"Women can feel quite vulnerable during a wanted pregnancy as they take the responsibility of gestating the baby quite seriously. Many worry specifically about a potential loss or harming the baby in some way by their actions, particularly if they have experienced a prior loss or infertility. I have found that women who have difficulty dealing with uncertainty, or the loss of control they can feel over their pregnancy, often feel worried. They worry about anything that can go wrong during a pregnancy, partly to cope with their anxiety, partly to protect themselves. Often they believe that by anticipating the worst it will either avert disaster (superstitious thinking) or it will hurt less should something go wrong (usually an incorrect assumption, as well).

To cope more effectively with pregnancy anxiety, I have suggested the following to many of my patients:

In the first trimester

• Take it one day at a time if at all possible. Remind yourself, "So far, so good," since you received a favorable report from your obstetrician at your last appointment.
• You will hopefully have chosen an OB who is understanding of your anxiety and also realistically reassuring. Some women find they need to go in for an extra appointment or two during the first trimester to hear the baby's heartbeat.
• Keep a journal through your pregnancy where you can vent your feelings, which can also help to externalize and ease some of your anxiety.
• Deep breathing, coupled with saying a meaningful and hopeful word or syllable to yourself with each exhalation (such as calm, peace, ohm) can help you to focus on yourself in a positive way.

The risk of loss decreases significantly in the second and third trimesters. Feeling your baby moving can help a woman feel more reassured that everything is okay.

Other techniques later in pregnancy

• Ask your OB if she/he recommends that you do daily kick counts. Familiarize yourself with your baby's pattern of activity.
• Visualize your healthy baby growing in your uterus and, with your hands formed like a heart externally over your uterus, send warmth and love to your growing baby.
• Keep busy. Finding a project that you find meaningful can help distract you and give you a sense of accomplishment. No pregnancy goes more slowly than one in which you are watching the clock awaiting delivery.

Most anxious women feel reluctant to let themselves bond with their baby as a way to self-protect. They then feel guilty for this. Continue to take good care of yourself and remind yourself that your attempt to hold back in bonding with your baby is really just another reflection of your concern and love for your baby.

Toward the end of your pregnancy

• Write a birth plan
• Consider getting a doula, if you haven't already done so
• Eliminate unnecessary stress (e.g., don't paint the apartment or move unless you absolutely must)
• Continue to practice relaxation techniques (e.g., deep breathing, pregnancy yoga, meditation), which can help you to feel more in control. You might also consider getting a book on anxiety that describes how relaxation can help you cope with the common symptoms of anxiety.

And, finally, keep your eye on the prize. Remember, you are almost there.