It was a hot afternoon in July.
I had been on bed rest for 4 weeks, only going outside for my weekly doctor’s appointments. I had no idea how many more weeks I would have to endure but what I did know for sure...I hated being on bed rest and having a high-risk pregnancy.
My days that used to be filled with teaching psychology classes, attending meetings for my nonprofit and conducting client sessions were now unrecognizable to me.
Instead of working out, I was vegging on the sofa, itching to move again. Instead of being outside enjoying the sunshine, I was cooped up indoors living vicariously through Olivia Pope and Mary Crawley.
I missed my friends, my colleagues and my family. I was so discouraged by how many hours I spent alone, filling my time searching on Dr. Google or imagining worst case scenarios.
As a therapist and women’s wellness expert, I knew that this kind of worrying or feeding my anxieties by searching online was not good for me or the health of my pregnancy.
But I was shocked that I couldn’t find any resources in my arsenal of tools meant specifically for women like me who were experiencing a high-risk pregnancy and on bed rest.
Having a plethora of contacts within the psychotherapy field, I knew I could easily find a therapist who specialized in women’s health. What I also knew, even more strongly, was that therapy wasn’t the answer.
Here’s why psychotherapy won't help most women during a high-risk pregnancy
First and foremost, most psychotherapies are not appropriate for, nor are they designed to help, anyone currently going through a trauma or medical crisis, which a high-risk pregnancy is.
The deep, introspective, self-reflective work that’s required of psychotherapy is exactly the opposite of what is truly helpful for anyone experiencing an ongoing trauma and could in fact exacerbate the trauma or worsen your feelings of depression, anxiety or helplessness.
When your health or your baby’s health is uncertain, it’s not the time to be exploring deeper issues or making deep changes.
It is a time for making healthy lifestyle choices to have a safer pregnancy and healthy baby to bring home. (Tweet that!)
While a therapist may be interested in your previous history with anxiety or exploring how your anxiety presents itself in other areas of your life outside of your pregnancy, what’s most helpful during a high-risk pregnancy, is knowing how to manage anxiety and release tension from your body fast so you can see improvements in your pregnancy complications.
In fact, diving deep into your anxieties, your past and opening up these emotions can have a negative impact on the health of your pregnancy.
I have heard from far too many women on hospital bed rest who have reached out to me after their nurses have told them to discontinue sessions with their therapist because they had significantly more preterm contractions during sessions than any other time of day.
Secondly, psychotherapy, at its very core, is designed to follow the medical model. This means therapists are trained to assess, diagnose and treat.
However, many women going through a high-risk pregnancy do not exhibit a diagnosable mental illness.
Instead, what women experiencing a high-risk pregnancy need most are tools and strategies on how to get through one day, one hour at a time.
Also, with a high-risk pregnancy, your emotional experience is deeply rooted in a very specific context that few people or professionals truly understand.
Being anxious about what could happen to your baby when you have no risks for complications is entirely different than being anxious about what could happen to your baby because you are already at risk for (or are currently dealing with) complications that are threatening your baby’s health. General anxiety support without considering this context will not be helpful for you.
While therapists routinely and successfully counsel clients through situations they haven’t personally been through, this poses several problems specifically during a high-risk pregnancy.
First, having to explain what your diagnoses, medications and treatments mean, could leave you feeling more frustrated and alone, adding to the stress you’re already under. While any therapist could spend some time learning about your medical conditions, there are particular nuances of your experiences that take time to explain to someone without an already deep understanding.
I know this first hand having tried to work with a therapist who was unaware of all of my complications and what a NICU stay entailed.
This is particularly problematic during a time of your life when receiving effective whole health support as quickly as possible impacts the health of your baby.
Relatedly, psychotherapy’s biggest drawback is similar to that of medical management, which is that it sees health from a telescope. Just like your doctor manages your health by treating your body, therapists manage your health by treating your emotions.
Still, an entire aspect of your health is missing even between these two health practitioners: your overall wellness.
Learning practical solutions on how to sleep better to lower your risk of preterm labor, eat healthy to improve your odds of developing pregnancy complications and manage your anxiety and your mood while working within your health restrictions is critical to giving your baby a healthy start to life.
This is beyond the scope of practice for both your doctor and your therapist.
Therapists also fail to recognize that many times your anxiety stems from misunderstanding, or not understanding, your medical condition, your treatment options or knowing how to navigate the medical system to get prenatal care that you feel confident about.
While a therapist could try to help you with this, it does not fall under the umbrella of psychotherapy to provide such services and will likely not to be the focus of your sessions.
So instead of getting clarity about what a subchorionic hematoma or an incompetent cervix is to help you feel calmer and more confident about your pregnancy, in therapy you would likely spend that time challenging your negative thoughts and exploring what this anxiety is triggering in you.
Not what you need at this time.
What you need during a high-risk pregnancy is practical support and guidance to get through each moment
Effective support during a high-risk pregnancy involves you learning coping strategies with practical, solution-focused support that are in line with the complexities of your particular high-risk pregnancy.
What you need are strategies on how to quiet your anxiety so you can calm your irritable uterus.
You need to know how to bring your anxiety down while you’re in the waiting room so you don’t get a false reading of high blood pressure when they call you back into the exam room.
What you need are ideas on how to sleep at night when you’re worried your baby’s kicks could send you into premature labor.
What you need is someone to teach you how to listen to your body so you’re not debating with yourself at 2am whether you should call your doctor or not.
What you need is someone to help you know exactly what questions to ask your doctor so you don’t make medical decisions from a place of fear but from a place of confidence.
As a clinically-trained therapist, I can tell you that all of this is outside the scope of psychotherapy.
Am I saying you should never work with a therapist if you have a high-risk pregnancy?
I strongly believe in the impact and power of therapy, but only under the right circumstances.
If you have a diagnosable mental illness, have thoughts of harming yourself or are taking anti-anxiety or antidepressant medications, it is imperative that you seek the counsel of a licensed mental health professional during your pregnancy.
In doing so, however, you should recognize the limitations of therapy and it’s ability to support you through the anxiety and stress you’re feeling during your high-risk pregnancy.
If you’ve already been working with a therapist prior to your pregnancy, consider adding another member to your care team to help you with high-risk pregnancy-specific wellness support and leave the mental health support for your work with your therapist.
However, if you are considering seeing a therapist for the first time during your high-risk pregnancy, stop and ask yourself exactly what type of support you are really looking for. (Tweet that!)
For example, if you’re looking for help managing your household while you’re on bed rest, an antepartum doula may be your answer.