“I’m overwhelmed; I think I might have postpartum depression. I was hesitant to reach out for help because I worry that makes me a bad mom. I’m really having trouble sleeping because I fear that my baby will stop breathing. And I worry about whether I’m a good parent. And I researched for hours but still think I chose the wrong stroller. And I don’t believe anyone is going to take care of my baby the way I will, so I can’t decide whether to send her to daycare or hire a nanny or go down to part-time work. And… And… And… I’m a planner and I like control, and this whole new parenthood thing is just so much to handle.”
These are the thoughts of a mother with postpartum anxiety. No, these are not direct quotes from a client of mine (that would not be cool), but the concerns shared by many of the folks I’ve helped. These themes of worry, fear, overwhelm, guilt, indecision, second-guessing, over-thinking, and desire for control are common in perinatal anxiety. Many who experience overwhelm and emotional distress during pregnancy or postpartum assume they have postpartum depression. While that may be part of what’s going on, perinatal anxiety is another option that I’d love to tell you more about.
What is Postpartum Anxiety?
Perinatal anxiety, also known as postpartum anxiety or PPA, is a term used for excessive worry during pregnancy or up to 1 year postpartum. There is not an official diagnosis of PPA, but we use the criteria established for generalized anxiety disorder or panic disorder. The same goes for OCD and PTSD, which are separate disorders that can also be experienced in the perinatal period and come with symptoms of anxiety.
Who Can Get Postpartum Anxiety?
Birthing people, most of whom are mothers, certainly meet the criteria for being “perinatal”, but can someone who has not been pregnant or postpartum develop PPA? Yes, absolutely. Non-birthing partners, adoptive parents, and fathers can all develop what we would categorize as PPA. I don’t mean to go off on a tangent here, but perinatal mood and anxiety disorders (PMADs) don’t just occur in people who have grown a fetus in their uterus. It’s not solely about hormones as antiquated postpartum lore may have us believe.
What are Risk Factors for Developing Postpartum Anxiety?
Certainly hormone fluctuations, particularly in the first few weeks after childbirth, as well as with any significant changes with lactation/breastfeeding, can impact mood and anxiety significantly. A history of endocrine dysfunction, such as those with thyroid imbalance or diabetes are at higher risk for perinatal mood or anxiety disorders. But beyond hormones, other significant factors that can contribute to risk of developing PPA are a personal or family history of anxiety, limited social supports, stress or trauma during pregnancy or birth, previous pregnancy loss, childhood trauma, and personality traits (such as perfectionism).
How Common is Postpartum Anxiety?
Prevalence rates of postpartum depression and anxiety vary, but the most widely accepted statistic is that 1 in 5 mothers suffer from a perinatal mood or anxiety disorder. PMADs include perinatal depression, anxiety, panic, OCD, PTSD, bipolar, and psychosis. If we’re talking about anxiety only, it is estimated that 6% of birthing parents develop anxiety during pregnancy and 10% during postpartum. These numbers don’t seem to include those with a history of anxiety who see an uptick in their anxiety during pregnancy and/or postpartum. And actually, a great deal of clients who I’ve helped would fall into this bucket of preexisting or even sub-clinical anxiety that increases perinatally.
Symptoms of Postpartum Anxiety
The experience of prenatal or postpartum anxiety can feel very overwhelming, often times both emotionally and physically. Symptoms can include excessive worry, racing thoughts, repeated thoughts, fears of something bad happening, concerns over health of baby or self, trouble falling or staying asleep, appetite changes, feeling agitated or irritable, and physical symptoms like chest tightness, shortness of breath, or heart palpitations.
Treatment for Postpartum Anxiety
You may be aware that some therapists specialize in treating postpartum depression, but did you also know that most of those therapists also treat postpartum anxiety? If we’ve received training in postpartum depression, typically the whole spectrum of perinatal mood and anxiety disorders are covered. And there are many of us who actually see more perinatal anxiety than depression. In addition to therapy with a licensed clinician trained in perinatal concerns, medication can often be beneficial. Research shows that many medications for anxiety, especially SSRIs, are safe to take during pregnancy and breastfeeding.
The reason I call postpartum anxiety the “lesser-known cousin of depression” is because often those who are struggling with perinatal anxiety will contact me saying they want to start therapy for postpartum depression. Most people (even many medical professionals) use the term “postpartum depression” to refer to any type of perinatal mental health concerns. I’d love for everyone to gain more awareness of the intricacies of different emotional challenges that can be experienced in parenthood.
So, I hope for this to be a small part of that education, and for folks to feel empowered with knowledge. Prenatal and postpartum anxiety are more common than you think. If you’re struggling with anxiety as you try to conceive, experience pregnancy, experience loss, adopt, give birth, or welcome a child in any other form or fashion, there are lots of us out there who know how to help in your unique situation. Don't be afraid to reach out!
The content on this blog is for informational and educational purposes only, and is not intended to be a substitute for professional mental health or psychological advice, diagnosis, or treatment. If you are in a mental health crisis, please call 988 or the Maternal Mental Health Hotline at 1-833-852-6262.