Supporting New Parents: Managing Postpartum Anxiety

The Second Most Common Postpartum Mood Disorder… that you’ve probably never heard of

Welcoming a new life into the world is a joyful occasion. But the reality of postpartum experiences can be more complex than meets the eye. While postpartum depression is a term most people are familiar with, the truth is that it is not the only mental health disorder that can occur during and following birth. Perinatal mood and anxiety disorders (also known as PMADs) can occur anytime during pregnancy or within the first year of birth. They often result from the tremendous physical, neurological, and hormonal changes that occur during and following pregnancy. The prevalence of PMADs is on the rise, and, in particular, experts are seeing a spike in women experiencing postpartum anxiety and postpartum OCD. However, with all that in mind, here’s the most important thing we want you to know: PMADs are nobody’s fault, and they can be treated effectively if you get help for them. Keep reading to learn more about managing perinatal mood and anxiety disorders in general, and postpartum anxiety in particular.

Who can have a PMAD?

PMADs encompass an umbrella of disorders and affects about one in 10 women. Non-birthing caregivers can also experience a PMAD. Though these disorders are common, they are often misunderstood or overlooked. It is critical that new parents know what to look out for and how to get the proper support if they are experiencing any of the symptoms associated with a PMAD. 

Do I have a PMAD?

If you’re here, you might wonder if you or someone you know is experiencing a PMAD, including postpartum depression, anxiety, bipolar disorder, psychosis, and more. While this blog will cover lots of information—from risk factors to treatment options—this is the one thing we want you to remember: PMADs are nobody’s fault and PMADs are temporary and treatable. 

How many different PMADs are there? 

Though this article will focus on managing postpartum anxiety, here is a brief overview of other PMADs: 

• Postpartum depression: this is different from the “baby blues.” Postpartum depression is more severe and lasts longer. Symptoms associated with postpartum depression, such as prolonged feelings of sadness, anger, irritability, loss of interest in things you formerly enjoyed, last for 2+ weeks and interfere with daily functioning. 15 to 20% of women meet criteria for postpartum depression. 10% of women experience antepartum depression or depression during pregnancy.
• Postpartum bipolar disorder: includes manic episodes (elevated mood, racing thoughts, lots of energy, decreased need for sleep—which is different from sleep deprivation that often accompanies postpartum life) in addition to depressive symptoms. Manic episodes often get missed. If you or your partner is experiencing any of these symptoms it is critical to get evaluated by a mental health professional.
• Perinatal psychosis: while perinatal psychosis is rare (occurring in .1 to 2% of births), it is critical to mention as it is often shrouded in secrecy. Perinatal psychosis can include delusions, paranoia, hallucinations, extreme irritability, agitation, hyperactivity, and/or decreased need for sleep. These symptoms are temporary and treatable (like all other PMADs). But due to the acute nature, they require immediate and appropriate medical care. Often the delusions that mothers can experience in a psychotic state involve hurting themselves or their baby—a small number of these mothers will die by suicide or commit infanticide. When someone is experiencing a psychotic episode, they are not connected to reality. These delusional beliefs seem very real and very scary. 

What does postpartum anxiety look like?

Postpartum anxiety is the second most common PMAD. But, despite it being so prevalent, almost no one has heard of it. 

Postpartum anxiety can include symptoms like:

1. Persistent and excessive worry about the baby’s health and safety.
2. Changes in appetite or sleep (outside of what is expected with new parenthood)
3. Constant fear of being unable to care for the baby properly.
4. Difficulty sleeping, even when the baby is asleep.
5. Racing thoughts and an inability to quiet the mind.
6. Physical symptoms such as hot flashes and GI issues.
7. Avoidance of social situations or activities due to fear or anxiety.

Individuals with postpartum anxiety often have catastrophic thoughts—what if my baby doesn’t eat enough, and then she loses weight, and then she has to be hospitalized, and then her development is impaired. 

What is postpartum OCD?

Postpartum OCD is another PMAD that is often hard to distinguish from general postpartum anxiety. Individuals with postpartum OCD experience persistent, intrusive thoughts of harm to themselves or their baby. These thoughts are specific and repetitive. It is critical to remember that these aren’t fantasies or wishes. Individuals with postpartum OCD don’t want to have these thoughts and don’t want to act on them, so they often engage in specific, compulsive behaviors to reduce the thoughts or the anxiety associated with the thoughts. For example, an intrusive thought such as “my baby will stop breathing” may be alleviated by checking on the baby while sleeping over and over again, despite knowing she is safe. 

It is also possible to have what we call “Pure O”—OCD with just the obsessions. An individual with Pure O has unwanted intrusive thoughts—I am going to hurt my baby—without engaging in related compulsive behaviors.  Unlike perinatal psychosis (discussed above), individuals with postpartum OCD know that these scary, intrusive thoughts are not real.

What is postpartum PTSD?

Postpartum PTSD is less common, but not that rare. About 9% of women experience PTSD following childbirth. Symptoms typically result from a traumatic childbirth experience, and then re-experiencing that trauma through thoughts or dreams or flashbacks. As a result of reexperiencing, individuals with postpartum PTSD typically avoid anything associated with the event. Postpartum PTSD often includes irritability, difficulty sleeping, hypervigilance and an exaggerated startle response (feeling “on-edge”). 

What is postpartum panic disorder?

Finally, individuals with postpartum panic disorder experience panic symptoms such as shortness of breath, chest pain, and heart palpitations. They sometimes feel like a heart attack, but are not actually due to any medical condition, and arise without warning. 4 to 10% of new mothers develop postpartum panic disorder. 

Can non-birthing parents experience a PMAD?

As is the case for all PMADs, non-birthing parents can experience postpartum anxiety. For example, about 10% of new fathers become depressed before or just after their baby is born. Further, depressive symptoms are especially common three to six months after the birth, with as many as one in four dads experiencing such symptoms. Like mothers, fathers experience hormonal changes after a baby is born.

What are the risk factors for experiencing a PMAD?

There are some risk factors that can predispose individuals to developing a perinatal anxiety disorder: a history of biological sensitivity to hormone changes (such as having premenstrual dysphoric disorder, or PMDD), a sleep disorder, previous history of mental health challenges, or any psychological factors such as feelings about parenthood or body insecurities or perfectionistic tendencies. There are also social and environmental factors—a history of trauma, limited social support, and systemic racism, for example.  

And still, we really cannot predict who will go on to experience postpartum anxiety (or any other PMAD). For that reason, we encourage families to have a postpartum plan in place that addresses the steps they can take should such symptoms emerge. Consider establishing support systems and creating a roster of mental health professionals trained in perinatal mental health, whom you can contact if necessary.

What should I do if I think I have a PMAD?

What should you do if you have one of the signs or symptoms of a PMAD? First, do not blame yourself. Remember, PMADs happen because of profound hormonal shifts, genetic predispositions, and environmental stressors – not because of anything you did! You did not cause a PMAD, it just happened. Next, get help—tell your partner, talk to your doctor, reach out to a support community. Don’t wait until your 6-week check-up or beyond. Postpartum Support International is a great place to start. 

If you have a PMAD, getting help is critical. Treatment is important for the entire family system. Research has shown that untreated PMADs are associated with less breastfeeding success, brain development, and behavioral problems in the child. Though mothers often attempt to “hold it all in” to protect their families, the truth is that the best thing you can do for your children is to get support and treatment. Your family will thrive best if you can show up as the healthiest version of yourself. 

What can I do right now to help my postpartum anxiety?

While seeking professional help remains the top priority if you suspect postpartum anxiety or another PMAD, here are some self-initiated steps to manage symptoms:

• Establish a Support Network: Try to surround yourself with supportive friends, family members, and fellow moms who can offer empathy, understanding, and practical assistance. Sharing your experiences with others who have walked a similar path can be incredibly validating and reassuring.
• Practice Self-Care: As a new parent, it’s easy to neglect your own needs while focusing entirely on your baby. However, prioritizing self-care is crucial for managing anxiety. This might involve taking short breaks to rest, making time for hobbies you enjoy, or engaging in relaxation techniques such as deep breathing, meditation, or yoga.
• Maintain a Healthy Lifestyle: Regular movement, a balanced diet, and adequate sleep are fundamental components of mental well-being. Try to incorporate movement into your daily routine, even if it’s just a brief walk around the neighborhood with your baby. Additionally, nourish your body with nutritious foods and prioritize rest whenever possible.
• Limit Exposure to Stressors: It can be helpful to identify triggers that exacerbate your anxiety and take proactive steps to minimize exposure to them. This might involve setting boundaries with well-meaning but overbearing relatives, limiting your consumption of distressing news or social media content, or delegating household tasks to alleviate overwhelm.
• Practice Mindfulness: Mindfulness techniques can help ground you in the present moment and reduce the grip of anxious thoughts. Incorporating mindfulness practices like breathing exercises or guided imagery fosters calmness and resilience in your daily routine.
• Challenge Negative Thought Patterns: Postpartum anxiety often involves distorted thinking patterns characterized by catastrophic predictions and excessive self-doubt. Challenge these negative thoughts by asking yourself if they’re based on evidence or irrational fears. Cognitive-behavioral therapy (CBT) can be particularly helpful in identifying and reframing these thought patterns.
• Prioritize Sleep: Sleep deprivation can exacerbate anxiety, so prioritize getting adequate rest whenever possible. Establish a soothing bedtime routine, delegate nighttime caregiving responsibilities when feasible, and nap during the day to make up for lost sleep.
• Be Gentle with Yourself: Finally, remember that navigating postpartum anxiety is a journey, and healing takes time. Be patient, compassionate with yourself, and celebrate small victories as you navigate challenges.

Also important to note, if you or someone you love is pregnant right now, consider doing the things listed above as a way to have a plan in place, in the event you do experience postpartum anxiety or another PMAD after giving birth. There’s nothing you can do to prevent having a PMAD. Remember, it’s nobody’s fault. But having a plan in place can certainly help when it comes to managing the overall experience and recovery.

How is a PMAD treated?

Treatment of a PMAD involves processing your feelings and learning ways to cope with them. For example, many individuals with a PMAD benefit from processing feelings of grief and mourning losses (like frustration about a mistimed pregnancy, disappointment in the sex of the baby, or not having that immediate sense of falling in love with your baby—by the way, all of these are normal) that they may not even realize they are experiencing. Therapists help clients in managing the massive identity shift and life transition that accompanies new parenthood.

Therapy provides a safe space to express a range of feelings without judgment. There are different kinds of therapy, including CBT (cognitive behavioral therapy), psychodynamic therapy, and Internal Family Systems. Your therapist will conduct an intake evaluation to understand your needs and collaborate on a treatment plan with you. The primary focuses of treatment are to increase support and decrease stress. That will likely involve learning coping skills, such as mindfulness and nonjudgmental emotional awareness, to manage strong feelings. It also might include processing family history and exploring generational patterns that may be contributing to symptoms.  

One important point: there is a myth that you cannot be on an antidepressant while pregnant or breastfeeding. This is not true. Some antidepressants are commonly used during pregnancy to prevent maternal health issues and harm to the baby from untreated depression. If you think you could benefit from medication, please consult with a medical professional.   

If you walk away from this blog with one take-away, we hope it’s the fact that PMADs are nobody’s fault and can be treated effectively. The more we know, the better we can help ourselves, our family, and our friends. 
If you think you or someone you love may be experiencing a PMAD, click here to schedule a complimentary consultation call with Upshur Bren Psychology Group to learn about support options that would be best for you.