Can you make room for children in a life shadowed by anxiety?

Having children is a life-altering decision for many. How do those with anxiety deal with it?

It might be reassuring to know that there is a perpetually upward surge in literacy around mental health in India, equipping more and more people to identify potential mental health concerns. At the same time, while the quelling stigma around mental health disorders hasn’t had a noticeable impact on their prevalence in India, factoring concerns—such as stress, anxiety and depression—across various areas of one’s life, including relationships and the workplace is a gradual, positive change.  

The influence of this behavioural metamorphosis trickles down to most life decisions we make today, including that of having children. According to a survey, reproductive decision-making was influenced by mental health problems in at least 25.7 per cent of the respondents. “To consider your mental health when planning to have children is as important as considering your physical health,” says Hansika Kapoor, a psychologist at Mumbai-based Monk Prayogshala. 

While there are reasons galore that rationalise this approach, should those battling anxiety really evaluate their decision to bear a child based on their mental health? We attempt to find out.

Parenthood can pose malaise for those with anxiety 

One out of five Indians suffer from anxiety; it affects intrapersonal and interpersonal relationships alike. On the flip side, changes in relationship dynamics can also spur anxiety. Case in point: pregnancy. “I haven’t really had any anxiety before motherhood and was always able to cope with my emotions well. But being a mother brought out a whole different side of me,” shares Sanjana Salunkhe, a Bengaluru-based journalist. There’s a major shift in your priorities as soon as you start planning for a child. And, when the pregnancy and postpartum phases kick in, your mind and body are in a quandary, grappling with a myriad of simultaneous changes—physical, mental, emotional as well as financial.

For someone with extant anxiety, any change can be unnerving and triggering. “Pregnancy often brings about significant changes in priorities, identity, and lifestyle, which can exacerbate pre-existing anxiety,” echoes Shaurya Gahlawat, a psychologist and psychotherapist. Aayushi Barman, a 34-year-old PR professional, touts overthinking and hyper-reactiveness as her key concerns while planning a child. “I do see some of my triggers overlapping with what I might feel before, during, or after pregnancy,” she begins. “I’ve even contemplated various scenarios, recognising that I may react unreasonably at times. However, acknowledging this doesn’t always guarantee a change in how I would approach those particular situations.”

While, at times, anxiety can be a pre-existing condition in individuals, it can  also be a ripple effect of the antenatal (or prenatal) phase. Research reveals that the prevalence of antenatal anxiety in Indian women ranges anywhere between 13 to 55 per cent as of 2023; in fact, the prevalence of pregnancy-related anxiety amongst pregnant women, at less than 24 weeks of pregnancy, in Bengaluru was at an alarming 55.7 per cent. Furthermore, this anxiety can spike significantly if a history of spontaneous abortion exists. 

Some women may even experience a phenomenon called ‘tokophobia’, which refers to a fear of childbirth. While globally, the prevalence of tokophobia is 14 per cent, it’s marginally higher in India, with 17.7 per cent of women facing it. It’s important to note that this data only accounts for women residing in urban India. “Tokophobia is a valid concern that many individuals experience. Seeking therapy with a qualified psychologist who specialises in reproductive mental health can be instrumental in addressing and managing it. Additionally, exploring alternative birthing options, such as counselling, hypnotherapy, or considering a supportive birth environment, may help individuals navigate through their fears and make informed decisions about starting a family,” says Dr Prerna Kohli, an award-winning psychologist and founder of MindTribe.

Pregnancy-related anxiety, alone, can stem from multiple sources. “Anxiety for me was about [questioning] my ability as a mom even before I ever thought of getting pregnant; the loss of progress in my profession, losing my independence, changes in my physical appearance and ability were also factors,” shares 36-year-old breast cancer surgeon, Anuja Raniwala.

Things can go from bad to worse in the postpartum period. “After having the baby, my anxiety had reached breaking point on several occasions, and I found talking to my friends and sisters helped. To be honest, nothing prepared me mentally for pregnancy, childbirth and postpartum; the anxieties are always at the back of my mind but I’m trying to find ways of dealing with them, using support around me whenever I feel like an imposter in this new role,” shares Raniwala. You are undoubtedly on an emotional roller coaster, says Salunkhe. “Your body doesn’t look the same anymore—it is changing rapidly, and you are suddenly responsible for another human. All of this is bound to make you feel anxious because it is happening for the first time with you.” Fathers can come across postpartum depression too. According to a survey, up to 13 per cent of men experience it worldwide, while one in 10 men go through it in India.

While an influx of sea change before, during, and after pregnancy can spike anxiety, the bright side is that you can pursue it, provided you have a robust mental health support system.

The prep to parenthood

The first step to brace yourself for parenthood is chewing over the reasons, or intentions, behind having a child. “It is important to discuss shared values, parenting styles, and future goals to help abate anxiety and ensure that both partners are on the same page. This is also needed because pregnancy brings about changes in priorities for oneself and as a couple. Communication with your partner is key, and if you are unable to do so, please seek professional help to navigate this,” adds Kapoor.

Making a rational decision about parenthood involves careful self-reflection, honest communication, and seeking professional support, opines Gahlawat. “Clients often grapple with this question during therapy, and being an existential therapist, I guide them through a process of exploration and decision-making. I encourage individuals to consider their mental health history, current well-being, support systems, and personal values. By weighing the pros and cons, exploring fears and concerns, and envisioning the kind of parent they aspire to be, they can arrive at a decision that feels authentic and aligned with their needs and circumstances.”

Uzma Khatri, a PR professional and mother to a four-month-old baby, developed anxiety during the third trimester of her pregnancy. Sharing how she combatted it, she says, “I’ve started therapy and I’m looking forward to healing myself from what I’ve gone through to make me a mentally and emotionally sound person so that I can do the best and be the best mother for my son. I started working in February, when my son was just three months old; I think the shift of mental focus also helps beat the anxiety.”

If you’ve landed on the decision to have kids as someone dealing with anxiety, seeking professional help is your best bet. “In therapy, one of my clients experienced heightened anxiety during her pregnancy. By addressing it head-on and developing proactive coping mechanisms, she navigated the changes with greater resilience and emotional well-being,” shares Gahlawat. According to the mental health expert, to manage anxiety while planning a pregnancy, individuals can adopt various coping strategies such as mindfulness and relaxation techniques, and opt for psychotherapy with a psychologist. If you’re already undergoing therapy, and have been prescribed anti-anxiety drugs, there’s nothing to worry about. “Inform your healthcare provider, and they will shift you to medications that are pregnancy-safe and can be continued throughout the pregnancy,” says New Delhi-based gynaecologist Dr Amodita Ahuja.

“However, women with mental health disorders should totally avoid tranquillisers like benzodiazepines in high doses during pregnancy, as this can lead to respiratory distress and sedation to the baby,” adds Ahuja. Nonetheless, there’s a plausible list of antidepressant and anti-anxiety pills that can be consumed while pregnant—involve your gynaecologist and therapist harmoniously in this matter.

How does the mental health of parents impact the child?

Generational trauma is a common by-product of how our society operates—and most parents don’t even realise when they end up incapacitating their children’s emotional and/or mental health by allowing the trauma to impact their offspring. According to research, the heritability of anxiety is approximately 30 per cent. But then there is a 70 per cent chance that your child wouldn’t inherit anxiety.

Nevertheless, giving careful consideration to your mental health, as to be-parents, is crucial. “Children learn through observation and if their parents are anxious and display poor coping skills, their children will learn the same, perpetuating the cycle of anxiety,” says Kapoor. “Parents serve as primary caregivers and role models, shaping their children’s emotional development and behaviours. When a parent experiences mental health challenges, it can impact their ability to provide consistent care, emotional support, and stability for their children,” echoes Gahlawat, in concurrence with Kapoor. “An example from my therapy practice involves a client who struggled with depression following a traumatic event in her life. As her depression deepened, she found it increasingly difficult to engage with her children and meet their emotional needs. Her withdrawal and emotional instability created a sense of insecurity and confusion for her children, leading to behavioural issues and academic challenges at school,” she exemplifies. 

Furthermore, a mental health disorder in either parent can also have an effect on their parental instincts. “When anxiety affects parenting and parental instincts, it can often lead to heightened stress, hypervigilance, and overprotectiveness. Parents with anxiety may struggle with constant worry and fear about their children’s safety, well-being, and future, leading to intrusive thoughts and behaviours. They may also worry about “being the perfect parent or having the perfect child”,” shares Gahlawat. 

“While research suggests a correlation between parental mental health problems and social-emotional development issues in children, it’s crucial to note that correlation does not imply causation,” says Kohli. “Individuals with anxiety can still consider having children, but it’s essential to prioritise managing their mental health effectively. Seeking therapy, practising self-care, maintaining a strong support network, and being proactive in addressing concerns can contribute to raising mentally healthy children,” she furthers.

Does anxiety impede you as a parent?

While some individuals may experience short-lived mental health struggles, for many, it can become a part of their being. So, does that make it imperative for them to give parenthood a pass? “Not necessarily,” says Gahlawat. “It does, however, underscore the importance of proactive mental health management.”

According to Kapoor, becoming a parent is a significant transition in one’s life. “When I was expecting my son, I remember waking up in the middle of several nights, worried that I didn't know how to change a diaper. It’s a very natural feeling to feel ill-prepared and uncertain; however, again, there is a difference between worry and debilitating anxiety that does not allow you to function.” If you are dealing with the latter, “you must seek help and work through your concerns regardless of whether you are considering having children. It applies to men as much as it does to women.”

Different people have different fears and triggers. “It’s not about whether someone has a mental health condition, but rather about their awareness, readiness to seek professional help, and commitment to creating a healthy and supportive environment,” advises Gahlawat. According to a survey by The Live Love Laugh Foundation, more people have the reliance on fostering meaningful relationships, despite having a mental health disorder.

It is paramount to note that the intensity of anxiety also plays an important role. “In my practice, I've observed that individuals with mild to moderate anxiety can often navigate parenthood effectively with support and coping mechanisms. However, for those with severe or debilitating anxiety, the decision to become a parent may require more careful consideration. I am working with a client who has severe panic disorder. Despite his deep desire to have children, he is delaying parenthood after recognising the potential impact of his anxiety on his ability to provide consistent care. He is making a responsible and informed decision and wants to feel better and be equipped with the right resources and coping strategies before being a father.”

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