A couple of weeks ago I wrote a blog about Postpartum Depression (PPD) talking about signs and symptoms of PPD and what you can do if you experience PDD (you can find the blog here). Most everyone has heard of PPD. It is well known and often assessed for in OBGYN and pediatrician offices after the birth of a child.
However, what is talked about and diagnosed far less often than PPD is Postpartum Anxiety (PPA). It is very unusual to hear people talking about PPA even though it affects significantly more women than postpartum depression does and can be just as impactful on a new mother. Even so, it often goes undiagnosed, is not assessed for, or is brushed off as normal worry. After all, most mothers, particularly first time moms, are always anxious, right? Unfortunately, as is common with postpartum depression, PPA is not taken as seriously as it should be and goes underreported by women due to shame and stigma associated with what it means to be anxious around a new baby.
PPA is a topic that is very personal for me. After the birth of my first daughter over 3 years ago, I experienced PPA that considerably impacted the first few months after my daughter’s birth. When the anxiety first began I didn’t recognize it as anything other than new mom worries. In fact, the anxiety struck me completely unprepared. My pregnancy was easy, almost perfect. I often avoided speaking to other women about my pregnancy because of how easy it was and how difficult pregnancy is for so many women. I didn’t throw up once the first trimester and my nausea was minimal. I had the very lucky experience of not gaining enough weight and was told to eat more (what every pregnant woman wants to hear) and I was never less stressed than I was during those 40 weeks. I was constantly pumped full of feel-good neurochemicals and excitement to meet my first child. My only complaint was insomnia - by the third trimester I struggled to get more than 4-5 hours of sleep per night by the end of my pregnancy.
My pregnancy was a breeze compared to many women, but the delivery was a different story all together. The labor was long and hard. I had contractions at two minutes apart for over 12 hours before I was able to begin the delivery process and it quickly became clear that my daughter was in distress. Her heart rate decreased with every contraction and, with time, stopped returning to normal and was slowing down more and more over time. And with each passing contraction a new nurse, team of nurses, or doctor entered the room to prepare for caring for her. The NICU team had arrived after 3 hours of active pushing and additional nurses and physicians for emergency c-section were prepped as other means to bring my daughter into the world had failed. My hospital bed was in the process of being moved to the OR when my daughter finally made her entrance, only to be immediately rushed to the NICU due to failure to breathe properly. I held her for only a moment before she was whisked away in an incubator with my husband. Several horribly long, scary, and impossible to describe hours later she was breathing perfectly, was finally returned to me, and I was able to really hold her and begin to bond with her.
In retrospect, I know the moment my anxiety began was when she was taken from my arms and to the NICU. I don't know if the labor and delivery had been easier if I still would have experienced PPA, but research has linked difficult pregnancies and deliveries with increased rates of PPA and PPD. Maybe if I hadn’t been sleep deprived for the the 5 months prior to my daughter’s birth, or maybe if she was a better eater or a better sleeper, maybe the anxiety would have never began. But that wasn’t the case for me and for and isn’t the case for many other mothers. Looking back on when the anxiety really took place I can now say that it was the moment she was back in my arms. I recall having the thought that I would do whatever was in my power to always keep her safe - and it was that thought the anxiety took hold of. “Whatever was in my power” was a lot less than my mind would let me accept. It was suddenly so clear to me that I had far less control in the world, and with the life of my daughter, than I ever could have imagined.
At first I thought the anxiety I was feeling was an after affect of fearing for my daughter’s life. Having more worry thoughts than I would have thought was normal seemed to make sense given what we had all just been through. The thoughts were continuous though. And at times, extreme. What if she got hungry and I was too tired to wake up and she was suffering? What if she was scared and I didn’t know it? Is this cry because she’s in pain, is something wrong? What if I fall asleep and my daughter stopped breathing because I wasn’t there to watch her? Thought after thought after thought. In addition to sleep deprivation due to a colicky, hungry newborn I found that sleep was difficult despite my exhaustion due to the ever present barrage of worry thoughts. It became clear to me that this wasn’t just new parent anxiety the night I found myself lying awake in bed worrying about the safety of my daughter as she slept soundly through the night for one of the first times. She was sleeping happily and I was awake with a mind sending me thoughts about what I feared most.
One of the reasons, beyond lack of awareness, that women don’t seek treatment is due to shame. Even now as I write this years after the fact, I feel that small little shadow of shame trying to reemerge. I almost didn’t write about my personal experience as I worried what my clients and colleagues may think. I’m a psychologist after all, shouldn’t I bee immune to experience these kinds of things - or at the very least better at recognizing it? Despite my concerns about how other people may react, and after much consideration, I felt that sharing my experience in a relatively public way was incredibly important because so many women can’t or won’t talk about their experiences. Until society makes more strides toward removing the stigma around mental health, people will continue to feel shame about their human experiences. Helping to normalize both PPA and PPD can help more women in recognizing symptoms and asking for help and I hope my story will aid someone in seeking help that they may not have felt empowered to do before reading this.
If you think that you, or someone you know, may be struggling with PPA, the information below may help you in finding some answers and gaining support.
Who gets PPA?
Unfortunately, any new mother is at risk of developing PPA and about 10% of women develop PPA (10-15% of women develop PPA or PPD) and one statistic estimates that 25-30% of these women begin to experience anxiety during pregnancy (1,2). Although the risk for PPA is much higher in woman who have given birth, studies show that PPA and PPD can occur in adoptive mothers as well (often called post-adoption depression). New fathers can also experience PPA/PPD due to the stressors of having a new child and similar other stressors that affect mothers(1).
However, mothers who have undergone pregnancy and delivery remain at the highest risk and experience symptoms at a significantly higher rate than other parents. Although anyone is at risk, certain factors can increase your risk of PPA. These include:
Previous anxiety or depression diagnosis
Family history of anxiety
Previous miscarriage or loss of child
Pregnancy as a teenager
Low socioeconomic status
Poor support system
Difficulty with job, housing, finances
What is PPA and how can I distinguish it from typical worry after a baby?
PPA can begin even before the birth of your child and up to one year after childbirth. If you feel that your worries are in excess, if you feel that your life is being disrupted by your worry or other symptoms, or if you feel distressed by your experiences it is recommended that you speak with someone. Some signs of PPA to look for are:
Fear of being left alone with your child
Physical symptoms (dizziness, fatigue, muscle tension, nausea)
You start to dread everyday activities
Taking specific action to reduce a thought (e.g., checking the baby’s crib multiple times/ritualistically to ensure the bed is safe)
Treatment for PPA
Anxiety can be incredibly overwhelming and difficult to cope with. However, it is a treatable condition that is nothing to be ashamed of and treatment is effective for most people. PPA typically resolves within a couple months of beginning treatment. Treatment options include:
Medication - If you’re interested, contact your primary care physician or a psychiatrist to explore medication options that are safe for you and your baby (if you are nursing or experiencing perinatal anxiety).
Therapy has been shown to be an effective option for treating PPA particularly Cognitive-Behavioral Therapy (CBT) which can help you learn ways to change and challenge your thoughts, increase relaxation, develop coping skills that work for your life, and connect with you child if this has been problematic due to symptoms.
Postpartum mood disorders are common and treatable conditions that affect almost one million women every year - not including unreported cases(3). The best first step if you think you’re experiencing PPA is to reach out to supportive friends or family members to get support. The earlier you recognize your symptoms of anxiety and seek treatment, the faster you will be on your way to feeling better. There are a wealth of mental health providers across the nation that are highly skilled in treating PPA. Reach out today for extra support if you need it.
Other PPA/PPD resources