There have been many awareness campaigns, celebrity interviews and doctor’s office brochures dedicated to postpartum depression. But new parents are less familiar with another common mental health struggle new mothers face: postpartum anxiety.
This condition is characterised by a constant sense of worry that goes to greater extremes than the typical concerns and emotions all new parents experience.
“Postpartum anxiety is considered a perinatal mood and anxiety disorder [PMAD],” said Becky Stuempfig, a licensed marriage and family therapist in Encinitas, California, who specialises in supporting mums with postpartum mood disorders. “Perinatal depression and anxiety are the most common complications after childbirth, and perinatal anxiety affects 6% of pregnant women and 10% of postpartum women. Some women experience anxiety alone, and some experience both anxiety and depression.”
Stuempfig noted that a personal and/or family history of anxiety, thyroid imbalance, traumatic pregnancy or childbirth, pregnancy or child loss, eating disorders, and of obsessive-compulsive disorder or post-traumatic stress disorder are all factors that could increase someone’s risk for postpartum anxiety. Race and socioeconomic status can also be risk factors.
“Postpartum anxiety takes on many of the same symptoms that generalised anxiety disorder does,” said Deema Soufan, a Chicago-based licensed professional counsellor who specialises in maternal mental health. “What separates generalised anxiety disorder and postpartum anxiety is the time frame of occurrence and the topics of worry.”
Although experts had believed postpartum disorders like postpartum anxiety (PPA) could only occur up to one year after giving birth, Soufan noted that recent research has suggested women can experience these symptoms for up to two years postpartum. Additionally, the stresses of the Covid-19 pandemic have led to PMAD case increases, with one 2020 study putting the anxiety rate among new mothers as high as 72%.
“The majority of women experiencing a perinatal mood disorder such as postpartum anxiety do not share this with anyone,” Soufan said. “Thousands of women are suffering in silence due to things such as stigma and fear that someone will take away their baby away from them. Women of color are at increased risk for developing postpartum anxiety and are disproportionately affected due to a number of barriers in treatment.”
Do you suspect that you or a loved one might be experiencing postpartum anxiety? Below, Stuempfig, Soufan and other experts break down some of the signs that it may be time to seek professional help.
1. Obsessive Thoughts
“Obsessive thoughts can be a red flag for postpartum anxiety,” Stuempfig said. “Many mums obsess about their baby being harmed in the middle of the night if they fall asleep, such as ‘I can’t fall asleep because my baby will stop breathing,’ or horrible accidents such as ‘What if I accidentally push the stroller off the side of the road?’”
These types of intrusive thoughts can be paralysing and interfere with a mother’s ability to function day-to-day. Many women who’ve experienced PPA have said they felt like their minds were constantly “racing.” Paige Bellenbaum, chief external relations officer for the New York-based mental health clinic The Motherhood Center, described “feeling as though your mind is a hamster wheel; it keeps spinning and spinning, and you can’t stop it or turn it off.”
Many women may also feel like bad mums due to the nature of their obsessive thoughts, which often pop into their heads out of nowhere.
“These thoughts are very distressing to new mums and oftentimes they feel too ashamed to admit they are having these thoughts, which can prevent them from getting support,” Stuempfig added.
2. Distress About Leaving Your Baby
Many mothers feel a sense of unease about leaving their babies with someone else for the first time, but with PPA, these negative feelings are heightened.
“It is normal to worry about leaving your baby,” Soufan said. “What separates worry from a clinical disorder is the level of distress the mother is experiencing surrounding the topic at hand. If you are dealing with difficulty separating from your baby, it is best to take a tapered exposure approach with this notion. For example, start low and slow and begin by allowing someone you trust to look after the baby while you are in the home and slowly build to leaving to run a quick errand, so on and so forth. A clinical provider can help you with this.”
3. Ruminating
One sign that might indicate postpartum anxiety is ruminating about different things related to motherhood. This rumination may reach severe levels of time and mental energy.
“Ruminating within the context of postpartum anxiety refers to when a mum continuously goes over something in her mind such as ‘I’m a horrible mother’ or ‘What is wrong with me for not enjoying my baby more?’” Stuempfig said. “The ruminating tends to be negative in nature and can often prevent mums from taking positive action to feel better.”
4. Exhaustion
These overwhelming feelings of worry can be exhausting, especially if anxious thoughts are keeping you up at night.
“Postpartum anxiety is one of the most active and exhausting PMADs,” Bellenbaum said. “The amount of physical and emotional energy that is taken up by these symptoms can leave women exhausted and weak.”
Having trouble sleeping can be a particularly difficult aspect of PPA, as that sleep deprivation may also interfere with your ability to function.
“Those suffering from postpartum anxiety also experience an inability to sleep ― even when the baby is sleeping ― irritability, and difficulty concentrating,” Soufan said.
Other physical symptoms may include dizziness, hot flashes and nausea, added Stuempfig.
5. Severe Guilt
“Any mum can develop anxiety during pregnancy or the postpartum period, but the factors that can often exacerbate a new mum’s anxiety include hormone changes, sleep deprivation, lack of support and the societal expectation that this ‘should’ be an extremely happy time in a mum’s life,” Stuempfig said.
This societal expectation has contributed to the silence and stigma around postpartum disorders. Mothers may hesitate to share how they’re actually feeling and seek help, which makes the problem worse.
“It’s common for mums to feel guilty for not enjoying their babies as much as they feel like people around them expect them to,” Stuempfig noted. “They may internalise these guilty feelings and blame themselves as ‘not good enough’ mums, which only exacerbates their anxiety symptoms.”
6. Difficulty Functioning And Making Decisions
“When a mum is struggling with postpartum anxiety, she has a level of worry and anxiety that interferes with her ability to live her life the way she wants and needs to,” said Kate Kripke, founder of Colorado’s Postpartum Wellness Center of Boulder. “Her anxiety is making it hard for her to sleep, eat, make decisions and engage in activities that she knows are good for her ― think seeing friends, going to exercise, accepting help with a baby.”
Bellenbaum echoed this, noting that there may be an inability to make even the smallest decisions or to look at situations rationally.
“She may feel ‘frozen’ ― incapable of completing simple everyday tasks,” she said, adding that appetite changes can also accompany PPA.
“One way to determine whether a mum needs to seek professional help for postpartum anxiety is to consider the frequency and intensity of her symptoms,” Stuempfig said. “In other words, how much are they affecting her functioning? Is she able to leave the house? Does she sleep when she has the opportunity? How much time in the day do her worries consume her thoughts?”
7. Persistent and Excessive Worry
“Postpartum anxiety is characterised as persistent, excessive worry,” said Dr. Terry Krause, a family medicine physician with UCHealth Primary Care in Highlands Ranch, Colorado. “Women may also report high levels of stress, difficulty relaxing and constant worry about their baby’s health and safety.”
These worrying thoughts may feel invasive and pervasive, and even evolve into a seemingly constant feeling of dread. The length of time these symptoms remain can indicate postpartum anxiety.
“Postpartum anxiety is not diagnosed when a mum is feeling anxious from time to time in new motherhood ― this is a normal experience that all mums have,” Kripke said. “It can feel really uncomfortable to be in charge of a little person’s life and wellness. But when a mum is feeling anxious often, for long periods of time, or even with reassurance, then it is time to reach out for support.”
Bellenbaum noted that approximately 70% to 80% of new mums experience some version of baby blues in the immediate postpartum period.
“This includes feeling overwhelmed, weepy, exhausted, irritable and anxious,” she said. “If these symptoms persist beyond the two-week mark and/or increase in severity, a PMAD might be at play.”
8. Heightened Emotions
Mothers experiencing PPA might feel like their bodies and emotions are in a heightened state.
Kripke pointed to “hyperarousal” as a a symptom. “This means that someone goes from zero to 10 very quickly ― her nervous system is heightened, and she might be in a fairly constant state of fight or flight,” she said.
“Black and white” or “all or nothing” thinking that goes only to extremes may also be at play, according to Bellenbaum. She noted, “There’s also catastrophising ― jumping to the worst possible case scenario.”
If you think you may be struggling with postpartum anxiety, don’t hesitate to reach out for professional help. Your OB-GYN, primary care physician or paediatrician should be able to offer screenings, resources or referrals. You can may also visit Postpartum Support International for educational materials, listings of area therapists trained in maternal mental health and online support groups.
“New mums often feel very alone, particularly when they are spending so much time in the house with a new baby, and they often begin feeling like they are the only mum to struggle with postpartum mood issues,” Stuempfig said. “The more a new mum can reach out for support, the less power her worries will have over her. I strongly encourage mums to connect with other trusted mums and share what they are experiencing and be open about how their experience of becoming a mum has been different from what they anticipated.”