The Telltale Signs Of Postpartum Anxiety

The perinatal period, defined as the weeks before and after childbirth, is a time of major change—a hormonal rollercoaster ride that’s both physically and mentally challenging. Whether you’re a new mom dealing with your first pregnancy, or you’ve experienced parenthood before, the responsibility of caring for a newborn can feel frightening and overwhelming. So many mothers find themselves dealing with anxiety at some point during their parenting journey.

However, there is a difference between what’s considered typical anxiety and the level of perinatal anxiety that warrants professional help.

Most people today have a general awareness of postpartum depression but are unfamiliar with the term postpartum (or perinatal) anxiety. While we’ve made some progress in normalizing the occurrence of pregnancy-related mental health conditions, we still have a way to go.

When new moms understand that postpartum depression is not a personal failing or a reason to feel shame, it helps reduce the barriers to care. Women may be more willing to talk about their symptoms and seek treatment. The same can be said about perinatal anxiety.

Neither condition is specifically listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as having its own official diagnosis. Instead, they fall under the umbrella of major depressive disorder (which can be diagnosed with the specifier of “with peripartum onset”) and various anxiety disorders (e.g., generalized anxiety disorder, panic disorder) or obsessive-compulsive and related disorders. There are a range of diagnoses that fall under the category of perinatal mood and anxiety disorders (PMADs).

A woman with perinatal anxiety can be described as experiencing acute anxiety during the perinatal period, which can begin in pregnancy and extend beyond birth. Often, the anxiety is focused on the baby, but it can also include generalized anxiety that’s amplified during the perinatal or postpartum period (immediately following childbirth).

Some of the symptoms new moms and their partners can look for include:

• Anxiety (usually focused on the baby) that lasts longer than expected, is more intense than usual, or more difficult to manage
• Extreme restlessness or difficulty concentrating
• Difficulty sleeping (beyond the typical new-parent sleep disruptions)
• Increased irritability
• Intrusive thoughts that are frightening and hard to control, such as images of the baby being hurt

To determine if a woman’s anxiety during the perinatal period falls under the classification of a perinatal mood and anxiety disorder, we’ll often screen her symptoms using a 10-question scale called the Edinburgh Postnatal Depression Scale (often the symptoms of depression and anxiety go together).

One important thing we are looking for is coping ability. Are you, as a new mom, coping as well as usual or unable to cope at all? With all major life changes—and certainly, adding an infant to the household is a life-altering event—there is a normal amount of anxiety and adjustment difficulties to be expected. The question is whether that anxiety is preventing you from functioning well enough. Are you able to care for your baby, leave the house, or effectively manage your fears?

There are several factors that can put you at risk for perinatal anxiety. If you have a history of anxiety and/or depression, pregnancy can make it harder to manage. This risk may increase if you choose to go off your medication during your pregnancy, and it’s something you should discuss with your psychiatrist and OB/GYN before making that decision. There may be alternate medications that are deemed safer for use during pregnancy. You and your providers may also decide that the risks of increased anxiety or depression to the pregnancy may outweigh any risks associated with medications used to decrease those symptoms.

Some medical conditions, such as diabetes and thyroid issues, may also increase your risk for perinatal mood and anxiety disorders.

Then there are the circumstantial risk factors that can lead to high anxiety, such as having a high-risk pregnancy or having experienced a previous loss or complication. In fact, any history of trauma—pregnancy-related or not—can put you at greater risk for perinatal anxiety.

Social or financial situations can also contribute to mood disorders, such as single parenthood or relationship problems; unemployment or underemployment; being an immigrant, new to an area, or without a strong support system; inadequate housing; a lack of insurance or good medical care; and more.

Depending on the intensity of your anxiety, you may find some coping strategies, such as mindfulness exercises and breathing techniques, to be helpful and don’t necessarily require the guidance of a therapist. But with so much going on in the postpartum period—and the responsibilities new moms must balance—it’s helpful to have the support of a professional to guide you.

A cognitive behavioral therapist can offer ways to directly address and reduce your anxiety while also helping you understand where some of it is coming from. It’s valuable to recognize how certain behaviors or thought patterns contribute to the cycle of anxiety to better control it.

Support groups are also a powerful tool for women facing perinatal mood and anxiety disorders, with many now online. Postpartum Support International is an amazing resource for accessing a variety of peer-led support groups. Speaking with others who have gone through a similar experience is highly effective when you’re feeling the isolation and loneliness that are so common during this period.

If you are the spouse or partner of someone with a perinatal mood and anxiety disorder, there are several things you can do to help. In addition to helping more with the baby and household chores and staying attentive to your partner’s needs, if you notice signs that your loved one is struggling, encourage her to call her provider (OB/GYN, primary care, or mental health professional).

One thing I emphasize is the importance of validating your partner’s feelings. It may seem reassuring to tell her she’s got nothing to worry about, but that can be invalidating and may compound her stress. Instead of wishing her anxiety away or waiting for it to pass, acknowledge that her experience is common and that you will find a way through it together. Simply using words like “I can understand why this is so scary for you” can make a big difference.

• The Ultimate Postpartum Checklist
• My Battle With Postpartum Depression
• Why Postpartum Depression Screening Failed Me