Anxiety

Why We Should Be Paying More Attention to Postpartum Anxiety

Postpartum anxiety gets overlooked too often. But it is treatable.

Posted May 29, 2020

You may have been asked to complete a questionnaire at your 6-week followup post-delivery appointment with your OBGYN or midwife, maybe even your baby’s pediatrician if they’re thorough. It probably contained questions pertaining to your ability in the past week “to laugh and see the funny side of things,” the degree to which your unhappiness was affecting your sleep, feelings of sadness, how much you’ve “blamed [yourself] unnecessarily when things went wrong.” 

This is the Edinburgh Postnatal Depression Scale, the most commonly used tool to screen for and study postpartum mental health symptoms. And while it does have a few questions that are aimed at catching anxious symptoms, it is actually, like the name implies, more reflective of depression symptoms.

Don’t get me wrong. The Edinburgh Postnatal Depression Scale is a wonderful screening tool. The fact that maternal mental health is getting more attention and more professionals are on the lookout for mothers struggling is impactful and encouraging. But the problem is that there is a range of postpartum mental health conditions, encompassing depression, but extending to postpartum psychosis, postpartum bipolar disorder, and varieties of postpartum anxiety. Taken together these are generally referred to as PMADs (perinatal mood and anxiety disorders). 

Postpartum Anxiety is Common and Treatable

There is a subset of postpartum mothers who are primarily experiencing unsettling and pervasive anxiety symptoms, but not depressive symptoms or more overt and clearly dangerous behaviors that catch the eye of professionals. These women who find themselves intensely anxious—but not so much depressed—are slipping through the cracks. They are left feeling isolated and like something is wrong with them. They struggle and don’t always know why. 

Depressive and anxious symptoms can of course co-exist, and often do. However, it is sometimes the case that anxiety is the primary experience and brings on hopelessness and feelings of despair because it feels so intractable. Meaning that if the anxiety were to be addressed in these cases, the depression would naturally be alleviated as well. 

Depression tends to get the spotlight but it is worth teasing apart specific symptoms in order to identify what is really going on. When we can accurately identify the symptoms, getting the most appropriate treatment becomes far more likely. Postpartum anxiety can be quite responsive to treatment. However, it is too often going unrecognized, therefore untreated. 

Think of it this way: As a culture, we’ve been narrowly focused and on the lookout for depression in postpartum mothers. We need to zoom out and make room for more and more nuanced ways women struggle with their mental health postpartum. Then we need to correctly identify and zoom back in on the specific symptoms in order to make more pathways for accurate treatment and alleviation of suffering. 

Mothers Miss the Signs, Too

In addition to providers missing the signs of postpartum anxiety, new mothers might also be overlooking them or not seeking help for a variety of reasons. 

Often, women are trained to only ask for help if things are utterly dire, to downplay distress. We might think what we’re experiencing is not real or serious enough to get help (“Isn’t anxiety normal for mothers?”). We believe we’re struggling because there’s something wrong with us and we need to tough it out. 

There may also be a great deal of shame or fear of the anxious thoughts themselves. Many new mothers fear that their baby will be taken away and that they will be viewed as unfit if they tell anyone what they’re really thinking. 

Because postpartum depression is what many people think to look for, anxiety that doesn’t fit as neatly into the preconceived idea of what struggling postpartum looks like might be completely overlooked.

Or all too often, new mothers simply feel too busy, tired, and unsupported to focus on getting help. 

Who is at Risk?

Those most at risk for developing postpartum anxiety are those who have a history of anxiety prior to and during pregnancy. Those with a family history of anxiety are more likely to experience postpartum anxiety as well. 

A new baby is a huge stressor. Many women who seemed to function perfectly well prior to having a baby may find themselves anxious, struggling, and baffled by the presence of their new anxiety. It could be that they were always susceptible to anxiety, but the stressor of having a new baby activated the underlying vulnerability. 

Additionally, being isolated and having a weak support network increases the likelihood of developing anxiety postpartum. 

Anna Stampfli/Unsplash
Source: Anna Stampfli/Unsplash

What Does it Look Like?

The categories of postpartum anxiety can be broken down below. Note that many of these symptoms can overlap. For example, physical anxiety symptoms that are characteristic of panic attacks are often present with others form of anxiety; difficulty sleeping can occur with all, etc. Also, note that these are not exact criteria for diagnosis, but meant to give a rough idea of the different ways anxiety can present postpartum. 

Panic

  • Good old fight-or-flight physiological responses: increased heart rate, shortness of breath, dizziness, sweating, shaking, numbness in limbs. 
  • Feelings of dread, worry that you’re dying.
  • Fear of the physical symptoms that exacerbates them. 

Generalized Anxiety

  • Catastrophic “worst-case scenario” thoughts.
  • Excessive worry, endless “what if’s.” 
  • Inability to stop or control worry.
  • Hypervigilance.
  • Trouble sleeping.

OCD

  • Unwanted persistent intrusive thoughts, often about the baby, sometimes taboo (e.g., sexual or violent).
  • An awareness that the thoughts may be extreme and not in line with values or intentions. 
  • Compulsive behaviors to try to neutralize anxiety (checking, researching, seeking reassurance) and avoidance (never being left alone with the baby, never letting anyone else help with the baby).

PTSD

  • A traumatic birth experience (e.g., mother or baby’s health at risk, an emergency c-section, feeling powerless or unsupported during birth, having a baby in the NICU, etc.)
  • Re-experiencing of the trauma (nightmares or flashbacks).
  • Hypervigilance.
  • Avoidance of stimuli associated with the trauma.
  • Depressed mood and feelings of detachment.

What to Do

If any of these descriptions resonated with you, even a little bit, speak up! Connect with other new mothers, talk to your partner/family or support system, and—most importantly—reach out for professional help. You are not an imposition, nothing is wrong with you, and you deserve to feel better. 

If you know someone who is about to have a baby or recently did (especially in COVID times), check-in with them, often. If you are a provider or professional of any sort that works with mothers, ask not just about depression, but anxiety too.

Postpartum anxiety is common, but not always talked about. It is distressing and disruptive to mothers—and therefore, their babies. It is not always recognized by medical professionals or mothers themselves. When it is identified and treatment sought out, relief is often quick to follow.