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Table 2 Themes and sub-themes associated with women’s personal experience with PNA

From: Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

Themes and Sub-ThemesQuotes
SOURCES OF ANXIETY
Unrealistic expectations of birth and motherhood
  1. Expectations of childbirthFG5.F3: she did this demonstration about epidurals… and she made it seem just really scary… I came away being absolutely terrified of any intervention… But I ended up being induced and having forceps, both of which were… well the induction wasn’t fine… but the forceps were. So I felt there was a lot of misinformation about what an intervention would be like… which made me unnecessarily anxious.
FG5.F2: my community midwife refused to tell me about induction because she thought it would happen naturally. But my waters broke before labour started, so I had to be induced… and I had no idea what was happening… (which) made me really frightened. And I remember thinking, but I’m allowed to ask you and you’re meant to tell me…
  2. Expectations of breastfeedingFG5.F3 It’s crazy how people make breastfeeding out to be this magical experience, when it just couldn’t be more different than that really.
FG4.F2: [antenatal classes] show you this video of a five month old baby breastfeeding quite happily in some sort of coffee morning, and it’s absolutely easy. But then the reality is so different. And I felt just a bit tricked by the whole lead up to having a baby…
  3. Unrealistic guidelines and normsFG4.F2: It worries me when things like the Babycentre say like at eight months your child should be doing this, especially sleep and feeding… you feel like you’re just doing everything wrong.
FG1.F3 I don’t know any mum who was able to put their child in a moses basket on their back from day one, and it just causes you an enormous amount of anxiety. So what are you meant to do, what can you do? I still don’t know.
  4. Unrealistic social comparisonFG2.F2: I just struggle with parenthood being completely honest. It’s like one of these things where there’s so much social media these days saying how you should be this and that. And for me that’s actually, like the biggest thing that really blocks me from thinking actually it’s OK, like this is normal.
  5. Societal pressureFG1.F5: I think they put so much pressure on a mother by saying breast is best which means… yes it’s all positive. But… if you don’t succeed then… you’ve failed as a mother, you’ve failed your kids and it’s just not true because fed is the best isn’t it?
FG1.F4: We’re still co-sleeping and everybody’s like… it’s so bad because SIDS and everything. Your babies will die if you co-sleep
Importance of Peer Support
  6. Offline social supportFG1.F6: Being here and away from family… has been the hardest part for me… but the girls in the (antenatal) group have been great. I think they’ve been the biggest support through all of this.
  7. Online peer support (positive and negative)FG5.F3: It definitely increases anxiety – those big forums definitely do. Because nobody wants to post when things go well. They just say terrible things…. which just made me really paranoid.
FG4.F1: I found those (Facebook) groups just brilliantly good peer support, and more helpful than some of the breastfeeding groups I’ve been in.
  8. Normalisation of experienceFG2, F1: So we just post whatever’s going on. So if you’re having a really naff day you’ll say Jesus Christ, the kids have done this, this and this. And someone goes oh tell me about it. And it’s just somebody, like, who’s feeling the same thing as you, so it’s not completely like… all the social media where it’s this perfect mum… it’s well I’m here with cereal stuck in my hair and it’s two o’clock in the afternoon. So at least with that it was other normal mums that were just like yeah, I’m doing the same thing as you. So you didn’t feel so alone.
Uncertainty and Maternal Confidence
  9. Unprepared for changeFG1.F1: I had absolutely no idea about any of motherhood I realised, y’know, the practical stuff.
FG4.F2: That’s actually why people then struggle. I suppose we all go through our lives being good at a lot of things. You’ve established a career, you’ve established yourself, you’ve got qualifications. And then suddenly… this baby arrives and you’re not good at anything.
  10. Maternal confidence and overwhelmFG1, F4: I was overwhelmed with everything, the household running, and I only had to look after the baby. But it was so demanding.
FG4, F1: (I have to know) when our daughter last fed, how much she’s fed and how much she’s vomited that day, how many wet nappies she’s had, and when her immunisation’s due… There’s this massive load that we’re carrying… And then you add to it just stupid things like the washing basket’s full…or I need to sterilise some things, and I need to do this and I need to do this. And I just find that there’s this constant like whir going on in my head.
  11. Conflicting (or extreme) informationFG1, F1: I think (the internet) is a curse and a blessing. Because in the very early days you Google everything and there’s all these forums, there’s Netmums, there’s a blog, a Facebook thing that I was on Mummy’s Gin Fund… And the actual problem is there’s like too much advice and everyone’s – ‘do that’ and then there’ll be someone with complete opposite opinions saying do this, do that. And actually you get yourself into such a state because you almost read too much. And it made me very anxious, it didn’t really help that much…
F2: …There’s just so much…
F6: …and a lot of it’s extremes as well...
F2: …Yeah… the last thing that I felt, or I feel that I need is like the polar opposite of opinions
FG5, F2: What you read on the internet is quite extreme. And you always end up on message boards where one woman is like ‘I was induced and I was in labour for 72 h and then this happened to me’, and it just becomes really terrifying…
ISSUES AROUND SUPPORT
Stigma
  12. Internal and external stigmaFG5.F4: I felt like I couldn’t talk to anyone about it, because I didn’t think it was normal and I felt like it was me not being a good mum
F3: Me too. Yeah, exactly. I thought people might think I was an awful mother.
  13. Disclosure avoidanceFG2.F2: I fear that if I went to somebody saying look I really suffer from anxiety, I get worried on who’s going to get involved with my kids.
F1: That was my fear, that social services would get involved if anyone found out.
Lack of Mental Health Support and Knowledge
  14. Lack of postnatal healthcare supportFG5.F4: You’re all geared up to give birth, and then you do it and you get home and you’re like, shit, now I have a baby… and there’s no support really. When I had her, I had really bad anxiety, like postnatal anxiety full on. Like I couldn’t leave the house, I couldn’t leave her to sleep, like I couldn’t let her be put down, I was sleeping in like 2 h shifts because I was just terrified that she was going to die… And it got to the point where I had like a complete melt down and I didn’t know why. But no one spotted it. I’d done, I’d had my initial appointment with the midwife or health visitor, whoever it was, but it was so rushed. They didn’t get it. I had to contact my GP myself to ask, y’know, to be put on the mental health service lists… but y’know, nobody contacted me. I waited for like 3 weeks…
  15. Mental health literacyFG5.F2: I felt like I was going totally mad. I knew I didn’t have postnatal depression… and I did those questions with the health visitor, and she seemed to think I was ok. But then I couldn’t stop worrying about (the baby). I’d constantly check on her. And I didn’t want to go out in case something bad happened. And that’s not right. I didn’t know what it was, but I didn’t feel depressed.
FG3, F2: I kept reading the books… and one page was on postnatal depression. I was like I haven’t got any of the symptoms, if anything I’m really happy but I’m not right.
FG2.F1: it definitely helps just knowing what it is. Because once I knew what it was I could, it was calmer in my mind a little bit.