Anxiety during pregnancy: a meta-ethnography of women’s experiences of antenatal anxiety and a qualitative exploration of women’s experiences of recovery from antenatal anxiety

Abstract

INTRODUCTION: Antenatal anxiety is common during the perinatal period and, if untreated, can have lasting effects on both maternal and infant outcomes. Despite this, there is little research seeking to understand the lived experiences of women who have had antenatal anxiety. In order to design appropriate perinatal mental health services for women, it is important to gain an understanding of their experiences from their perspective.

METHODS: A meta-ethnographic approach was used to systematically search and synthesise qualitative research exploring women’s experiences of antenatal anxiety. Five electronic databases (ASSIA and Social Services, PsychInfo, Medline, EMBASE, and CINAHL) were searched. Quality appraisal was carried out using a modified Critical Appraisal Skills Programme checklist. For the empirical project, Interpretative Phenomenological Analysis was used to explore women’s lived experiences of recovery from antenatal anxiety. Ten women who self-reported experiencing mild-moderate antenatal anxiety were recruited via social media. Interviews were conducted remotely and transcribed verbatim.

RESULTS: Fourteen qualitative studies were included in the meta-ethnography. The themes across the studies were sufficiently similar to complete a reciprocal translation. Three main themes were identified: ‘Characteristics of antenatal anxiety’, ‘Paradoxical influences on antenatal anxiety’, and ‘Striving to be a good mother’. For the empirical project, one overarching theme was identified – ‘Journey to recovery’ – that encapsulated four main themes. The four themes were: ‘Someone that “gets it”’, ‘Safe responsive relationship(s)’, ‘Locus of control’, and ‘Knowing what to expect’. Importantly, there was no one aspect that supported recovery, rather it was a combination of factors that worked together over time.

CONCLUSIONS: The synthesis raised new insights into the way in which the “good mother” ideal impacts on the influences on antenatal anxiety and the characteristics of antenatal anxiety. It highlighted that there are a number of key mitigators for antenatal anxiety that could be built upon when designing services. The findings from the empirical project highlighted the need for universally accessible information regarding antenatal anxiety. Additionally, it shows the role of relationships and attuned care in allowing women to share the burden of antenatal anxiety. Clinical and research implications are discussed.