Managing the Scary What If’s of Pregnancy and Delivery

It is official, I have reached 30 weeks pregnant with my twin girls. I have been extremely fortunate to not have any major concerns. But, now that I have hit the 30 week mark, I am higher risk for pre-term delivery. This is something I think about often. Like most new moms, the delivery portion of the pregnancy is the scariest part. Unfortunately, when I was in nursing school all you every learn about is the bad things that can happen during child birth. As as psych nurse I try to be mindful of my thoughts, and look to psych theory for guidance. I have been trying to implement some concepts from CBT and DBT to reframe my thinking, keep a more positive mindset going into delivery and reduce my current anxiety level. Two main exercises I use are:

1. Challenging negative thoughts – This comes from CBT. Generally, we start with an initial thought such as thinking about complications i.e. eclampsia, placenta accreta, postpartum haemorrhage etc. These thoughts lead  to feelings of anxiety and fear, which can cause body sensations such as rapid heart rate, and nausea. These feelings and sensations then cascade into behaviours such as social isolation, and crying. This cycle will then perpetuate more negative thoughts, which will dominate your day and cause a negative view on the pregnancy and delivery.By challenging the negative thoughts, we can change the cycle into a more positive reaction. For me, I think about severe postpartum haemorrhage leading to disablement or death, but I challenge the thoughts by first looking at the facts. Postpartum haemorrhage is very rare to develop to the point of causing death. I will have a number of very qualified medical professional taking care of me to prevent this complication. I know tons of women who has given birth, but none of them have suffered severe impairment due to postpartum haemorrhage. Therefore, although this is a real delivery complication, I cannot give it too much weight, as it is unlikely to happen. By creating a more realistic and balanced thought, it helps to change the negative cascade related to being stuck on this thought. Challenging negative thoughts takes practice, and is not always easy. But the more often you do it the more able you are to stop negative thoughts in their tracks before they become overwhelming.
2. Radical acceptance – This one is my favourite and comes from DBT. Radical acceptance means to acknowledge reality, and stop fighting against what we cannot change. Another fear I have is of not having control during delivery. With a twin delivery, there is a higher risk for C-section, and additional delivery interventions. This prevents many twin moms from being able to fulfill their birth plan. Instead of trying to fight to implement a detailed birth plan, I am trying to practice radical acceptance. I am acknowledging the reality that how my twins are born will be out of my control, and I am safest to follow my OBGYN’s medical recommendations to ensure the safety of my babies and myself. Much like challenging negative thoughts, when I am confronted with things in my pregnancy I cannot change, I try to stop in the moment, accept the reality of the situation, and find solutions within those parameters.

As I continue through the next few weeks, I will keep these in my mental toolbox to help relieve some of my anxiety and stress related to childbirth. Everyone needs to find the strategies that work best for them, these are strategies I have learned in my practice as a psych nurse, and hope they can help someone else during pregnancy. But, it is important to note, to always report your mental health symptoms to your healthcare provider. Some anxiety and changes in mood are expected with the changes happening in and around you during pregnancy, but if it feels as though your mental health symptoms are overwhelming and consume the majority of your day, seek medical advice and reach out for help. Untreated mental illness during pregnancy will not only have an impact on the mother, but also the baby. Pregnancy is a great time to put more focus on your health and wellbeing.

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