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Mom Matters

Postpartum Anxiety (PPA) — One of the most common mental health conditions for new moms

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After having my daughter Sunday in the summer of 2019, my mind was spinning. I woke up from dreams where I was rolling over my daughter in bed (she was sleeping peacefully in her crib). I checked her breathing while my husband slept. I couldn’t really sleep.

What is Postpartum Anxiety or PPA?

I wrote all of this off as normal new mom worry (the checking, the not sleeping, the dreams). Looking back, it’s more clear what was at play: postpartum anxiety (PPA). By some counts, PPA is the most common perinatal mood and anxiety disorder (PMAD), more common than its close relative, postpartum depression (PPD).

Generally, it’s thought that about 10 percent of women develop PPA postpartum, with about 6 percent of women developing PPA during pregnancy. But today, in the midst of a global pandemic, those numbers are higher. 

A small study of 900 women published in Frontiers in Global Women’s Health found that 29% of pregnant women or new moms had moderate to high anxiety pre-COVID and 72% had moderate to high anxiety throughout the pandemic.

How does Postpartum Anxiety affect new moms?

When left untreated, there are a slew of consequences associated with PPA. It negatively impacts breastfeeding and bonding. It hampers sleep. It can impair cognitive development in children. Moms I work with tell me that they feel as though PPA and PPD stole the joy out of their postpartum experience.

By the time my second daughter came around in February of 2021, I knew more. I could more accurately identify anxious thought patterns and behaviors. I filled our house with the most amount of support possible. Anxious thoughts were still — and are still — there from time to time, but I feel more equipped to see them for what they are (thoughts). I have the support I need. 

Anyone can get postpartum anxiety. But there are risk factors that predispose you to it (being more educated and being employed, to name a few surprising ones). There are also — and this is the most important thing to know — many effective, lasting treatments.

When you’re in it, PPA can feel permanent; overwhelming and all encompassing. But it is temporary and it is treatable — and knowledge is the first step in feeling better. Below, a bit about PPA, how to spot it, and how to seek the help you need to feel better.

Symptoms of Postpartum Anxiety:

Some worry postpartum is perfectly normal. Both pregnancy and childbirth change the brain, causing the parts that respond to threat and danger to be more active. By nature, you’re more likely to think about your baby, worry about them, and wonder if they’re okay. 

Postpartum, you’re also sleep-deprived (a large risk factor for mood disorders in general) and sorting out a new normal. If you deliver your baby, your body is healing.

But there’s a difference between “normal” postpartum worry and PPA. 

Normal worries tend to be more mild in nature. You might worry about your baby but be able to sleep when they sleep and, for the most part, go about your day normally (albeit sleep-deprived). If you have developed PPA, you might feel like your worry is constant (it starts when you wake up and doesn’t stop even as you’re trying to fall asleep). You might feel as though something bad is going to happen. You could have racing thoughts, not be able to sleep or eat, not be able to sit still, be irritable, or have physical symptoms (nausea, hot flashes, dizziness). 

Moms with PPA often tell me they feel like they can’t “turn off” their thoughts. They feel like their mind is “always running.” They cling to thoughts.

Generally, practitioners consider these three factors in determining PMAD (perinatal or postpartum mood and anxiety disorder):

  • the frequency of the symptoms (how often they’re happening)
  • the duration of the symptoms (how long they’ve been happening)
  • the intensity of the symptoms (do they interfere with your ability to go about your day?)

If you have symptoms that are seemingly constant, persist beyond two weeks postpartum (the normal timeframe for the “baby blues” to happen) and/or have symptoms that have been around for months, and/or are getting in the way of your ability to care for yourself and your baby, you could have a PMAD.

I always remember something that Hilary Waller, L.P.C., the director of programming at The Postpartum Stress Center once told me when it comes to all of this:

It’s less about fitting a particular diagnostic criteria and more about just not feeling like yourself.

Risk Factors for Postpartum Anxiety:

Any parent can get PPA. But there are many risk factors for PPA to be aware of.

  • Having a personal or family history of anxiety
  • Having a thyroid imbalance
  • Age (being a younger mother)
  • Having a C-section
  • Fearing birth
  • Premature delivery
  • Lack of social support
  • Relationship problems
  • Being of a lower socioeconomic class

Especially if you’re pregnant, knowing that you’re at an increased risk for a PMAD can help you build a support team.

Treatments for Postpartum Anxiety:

PMADs such as PPA are temporary and highly treatable. Treatments vary from person to person, but generally include these three facets:

Therapy for Postpartum Anxiety

If your symptoms are more mild, and even if they’re more severe, therapy can help PPA. Working with a trained professional can help you work through your anxiety, spot problematic thought patterns, and form healthy coping strategies. Therapy also provides support, an important component of postpartum healing. If you are struggling with PPA, it is important to see a provider who is trained in maternal mental health. Postpartum Support International (PSI) has a directory of thousands of providers across the country who are specialists.

Medication for Postpartum Anxiety

Sometimes, PMADs require medication. Fortunately, antidepressants for PPA, known as Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and norepinephrine reuptake inhibitors (SNRIs) can be effective in treating PPA. Sometimes, other prescriptions such as anxiolytic medication (lorazepam or clonazepam) can help you manage anxiety symptoms and sleep issues, too, particularly while waiting for an antidepressant to take effect. A reproductive psychiatrist can work with you to help figure out which types of medication would be best for you. Many antidepressants are safe and effective in pregnancy and while breastfeeding once they are cleared by your doctor.

Social support for Postpartum Anxiety

Becoming and being a mother in a pandemic has been incredibly challenging. Much of the social support that new moms count on — family members to pitch in, night nurses to help with overnight care, in-person mom groups — stopped. The lack of social support has given way to a huge risk factor for PMADs. While remote support isn’t the same as in-person support, many lactation consultants and postpartum doulas will consult with clients via FaceTime, there are virtual mom groups pregnant women and new moms can join (I run some of my own at Dear Sunday Motherhood), and with the world opening back up, asking for help where you can is key. After all, the general consensus among researchers in the field is that more social support is associated with lower rates of PMADs such as PPD and PPA (friends, family members, colleagues, professional support).

Mothering is not something that was meant to be done in isolation — and asking for and receiving help can be a healing part of your journey.

The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant's pediatrician. Never disregard professional medical advice or delay it based on the content on this page.
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The content on this site is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment. Discuss any health or feeding concerns with your infant’s pediatrician. Never disregard professional medical advice or delay it based on the content on this page.

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Meet the Expert

Cassie Shortsleeve

Cassie Shortsleeve is a journalist, perinatal health coach, and the founder of Dear Sunday Motherhood. Her writing has been published in Parents, The Washington Post, Women’s Health, What to Expect, and other national titles.