What is postpartum anxiety (& what to do about it)?

Most people know about postpartum depression (PPD) and, thankfully, it is becoming a much more talked about topic, which means that there is less shame and more resources available for mothers and their families.

Studies show that PPD affects 1 in 7 new mothers, who can develop symptoms any time in the first year after they gave birth (it's commonly believed that PPD shows up immediately after birth, but this is false). (1) 

There are a variety of risk factors that increase a woman's chances of developing PPD. These include social risk factors (ex. lack of support, not being in a safe home...), physical risk factors (ex. complications during birth, genital prolapse...), and biological risk factors (ex. a family history of mood disorders, hormonal influences, and nutritional deficiencies...).

Mental health is a topic that we need to take very serious, especially when it comes to mothers who are responsible –practically overnight– for a baby's life and well-being. Thankfully, most doctors today ask women about any symptoms of PPD in their 6-week follow-up appointment. 

BUT, there is something else that happens to many new mothers that is far less talked about and not routinely screened for by anyone:

Postpartum Anxiety

Postpartum anxiety can show up on its own or in conjunction with PPD. Early studies suggest that the occurrence of postpartum anxiety exceeds the occurrence of PPD, which means that thousands of women fall through the cracks and are dealing with a much harder, worry- or even panic-filled postpartum and early motherhood phase than they need to without getting any proper support.

"We call postpartum anxiety the hidden disorder because so few moms recognize it and it goes undiagnosed," says Jonathan Abramowitz, Ph.D., associate chairman of psychology and director of the Anxiety and Stress Disorders Clinic at The University of North Carolina at Chapel Hill. "It hasn't been discussed or studied much, even though it's a lot more common than postpartum depression." In a study that tracked 1,024 women during the first three months after they gave birth, researchers from the University of Heidelberg in Germany found that more than 11 percent fell victim to postpartum anxiety disorders, while roughly 6 percent developed postpartum depressive disorders. And that only includes the first 3 months!!

When does Postpartum Anxiety typically show up?

Postpartum Anxiety most commonly show up in the first year of motherhood, but up to 35% of women who are diagnosed with postpartum anxiety already experienced anxiety during their pregnancies. Other women begin to experience postpartum anxiety upon weaning which is another prime time for hormonal fluctuations. I personally have experience an intense period of anxiety and panic-like symptoms when I weaned my first son and I can tell you, it was a painful few weeks.  

In addition, mothers who have previously experienced anxiety, suffered from PPD with previous children, have a family history with mood disorders, or who have previously had a miscarriage or stillbirth, are at higher risk for developing postpartum anxiety. 

Many moms I have talked with in the last years, who later found out that they suffered from postpartum anxiety, just assumed that their often paralyzing thoughts of worry, their inability to relax, or their loss of appetite is due to sleep deprivation and a "normal" part of motherhood. Others have told me that they simply assumed that they were bad moms. If you feel like something is off, please be sure to make yourself heard and find the right kind of support to guide you through your experiences. 

Anxiety is the most common mental disorder in the U.S., affecting 40 million adults and children in the U.S. (2), so it makes sense that its occurrence would increase during one of the most physically and emotionally taxing times in a woman's life: early motherhood when her body is depleted of nutrients (nobody talks about the importance of nutrient replenishment post pregnancy, which is a topic I teach in Well Mama and have talked about in a previous article) and we live in a society where we often have very little support while the expectations of new mothers are through the roof.

So, what are the most common symptoms of Postpartum Anxiety?

  • racing thoughts
  • inability to relax
  • not being able to quiet your mind
  • constantly over-worrying that something terrible will happen to you or your child(ren)
  • having disturbing thoughts about terrible made-up scenarios of what could happen to you or your baby
  • fear or being alone with your baby
  • physical symptoms like stomach upset, nausea and a racing heart
  • panic attacks
  • lack of appetite
  • trouble sleeping and falling asleep

How much anxiety is "normal?"

To some extent, anxiety or worry is a normal reaction to a new mother's desire to protect her baby. With the birth of my first son, I found that there was so much fear-driven language in everything I was preparing for him –from what his crib looked like, to which swaddle technique we used, to what he was eating– that I went through a phase of worrying all.the.time. I was almost certain that if I left him lying in the vicinity of a lose blanket for 30 seconds, he would find a way to suffocate. It took some effort for me to interrupt these thought patterns and calm my mind.

However, if you have worrying thoughts particularly around death, your thoughts become irrational, you cannot get them out of your mind and they begin to disrupt your life in the ways I discuss above, you want to be sure to get professional support. It's always better to ask for help one too many times.

What to do if you think that you have Postpartum Anxiety:

1. Get support. If the above symptoms sound familiar to you, be sure to mention it to your doctor (your OB, your midwife, your pediatrician) and ask for a referral to a therapist who has experience with perinatal mood disorders.

2. Replete your nutrients. You can read all about the specific nutrients that are commonly depleted in mothers and how you can replete them here. While all of these nutrients are key, Omega-3 essential fatty acids are on top of the list if you're struggling with your mood. If you're not on a high quality supplement already, I like Heart HealthTM Essential Omega III Fish Oil with Vitamin EDesigns for HealthNordic Naturals ProOmega or Green Pastures Butter Oil/Fermented Cod Liver Oil Blend (which is high in vitamin A for skin issues as well as  vitamin D). The recommended dosage is between 1000-3000mg/ day.

3. Support your mind. Try meditation or another type of mindfulness exercise to help you in calming your thoughts. My friend, Emily Fletcher is the founder of ziva meditation, an incredible online resource.

4. Do less. Clear your plate, focus on your baby, and get the support you need so that you can focus on what is essential rather than taking on more work that will only add worry. 

5. Exercise and get outdoors. Six weeks of resistance training or aerobic exercise led to a remission rate of 60 percent and 40 percent, respectively, among women ages 18 to 37 with generalized anxiety disorder, a study done by The University of Georgia finds.

6. Consider taking an adaptogen. Adaptogens are herbs that enhance nonspecific resistance and improve the stress response. Generally, adaptogens aren't to be used during pregnancy, but many adaptogens are compatible with breastfeeding. These include:

  • Ashwagandha
  • Eleuthero 
  • Rhodiola
  • Holy Basil (also known as Tulsi)

Personally, I have tried Gaia Herbs Adrenal Health Daily Support, which contains Rhodiola and Holy Basil, while nursing my second son and I am a huge fan.

6. Consider medication. For more severe cases of postpartum anxiety, medication may be recommended. Be sure to work closely with your doctor and check any medication you are taking at InfantRisk.com, which is a great resource to help you make sure that your medication is safe for you and your baby.

In the comments below, let me know: Have you or do you think you're dealing with postpartum anxiety? Did you know it existed as such? What worked for you in resolving it? 

Sources:

(1) https://www.cdc.gov/mmwr/volumes/66/wr/mm6606a1.htm?s_cid=mm6606a1_w
(2) https://adaa.org/understanding-anxiety