Everyone expects pregnancy to come with some worry. The books prepare you for it. The midwife reassures you about it. Friends who have been pregnant before nod knowingly and say: oh yes, I was anxious too. And so a certain amount of anxiety gets absorbed into the general texture of pregnancy — normalized, managed, waited out.

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But for many pregnant people, the anxiety is something different. It doesn't respond to reassurance. It doesn't quiet down after a good scan. It moves — from one worry to the next, always finding a new object, always one step ahead of the evidence that everything is fine. Or it settles heavily on one fear and stays there, immovable, resistant to logic.

This is the anxiety worth paying attention to. Not because something is wrong, but because something is trying to be understood.

What the Clinical Picture Misses

Anxiety during pregnancy is common enough to have its own clinical category. It is screened for, sometimes treated with therapy or medication, and often framed as a risk factor — something to be monitored for its potential effects on the developing baby.

All of that has its place. But the clinical frame tends to ask: how much anxiety is there, and how do we reduce it? It rarely asks: what is this particular person anxious about, and why?

That second question is the more interesting one. Because anxiety is not a uniform experience. It has content, and texture, and direction. It attaches itself to things — to specific fears, specific scenarios, specific people — and those attachments are not random. They are, if you are willing to look at them, a map of something.

What Pregnancy Stirs Up

Pregnancy is not only a physical event. It is a psychological one — a period in which the usual boundaries of the self become less stable, defenses that have held for years become more permeable, and feelings that have been successfully kept at a distance begin to press forward.

What often surfaces is old. The pregnant person who is terrified that something will go wrong with the baby may, underneath that terror, be someone who learned early that good things do not last — that what you love can be taken, that anticipating loss is safer than hoping. The anxiety may be less about this pregnancy specifically than about a much older and more fundamental sense of the world as an unsafe place.

The pregnant person whose anxiety is focused relentlessly on whether she will be a good mother is often someone for whom that question has deep roots. What kind of mother did she have? What did she receive, and what was withheld? What did she swear she would do differently, and what does it mean to her that she might not? The worry is about the future — but it is being generated by something formed much earlier, an idea about how the world works, about what can be expected, about whether she and the people she loves are safe. That idea was created in the past. But it is not in the past. It is here, now, running quietly beneath the surface of the pregnancy, shaping what she fears and how much she fears it.

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This is not to say that every anxious pregnant person has had a difficult childhood, or that the anxiety is always pointing somewhere dramatic. Sometimes it is pointing toward something more immediate — a relationship that feels uncertain, an ambivalence about the pregnancy itself that has had no space to be acknowledged, a fear of losing the self that exists before the baby arrives. These are ordinary and important things. But they need to be asked about.

What the Worry Attaches To

One of the most useful clinical questions in the face of pregnancy anxiety is deceptively simple: what, exactly, are you afraid of?

Not the general answer — something going wrong, the baby being hurt, not coping — but the specific, almost embarrassing particular. The image that comes at three in the morning. The scenario that the mind keeps returning to. The fear that feels too strange or too revealing to say out loud.

Because the specific content of the anxiety often contains, in condensed form, something that the person has not yet been able to think directly. The pregnant person who is consumed by fear of the birth itself may be someone for whom surrender of control — of the body, of what happens next — is unbearable in a way that has nothing to do with obstetrics. The one who cannot stop researching fetal abnormalities may be someone who experiences not-knowing as fundamentally threatening, for reasons worth exploring. The one whose anxiety circles endlessly around the partner — will he be there, will he cope, will he stay — may be someone for whom the question of being held has always been the central question.

The worry finds something to fasten onto. And what it fastens onto is worth being curious about.

Ambivalence and the Anxiety It Produces

There is another source of pregnancy anxiety that is almost never named: ambivalence about the pregnancy itself.

The expectation is that a wanted pregnancy will be experienced as wanted, fully and without complication. But wanting something and having complicated feelings about it are not mutually exclusive. A pregnancy can be deeply desired and also frightening, also grieved, also resented at moments, also the occasion for a kind of mourning — for the life that is ending, for the self that will not survive intact, for the freedom that is already beginning to close.

When this ambivalence has no place to go — when it cannot be spoken because it feels too dangerous, too ungrateful, too much at odds with the story of joyful expectancy — it tends to convert. It becomes anxiety. The hostility or ambivalence that cannot be felt directly finds a more acceptable form: not “I am not sure I want this” but “I am terrified something will go wrong.” Not ”I am angry about what I am losing” but “I cannot stop worrying about the birth.”

This is not a criticism of the person feeling it. It is simply what the mind does with feelings that have nowhere else to go.

When the Body Becomes the Object of Fear

For some pregnant people, the anxiety is located in the body itself — in the strangeness of being inhabited, of no longer being fully one's own. The body is doing something enormous and largely outside of conscious control. It is changing in ways that cannot be undone. It belongs, in some sense, to the pregnancy now.

For people who have a complicated relationship with their bodies — who have worked hard to feel at home in them, or who have experienced their bodies as sites of pain, violation, or unreliability — this loss of sovereignty can be profound. The anxiety is not irrational. It is a response to something real: the self is being reorganized, from the inside, without being asked.

This particular form of pregnancy anxiety rarely appears on a screening tool. It is not easily captured by questions about worry frequency or sleep disturbance. It needs to be asked about in a different register — with curiosity about what the pregnancy feels like to inhabit, what the body feels like, what it means to this person to be changed in this way.

More Than a Risk Factor

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Pregnancy anxiety is real, and when it is severe, it deserves prompt and skilled attention. But it is also, always, a communication. It is the psyche registering something — about the past, about the present, about what is feared and what is longed for — in the only language available to it at that moment.

The goal of treatment, from this perspective, is not only to reduce the anxiety — though relief matters, and suffering matters. It is also to understand what the anxiety has been trying to say. To follow it back to its sources. To give it somewhere to go other than the next thing to worry about.

When that happens, something usually shifts — not because the anxiety was conquered, but because what it was carrying finally had somewhere to land.

Start Working With A Postpartum Anxiety Therapist in Washington, DC

If your worry during pregnancy feels like more than the usual kind — if it won't respond to reassurance, or keeps finding new things to attach to — that is worth paying attention to. I'd welcome the conversation. You can start your therapy journey with Nina Van Sant, LICSW by following these simple steps:

Schedule a consultation
Meet with a caring therapist
Start finding the reassurance you deserve!

Other Services Offered with Nina Van Sant, LICSW

Postpartum therapy is not the only service offered at Nina Van Sant, LICSW. I’m happy to offer multiple services to support clients in better self-understanding and lasting healing. Other services offered include psychoanalysis, infertility-related stress, psychodynamic therapy, and therapy for teens and older adults at different developmental stages. I also work with expats and international professionals who are managing cultural adjustment, relocation stress, and the emotional weight of significant life changes.

Pregnancy Anxiety: When Worry During Pregnancy Is More Than Normal