Most of us go into pregnancy and postpartum expecting to experience what we see in the movies—happy, healthy and energetic mothers who are reveling in their new role as “mom.” But the reality is often a starkly different one. In fact, many new mothers grapple with postpartum depression or its sister postpartum anxiety. The latter is arguably even more common and just as debilitating.
What is postpartum anxiety?
Postpartum anxiety, or PPA for short, is a mental health condition that involves persistent symptoms of worry and fear. It is a type of perinatal mental health condition, or PMAD, which is a group of mental health conditions that affect pregnant and postpartum women. Other PMADs include postpartum depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
The symptoms of PPA can vary from person to person, but typically include:
- Worry that is hard to control
- Fear that something bad is going to happen
- Intrusive or racing thoughts
- Irritability
- Agitation
- Difficulty sleeping
- Changes in appetite
- Physical signs like dizziness, difficulty catching your breath, and racing heart
Experts believe that PPA is caused by a combination of factors, including hormonal changes that occur after giving birth, sleep deprivation and the stress of caring for a newborn and navigating new parenthood. Some women are at greater risk of developing PPA than others. Common risk factors include having a history of an anxiety disorder, a lack of support during the postpartum period and a past history of trauma.
PPA affects around 15 to 20% of postpartum women. While the symptoms listed above are common among women with PPA, the experience of anxiety during the postpartum period is unique. The way that postpartum anxiety shows up, the specific worries and fears, and the impact on a woman’s life can differ significantly from one woman to another.
Many women with PPA experience intrusive thoughts, which are unwanted and distressing thoughts, images, or urges that seem to pop up out of nowhere and are hard to get rid of. Often these thoughts have to do with something bad happening to the baby. Some women have thoughts that they could hurt their baby, even though they have no desire to. This is very distressing and can cause considerable guilt and shame, which causes many women to stay silent.
Women with PPA may also experience obsessive thoughts that cause them to engage in compulsive behaviors. This is called obsessive-compulsive disorder, which is a type of anxiety disorder that affects between 7 and 11% of postpartum women. These compulsive behaviors temporarily alleviate some anxiety, but only for a short while. The anxiety eventually comes back, sometimes even stronger than before. A common obsessive thought is fear that something bad will happen to the baby while they’re sleeping. A woman with PPA may feel so consumed by these fears that she herself cannot sleep. She may repeatedly check her baby throughout the night, making it nearly impossible to get any rest, which further fuels her anxiety. This constant worry and checking makes it very difficult to function or focus on anything else.
The impact of postpartum anxiety
Here are some of the ways that postpartum anxiety can affect your life:
Marriage
Postpartum anxiety has a way of making a woman feel incredibly isolated. When it comes to marriage, it’s common for women to feel like their partners don’t understand. I see this when I work with new parents in my therapy practice.
Many times the woman’s partner will try to take a rational approach to the anxiety. For example, if a woman is anxious to leave the house, her partner may try to convince her that she has nothing to be afraid of. This urge to challenge the anxiety is only natural. While this can be helpful in some cases, it typically causes the woman to feel frustrated and even more alone.
When someone is in a state of anxiety or panic, it’s much more helpful to ask them “do you need me to listen or do you need advice?” When I bring this up to partners, they express to me that it feels too passive or like they’re not doing anything at all. The truth is that ‘just listening’ is doing something. Sitting with someone in their pain, letting them talk, and expressing understanding is often most effective in these moments.
Other Relationships
All too often I ask my clients with postpartum anxiety about who they have told about what they are going through. More often than not, the response is nobody. They hide their true feelings from their friends and family and suffer in silence. When I ask why, the most common answer is that they’re scared to be vulnerable. They’re worried that they’ll be judged as being a bad mother or too weak if they let people know.
The problem with suffering in silence is that it makes anxiety worse. Anxiety likes to fester in your head and tell you things about yourself, others, and the world that simply aren’t true. When you’re alone in your own head, you can find yourself going down rabbit holes of worst-case thinking.
It’s Brene Brown that said “We don’t have to do all of it alone. We were never meant to.” She encourages us to be vulnerable and explains that it is the only way to experience true connection with another person. So as uncomfortable as it can be, it’s important that you find at least one person or outlet to share these feelings with.
Parenting
Postpartum anxiety can also make parenting more challenging. Caring for a newborn is stressful to begin with, but when you add PPA to the mix, it can feel even harder.
The mental load or ‘mother load’ is a term used to describe the invisible load that comes with running a household and family—it includes the endless to-do lists and household chores. For parents of babies, it also can include keeping track of wake windows, tracking sleep, feeding and pumping schedules, keeping the diaper bag stocked, and so on and so on.
Some of the women I work with start to judge how overwhelmed they feel. They compare themselves to other mothers who seem to have it all together and tell themselves that it’s just them that can’t keep up. This results in guilt, shame and a cycle of negative self-talk. The truth is that all of us moms are overwhelmed. We need to stop judging ourselves and comparing and instead work on accepting ourselves where we are at.
Work
For many postpartum women who work outside of the home, the transition back to work is a source of significant anxiety. Many women worry about how they will be able to balance work and home life now that they are parents. Another common worry is childcare, including how to find affordable and good quality child care and whether their babies will be well-taken care of when they’re working.
Postpartum anxiety can also make actually working more difficult. Anxiety has a way of consuming your thoughts, which can make it hard to focus. Postpartum women often describe feeling like they are in a fog and unable to show up to work and give 100 percent. I remind moms that they have just gone through a significant life change and they can’t expect themselves to show up in the same ways that they did before. The fog will lift over time, but part of the journey is finding a new rhythm. This process takes time. Be patient with yourself as you embark on this new adjustment.
When to seek help for postpartum anxiety
Postpartum anxiety is treatable. No one should suffer when there is help and support out there. Just like you would get help for a broken bone, you deserve to get help for postpartum anxiety.
Typically postpartum anxiety is treated with psychotherapy, either in an individual or group setting, or both. Therapy helps in a number of ways. It helps you understand why you are feeling the way that you are. It also gives you insight into your thinking and how to change your thoughts. When you have anxiety, it seems like your thoughts control you. Therapy can help you take back your power by becoming the one in control of your own thoughts.
Some women who suffer from PPA also benefit from psychiatric medication. The choice of whether to take medication is a personal one. I highly recommend speaking with a psychiatrist or psychiatric nurse practitioner about whether medication is right for you. If you’re pregnant or breastfeeding, it’s especially important that your provider has experience in this area and can give you information on the safest options.
Postpartum anxiety may look different for everyone
Like I mentioned, there is a wide spectrum when it comes to postpartum anxiety. Your experience is likely to be very different from another woman’s experience. Each woman is on her own journey.
Regardless of your exact experience, finding a safe space to talk about your thoughts and feelings is so important. Whether it’s with a friend, family member, coworker, therapist, or in a support group, shining light on your dark thoughts can help eliminate much of the fear, shame, and loneliness. It can be scary at first, but the long-term benefits are worthwhile!
For support from other moms like you who suffer from postpartum anxiety, visit The Mother Chapter.
