Postpartum Anxiety Affects 1 In 8 New Moms. Here's What It Looks Like

My husband and I were together for 15 years before we had our one and only son. Needless to say, we were the last of our friends to do the kid thing, and I was excited when it was finally my turn. Two days after giving birth, we made our way home, where grandparents excitedly awaited—and I felt sad.

Sad?? It was an emotion I wasn’t anticipating. It was a deep melancholy that made my heart hurt. How could I be sad when I had a new baby?! The guilt I felt for feeling sad only exacerbated my anxiety. I started worrying, fretting and losing even more sleep.

Luckily, within a few weeks, the feelings subsided. But for many women, they can be overwhelming and practically crippling. Postpartum Anxiety (PPA), which is slightly different from Postpartum Depression (PPD), affects 12.3 percent of mothers worldwide, and it’s almost as common as postpartum depression.

It’s something that not only has an impact on mom but also on the entire family unit, including baby. And despite the fact that it’s unfortunately pretty common, it’s still something that’s not very talked about. Until now.

What is postpartum anxiety?

Postpartum Anxiety is characterized by persistent, excessive worry, fear, and nervousness about the new baby and about being a mom. Symptoms can include physical signs like restlessness and a racing heart, mental indicators such as intrusive "what if" thoughts, and behavioural changes like obsessively checking or avoiding situations. “PPA and PPD can overlap. You can have PPD that comes with a lot of worrying, and PPA can be so severe that it causes a lot of sadness,” explained Dr. Natalie Feldman from the Department of Psychiatry at Brigham and Women’s Hospital. “You can have one or the other, or both. If you’re experiencing sadness or hopelessness, it’s more PPD, and if it’s worry or fear, it’s PPA. The good news is, we have good evidence that therapy, and in some cases medication, will treat both conditions.”

How common is postpartum anxiety?

According to a 2018/2019 Statistics Canada survey, 23 percent of mothers who recently gave birth in Canada reported feelings consistent with postpartum anxiety or depression. This means approximately one in four new mothers in Canada experienced symptoms of these conditions. As mentioned, more than 12 percent of moms associated their feelings specifically with PPA after giving birth, which is an alarming statistic, for sure. However, more research and awareness are needed.

“We have seen medication treat PPA well clinically, but what we’ve learned is we need more research to prove the medication is working as well as it does,” Feldman said. “In my clinic, I’ve seen medication make life-changing improvements, and when untreated, there are risks for mom's and baby’s health down the road. When we treat both conditions, those risks get better, which is why treatment is so important.”

Globally, anxiety and depression during pregnancy and the postpartum period affect approximately one in seven women, representing a significant public health challenge, according to a clinical review. However, it is estimated that up to 50 percent of cases remain undiagnosed, largely due to the stigma surrounding these conditions and many women’s reluctance to openly discuss their symptoms.

Who is most at risk?

Many new moms might be at risk of getting PPA. Those with a history of mental health issues are susceptible, as are younger mothers, those lacking adequate social support, individuals experiencing financial stress, immigrants and refugees, and minorities who may not have the support they need. Other risk factors include having a history of domestic violence, an unplanned or unwanted pregnancy, complications during pregnancy or birth, and fertility challenges. The most important step in improving symptoms is early recognition of PPA and PPD. That way, treatment and support can be sought out sooner.

Signs and symptoms of postpartum anxiety

There’s a fine line between more common feelings of being overwhelmed as a new parent and suffering from a mental health challenge like PPA. “With postpartum anxiety, there’s a lot of worry, and those worries are often about the baby’s safety or your own ability as a mom,” said Feldman. “Moms with PPA can often experience scary mental images of bad things happening to the baby. It’s really the brain’s way of making sure you keep your baby safe, but it can be very scary. Those images are almost universal and are something almost all new moms experience, but when it’s happening a lot of the time, or it’s really upsetting, this is part of PPA.”

Since working with new moms who have experienced postpartum anxiety, Feldman has come across countless women who didn’t know PPA existed and thought something was wrong with them. “PPA and PPD are both serious conditions; they both impact babies' and moms' health, and they both deserve treatment and attention,” Feldman added.

Why postpartum anxiety matters for families

If left untreated, perinatal mental health issues can lead to less mother-infant interaction. It can also mean poor infant development and increased risks of emotional and behavioural problems later in childhood. Maternal stress and anxiety can have a negative impact on communication with the infant, which may influence the baby’s ability to self-soothe and increase their risk for conditions like ADHD. It also undoubtedly impacts a mother’s quality of life and can cause strain on family dynamics and support networks, too.

Treatment and support options

As more light is shed on PPA, there has been an increase in treatment options. Cognitive Behavioral Therapy (CBT) has shown strong promise (group, individual, and prenatal); however, other treatments are still under-researched.

Social support networks play a big role in helping new moms cope with postpartum challenges. And there are practical steps new parents can take, like talking to their family doctor or OBGYN, and joining peer communities. The key is reaching out for help sooner rather than later.

Natasha MacDonald from Candiac, Quebec, has three kids (ages 11, 8 and 6), and she says that after her first child, navigating her mental health became a constant battle. “I still had a lot of anxiety once my second and third were born, and it was sort of like a cycle of back and forth, learning how to cope and support my mental health,” she explained. “Exercise helped me deal with my perinatal mood and anxiety disorder, but I never went as far as opening up to my family or a professional as to how I was feeling. Looking back now, I think it would have been a tremendous help.”

Maternal wellness specialist and CEO of Misty Phases promotes a holistic vision of the postpartum experience, in which physical and emotional care are addressed together. Recognizing the importance of physical well-being as part of emotional balance contributes to a more conscious, supported, and empathetic postpartum journey, she said in a press release.

Breaking the silence

Feldman said the time to rigorously and thoroughly study PPA is now. “People should be aware of postpartum anxiety, as well as PPD. If you’re sad, worried, or overwhelmed, that does not mean you’re not doing okay. Having a new baby is exhausting, and it’s normal to have feelings of being overwhelmed, sad, and worried. It’s a big change, and if you’re not happy all the time, it doesn’t necessarily mean you’re depressed.”

MacDonald agreed, “It isn't addressed properly or enough. When we're pregnant, or even right after birth, there's so much focus on the baby's health and development, and not enough focus on how the mother is coping. I feel like we're part of an environment that leads us to believe that we are destined to be mothers, that motherhood will come so naturally once your baby is born, but that isn't the case for everyone. For some, it can be a scary, isolating and confusing time. Not everyone might feel that immediate love at first sight towards their baby. The more we talk about the vastness of what mothers may feel after pregnancy, the more we lift the veil on the stigmas associated with postpartum disorders.”