The bumpy road to motherhood: anxiety crises and pregnancy planning

Family planning is one of the most exciting times in life. However, for women suffering from panic disorders, this journey can be clouded by fears and additional difficulties. How to reconcile panic attacks and the desire to become a mother? How to go through pregnancy and IVF protocols while preserving mental health? In our blog, we addressed the issue of panic attacks: symptoms, causes, and strategies to overcome them.

This article aims to provide helpful information and shed light on the key aspects of this issue.

Important note: the information contained in this article does not replace consultation with a specialist. If you are considering pregnancy while suffering from panic disorders, it is essential to work closely with your primary care physician, psychotherapist, gynecologist, and, if necessary, your fertility specialist.

1. Panic attacks before pregnancy: preparation phase

Good planning is the key to success. If you suffer from panic attacks and are preparing to conceive a child, the first and most important step is prenatal preparation.

• Consultation with doctors:
  • Psychotherapist/psychiatrist: Discuss your plans. The most urgent issue is medication treatment. Many drugs used to relieve panic attacks (especially certain tranquilizers and antidepressants) are incompatible with pregnancy due to teratogenic risk (risk to the fetus).
  • Adjustment of treatment: The doctor may suggest several options:
    1. Gradual discontinuation of medications and substitution with psychotherapy (for example, cognitive-behavioral therapy).
    2. Switching to safer medications compatible with pregnancy, even before conception.
    3. Developing a “Plan B” in case of aggravation.
• Learning self-help techniques: this is your main tool. Breathing exercises, muscle relaxation techniques, meditation, and mindfulness will help you manage your anxiety without medication.
• Improving lifestyle: normalizing sleep, maintaining a balanced diet, and engaging in moderate physical activity (yoga, swimming) reduce overall anxiety levels.

2. Panic attacks and natural pregnancy

The fear of the unknown is the main trigger of panic attacks during pregnancy. “Will the attack harm the baby?”, “How will I manage childbirth?”, “What if I can't take medications?”

• Hormonal “fluctuations”: pregnancy causes a powerful hormonal upheaval (increased levels of progesterone and estrogens), which can influence emotional state. In some women, panic attack symptoms paradoxically decrease, while in others, they worsen.
• Impact on the fetus: a panic attack (accelerated heartbeat, shortness of breath) is short-lived and does not directly harm the fetus. The danger lies in chronic high levels of anxiety and stress. Constant release of cortisol (the stress hormone) can be associated with risks of premature birth or low birth weight.
• Managing the condition: The main goal is to prevent acute panic from turning into chronic anxiety. For this, relaxation techniques, support from loved ones, and regular sessions with a psychotherapist are helpful.

3. Panic attacks and IVF protocols (in vitro fertilization)

The IVF process is an endurance marathon, both physically and psychologically. For a woman suffering from panic disorders, it is a double challenge.

• Stress source #1: hormones. Stimulation protocols involve taking high doses of hormonal medications. These have a direct effect on the nervous system and can cause mood swings, tearfulness, and aggravation of anxiety disorders.
• Stress source #2: uncertainty. The entire IVF process is a series of waiting periods: “Will the follicles develop?”, “Will the eggs be fertilized?”, “Will the embryo implant?”. Each step is a potential trigger for panic.
• Stress source #3: procedures. Follicular aspiration, embryo transfer, regular ultrasounds, and blood tests: all these medical manipulations can themselves provoke fear and anxiety.

What to do?

• Information: discuss all stages in advance with your gynecologist. Understanding what is happening in your body reduces fear.
• Psychological support: the Natuvitro reproductive medicine clinic helps people become parents despite various difficulties. Our clinic has psychologists specialized in reproductive issues. Do not neglect this help.
• “Gentle mode”: as much as possible, minimize other stress factors (work, conflicts) during the protocol period.
• Partnership: your partner's support is more important than ever during this time.

4. Panic attacks during pregnancy (development of the topic)

If pregnancy has occurred (naturally or via IVF) and panic attacks persist, a difficult period of balance begins.

• Fear of childbirth (tocophobia): towards the third trimester, a panic fear of childbirth can develop. It is important to work on this fear with a psychologist.
• Medication question: if panic attacks become uncontrollable and disrupt normal life, the doctor (psychiatrist in collaboration with the gynecologist) may consider prescribing medications. There are antidepressants (mainly SSRIs) considered relatively safe during the second and third trimesters. The decision is always made on a case-by-case basis, evaluating the risk of taking the medication versus the risk of the mother's serious condition.
• Non-drug methods: therapy remains the priority. Cognitive-behavioral therapy has proven effective in treating panic attacks and helps modify thoughts and reactions to fear.

5. Panic attacks after pregnancy (postpartum period)

The birth of a child is not only a source of joy but also enormous stress for the body and psyche.

• Sudden hormonal drop: immediately after childbirth, estrogen and progesterone levels plummet, which can trigger emotional instability.
• New triggers:
  • Lack of sleep: chronic sleep deprivation exhausts the nervous system.
  • Hyperresponsibility: fear for the baby's life and health (“Is he breathing?”, “Why is he crying?”).
  • Physical recovery: pain after childbirth or C-section.
• Postpartum anxiety and panic attacks: This state is often mistaken for postpartum depression, but it is characterized less by depression and more by constant concern, obsessive thoughts, and sudden panic episodes.
• Importance of help: do not stay alone in this situation, attributing everything to “fatigue” or “baby blues.” If panic prevents you from caring for your child and enjoying motherhood, seek medical help immediately. Treatments (therapy and, if necessary, medications compatible with breastfeeding) are effective.

Conclusion: you are not alone

The path to motherhood with a panic disorder is difficult but achievable. Your main allies in this journey are awareness, planning, and a support team.

1. Do not fear doctors: find specialists who understand your problem and are willing to work in tandem (gynecologist + psychotherapist).
2. Acquire skills: psychotherapy and relaxation techniques are your foundations.
3. Do not stay silent: talk about your fears with your partner, loved ones, and your doctors.

Take care of yourself: abandon the perfectionism of the “ideal pregnancy.” You have your own particularities, and taking care of your mental health is also caring for your future baby.