About Postpartum Anxiety

What is Postpartum Anxiety?

Postpartum anxiety, also known as perinatal anxiety or PPA, is a type of perinatal mood and anxiety disorder (PMAD). Mothers with PPA experience high levels of worry and fear, along with other distressing symptoms.

Roughtly 20% of new mothers experience PPA, making it the most common PMAD, even more common than postpartum depression. 

Mothers with PPA experience worry and fear about a variety of things related to birth, caring for a newborn, and adjusting to life as a new mother. 

Common worries or fears reported by new mothers include concerns about:

• Juggling multiple roles and demands
• Lack of sleep
• Finances
• The baby’s health, safety, and wellbeing
• How they are parenting
• Their body image and health

It’s important to note that fathers and non-birthing parents may also experience anxiety after welcoming a new baby. While we recognize that all parents can be impacted by PPA, for this article, we use the term “mother” and focus on research conducted on birthing women.

Signs and Symptoms of PPA

The main symptoms of PPA are worry and fear which often occurs and makes it hard for a mother to function and carry out her responsibilities. A mother with PPA will also experience other symptoms such as:

• Irritability
• Difficulty sleeping
• Racing thoughts
• Poor focus and concentration
• Low energy
• Muscle tension
• Restlessness

Some mothers with PPA may experience panic attacks, which are episodes of intense fear or discomfort. Panic attacks often feel like they come out of nowhere. During a panic attack, a mother may experience:

• Heart palpitations
• Sweating
• Chills
• Shaking
• Difficulty breathing
• Chest pain
• Numbness or tingling
• Nausea or stomach pain
• Dizziness
• A sense of being detached from one’s self or reality
• Fear of dying
• Fear of losing control

While panic attacks may only last a few minutes, they are very scary for the person experiencing them. A person who experiences panic attacks may fear having future attacks and avoid going out in public.

Is it normal to have scary thoughts?

Intrusive thoughts are distressing thoughts or images that can pop into your head out of nowhere. Mothers may feel like they have no control over these thoughts. Intrusive thoughts are very common during the postpartum period, especially among mothers with anxiety. As many as 90% of new mothers experience intrusive thoughts. These thoughts are often scary and involve something bad happening to the baby. These thoughts may be of a violent or sexual nature. It’s common for mothers to feel terrible for having these thoughts, but the truth is that they are outside their control. The treatment approaches described below can help mothers manage and cope with their intrusive thoughts. 

How can you tell if it’s postpartum depression or postpartum anxiety?

Postpartum depression (PPD) and PPA are both PMADs that cause distress during the postpartum period. Some of the symptoms of PPD and PPA are the same. For example, mothers with PPD and PPA may experience:

• Irritability
• Difficulty concentrating
• Low energy
• Sleeping problems

The key difference between PPD and PPA is the primary symptoms. For mothers with PPD, the main symptom is a sad mood that persists nearly every day, while for mothers with PPA, the main symptom is chronic worry or fear. Many mothers experience both PPD and PPA at the same time. Experts believe that two out of every three women with PPD also have anxiety. The recommended treatments for PPD and PPA are similar, so mothers experiencing both can get the help they need.

Causes of PPA

The exact causes of PPA are unknown. The consensus among experts is that it is likely caused by a combination of hormonal changes, genetic factors, and the stress of adjusting to parenthood. From an evolutionary perspective, moderate amounts of anxiety are adaptive during the postpartum period. Anxiety can keep parents alert to threats and motivate them to take action to protect their babies. The problem arises when anxiety becomes severe enough to affect a parent’s health and functioning.

Risk factors

Risk factors are characteristics or events that increase the likelihood of experiencing a condition. Risk factors for PPA include:

• Anxiety or depression during pregnancy
• Premature birth
• Feeling a lack of control during labor and delivery
• Giving birth via cesarean section
• Marital conflict
• Lack of family support

Having more risk factors increases the chances of developing PPA, but it’s also possible to develop PPA without any risk factors. Keep reading to learn about treatment options and strategies for coping with symptoms.

Treatment

Postpartum anxiety is treatable. There is no reason to suffer when help is available. The recommended treatment for PPA is therapy. Some mothers may also benefit from medication. 

Therapy

Like treatment for postpartum depression, the cornerstone of treatment for PPA is therapy. There are many different types of therapy available, but a specific type of therapy called cognitive behavioral therapy (CBT) is effective for treating PPA. CBT focuses on how a person’s thoughts, feelings, and behaviors are connected. It assumes that negative emotions, like anxiety, are tied to a person’s thoughts. One of the main goals of CBT is to identify and change thought patterns that contribute to negative emotions. 

Medication

Mothers with moderate to severe anxiety may also benefit from medication. A type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may be prescribed for anxiety during the postpartum period. Other types of medications may also be prescribed to alleviate panic attack symptoms. Many mothers understandably have apprehension about taking medication for their anxiety. They are often concerned about whether it is safe to take medication while breastfeeding or if they become pregnant again. They may also worry that medication could be addictive or have a numbing effect. Because of the complexities of prescribing medication during the perinatal period, mothers must work with a psychiatric provider who is trained in this area. They can conduct a thorough evaluation to determine whether medication is right for you and help you consider the pros and cons. 

Coping with PPA

Regardless of whether you are seeking professional treatment, it’s important to take measures to cope with your anxiety. Finding time and energy to prioritize self-care during the postpartum period is incredibly challenging. It may take time to create a solid routine. Aim for baby steps to start, and anticipate slow but steady progress. Here are some ways to cope with PPA:

• Lower your expectations: Many mothers with high levels of anxiety put immense pressure on themselves to keep up with everything that they did before. They have trouble accepting that they need to rest and take things easy during this time. If this sounds like you, try to work on giving yourself permission to do less. Remember that your worth is not tied to how productive you are.
• Delegate: As you accept that you need to do less, consider delegating tasks to others. Don’t expect yourself to do it all.
• Incorporate movement: Exercise offers positive benefits for your mood and has been shown to lower stress and anxiety. Just 30 minutes of movement a few times a week can go a long way. Walking and stretching are good ways to start once you are cleared to do so by your healthcare provider.
• Connect with other mothers: Social support is an important part of maternal mental health. Connection, especially with other new mothers, is vital. If you do not have an existing support system, consider joining a support group or mommy-and-me class. There are many in-person and virtual options available. 
• Limit caffeine: Caffeine can worsen anxiety and some women are more sensitive to the effects of caffeine. If you notice that your anxiety gets worse after consuming a caffeinated beverage, consider cutting back or stopping altogether.

Postpartum anxiety is the most common PMAD experienced by new mothers. Treatment can help you manage your symptoms and feel more in control of your own thoughts and feelings.

At Phoenix Health, we specialize in treating maternal mental health conditions like postpartum anxiety. Schedule an appointment with a maternal mental health specialist and start feeling better today.