Understanding Postpartum Anxiety
Psychologist Dr. Hannah Cassedy details the often-overlooked condition, postpartum anxiety.
Postpartum depression gets a lot of attention: it has a catchy name and people like me write about it on sites like this. A common misconception is that depression the only kind of “postpartum” you can get. But postpartum depression is just one piece of the puzzle. Postpartum anxiety is also extremely common but less frequently discussed. There are other perinatal mental health disorders too, like postpartum obsessive-compulsive disorder (OCD), postpartum post-traumatic stress disorder (PTSD), and postpartum psychosis.
What is Postpartum Anxiety?
Diagnosable anxiety develops in six percent of pregnant women and ten percent of postpartum women. It is very common — in fact, I probably see it more than postpartum depression in my practice. Postpartum anxiety symptoms can include insomnia, low appetite, near-constant worry or nervousness, fear of impending doom (including fear of illness, fainting, danger, or losing control), and physical symptoms like shakiness, dizziness, hot flashes, nausea, racing heart, and shortness of breath. Some people with anxiety – but not all – also develop panic attacks, which are brief but very intense episodes of those physical symptoms. Panic attacks can be very frightening: they are often described as feeling like suffocating or a heart attack. Women with a history of anxiety or depression are at heightened risk of developing postpartum anxiety. But with a prevalence rate as high as ten percent, it can happen to pretty much any mother.
One way to think about anxiety is from a physical perspective. During pregnancy, you become closely attuned to physical sensations because this is the primary way that your baby can communicate with you in utero. When you’re pregnant, you learn to stay attentive to when you need more blood sugar, for example, or when you need a nap. But being hyper-attuned to your body can also result in your brain misinterpreting normal physical sensations as signs of danger when you’re actually perfectly safe. When these false alarms happen, the brain might tell your body that it needs more adrenaline, pronto, to fight off some impending disaster, and your body dutifully complies. That’s where the physical symptoms like shakiness, racing heart, and shortness of breath come in. Part of treating anxiety involves learning to tell your brain that enough is enough and that you have plenty of adrenaline already, thank you very much!
Another way to think about postpartum anxiety involves recognizing the many real worries that mothers have to deal with. For starters, your precious baby is outside of your body for the first time, and keeping him or her safe is a top priority. You might get preoccupied by all of the things that could go wrong, all of the ways in which your baby could be unsafe. You might get caught up with expectations about getting the nursery ready in time, or you might worry about how to be the best mother you can be. You might struggle to balance your role as a parent with your role as a spouse or a professional or a daughter or a friend. You might feel like you have to take care of everything yourself. Anxiety is the accumulation of these worries: worries that are, in fact, perfectly reasonable and even predictable. It would be concerning if a parent didn’t worry. But when the worry gets really bad – when you have a hard time thinking about much else, or when it interferes with your ability to take care of yourself – then you’ve got a problem on your hands.
It can be hard to know where the line is between healthy worry and troublesome anxiety, and that’s why it’s important to talk to a professional if you have concerns. Mental health providers who are trained in perinatal mental health have specialty knowledge about the spectrum of worry and anxiety in the context of childbearing, and they can help you manage your distress, wherever you fall on that continuum. You should know that even severe postpartum anxiety is treatable with the help of professionals. Therapy is usually the first course of action. Sometimes people take medications, too. Some mothers-to-be who have had anxiety or depression in the past choose to take proactive measures when they get pregnant, aware of their heightened risk of a postpartum recurrence. Proactive measures could include getting into therapy, starting on a low-dose medication with their OB’s approval, or getting those tools in place to start if symptoms develop. It may feel like it takes a little planning and coordination, but help is readily available if you reach out for it. A good place to start is by talking to your OB and by looking at Postpartum Support International resources.
It’s important to note that postpartum anxiety and depression sometimes go hand-in-hand, like two sides of the same coin. So if you’re concerned about anxiety, I recommend reading up on postpartum depression as well. Anxiety can also sometimes take the form of OCD or PTSD, which you can read more about in my article OCD, PTSD and Psychosis: What they’re really like.
Dr. Hannah Cassedy is a Dallas-based clinical psychologist with specialty training in perinatal mental health. She treats women and men struggling with anxiety, depression, and adjustment to major life changes like the birth of a child.