Pregnancy anxiety and postpartum anxiety therapy in the Seattle area and online

For some women the anxiety gathers around labor: the pain, losing control, hospitals, or something you've heard about or lived through before. When it's strong enough to shape your decisions or keep you from thinking about the pregnancy at all, it has a name, tokophobia, and it deserves more than "everyone's a bit nervous."

The months before your due date are good working time. We look at what you're picturing and where those images came from. We figure out which questions you need answered by your care team before the day, and what you'd want the people in the room to know about you. We can also plan how our sessions go around the birth, whether that's a short break or a check-in soon after, so you aren't left wondering.

If this pregnancy comes after a loss, the vigilance makes complete sense. The part of you that once relaxed and then grieved is often unwilling to do that again, so hope itself can feel unsafe and every milestone gets met with held breath. I won't ask you to feel hopeful on anyone's schedule. Not buying anything for the baby yet is allowed. The grief from the earlier loss is often still there too, sometimes unspoken for years, and I've written about why so many women grieve miscarriage in silence. We make room for the mourning and the fear together, because they tend to travel as a pair.

Sometimes anxiety brings frightening, unwanted thoughts: an image of dropping the baby, of something terrible in the bath, sometimes of harm you'd never want to cause. They're far more common than anyone tells new parents. The fact that they horrify you is the point. They're the opposite of what you want, which is why they feel so loud.

Many women keep these thoughts to themselves for months because they're afraid that saying them to a professional will get someone called. Thoughts you don't want, that distress you and that you're working to avoid, are a symptom, and I treat them as one. You can tell me the thought in full, in your own words, whenever you're ready. I won't be alarmed, and it won't change how I see you.

When the thoughts are frequent and you've started managing them by checking, hiding the knives, avoiding being alone with the baby, or asking for reassurance over and over, it may be perinatal OCD (postpartum OCD, if it started after birth). That's a specific condition with its own specialized treatment, and I don't treat it myself. If that's what I'm hearing, I'll tell you plainly and help you find a perinatal OCD specialist. Many intrusive thoughts are part of postpartum anxiety instead, and those I do work with.

Postpartum psychosis is different: a person loses touch with what's real, with hallucinations, confusion, or beliefs that aren't true. If that's happening, or if thoughts of harm start to feel reasonable instead of frightening (often a partner notices before the mother does), call or text 988 or go to the nearest emergency department.

For many women anxiety spikes the moment someone else takes over. The first daycare drop-off, a new nanny, a grandparent who does things differently. You spend the morning refreshing the daycare camera, then feel guilty for not working, then guilty for being at work at all. Ordinary separation is hard for nearly everyone and eases within a couple of weeks. Anxiety doesn't ease, and it can keep you from accepting help you badly need. It can also start late. Some women feel fine for months and notice it building around weaning or the return to work, just when the checkups have tapered off and everyone assumes you've found your footing. Others find work steadies them during the day, and the worry moves to evenings and weekends. We work on the specific fears and on the guilt that sits beside them. For the bigger questions about raising little ones, see parenting young children.

In the first appointment I'll ask about the pregnancy or birth, any earlier losses, your sleep, and who is around. Most of the time, though, goes to getting specific, because "I'm just anxious" covers a lot of ground. We list exactly what you check and how often, what you're afraid would happen if you didn't, and what you've stopped doing because of the fear. Seeing that map usually shows us where to start, and it's often the first time a woman has seen the whole pattern laid out in one place.

Anxiety rarely stays inside one person. Partners get recruited into confirming that the door is locked, that she's breathing, that the car seat straps are right. Each answer helps for a minute, and before long both of you are running the loop. Some partners carry their own anxiety on top of that, lying awake listening for breathing or worrying constantly about money, while assuming it doesn't count because they didn't give birth. It counts. I see partners on their own, and I see couples who want to step out of the reassurance loop together; my page on couples therapy has more.

In pregnancy it usually centers on monitoring: the symptom search that starts reassuring and ends terrifying, counting kicks past the point of comfort, the home doppler that promised peace of mind and became one more checkpoint. After birth the same vigilance moves to the baby. Breathing, temperature, ounces, diapers. You can't sleep when the baby sleeps, because someone has to stay alert. Your body joins in with a pounding heart, a tight chest, nausea, a jaw you can't unclench, and sometimes a first-ever panic attack late at night once the day's adrenaline drops.

Some worry comes with the job. What I look at is how much room it takes up: whether it's there most days, whether it's reaching your sleep and appetite, whether reassurance lands or wears off within the hour (or the worry just jumps to a new target), and whether you've started avoiding things to keep the fear down. When the worry has become the weather you live in, that's when therapy helps.

Some monitoring is exactly what your care team wants from you, and I'd never ask you to ignore your body or your midwife. The trouble is that anxious checking and instructed checking feel identical from the inside. So I like to draw a clear line. Ask your OB or midwife the medical question once, get a real answer about what they want you to watch for and how often, and then we work on everything that happens in you after that answer. The same goes for your body. A racing heart, breathlessness and bad sleep are common in pregnancy itself, so I'd want those checked first. If they've been ruled out and you still feel braced for danger most of the day, that's ours to work on.

With your written permission, I'm glad to talk with your OB or midwife directly, so we're all working from the same idea of what "enough" monitoring looks like. That one conversation can take a surprising amount of pressure off. If medication becomes part of the picture, that's a decision for you and your prescriber, and I'm happy to coordinate there too. And if nobody at your visits has asked how you're doing emotionally, you can bring it up yourself. "I've been more anxious than I expected" is enough of a sentence.