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. 2021 Feb 12;30(2):98–107. doi: 10.1891/J-PE-D-20-00018

Mothers' Worries During Pregnancy: A Content Analysis of Reddit Posts

Pamela D Pilkington, Isabella Bedford-Dyer
PMCID: PMC8061722  PMID: 33897234

Abstract

Qualitative investigations into maternal worries during pregnancy are limited. The aim of this study was to identify the content of women's pregnancy-related worries by completing a content analysis of posts on Reddit. A total of 217 posts by 196 unique users were analyzed. Most worries related to infant factors (32.6%), individual factors (27.1%), and antenatal care factors, such as medical procedures (25.2%). The remaining worries related to situational factors (10.9%) and the partner relationship (4.3%). Although most fears related to fetal well-being, other concerns included problems with family members, women's own mental health, and not being a “good mother.” These findings support calls for antenatal education to more adequately address women's psychosocial concerns.

Keywords: mothers, antenatal education, fears, anxiety, pregnancy

Pregnancy is a major life event that naturally evokes a range of worries. Concerns may escalate into pregnancy-related anxiety for approximately 15% of women (Dennis et al., 2017; Poikkeus et al., 2006). Pregnancy-related anxiety is characterized by pregnancy-specific worries (e.g., fear of childbirth) accompanied by excessive rumination and somatic anxiety symptoms (Bayrampour et al., 2016). It is associated with adverse outcomes such as lower perceived attachment to the unborn baby (Schmidt et al., 2016), and increased risk of obstetric complications, prematurity, and low birth weight (Blackmore et al., 2016).

The current study focuses on the cognitive component of pregnancy-related anxiety. Bayrampour et al. (2016) completed a systematic review and concept analysis of pregnancy-related anxiety and identified nine cognitive dimensions: fetal well-being, miscarriage, childbirth, woman's own well-being, body image, the maternal role, health care, financial, and family and social support. Improved understanding of these pregnancy-related fears can inform antenatal education efforts, and facilitate dialogue between health professionals and women (Wigert et al., 2020). This information could also be used to facilitate conversations between partners, given evidence that partners can mitigate their risk of emotional difficulties during the transition to parenthood by being supportive and communicative (Alves et al., 2020; Pilkington et al., 2015).

Researchers have primarily investigated the content of worries in pregnant women using structured questionnaires such as the Pregnancy-Related Anxiety Questionnaire (PRAQ; Huizink et al., 2016) and the Cambridge Worry Scale (CWS; Green et al., 2003). These self-report questionnaires ask respondents to indicate the extent to which they are experiencing worries in preidentified domains. The CWS also includes a single open-ended question that asks women to identify additional worries not captured by the close-ended items. Research using these measures consistently shows that the most prevalent fears among pregnant women are the potential for fetal loss, the well-being of the unborn baby, and childbirth (Brunton et al., 2015; Brunton et al., 2019; Fenwick et al., 2009; Maimburg et al., 2013; Penacoba-Puente et al., 2011). However, inspection of responses to the open-ended question of the CWS demonstrates that women experience a broad range of worries, in addition to these common concerns. For example, Ohman et al. (2003) administered the CWS to 200 pregnant women in Sweden, and found that 30% of women disclosed fears that were not captured by the core items. These included worries about maternity services, having other children at home, lack of time, weight gain, giving up work, and having both pets and a baby at home. The variety of these responses suggests that existing measures may not adequately capture the diversity of mothers' worries during pregnancy.

In support of this, reviews by Bayrampour et al. (2016) and Brunton et al. (2015) concluded that existing scales do not comprehensively assess the known cognitive dimensions of pregnancy-related anxiety. For example, the PRAQ assesses pregnant women's concerns in the following domains: childbirth, fetal well-being, and the effect of pregnancy on physical appearance (Huizink et al., 2016). These concerns overlap with only three of the nine cognitive dimensions of pregnancy-related anxiety identified by Bayrampour et al. (2016). More generally, few pregnancy-related anxiety scales comprehensively assess fears about important psychosocial factors such as mental health or the partner relationship (Bayrampour et al., 2016; Sinesi et al., 2019).

Qualitative approaches may therefore be more appropriate for identifying the diverse range of worries experienced by mothers. Surprisingly, few studies have used qualitative methods to identify mothers' fears. The existing thematic analyses tend to be limited by small sample sizes and other methodological constraints. In particular, studies have tended to investigate pregnancy-related worries by asking women in the postnatal period to retrospectively report on their concerns during pregnancy (e.g., Melender & Lauri, 1999; Rowe & Fisher, 2015) or grouped responses from women in the antenatal and postnatal periods into a single analysis (e.g., Goldfinger et al., 2019). Given that the experience of childbirth and early parenthood may influence retrospective recall, studies should seek to recruit women who are currently pregnant. Nonetheless, the results from these studies generally converge with the quantitative findings. For example, Melender and Lauri (1999) conducted semistructured interviews with 20 Finnish women at 2 to 3 days postpartum, and found that the most common pregnancy-related fears were the baby's well-being, the possibility of miscarriage, and childbirth. Qualitative investigations with larger, contemporary samples of women who are within the antenatal period are needed. This can facilitate a more nuanced and in-depth understanding of the diverse worries experienced during pregnancy.

Online forums such as Reddit are an ideal alternative to traditional qualitative methods and quantitative approaches as they enable access to text-rich, ecologically valid data (Amaya et al., 2019; Jamnik & Lane, 2017). Reddit allows individuals to post text, images, and hyperlinks to thousands of online forums (subreddits) dedicated to specific topics (Amaya et al., 2019; Jamnik & Lane, 2017; Shatz, 2017). It is the third most popular site in the United Kingdom and sixth most popular in both the United States and Australia (Alexa, 2020). Reddit therefore enables access to larger and more diverse samples than traditional recruitment methods (Jamnik & Lane, 2017). Reddit also affords users a high degree of anonymity, which facilitates discussions characterized by high rates of self-disclosure (De Choudhury & De, 2014). A growing number of researchers are leveraging Reddit data to investigate health issues, such as mental health discourse (De Choudhury & De, 2014), attitudes to infectious disease (Park & Conway, 2017), and detecting anxiety (Shen & Rudzicz, 2017).

Of key relevance to the current study is the work of Pilkington and Rominov (2017), who identified fathers' worries during pregnancy by completing a content analysis of the subreddit PreDaddit. Fathers disclosed a range of worries, but the dominant fears centered on perinatal loss, childbirth, and the well-being of their partners. The aim of the current study was to apply this methodology to identify the types of worries reported by expectant mothers posting to the subreddit BabyBumps. It is reasonable to expect that women will express concerns about different issues, given that, unlike men, they directly experience the physiological changes associated with pregnancy and childbirth. Although the content of women's worries is likely to diverge from the concerns of fathers, few studies have investigated gender differences in worries during pregnancy. Biehle and Mickelson (2011) asked couples in the United States, who were in their third trimester of pregnancy, to list their worries over the past 6 months. They found that the baby's well-being and childbirth were the dominant concerns for both men and women. Fathers reported more worries relating to financial matters and work–family balance, while women reported more concerns about the baby's health and their relationships with their partners, families, and friends. Therefore, a secondary aim of the current study was to extend the emerging literature on gender differences in worries during pregnancy.

METHOD

A content analysis of the Reddit forum BabyBumps was conducted to identify mothers' worries during pregnancy. BabyBumps describes itself as “A place for pregnant Redditors, those who have been pregnant, those who wish to be in the future, and anyone who supports them.” The subreddit is currently moderated by five moderators and users are asked to adhere to rules relating to treating everyone with respect and posting content to the relevant threads, and not posting spam, political discussions, identifying information, or medical advice. This subreddit was selected as it is the largest subreddit focused on pregnancy, with more than 150,000 members. The project was reviewed by the Human Research Ethics Committee at the Australian Catholic University (2019-74EAP).

Data Collection

The data were retrieved from BabyBumps via BigQuery (http://www.bigquery.google.com), a Google cloud storage service that enables access to large datasets. The original dataset comprised all posts submitted to BabyBumps during January 2019. Data included the time and data posted, post title, post content, username, and number of comments.

The dataset was imported to Microsoft Excel, and posts were included based on the following criteria: (a) the post contained a reference to a worry or concern; and (b) the post author indicated she was a woman who was currently pregnant. Posts were excluded if: (a) the post consisted of a uniform resource locator (URL) or an image or did not contain sufficient text to code; (b) the post author indicated that they were not currently pregnant (e.g., women in the postnatal period); (c) the post author indicated that they were male.

Content Analysis

Content analysis was used to code the worries into meaningful themes and calculate the frequency of each theme. This was completed in accordance with the six steps of thematic analysis outlined by Braun and Clarke (2006). The posts were first coded into themes developed by Pilkington and Rominov (2017). A priori coding was utilized to improve transparency and allow for comparison between men and women's worries. The following a priori themes and subthemes were used: (a) infant factors: perinatal loss, well-being of infant following childbirth, and genetic or chromosomal abnormalities; (b) individual factors: mother role, feeling unprepared, and changes to daily life following childbirth; (c) situational factors: financial pressure, concerns regarding family and friends, work–family conflict, and pets; (d) partner factors: concerns regarding sexual relationship changes, and partner relationship problems.

As some worries were not adequately captured by the a priori codes, the following new themes and subthemes were created: “medical procedures” and “problems with health professionals” were grouped with the preexisting subthemes “childbirth,” and “appointments” to form a new overarching theme named “antenatal factors.” The new subthemes “body image,” “mental health of self,” and “physical health of self,” were grouped under “Individual Factors.” The new subtheme “other children” was grouped with “Situational Factors,” and “fetal well-being” was grouped with “Infant Factors.” The subthemes “partner well-being” (referred to as “maternal well-being” in Pilkington and Rominov (2017)), “naming the child,” and “gender of infant” were not used as post authors did not cite these concerns. Table 1 provides theme definitions and examples of posts for the final themes and subthemes.

TABLE 1. Theme and Subtheme Definitions and Example Post Excerpts.

Themes and Subthemes Definition Example Post Excerpt
Infant factors
Perinatal loss Potential for miscarriage “I have found out today that I am 5 weeks and 5 days pregnant. I had discussed in a previous post of mine that I was afraid of a miscarriage and this is still holding true …”
Well-being of infant following childbirth Child's physical and emotional well-being following childbirth “My anxiety is a tad high on things like How often and how much should I feed this kid? How often should they be sleeping? and other a …”
Fetal well-being Physical well-being of the unborn baby “I had an ultrasound at 33 weeks that confirmed his was head down but I'm concerned he flipped somehow … maybe I'm paranoid but worried he's now breech.”
Genetic or chromosomal abnormalities Genetic or chromosomal abnormalities such as cystic fibrosis “I got a false positive for Turners Syndrome and it ruined the beginning of my pregnancy since I couldn't do anything but worry for weeks …”
Individual factors
Mental health of self Mothers' own emotional and mental well-being “Now at 23 weeks, I've really felt my anxiety get a lot worse … I always told myself if my anxiety became unmanageable I would consider medication …”
Physical health of self Mothers' own physical well-being “I'm kind of a ball of anxiety the past few days due to hearing I have preeclampsia …”
Mother rolea Not being a “good mother,” not feeling excited about becoming a mother, or mothering being judged by others “I'm worried of losing my identity and always being a mom first … that I'll have to spend too much time and mental effort on baby.”
Feeling unprepared Not being ready to be a mother for personal or situational reasons “My anxiety is through the roof, I feel unprepared and scared for this baby.”
Changes to daily life following childbirth The changes and losses associated with parenting an infant, such as sleep deprivation and less time for leisure or social activities “I'm getting really scared, rather than excited, about all the changes to come. I know everything is going to be different, so I' already mourning the loss of my old life …”
Body imagea Changes to bodily aspects or physical appearance during, or postpregnancy such as stretch marks, or weight gain “So, ever since I got pregnant, I've become increasingly self-conscious about how much I smell …”
Situational factors
Concerns regarding family and friends Family and friends, relationships, such as announcing the pregnancy, maintaining personal boundaries, and the impact of others on the well-being of the infant “I'm 31 weeks and getting anxious about people being around the baby … My family doesn't tend to take care of themselves when it comes to routine health care …”
Financial pressure Financial status is not adequate for the costs associated with parenthood “I am terrified and nervous. I understand that's normal, but I feel like the most irresponsible woman for not having health insurance …”
Work–family conflict Negotiating work and family, including the impact of work on family life and vice versa “I only have 2 weeks of leave saved up … I'm freaking out because I want to take 12 weeks off but I'll be surprised if I can risk the required 6 weeks.”
Other childrena The impact of a new child on existing children “My main thing is fear and worry over cultivating a good relationship between the new baby and my almost 3 year old.”
Pets Introducing the baby to a household with a pet “… We adopted a kitten …Tuesday evening I found out I was pregnant, yay! But now I'm really worried about toxoplasmosis.”
Partner factors
Sexual relationship Changes to the sexual relationship during pregnancy and following childbirth “I am so scared to have sex or orgasm and see any spotting. I feel so bad for my husband who has not gotten laid since before I found out I was pregnant.”
Partner relationship problems Changes or difficulties with the partner relationship, such as conflict “My husband and I typically have fairly good communication. The times I have told him I need more help from him however he gets really defensive and angry … I just feel kind of hopeless and resigned to it.”
Antenatal care factors
Childbirth Labor and/or childbirth “I'm 36+5 and tomorrow I'm having my c-section because I started having issues with my blood pressure … I'm so scared …”
Medical proceduresa Procedures other than childbirth such as a membrane sweep “My appointment is coming on quickly today, and with this appointment I'll be getting my first sweep … Even with the support I'm a little scared of any pain.”
Appointments Upcoming contact with health professionals, such as ultrasound appointments “Tonight is my first OB appointment ever and I'm SUPER anxious about it …”
Problems with health professionalsa Quality of health care, or judgment from health professionals “I chose a new doctor before we started trying for our second and she seemed great! However I have only seen her one time during this pregnancy and it felt rushed and different than with my first provider …”
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a

Indicates a posteriori themes and subthemes

Both authors independently coded the posts into the themes and subthemes. The proportion of discrepancies was 20.6%. These were resolved through discussion until consensus was reached. As more than 85% of posts referred to the duration of the pregnancy, posts were coded into trimesters where possible.

RESULTS

The initial data set retrieved from BabyBumps comprised 2,668 posts. Of these, 2,451 posts were excluded for the following reasons: 796 posts consisted of a URL or an image, or did not contain sufficient text to code; 1,558 did not reference mothers' worries; 78 posts were authored by women who were not currently expecting a child; and 19 were authored by fathers. The remaining 217 posts were included in the final dataset. The included posts totaled 50,407 words in length (M = 232 words per post) and were authored by 196 unique users.

Worries Disclosed by Mothers on BabyBumps

The frequency of the types of worries and concerns disclosed by pregnant mothers on the BabyBumps subreddit are shown in Figure 1.

Figure 1. Frequency of worries organized by themes and subthemes.

Figure 1.

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Infant Factors

Most worries were related to infant factors (32.6%). These primarily focused on worries related to perinatal loss (15.1%), and fetal well-being (11.6%). Other fears included the possibility of chromosomal or genetic abnormalities (3.1%), and the well-being of the infant following birth (2.7%).

Individual Factors

The second most common theme of worries was individual factors (27.1%). This included worries about the mother's own physical well-being (10.1%) or mental health (5.1%). Other worries related to feeling unprepared for parenthood (4.3%), the mother role (3.5%), possible changes to daily life following childbirth (2.3%), and changes to body image (1.9%).

Antenatal Care Factors

The third most common theme of worries was antenatal care factors (25.5%). These included worries regarding medical procedures (11.2%) and childbirth (10.5%). A minority of posts described worries about problems with health professionals (2.3%) and upcoming appointments (1.2%).

Situational Factors

A proportion of worries were regarding situational factors (10.9%). These included concerns about family or friends (4.2%), work–family conflict (2.7%), and financial pressure (2.7%). A small number of posts referred to worries about parenting multiple children (0.8%) and having a pet and a child in the same household (0.4%).

Partner Factors

Finally, 4.3% of posts referred to worries regarding the author's partner. These included concerns about partner relationship problems (3.9%), and changes to the sexual relationship (0.4%).

Most Common Worries in Each Trimester of Pregnancy

The five most common worries reported by pregnant women at each trimester are presented in Figure 2. Perinatal loss was overwhelmingly the most common worry during the first trimester. Other worries included fetal well-being, and the woman's own physical well-being. During the second trimester, perinatal loss and fetal well-being were most frequently mentioned. Worries regarding childbirth and medical procedures were the most prevalent in the third trimester. Concerns about the well-being of the unborn child, and the physical health of the mother were also prominent.

Figure 2. The five most common worries by trimester.

Figure 2.

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DISCUSSION

The aim of this study was to identify the types of worries experienced by mothers' during pregnancy, by analyzing posts on the online forum Reddit. A content analysis of posts to the BabyBump subreddit identified a broad range of concerns relating to infant factors (e.g., the potential for perinatal loss), individual factors (e.g., mothers' own physical well-being), antenatal care factors (e.g., medical procedures), situational factors (e.g., concerns about family and friends), and partner factors (e.g., problems in the partner relationship). Perinatal loss, fetal well-being, the mother's own physical well-being, and medical procedures were the most frequently cited worries.

These findings are consistent with both quantitative and qualitative research, that has consistently identified fetal well-being, the potential for fetal loss, and childbirth to be the most prevalent worries in pregnant women (Brunton et al., 2015; Brunton et al., 2019; Fenwick et al., 2009; Maimburg et al., 2013; Melender & Lauri, 1999; Penacoba-Puente et al., 2011). The worries identified in the current study also correspond to the nine cognitive dimensions of pregnancy-related anxiety identified by Bayrampour et al. (2016). In addition to perinatal loss, fetal well-being, and childbirth, women in the current study identified concerns relating to their partner relationship, emotional well-being, body image, and transitioning to the maternal role. This suggests more comprehensive measures of pregnancy-related anxiety that include items in these psychosocial domains (e.g., the Pregnancy-related Anxiety Scale [PrAS] and CWS) may be more appropriate than narrower measures such as the PRAQ (Huizink et al., 2016).

In addition to examining the content of women's worries, we investigated the frequency of worries within each trimester. Perinatal loss was the most frequently mentioned concern by women in the first trimester. In the second trimester, concerns about fetal well-being and perinatal loss were prevalent, while in the final trimester, the most common worries related to childbirth and medical procedures. This is consistent with quantitative findings indicating that the possibility of miscarriage is a common fear in the first trimester (Ohman et al., 2003), while the third trimester is characterized by anticipation about the upcoming birth (Brunton et al., 2019).

The findings of the current study largely converge with the results of Pilkington and Rominov's (2017) study on fathers' worries. Both men and women posting to Reddit frequently cited worries related to the well-being of the unborn baby, childbirth, and perinatal loss. In addition, the frequency of worries across trimesters followed a similar pattern, with the initial focus being on perinatal loss, and then changing to childbirth as the pregnancy progresses. However, there were also key differences. Mothers did not identify any worries about their partner's well-being but did express concerns about their own physical and mental health. The converse was found in Pilkington and Rominov's study: fathers frequently reported concerns about their partner's well-being but did not report any concerns about their own well-being. This is consistent with the focus on mothers that dominates pregnancy discourse and could reflect the fact that fathers' do not undergo the physiological act of pregnancy. Alternatively, women may be more likely to disclose concerns about their emotional well-being than men, due to gendered societal norms about the expression of vulnerability (White, 2006).

Women also expressed worries not identified by fathers, including concerns about difficulties with health professionals and body image. The finding that women expressed worries about body image is in keeping with Bayrampour et al. (2016) conceptualization of pregnancy-related anxiety as including concerns about appearance and weight gain. Pregnancy is clearly associated with marked and rapid changes to body shape and size that can increase a woman's vulnerability to body image problems (Brunton et al., 2019; Chan et al., 2020). Awareness of these gender differences in the content of worries could facilitate supportive conversations between partners, as well as increase health professionals' sensitivity to the differing emotional needs of men and women.

IMPLICATIONS FOR PRACTICE

The insights into the content of mothers' worries during pregnancy can be used to inform antenatal education. Our findings demonstrate that women commonly experience worries regarding childbirth, fetal well-being, and the possibility of perinatal loss. Current models of antenatal education tend to focus on the physical aspects of labor and childbirth (Ferguson et al., 2013). Correspondingly, mothers who attend antenatal education report less fear of childbirth and increased childbirth-related maternal self-efficacy (Karabulut et al., 2016; Serçekuş & Başkale, 2016; Uslu Yuvaci et al., 2020). However, a significant proportion of women's worries relate to psychosocial concerns.

Antenatal education programs may not adequately address women's fears about the psychosocial aspects of pregnancy highlighted by the current study, such as mental health, relationship problems, and transitioning to the mother role (e.g., Widarsson et al., 2012). In support of this, a randomized controlled trial by Maimburg et al. (2013) found that although women who attended an antenatal education program reported fewer worries related to medical procedures and childbirth, they showed no decrease in worries about relationships and socioeconomic status. Qualitative studies conducted in Australia (Woolhouse et al., 2014), Sweden (Widarsson et al., 2012), and the United Kingdom (Hore et al., 2019) also suggest that parents would like antenatal care providers to better prepare them for emotional and relationship changes. A greater focus on emotional and mental health is warranted given women's increased vulnerability to depression and anxiety during the transition to parenthood. For example, up to 25% of women experience clinical anxiety in the final trimester (Dennis et al., 2017). The current study therefore echoes recent calls for antenatal care to broaden its focus to include emotional and social concerns.

STRENGTHS AND LIMITATIONS

A strength of this study was the use of Reddit data, which enabled access to rich textual data from almost 200 women. This contrasts to previous qualitative studies that have used small samples and focused on worries in the context of clinical distress (Rowe & Fisher, 2015). The current results are not affected by researcher influence and social desirability bias, as the analyses are based on naturalistic data. The findings provide deeper and more nuanced insights into women's specific areas of concern during pregnancy.

Nonetheless, the use of anonymous, preexisting data also confers limitations, as it is not possible to determine the post authors' characteristics, verify the trustworthiness of responses, or complete member checks. Reddit users tend to be more educated (Jamnik & Lane, 2017) and are more likely to reside in English-speaking countries (Amaya et al., 2019). Therefore, it is likely the viewpoints of women from certain socioeconomic backgrounds were not captured. In addition, it was not possible to determine whether post authors were experiencing normal worries or clinical worries that were more intense or persistent, despite evidence that this distinction is clinically and conceptually important (Goldfinger et al., 2019). A related concern is the inability to determine whether women were experiencing state-based anxiety or ongoing mood problems. Finally, the decision to use a priori codes from a study on fathers' worries could be critiqued for applying a patriarchal framework to women's experiences. However, men and women's worries overlapped substantially—the most frequent worries for both men and women were perinatal loss and maternal well-being. Furthermore, we remained open to the possibility that the a priori codes may not fit the data, and consequently developed seven new themes, and omitted three that lacked relevance.

FUTURE RESEARCH

Future studies could explore using online technologies to provide women with informational and emotional support regarding their concerns. Online platforms are frequently used by mothers to inform their decision-making during pregnancy (Lagan et al., 2011; Larsson, 2009; Romano, 2007). Online forums should be considered by antenatal educators as a cost-effective, accessible platform to supplement professional care. For example, an online forum moderated by a health professional with perinatal expertise could provide women with social support and reassurance, while directing women to accurate, evidence-based information.

CONCLUSION

It is important that health providers are attuned to the worries experienced by women during pregnancy so that they can provide informational support and reassurance (Wigert et al., 2020). This investigation has provided insights into the diverse worries reported by mothers. In addition to concerns about childbirth and fetal well-being, women also expressed fears about their relationships with their partners, friends, and family members, their own mental health, and not being a “good mother”. These findings support recent calls for antenatal education to address emotional and psychosocial concerns, alongside childbirth, labor, and physical well-being.

Biographies

PAMELA D. PILKINGTON is a clinical psychologist and researcher at the Australian Catholic University. Her research interests are in perinatal mental health, parenting, and the prevention of mental illness.

ISABELLA BEDFORD-DYER is a provisional psychologist. She recently completed Honours in psychology at the Australian Catholic University and is now completing a Master of Psychology at the Cairnmillar Institute.

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.

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