Postpartum Anxiety: A Unique Problem Faced by Women

You’re thinking about the birth or just had a baby. You’re not ill, you’re thrilled about having a baby. You’re not depressed, but you’re on edge and worried about having so much responsibility for this beautiful, helpless baby. If you’re experiencing some of these feelings, you are not alone. In my 25 years of taking care of patients as a board-certified obstetrician/gynecologist, I saw a lot of peripartum (around the time of birth) and postpartum (after birth) anxiety. I saw it in my patients more often than postpartum depression, which is closely related because they both center around worry. In this post, I’ll explain the symptoms of postpartum anxiety and what to do about it.

Postpartum anxiety affects about 10 percent of new moms. The anxiety can add to the feeling of overwhelm that most moms experience, whether it’s your first baby or your third. It’s a level of vigilance that starts to impair one’s health, like checking to make sure the baby is still breathing while napping. It can even worsen the sleep deprivation of being a new mom, making the anxiety symptoms worse or even becoming obsessive. 

What is postpartum anxiety?

It’s a feeling of worry about what is about to happy or could happen, being on edge, cannot calm down, and believing that something could go wrong like the death of one’s baby. Onset around the time of birth or up to 12 months after birth. Some new mothers feel the need to run away or avoid this dramatic new change in their life. It occurs after the birth of a baby. It’s beyond just having a bad day–more of a feeling of dread or distress that persists despite the usual measures of trying to calming down like sleeping, talking to someone reassuring, relaxing, or meditating.

How long does it last? 

Can vary up to 12 months after giving birth.

What are the symptoms, treatments, and medication? 

Symptoms can overlap between postpartum anxiety and depression, and postpartum anxiety can even lead to postpartum depression.

Symptoms: 

• Persistent worry or panic
• Racing thoughts and cannot relax
• Fear of something bad happening like the baby not waking up from a nap, or falling, or drowning during a bath, the “what if’s”, etc.
• Fear of being alone with the baby
• Physical symptoms: rapid breathing, shortness of breath, stomach pain, headaches, nausea, loss of appetite, restlessness1
• See Diagnostic and Statistical Manual for more complete list

For further online reading, this list is fairly good and this website lists the basics about postpartum depression.

Research suggests that postpartum anxiety puts the infant-mother bond at risk. It can interfere with approximately 21-27% of variation in bonding. 

Treatment starts by talking to your obstetrician as soon as possible and making sure they understand this is not just the routine postpartum worry or blues. Get the help you need.

In functional medicine, we perform testing of the various systems of the body, such as the Hypothalamic-Pituitary-Adrenal-Thyroid-Gonadal (HPATG) system, the gut/brain axis, detoxification, and genomics. All have been implicated in anxiety although data are lacking in post partum anxiety. Then we use a specific and personalized protocol to ease anxiety that addresses systems biology rather than jumping immediately to prescription pharmaceuticals like a selective serotonin reuptake inhibitor or a benzodiazepine.

What’s the difference between postpartum anxiety and postpartum depression?

Both are rooted in overactivation of the control system for hormones (hypothalamic-pituitary-adrenal axis), often triggered by stress, in this case, having a baby. Both postpartum anxiety and depression share the same neurotransmitters: serotonin, dopamine, epinephrine, norepinephrine.

Look at the Diagnostic and Statistical Manual for the clinical details but I think of the difference as postpartum anxiety as the loss of the normal sense of balance and calm, and postpartum depression as a loss of heart, of assuming a bad future as a mother or in one’s life, of giving up.

Note that they are unique syndromes, not merely anxiety or depression that occur at a particular time in a woman’s lifecycle. They need to be treated as such. Additionally, there is overlap between them: postpartum depression has more of a worry feature than major depression that occurs at other times in life. 

Postpartum anxiety and postpartum depression are real and unique problems for women undergoing the dramatic hormonal changes of pregnancy, childbirth and postpartum. They deserve expert attention. How can you help? By listening carefully when new mothers are suffering, by sharing our own experiences and reaching out to other new moms who may be struggling. Recommend a qualified therapist, and ideally a functional medicine practitioner. In functional medicine, we test carefully a woman’s hormones, gut function, detoxification, and genomics. Then we design a customized protocol by adjusting diet, exercise, and other lifestyle changes, along with supplements. Getting help is the first step to getting relief.

For more on the hormonal changes a woman faces throughout her lifecycle, check out my book, The Hormone Cure.