Postpartum Anxiety: What are the Symptoms and Treatment Options?

Having a child is a life-changing experience. Quiet nights quickly morph into running around the house changing diapers and responding to the sounds of crying at 4 a.m. These developments can produce a bevy of feelings that leave you stressed, worried and scratching your head wondering if you are a capable parent.

In spurts, these feelings are normal. But they can easily turn into more disruptive behaviors as a part of postpartum anxiety. How do you decipher between normal worrying and anxiety, though? Use this blog to understand the symptoms and what you can do to treat this disorder.

What is postpartum anxiety?

Postpartum anxiety describes anxiety – intense, excessive and persistent worry – that mothers or new parents experience in the first 12 months after the birth of their child. Many parents worry about their newborn, whether it’s health or development. But postpartum anxiety occurs when these feelings consume you and make you worry around the clock. 
As many as 20 percent of women experience postpartum anxiety, although these figures are hard to pinpoint since there isn’t a specific screening like there is with postpartum depression. While most people associate this type of anxiety with women, fathers can also experience persistent worry and fear about their baby.

Postpartum anxiety is sometimes referred to as the umbrella term perinatal mood and anxiety disorders (PMAD), which lumps together disorders pregnant women and new parents can experience. PMAD includes depression, panic disorders and obsessive compulsive disorders. There is a noticeable difference between postpartum anxiety and postpartum depression, though – the anxiety creates worry, not sadness.

Here are some common examples of postpartum anxiety disorders:

• Generalized anxiety disorder: The most common type of postpartum anxiety, generalized anxiety causes excessive worry and fearful thoughts after birth. It occurs in about 10 percent of women during the first six months.
• Panic disorder: These recurrent panic attacks occur in about 3 percent of women during the first six to 10 weeks after delivery. It can lead to shortness of breath, chest pain, dizziness or excessive sweating.
• Social anxiety disorder: As the name suggests, this type of anxiety occurs when there is a fear of being watched or judged by others in public or social settings. Up to 7 percent of women experience social anxiety disorder during the first few weeks after birth.
• Obsessive compulsive disorder: Postpartum OCD usually presents itself in the form of constant “what if” questions. For example, you may ruminate over thoughts about “what if I drop my baby?” or “what if my baby chokes?” Three to 5 percent of postpartum women experience OCD.

Regardless of the specific disorder, the anxiety can present itself at any point during the first year of your child’s life. For some, it may occur hours after delivery while you’re still at the hospital. For others, it may come when they leave the newborn phase and you begin to worry when they’ll roll over or sit up. Many new mothers also have anxiety about who can care for their child. The worry of leaving your child with a parent or even a spouse can become crippling. 

Anxiety can also present itself as worrying about everything or a single issue that persists (your child becoming sick or being underweight at checkups).Women are more at risk of developing postpartum anxiety if they experienced anxiety during their pregnancy, are a younger mother or had a stressful event during pregnancy such as a birth defect diagnosis.

Why do new parents experience anxiety?

Taking care of a newborn is both physically demanding and mentally challenging. Add in changes to your body, and it’s a recipe for anxiety if you’re not careful. 

The following can contribute to postpartum anxiety: 

Changes in hormones: Estrogen and progesterone, two important hormones needed to grow a fetus and prepare for childbirth, decrease after delivery. The brain’s response to the drop in hormones can make it harder to deal with the difficulties of the postpartum period.

Stress: Stress levels are high in the days, weeks and months following the birth of your child. Sleepless nights lead to poor eating habits, which creates a vicious cycle of unhealthy behaviors that make it harder to control stress.

Breastfeeding: Many new mothers turn to breastfeeding as a way to both nourish their baby but also connect with them on a deeper level. Some babies have trouble latching, which can create anxiety. Others stress about if their newborn is drinking enough milk to grow and develop.

Sleep deprivation: Newborns can eat as many as 12 times a day. With only 24 hours a day, that equates to every two hours, meaning you or your spouse will be up several times in the middle of the night. These sleep disruptions make it hard to stay rested.

Greater responsibilities: The days of staying out late and only worrying about yourself are over when you have a child. Replacing your independent life with a newborn can be a challenge for many people, as these new responsibilities often lead to anxiety.

Changes in routines: New parents find it hard to stay on top of the most basic tasks, such as working out or eating meals at regular times. Some people can’t adjust to these different demands.

Previous trauma: Complications during a pregnancy, such as from a congenital diagnosis, can make new parents worry even more after birth. In addition, people who experience adverse childhood experience are also more likely to have anxiety about their child.

What does postpartum anxiety feel like?

Postpartum anxiety tends to present itself as worrying to the point where it becomes disruptive. For example, you may be overly protective of your child and have pervasive thoughts about them dying in their sleep. This anxiety can cause you to stay awake all night out of fear they may stop breathing.

New parents facing anxiety often can’t relax as they dread something catastrophic will occur. Others become ill and experience gastrointestinal symptoms similar to an upset stomach.

Symptoms of postpartum anxiety can be physical, emotional or behavioral. 

Physical symptoms

• Insomnia
• Increased heart rate
• Chest pain
• Nausea or vomiting
• Diarrhea
• Frequent urination
• Shortness of breath
• Loss of appetite
• Restlessness 
• Muscle spasms
• Fatigue
• Panic attacks

Emotional symptoms

• Intrusive thoughts
• Obsessive thoughts
• Inability to focus
• Irritability
• Constant fear
• Feelings of impending doom
• Feeling like you’re going crazy

Behavioral symptoms

• Repetitive checking
• Issues with control
• Inability to detach from your child
• Fear of going in public
• Avoiding friends and family

What’s the difference between worry and anxiety?

In general, anxiety is best viewed as a spectrum. In other words, anxiety isn’t always a bad thing. People experience anxiety each day, and it can actually be beneficial. For example, worrying for a brief time about an upcoming project or presentation at work can actually make you focus more. However, too much anxiety can be crippling when it becomes persistent.

As a parent, it’s normal to worry about the health and wellness of your child. You may wonder if your child is eating enough, see them finish a bottle or breastfeed for 20 minutes and move on with your day once the problem is solved. That is normal. Worry is limited to your brain and doesn’t affect your body. It is also both temporary and limited to specific thoughts.

Anxiety, by comparison, occurs when the worry or fears become persistent and begins to influence decisions. Anxiety isn’t temporary and it involves both a cognitive response and a psychological response. Having an anxiety disorder can disrupt your daily life and preclude you from enjoying the things you typically take part in.

In the example of feedings, anxiety about your child’s eating habits can manifest into sleepless nights on the internet researching potential disorders. Physically, it may cause you to become overly controlling and start weighing your newborn daily or create further eating issues by force-feeding your baby even if they’re not hungry.

How do doctors treat postpartum anxiety?

If postpartum anxiety starts to get in the way of your life and your ability to care for your child, consult a doctor about creating a treatment plan that works best for you and your family.

Usually, this begins with cognitive behavioral therapy, a type of talk therapy (psychotherapy) that helps you change behaviors by focusing on coping techniques and how to respond to stress and worry in a more productive way. CBT is an effective form of therapy as long as you have time (and money) to commit to several sessions with a counselor, psychologist or other mental health provider.

In more moderate or severe cases of anxiety, your doctor may discuss using selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to increase the level of serotonin in your brain. Serotonin is a neurotransmitter and a type of happy chemical that affects your mood and emotions.

For breastfeeding mothers, talk to your doctor about any risks the drugs may have on your baby. Small amounts of anti-anxiety medications can be transferred to your child through breast milk, which sounds scary. But for people who take SSRIs or SNRIs while breastfeeding, the benefits typically outweigh the risks. That’s because untreated anxiety can cause direct harm to your and your child. For example, constant stress and worry can impact your milk production and cause breastfeeding issues.