What is postpartum anxiety? 

The postpartum period comprises three stages, starting immediately after childbirth and lasting up to several months.¹

Anxiety is an uncomfortable feeling, comparable to worrying and can vary greatly in type, severity and duration. 

The postpartum period is accompanied by many impactful changes to the mother's body and life, understandably this can allow the mind and body to become more vulnerable to disorders.^2,3 As a result, mental health conditions following birth are very prevalent and include postpartum anxiety, which is estimated to affect 15% of mothers globally. This article will explain this disorder, ranging from its symptoms and causes to its risk factors and treatments.³ 

Postpartum anxiety often manifests as intrusive worries and thoughts regarding the mother’s capabilities in looking after their baby and the baby’s health.⁴

Types of postpartum anxiety 

• Generalised anxiety disorder (GAD)
• Obsessive-compulsive disorder (OCD) /maternal OCD 
• Maternity neurosis 
• Post-traumatic stress disorder (PTSD)

Signs and symptoms

Psychological 

• Intense, irrational worrying
• Obsessive thoughts
• Fear of the worst-case scenario that is unlikely to happen
• Worsened memory 
• Unwanted and intrusive thoughts about harming their baby, this can be very scary for the mother - importantly and to reassure those struggling, intrusive thoughts of this nature, caused by an anxiety disorder, are extremely unlikely to reflect the mothers true intentions

Behavioural 

• Seeking control over situations 
• Repetitive checking, for example, checking that their baby is still breathing 
• Staying away from particular individuals, locations and activities^7,8 

Physical 

• Panic attacks 
• Increased breathing and heart rate 
• Inability to stay still 
• Sleep problems, for example, due to staying up through the night to check that their baby is okay
• Stomach problems 
• Minimal desire to eat 

Hormones

Hormones are special chemicals in our bodies with unique functions that rise and fall during important bodily events, for example, during and after pregnancy. 

Important hormones in postpartum disorders

• Oestrogen 
• Progesterone 
• Oxytocin 
• Cortisol 

Causes of postpartum anxiety

Whilst the hormonal causes of postpartum mood disorders are not fully known yet, we do have some understanding of what may be contributing to these disorders.⁴

• Hormones – after childbirth there is an abrupt change in the level of certain hormones, this is suggested to be the cause of postpartum disorders, such as postpartum anxiety^9,11
• Immediately after birth, levels of the hormone progesterone decrease largely, the body will only start to produce progesterone again during the mother’s next menstrual cycle – this can create a lengthy period of hormonal imbalance in the body⁹
• To allow mothers to breastfeed, oestrogen levels drop following childbirth, oestrogen is known to help our body make serotonin and dopamine which are chemical messengers for our brains, and are known to boost our mood and therefore low amounts can result in mental health disorders, such as anxiety^9,10
• Reduced sleep quality – a newborn baby is often accompanied by sleepless nights, reducing the quality of sleep, which has been found to increase a mother’s risk of postnatal anxiety^12.13,14
• Lack of maternal self-confidence can lead to anxiety surrounding a mother’s ability to care for their child¹⁵
• Stressful life events may trigger anxiety 
• Feeling responsible for the health of your child may be overwhelming and cause anxiety 

Risk factors for postpartum anxiety

• Stress-inducing events throughout pregnancy or during birth^4.15
• Stressful and traumatic life events 
• Lack of recognised social support 
• Genetic risk of mood disorders 
• Anxiety during pregnancy 
• Previous history of depression or anxiety 
• Financial struggles and other socioeconomic influences 
• Unwanted pregnancy 
• Past intentional abortion

How to spot the difference between postpartum depression and anxiety and the “baby blues”? 

What is postpartum depression?

Postpartum depression is a common mental health disorder in new mothers, arising anywhere between 6 weeks to 6 months postpartum. Symptoms are very similar to depression and include a persistent low mood, guilt, reduced focus, increased irritability, inability to sleep or conversely excessive sleep, and potentially suicidal thoughts.

Postpartum depression often occurs alongside postpartum anxiety, and many of their symptoms are the same or very similar. This can make differentiating the two quite difficult. 

Here is some information to help you understand their differences:^4,5,14

Is it the “Baby blues”?

The “baby blues'' are a drop in mood during the first week postpartum. During this early postpartum period up to 80% of mothers struggle with anxiety, insomnia, and sadness, are likely to cry, and experience mood fluctuations and irritability.¹⁵ Due to the vast majority of women experiencing postpartum blues, they are generally considered normal. The key takeaway is that postpartum blues are short-term, typically lasting a week, whilst both postpartum depression and anxiety are persistent and much more severe. 

Ways to help prevent postpartum anxiety 

It should be noted that there is no set way to prevent postpartum anxiety; it is not because of something one has done and it is not anyone’s fault.^4,6 However, here are a few suggestions that could be useful and can be of help: 

• Educational schemes aimed at increasing an expecting mother’s knowledge and awareness of postnatal mood disorders
• Planning your birth and postpartum journey to feel more prepared and supported
• Joining a support group 
• Therapy or counselling to equip expecting mothers with the toolkit needed to manage postpartum disorders
• Involving medical professional and screening for your risk of postpartum anxiety to ensure early intervention
• Ensuring you maintain postpartum care through regular check-ups

When to seek help from your doctor?

In short, as soon as you feel you need extra support or advice, reach out to your doctor. 

Experiencing anxious thoughts after having a baby can be perfectly normal, you suddenly have a child to take care of – it makes sense to be feeling overwhelmed. However, if these thoughts are persistent, worsening, affecting your ability to carry out daily tasks, bond with your baby, or take care of yourself. In this case, it is important to prioritise your well-being and seek help from your doctor. 

Women with anxiety are much less likely to report their symptoms compared to those with depression, however, the majority of those who do seek help from a health professional, find it useful. Medical professionals will be able to recommend the best treatment and support options to help you through this difficult time.

Treatment and support

Summary 

Postpartum anxiety is a type of mood disorder affecting mothers following childbirth. Its main symptoms include obsessive, intrusive and unwanted thoughts largely surrounding their baby’s wellbeing, leading to compulsions such as constant checking of their baby, sleepless nights, loss of appetite and generally low quality of life. 

While most new mothers face anxiety and low mood following childbirth (“baby blues”), postpartum anxiety is a lot more severe and persistent. Similar to, and often occurring alongside postpartum anxiety is postpartum depression, understanding the differences between the two is important. 

There are some preventive methods and treatment options for postpartum anxiety, the best way to understand what would work best for you, is to reach out to mental health and medical professionals.