I’m constantly worried I’ll have a miscarriage. What’s going on?

For some, finding out that you’re pregnant brings an immense amount of joy. But often, that’s not the only emotion involved—even when you want to have a child. Worry, fear, and anxiety can arise at any point in pregnancy, and no matter how healthy your pregnancy is, a preoccupation with miscarriage can take hold. And fear of pregnancy loss doesn’t discriminate—it can affect a first-time mom in her 20s who dreamed of starting a family since she was old enough to play with dolls, or an expectant mother in her 40s who conceived after years of fertility treatments and failed attempts. 

The early days of pregnancy can feel especially fragile, with fear of miscarriage being most common in the first trimester (although the worry can linger for longer). During those early days, most women also know the chances of miscarriage are higher. The statistics surrounding miscarriage don’t help, with some figures stating that about 10 to 20% of all pregnancies end in miscarriage.

While feeling protective over the health of your pregnancy is entirely understandable, it’s important to take stock of how you’re coping with the fear of miscarriage. 

Does the fear seem to overpower you, hijacking your thoughts for many hours a day? Does the slightest sight of discharge when you are using the bathroom send you spiraling with thoughts that something has gone wrong? Do ultrasound appointments and fetal heartbeat monitors and other tools have an outsized place in your pregnancy journey? Are you constantly asking others for reassurance about anything that feels “off”?

Again, there’s no one right way to cope with pregnancy anxiety. But when fear of miscarrying interferes with every facet of your life, there’s great benefit to knowing if something beyond normal “pregnancy jitters” is at play—so you can get the help you deserve. Let’s explore this further. 

Is a mental health issue playing a role in your fears of miscarriage?

Studies show that 20 to 50% of women experience anxiety during pregnancy. Even on the low end, that is still approximately 1 in 5 people during pregnancy. Those with a history of mental health diagnoses—such as anxiety, depression, obsessive-compulsive disorder (OCD) and other issues—may see an increase in their symptoms during pregnancy. But a previous history of mental health conditions isn’t a prerequisite; plenty of people experience mental health symptoms for the first time during pregnancy. 

There’s no one-person-fits-all explanation for why. Higher levels of anxiety can be caused by biological changes, including sensitivity to increased hormones like progesterone and estrogen or an increase in cortisol levels. Logistical concerns may also play a role in mental health changes during pregnancy. For instance, a new pregnancy may have a woman wondering what daycare will look like for her infant, how work life will change, and even how her connection with her partner may be affected with a newborn added into the picture. 

Perinatal Generalized Anxiety Disorder (GAD) is not uncommon; it’s believed to affect 8.5 to 10.5% of pregnant mothers. Post Traumatic Stress Disorder (PTSD) from a previous pregnancy that ended in loss could also be a factor. Yes, of course, run-of-the-mill pregnancy nerves also explain miscarriage anxiety some of the time. But if you’re concerned, you deserve proper care and evaluation from a medical professional so you can move through pregnancy with as much ease as possible and quiet distressing thoughts. 

What to do if you’re having intrusive thoughts about miscarriage

As a therapist, I have worked with many pregnant women who report feeling like they have no control over what comes into their mind about their pregnancy. And for some, these uncontrollable thoughts and worries are followed by certain irrational behaviors (also known as compulsions) that they do to quiet their thoughts or feel better about their pregnancy. 

An intrusive thought is unwanted, comes into a person’s mind without any warning, and can be quite unsettling. Some examples of intrusive thoughts a woman might experience during pregnancy are: 

• What if I am miscarrying and I bleed to death? 
• What if I can never carry a pregnancy to full term? 
• The tuna sandwich I ate, the chlorine in the city water I drank, or the lack of prenatal vitamins in my system (I throw up when I take them) are going to cause me to miscarry.
• There is something wrong with me and my body isn’t capable of carrying a pregnancy full term.
• My husband will leave me if I can’t have babies. 

Sometimes, experiencing intrusive thoughts about miscarriage during a pregnancy may be a symptom of a mental health condition like OCD. A woman may already have this diagnosis and notice an increase in intrusive thoughts around or related to her pregnancy, while others may be experiencing symptoms of OCD for the first time. This may qualify for a diagnosis of Perinatal OCD. Of course, intrusive thoughts are only one part of an OCD diagnosis, so it is important to consider some of the other things that may be present in Perinatal OCD. 

What is Perinatal OCD?

Perinatal OCD is a condition that affects an estimated 1 to 2 women out of 100 women. OCD is not just about obsessive thoughts, feelings, urges, or images, but also about the compulsions, or corresponding behaviors, mental or physical, that you do to ease the anxiety that comes from an obsession. In other words, persistent anxious thoughts and actual obsessive compulsive disorder are not the same thing.

Compulsions are irrational repetitive physical or mental acts that people engage in to reduce their anxiety around the fear of miscarriage. While the following list describes some compulsive behaviors related to a fear of miscarrying a pregnancy, it’s important to know that doing any of these things does not automatically indicate an OCD diagnosis. That’s why evaluation from a mental healthcare professional is critical. 

• Staying up all night to check a heartbeat with a fetal monitor
• Not leaving the house because of a fear of getting hurt and causing harm to the fetus
• Compulsive, unscheduled trips to the doctor to check the pregnancy
• Avoidance of anything strenuous, even simple things like walking up and down stairs 
• Excessive reassurance-seeking from doctors, loved ones, and friends
• Constant reading and researching about ways to prevent miscarriage

People diagnosed with OCD will experience both obsessions and compulsions—though these compulsions may be difficult to identify. Often, many areas of a new mother’s life, like work and relationships, are severely affected. 

How to ease your fears of pregnancy loss

Depending on the severity of your fears about miscarriage, self-help techniques may or may not provide adequate relief. Still, it’s worth knowing some common lifestyle habits that you can do to reduce stress that could be leading to worry. If it’s possible to prioritize sleep, keep stress levels to a minimum, and have a support network around you, you may find that your worries and fears become more manageable.

This does not mean, of course, that an early bedtime or moment of peace will do the trick. If you find yourself experiencing a high level of fear and anxiety around miscarriage, then evaluation by your doctor and a mental health professional may be warranted. If you notice that your thoughts about miscarriage are also linked to compulsive behaviors to try to tamp down the worries, then working with a specialist who treats OCD and has experience working with Perinatal OCD in particular could also be very valuable. 

Here at NOCD we have trained professionals that can evaluate your symptoms and help you with next steps. For Perinatal OCD, as with all subtypes of the condition, the most effective form of treatment is a form of therapy called Exposure and Response Prevention, or ERP. ERP is the gold standard treatment for ERP, with decades of research backing up its effectiveness. 

You might be wondering if talk therapy or other therapy methods can be a replacement for ERP for Perinatal OCD; the answer is an emphatic no. In fact, sometimes other methods backfire, only further reinforcing compulsive behaviors like reassurance-seeking or rumination, and making one’s fears and obsessions more intense over time. With the right form of treatment from experts, however, you can overcome Perinatal OCD and feel better in control during this pivotal period of your life.