Dr. Aimee interviews Dr. Alice Domar, Executive Director of the Domar Center for Mind Body Health

How to Deal With Pregnancy Anxiety After A Miscarriage or Infertility

Just being pregnant can put your anxiety circuits into overdrive — even if you haven’t had any fertility issues or faced a pregnancy loss. Everything in your world is changing, including your body, your relationships with other people, and drum roll, please, your entire future! Yes, its true, but it’s also an amazing and wonderful passage to embrace. I also know that for women who have faced a pregnancy loss or infertility that pregnancy, especially the first trimester, can be really really challenging.

That’s why I recently sat down with Dr. Alice Domar, a cognitive behavior psychologist and a pioneer in the field of Mind/Body medicine. As executive director of the Domar Center for Mind/Body Health at Boston IVF, and an associate professor at Harvard Medical School, she conducts on-going ground-breaking research which focuses on the relationship between stress and infertility. Her new book is called Finding Calm for the Expectant Mom. It’s about how to find ways to counteract stress, put your anxieties into perspective, and bring peace to your pregnancy. It also includes some fun quizzes, stories of women with whom Dr. Domar has worked, advice, and mind-body techniques that can relieve stress, anxiety and moodiness. Here are some quick tidbits from the book… what busy about-to-be mom can’t use that?

EW: What was the motivation behind your latest book?

Many of my patients completely spiral out of control with anxiety. For example, one of my infertility patients who recently found out that she was pregnant wrote me an email saying, “I thought I’d be really happy and excited, but I’m feeling terrified!” I wrote her right back and said, “That means you’re normal!” When you get pregnant after infertility or a pregnancy loss, the stakes are so much higher because it’s now tangible and you feel like you could lose it. It’s completely understandable why it feels so scary.

EW: What do you recommend to these patients?

I recommend a buffet of techniques to help you relax. I would never tell a patient: you have to do this one thing or program to feel better. Everyone is different and needs a personalized approach. But overall, I would recommend some form of relaxation every day. Try meditation, try mindfulness, try progressive muscle relaxation and try yoga. Keep on trying something until you find something that feels comfortable to you. Studies have shown that these techniques will help you to relieve your anxiety.

EW: Where’s the first place to start?

Let’s focus on what you can control. You can control your anxiety by learning relaxation techniques and other stress management modalities. You can’t control the genetic makeup of your baby. It’s very hard to be pregnant because you feel so out of control. So let’s focus on the things that we know can have an impact and the things that you can control.

EW: In your book, you recommend a combination of physical exercise and psychological exercises to help with anxiety. What are they?

Through my conversations with patients who have needed to reduce stress, I saw nine different ways to approach it. Four of them are physical and five of them are psychological.

The Four Physical Techniques:

1. Relaxation Techniques: meditation, progressive muscle relaxation or yoga.
2. Mini-relaxation: Breathing techniques.
3. Exercise. Studies show that physical exercise is probably the most powerful antidote to anxiety and depression that we know. As long as your OB-GYN is comfortable with you exercising during pregnancy then taking a good long walk or going for a swim or a bike ride are the best things to do to make you feel psychologically healthier.
4. Nutrition. Women and food are a very anxiety provoking equation. We teach our patients what we call the 80–20 plan. Eighty percent of what you eat should be good for you — i.e whole grains, nuts, fruits and veggies. The other twenty percent can be the whoopie pies that you’re craving!

The Five Psychological Approaches include:

1. Cognitive Restructuring. This means challenging automatic negative thought patterns. For example, try to change the thought, “I’m gonna miscarry!” to “I’m pregnant now! All my numbers look good. I’m hopeful for that future.” It’s not Pollyanna thinking. It’s just repeating true statements.
2. Social Support: If you’re pregnant after a miscarriage, the best person to talk to is someone who just had a baby who had a miscarriage in a previous pregnancy. Or commiserate with someone who is also pregnant after a miscarriage. Just sharing your feelings will help you feel calmer. There is strength in numbers.
3. Emotional Expression: Contrary to popular belief, talking about your fears is not nearly as effective as writing about them. If you keep a journal and write down everything that’s going through your head, it’s not just cathartic, but it gives you insight into what your fears are. And then, you can let them go! The psychologist James Pennebaker has done incredible research on the power of writing about trauma, and how writing about it leads to better emotional health.
4. Self Nurturance: Women are not good at meeting their own needs. A good place to start self nurturance is to wake up every morning and think: what do I need? How can I treat myself with the same love and compassion as I treat people in my life? This is a very hard lesson for most women to learn. When women get pregnant they tend to only think about what the baby needs. I’m like, “Hey, Hello! What do YOU need?” Pregnancy is a great time to start learning that because once that baby arrives, you’re gonna get gobsmacked. You have to learn some of these self nurturing skills when you’re pregnant.
5. Avoid Perfectionism: Today if you talk to a pregnant woman, she’s worried that if she looks at a can of tuna fish, her kid is gonna have two heads. I keep telling my patients, “You know what? Your mother probably smoked and drank the whole time she was pregnant with you and you seem fine.” Fetuses are more resilient than the media’s leading people to believe. I would not tell a pregnant women to go get a drink, but if she had a drink before she found out she was pregnant, it’s really not cause for concern.

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