What Is Postpartum Anxiety?

Sally is a new mom to a healthy, 5 month old baby boy. Sally describes feeling consumed by worries that her baby will stop breathing in his sleep. She feels tense, restless, and unable to fall asleep most days. Because of these worries, Sally sleeps with the baby monitor in her hand, sets an alarm in the middle of the night to check on the baby, and asks that her partner check on the baby when Sally is sleeping. To try to give herself more reassurance that her son is safe, Sally googles information on sudden infant death syndrome (SIDS), and makes extra appointments with her pediatrician.

You might be thinking that Sally sounds familiar. Almost every parent worries to some degree about having a baby and raising children.

         Will I be able to breastfeed?

         Is my baby too hot or too cold?

         Is my baby sick?

         Is it okay to let my baby cry?

         Will I be a good parent?

The responsibility of caring for a baby can feel enormous. For first time parents especially, they simply lack experience to feel confident in what they’re doing. Many gain confidence relatively quickly. But what happens when these worries become more severe? What happens when you can’t get these worries out of your mind, and they interfere with your ability to do things in your day-to-day lives? If left unmanaged, these worries can become postpartum anxiety.

So what is Postpartum Anxiety?

Postpartum anxiety (PPA) is anxiety that starts after having a baby, and that is more severe and debilitating than the typical levels of anxiety experienced by new parents.

Common symptoms include:

• Frequent worry or racing thoughts

• Feeling that something bad is going to happen

• Difficulty sleeping

• Change in appetite

• Restlessness

• Physical symptoms such as heart racing, tight chest, muscle tension, feeling hot and sweaty

• Repeatedly checking for safety

• Seeking reassurance from others or the internet

• Avoiding situations/triggers

• Being hypervigilant (looking out for danger) or extra cautious

PPA really doesn’t get the attention it deserves. Most of us have heard of postpartum depression, but did you know that postpartum anxiety is actually more common? Up to 20% of women will experience an anxiety disorder during pregnancy or the postpartum period. Unfortunately for many women, it will go undiagnosed for a long time.

PPA can take different forms including:

• Generalized Anxiety Disorder (Excessive worry)

• Obsessive-Compulsive Disorder (Repetitive unwanted upsetting thoughts and/or feeling the need to do certain things over and over again to reduce anxiety)

• Panic Disorder (panic attacks which are not dangerous but feel very unpleasant)

Who is likely to experience PPA?

Common risk factors for PPA include:

• History of anxiety (prior to or during pregnancy)

• Family history of anxiety

• History of endocrine dysfunction (e.g., thyroid imbalance)

• Previous mood reaction to hormonal changes (e.g., puberty, PMS, PMDD)

• Perfectionism (e.g. Type A)

• Stressful life experiences (e.g., previous miscarriage or infant loss, high risk pregnancy, financial crises)

• Limited or no social support

Here’s the good news! There are two main methods that manage PPA very well – cognitive behavioural therapy (CBT) and medication. With CBT, the main goal of therapy is to help people change the way that they think and change what they do in order to feel better. There are also effective and safe medications that can be prescribed during pregnancy and the postpartum period. If you are suffering from anxiety and are wondering if medication is right for you, we strongly encourage speaking with your family doctor who can discuss treatment options with you.

Let’s get back to Sally:

Sally connected with a Perinatal Psychologist with training in CBT. Sally and her therapist worked to identify Sally’s unhelpful and unrealistic thoughts (e.g., something bad will happen to my baby if I don’t check on him), and develop more realistic ways of thinking about the situation (e.g., SIDS is not common, my baby is safe is his crib, checking on my baby doesn’t prevent bad things from happening). Sally was tasked with doing exercises designed to gently expose her to her fears, whereby she increased the time between checking on the baby, and placed the monitor on her partner’s side of the bedroom. Sally was also taught techniques to help her relax, and was encouraged to exercise and get out of her house every day. Sally’s anxiety improved over time, and she was able to stop worrying as much about her son, and sleep more restfully at night.

If you or someone you know is experiencing the symptoms described above, please reach out to a healthcare provider. A good place to start is with your family doctor, midwife, obstetrician, or mental health provider trained in perinatal mental health. If you are interested in seeing a perinatal psychologist, check out our team at the Well Parents Centre. Remember that “you are not alone, you are not to blame, and with help you will be well” (Postpartum Support International).