Why it's time to talk about postpartum anxiety


by Andrea Palmer, MD

May 12, 2023

There is so much excitement and joy when a new baby joins your family, but adjusting to life with a little one is also stressful. From monitoring the number of ounces they’re getting to wondering if you’ll ever sleep again, there is a lot to worry about.

Worrying about your baby is perfectly normal and completely expected after such a life-altering, body-changing event. All of a sudden you have another human to care for and it can prompt an overwhelming sense of responsibility.

But there can become a point where the worrying intensifies so much that it’s disrupting your everyday life. It’s called postpartum anxiety. Here’s what to know and how to tell if the feelings you’re experiencing are due to postpartum anxiety or normal new parent worries.

Postpartum anxiety versus postpartum depression

While both postpartum depression (PPD) and postpartum anxiety (PPA) are in the same spectrum of mood disorders and are typically treated with similar methods and medications, there are some pretty distinct differences.

Postpartum depression is generally defined as an unshakeable sadness or apathy. Other symptoms include frequent crying, the inability to sleep despite being exhausted and feeling unable to cope with ordinary emotions.

With postpartum anxiety, we see women worrying excessively—sometimes to the point of panic attacks—and feeling angry or irritable. It is also very common for someone experiencing postpartum anxiety to feel the need to control everything baby-related, obsessively worry about the health and safety of their child, and believe that they alone are the only suitable caretaker of the baby.

Physical symptoms of postpartum anxiety can include:

  • Feeling restless or an impending sense of doom
  • Changes in appetite
  • Fast breathing
  • Increased heartbeat

What causes postpartum anxiety?

Postpartum anxiety can arise anytime in the first year after birth, although it is typically experienced in the weeks immediately after delivery. This is due to the extreme hormonal changes that take place during pregnancy and again after giving birth. Other contributors are sleep deprivation, history of anxiety or depression prior to pregnancy, and the common stressors that the newborn stage brings. 

In stressful situations, our nervous systems trigger the fight-or-flight mode. This is the body’s unconscious reaction to a threatening situation. Anxiety arises when the body and mind are in a stressful state for an extended amount of time, and according to the National Center for Biotechnology Information, can harm every system in the body.

Thankfully, postpartum anxiety and other related mood disorders can—and should—be treated. If anxiety is starting to affect your day-to-day life or decision making, it’s time to address the issue. There are several approaches to explore to help you get back to feeling like yourself.

Treatment options for postpartum anxiety

The first step if you’re feeling anxious during the postpartum period is to talk with your OBGYN. This is often built in to your post-delivery follow-up visits, but you should know you are always welcome to speak up about any mental health concerns with your doctor.

During your follow-up visits, your OBGYN will typically go through a basic questionnaire to screen for postpartum mood disorders, and this is a great time to start a discussion on the need for any treatments, which usually include therapy, medication or a combination of the two. Your OBGYN can help guide you on next steps.

Coping with and preventing postpartum anxiety

Therapy and medication are wonderful treatments for postpartum anxiety, but what do you do in the very moment you start to feel anxious? This sounds overly simple but breathe. There is a breathing technique called Box Breathing that is widely used to steel nerves by U.S. Navy SEALS and other professions in high-stress situations. This technique helps reset the mind and regulate the body.

First, exhale slowly, emptying your lungs. Then start the exercise:

  1. Breathe in through your nose while counting to four.
  2. Hold your breath for four seconds.
  3. Slowly exhale for a count of four.
  4. Repeat three more times, or until you feel a sense of calm.

There are also several smartphone apps available that can aid in deescalating anxiety.

In addition to breathwork, get outside and move your body if you have time. It doesn’t have to be strenuous exercise—it can be a simple stroll around the block. Studies show that any movement decreases cortisol, the hormone that causes stress, and produces the endorphins that make you feel good. Natural sunlight, especially morning light, is proven to increase serotonin levels, serotonin being a natural chemical in the body that directly affects mood.

Postpartum mood changes might not be openly talked about, but they are very common. In fact, 40-60% of new mothers experience postpartum mood changes. It is believed that the number is much higher than that, but many women do not share their experiences with their loved ones and doctors out of fear or shame. We must normalize these emotions by talking about them more openly, so more parents feel empowered and encouraged to seek help.

If you’re struggling with postpartum anxiety, remember—you are not alone.

Want to talk more about this? Speak with your OBGYN or find one near you.

About the Author

Andrea Palmer, MD, is an obstetrician-gynecologist (OB/GYN) on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth.

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