss.
I thought I knew anxiety having experienced it on many occasions in different circumstances. I understood the stomach flipping, hands shaking, heart beating faster, mind spinning, difficulty thinking / talking / functioning that comes with being fearful. I understood the, sometimes catastrophic, interpretations I would make of situations and how this exacerbated these feelings. But what I didn’t understand was what it would be like to exist in a state of anxiety every single day. For almost every single minute of every single day. And reassurance was often short lived and in the moment – and for me, worked less effectively and for less time as pregnancy progressed.
If we take it back, I am sure that we are all aware that anxiety serves a very important function in an evolutionary sense. It helps to protect us, to enable us to act in situations of real threat: to fight that sabre tooth tiger or to run like the wind to get away (that would always be my default since I am a lover not a fighter). The classic ‘fight-flight’ response. We have all experienced that moment of complete terror when we have accidentally stepped into the road too soon, only to jump immediately backwards to get out of the way of a passing car that we didn’t see until it sped around the corner. The fast breathing, heart pounding, legs shaking that takes a few minutes to recover from. We have all had the sense of trepidation before doing something important or scary: taking exams, public speaking, interviews or white water rafting (for which I definitely need some therapy to recover from). Anxiety is functional in that it has kept us alive as a species and can motivate us to achieve and succeed. Yet in modern life, it often misfires when it is not actually required.
From a cognitive behavioural therapy (CBT) perspective, in therapy we would look at the automatic thoughts that pop into your mind or the interpretations you make of any given situation and see how these cause or maintain the cycle of anxiety. The thoughts may precede the physical and emotional response, or they may come afterwards. However, what is key is that they are all interlinked and cause a big vicious cycle of perpetual anxiety – what CBT therapists call a ‘hot cross bun’:
Of course, this is more often than not just the start of working with anxiety. I like to think of this as the beginnings of understanding anxiety in the ‘here and now’ and learning to build a toolkit to manage these symptoms (i.e. manage the overwhelming thoughts and interpretations and physical responses). These can take the edge away from what is a scary and very physiological experience and can help you to feel a little more in control. Yet, there is often an underlying cause of anxiety that requires a lot more exploration: previous traumas, childhood experiences, underlying schemas as a result of these experiences. This will inevitably take longer to develop an understanding of, and different strategies to overcome, but it is possible. And as much as I would like to talk in lots of detail about my favourite type of therapy (schema), I won’t be able to do it justice and will talk too much through my over excitement. All I will say is that when I refer to schemas, I am referring to broad, pervasive themes about yourself and your relationships to others that are developed during childhood and elaborated throughout your life.
But back to PAL and my experience of anxiety during this time (because of course, everyone’s experience is as unique as them). As soon as I took that first positive test, the anxiety hit me at full force; to have overwhelming joy alongside intense and overwhelming anxiety is incredibly confusing and something I have never before experienced. The happiness that we were able to fall pregnant again so quickly and that we may be lucky enough to take a baby home existed in stark contrast to the fear that we would lose another baby. This was our third pregnancy in 16 months and we had experienced first-hand how this can end in emergency surgery, removal of fallopian tubes and the death of a healthy full term baby. Not all pregnancies result in a live healthy baby and we had learnt that the hard way.
I would say that anxiety / fear / terror / traumatic / pure blind panic are the words that I would use to best describe my own PAL journey. It was the overriding emotion and the vast majority of my thoughts consisted of some form of anxious premonition of something terrible occurring. Looking back, it is interesting to see how it manifested for me day to day and the impact it had on my ability to function. It hung around my neck and shoulders like a lead weight and consumed almost every waking thought. Yet to the outside world, I am sure I looked like a fairly functioning human being (I hope). Inside however was a completely different story and carrying this each and every day was gruelling – and this is on top of the ‘normal’ fatigue and aches and pains of pregnancy, of which I was going through my second full term pregnancy in less than a year.
This is by no means exhaustive, but a summary of some of my key worries:
- I worried about walking too much or pushing myself too hard at yoga, yet I also fretted about not exercising enough
- I worried about what I ate: should I eat the same things as I did in my first pregnancy or should I try and change everything?
- I felt confronted by risks all around me: on my morning commute, I would visualise the train stopping suddenly and people falling into me; walking down the road I had intrusive thoughts of tripping and landing on my bump
- I feared that the clothes I wore might be too restrictive and would hurt the baby
- I felt unable to think clearly or make decisions, normally about meaningless tasks
- I became almost obsessive about the baby’s movements, focussing on this pretty much all of the time
- However, I did not feel able to trust my own judgements or perceptions of movements and needed reassurance that everything was okay
- I was fearful of asking for help and reassurance through fear of 1) being told again that there was no heartbeat and 2) being seen as overreacting or a nuisance (and therefore weak and pathetic)
- I needed to be reassured and supported in asking for help (e.g. calling my midwife so that she could tell me to go to MAU for monitoring)
- I worried about going to sleep at night, terrified that our baby would get into distress and I wouldn’t even know
- Upon waking, my initial thought would always be ‘has the baby died’ and I would not be able to rest again until I had felt significant movement. This could result in being awake for a while, having to get up or moving / poking in order to wake baby up
- When distracted, for example in a meeting at work, suddenly having an intrusive thought (‘Have you felt the baby move? What if they have died?) and feeling the blood drain from my face. Completely switching off to what is going on around me until I could feel some reassuring movement
- And when things became all too much, completely detaching and shutting off from my emotions
- I avoided socialising in large groups and very rarely went out at night
- And when I did need to engage with activities, I spent the majority of the time fighting worrying thoughts and the rest of the time focussing on trying to be ‘normal’
Every aspect of daily life carried with it a potential risk and huge fear – and learning how to navigate these, challenge unhelpful thinking and try to engage with everyday life was exhausting. Gruelling even. And it was these things that would trigger that vicious cycle of anxious thoughts, feelings and sometimes unhelpful responses.
It was often the smaller things that I found more challenging: choosing which brand of aspirin or pregnancy vitamin to take took me hours and visits to multiple drug stores (being in the States for the first trimester did not help matters with their different drug dosages); choosing clothes to wear each day or what meals to have. The bigger decisions, in particular those that I would make at work, seemed a lot easier, maybe because they were less intrinsically linked with our baby. But to think that I could function pretty well, in fact very productively, at work and yet spend hours standing in a shop aisle feels very unlike me.
From a CBT perspective, I have thought about the types of unhelpful thinking patterns (dysfunctional thinking patterns / negative automatic thoughts etc.) I experienced, including:
- Predicting the future (negatively)
- Catastrophizing (not feeling the baby move for short periods of time = my baby has died)
- Jumping to conclusions (it’s all going to go wrong again)
- Emotional reasoning (I feel scared, therefore there is something to be scared of)
- All or nothing thinking etc. etc.
And I was able to challenge them and come to a more balanced alternative a lot of the time. But this was hard work. I mean really hard. Because I guess what I hadn’t appreciated is that anxiety can be there all of the time and therefore you have to work hard all of the time to manage it. Of course, it does get easier sometimes – but it can also sometimes get harder. And you never know when those triggers will occur and those waves are going to crash. Moreover, when you have suffered a trauma, these thoughts are based in reality: something really bad has happened before; but you need to train your mind to believe that it won’t necessarily happen again.
From a schema perspective, PAL triggered all sorts of underlying beliefs about myself. I am someone who is a ‘perfectionist overcontroller’: I manage my anxiety by overcompensating and trying to control everything and ‘get it right’ in order to avoid things going wrong or being criticised. I am someone who feels overwhelming responsibility for the feelings of others, so it exacerbated the already huge sense of responsibility I felt for this baby and how the potential loss of him/her would impact on family and friends. I felt like a burden and that if I lost another baby, people would begin to tire of me and my needs. Anxiety in PAL triggered all sorts of underlying aspects of my personality and functioning that isn’t necessarily functional at all.
For me, the anxiety in PAL was gruelling. It intruded on my thoughts, it caused my body to surge with cortisol and it impacted on my actions and reactions. It resurrected and exacerbated the anxiety of grief and loss and triggered parts of my personality that I know are not always helpful and are certainly not self-compassionate. It was visceral and all-consuming. And it was a small insight into what I have seen clients present with in my sessions and what they have to endure.
I will do a whole other post on how I managed these intense feelings in PAL as I feel that warrants a space of its own. For now, I am slowly trying to pick apart these last few months and make sense of what these experiences have been for me: remembering them, how they manifested and why life felt so bloody hard at times. In doing this however, although I know that this is a helpful start, I will at some point want to find someone to do this with in therapy. However, as you can probably imagine, psychologists often make the most challenging of clients, so I will need to do my research to find the best fit for me!