Postpartum Anxiety: Signs, Symptoms, & Treatments

What Is Postpartum Anxiety?

Postpartum anxiety is a type of perinatal mood and anxiety disorder, like postpartum depression.¹ Some anxiety after giving birth is normal, especially during the first few weeks post-delivery. This is referred to as the “baby blues.” Many women begin to feel less anxious about two weeks after giving birth, but some women may continue to feel anxious and develop a postpartum anxiety disorder.

Postpartum Anxiety vs. Normal New Parent Worries

Experiencing some anxiety during the postpartum period is normal. Many women experience the “baby blues,” which typically includes mild worry, tearfulness, and exhaustion during the first two weeks after giving birth.⁷ For most women, these symptoms go away on their own after about two weeks and do not require treatment. Having a good support system and getting adequate rest can help you cope with the baby blues.

However, if your symptoms do not go away after two weeks, are moderate to severe, and interfere with your ability to function or care for your baby, then you may have a postpartum anxiety disorder.

Postpartum Anxiety vs Depression

Postpartum depression (PPD) and postpartum anxiety are similar in that both conditions can cause symptoms like irritability, fatigue, sleeping problems, difficulty concentrating, and negative thoughts.⁴ Both can significantly impact a woman’s life and affect her ability to care for herself and her children, as well as keep up with responsibilities at home, work, school, and in relationships. However, the main difference between the two conditions is that the primary symptom in PPD is sadness, while the primary symptom of postpartum anxiety is excessive worry.

Can Someone Have Both?

Some women may suffer from both PPD and postpartum anxiety at the same time. A woman with both conditions will feel depressed and sad most of the time, as well as fearful and anxious. This combination can cause considerable distress for a woman. Fortunately, there are treatments available, including therapy and medication, that can address symptoms of both PPD and postpartum anxiety at the same time.

Postpartum Anxiety Symptoms

Like other types of anxiety disorders, postpartum anxiety involves excessive worry that affects a woman’s ability to function.

Common symptoms of general postpartum anxiety include:^2,3

• Significant worry that is more than what would be expected in a given situation
• Intrusive thoughts, such as thoughts about the baby being harmed
• Difficulty sleeping
• Feeling on edge or irritable
• Problems concentrating
• Feeling more tired than usual
• Muscle aches or pains
• Panic attacks, which are intense anxiety episodes that can involve heart palpitations, difficulty breathing, shaking, and fear of losing control or dying

Generalized postpartum anxiety is the most common type of postpartum anxiety disorder.⁶ In some cases, people may experience more than one type of anxiety disorder at the same time or also experience other conditions, like postpartum depression, PTSD, or OCD.

Postpartum PTSD

Post-traumatic stress disorder (PTSD) is another type of anxiety disorder that can develop in the postpartum period. Many women who develop postpartum PTSD have experienced a traumatic childbirth, such as a birth involving complications where the woman or baby’s life were threatened.

Common symptoms of postpartum PTSD include:^3,4

• Re-experiencing the traumatic event in some way, such as through flashbacks, nightmares, or intrusive thoughts
• Avoidance of reminders, thoughts, or feelings related to the traumatic event
• Increased arousal, such as feeling easily startled, on edge, and difficulty sleeping
• Changes in mood, such as feeling down, guilty, or shameful, having negative thoughts, and a loss of interest in things that were once enjoyable

Postpartum OCD

Postpartum women may also develop obsessive-compulsive disorder (OCD), which is an anxiety disorder that involves obsessive thoughts and compulsive behaviors.

Common symptoms of postpartum OCD include:^3,5

• Obsessions, which are intrusive thoughts that cause considerable anxiety
• Attempts to suppress or ignore the obsessions
• An awareness that the obsessions are coming from their own mind
• Compulsions, which are time-consuming and repetitive behaviors that temporarily reduce anxiety associated with the obsessions

How Long Does Postpartum Anxiety Last?

The duration of postpartum anxiety can vary from woman to woman depending upon the severity of symptoms, social support, and whether she seeks treatment. For some women, postpartum anxiety can resolve on its own, but this is not always the case. Women who receive treatment for postpartum anxiety disorders may experience relief of their symptoms in as little as three months depending upon their specific diagnosis, the type of treatment, and how they respond to treatment.⁶

One study found that women who experienced less stress in their relationships with their partners were more likely to fully recover from postpartum anxiety and depression.¹³ Women who have more severe postpartum anxiety that involves uncontrollable worry may also have a more difficult time recovering compared to women with mild to moderate symptoms.¹⁴

When to Talk to Your Doctor

You should consider seeking treatment for your anxiety if it is moderate to severe, does not appear to resolve within a few months postpartum, and is affecting your ability to function. Women who struggle to care for themselves and their children because of their anxiety should highly consider getting help. If your symptoms are accompanied by suicidal thoughts and urges to harm yourself or your baby, you should also get help immediately by calling 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

What Causes Postpartum Anxiety?

Postpartum anxiety is caused by a combination of biological and environmental factors. When it comes to biological factors, significant hormonal changes during pregnancy, delivery, and postpartum and sleep deprivation play a role in the development of postpartum anxiety. In regards to environmental causes, the demands and stress of caring for a newborn can be taxing for new mothers, particularly those with less social support.

Biological Factors

People experience significant hormonal changes during pregnancy and the postpartum period that can put them at increased risk of developing anxiety.⁸ During late pregnancy, the hypothalamic-pituitary-adrenal (HPA) axis, a part of the brain involved in the stress response, is suppressed. This causes the brain to be less responsive to stressors. However, if the HPA axis is not suppressed, people may be at risk for anxiety.

During pregnancy and delivery, women also experience significant fluctuations in estrogen and progesterone.⁸ Researchers believe that it is not necessarily the fact that these hormones shift, but rather how dramatically they shift during the postpartum period that can explain why women may develop anxiety. Some women may be more susceptible to these hormonal changes than others.

Lack of Sleep

Sleep deprivation is another biological factor that is linked to postpartum anxiety.⁹ The postpartum period often involves significant sleep disturbances for new parents, since newborns may only sleep a few hours at a time and wake up frequently throughout the night. Some women may also have dealt with sleeping problems like insomnia during pregnancy or prior. At this time, researchers are unsure if sleep deprivation causes anxiety, is a symptom of it, or both.

Coping With New Motherhood

Becoming a mother is a stressful experience that comes with new demands that can be difficult to manage.¹⁰ For some people, coping with this transition to motherhood can be taxing and may put them at risk for anxiety problems. This is especially true for first-time mothers, who may feel less prepared to meet the demands of caring for a newborn compared to those who have other children.

One study found that anxiety generally increased over the postpartum period for first-time mothers. However, for women with multiple children, anxiety decreased during the first two years postpartum.

Lack of Support

Lack of support from family and friends also contributes to anxiety.¹⁰ Western cultures like the United States take a more individualistic approach to family-life. The nuclear family (i.e. mother, father, and children) are expected to care for and support one another with limited help from extended family members.

This differs from collectivist cultures, which value family and community support. Mothers who feel unsupported may struggle to keep up with the demands of this new role, which can put them at risk for postpartum anxiety.

Risk Factors that Increase the Likelihood of Postpartum Anxiety

Risk factors are personal characteristics or experiences that can increase the likelihood that a person develops a condition.

Risk factors that can increase the chances that someone experiences postpartum anxiety include:^9,11

• A past history of depression or anxiety
• History of trauma, abuse, or neglect
• Lack of social support
• Domestic violence
• History of previous miscarriage or perinatal loss
• Negative childbirth experience
• Difficult child temperament
• Sleep deprivation
• Younger age
• Lower level of education

If you have one or more of the above-listed risk factors, it does not necessarily mean that you will develop postpartum anxiety. However, it does indicate that your risk may be higher. If this is the case, it would be beneficial to consider preventative steps to take before and after delivery to reduce the likelihood of developing postpartum anxiety.

Postpartum Anxiety Treatment

There are several different ways to effectively treat postpartum anxiety. These treatments can be done on their own or combined with one another. Whether or not you choose to take medication or attend therapy, getting adequate self-care is necessary for recovering from postpartum anxiety.

Medication

Mental health medications, including antidepressants and benzodiazepines, may be used to treat postpartum anxiety.⁶

Should you take medications when breastfeeding?

These medications can help reduce anxiety symptoms, but should be prescribed with caution if you are breastfeeding. You can speak with your physician, OBGYN, or a psychiatrist for more information about the effects of anxiety medication during pregnancy and in the postpartum period, and whether it’s right for you.

Therapy

Cognitive behavioral therapy (CBT) is an effective therapy for treating postpartum anxiety.⁶ CBT for anxiety helps you change unhealthy thoughts that are causing your anxiety and teaches you new skills to cope with worry and stress.

Mindfulness Training

Mindfulness, the act of being aware of the present moment, can help reduce symptoms of postpartum anxiety and depression and increase self-compassion.⁶ This practice can be done on your own, in a group format, or with the help of a meditation app.

Self-Care

Taking care of your body is important for treating your anxiety, despite whether you also choose to take medication or attend therapy. Exercising, eating well, and getting adequate rest can all help you cope with your postpartum anxiety.

How to Get Help for Postpartum Anxiety

It is never too early or the wrong time to seek help. To get help for postpartum anxiety, you can start by speaking with your physician, OBGYN, or midwife about your symptoms. They will be able to help you determine whether you do in fact have postpartum anxiety and provide you with a referral for a therapist or other treatments.

What Self-Care Strategies Are Helpful in Decreasing Postpartum Anxiety?

If you are suffering from postpartum anxiety, you may be wondering what you can do on your own to help yourself. There are certain steps you can take that may help your anxiety and others that may make it worse.

These strategies can help you cope with postpartum anxiety:

• Seek support from other positive people, whether it is spending time with loved ones or joining a mommy-and-me or postpartum support group.
• Eat a healthy diet consisting of whole-grain carbohydrates, healthy fats, protein, fruits, and vegetables, and avoid processed foods and large amounts of sugar. If you are struggling in this area, consider meeting with a dietitian or nutritionist.
• Engage in at least 30 minutes of exercise three times per week, with your doctor’s approval. Cardio, walking, yoga and stretching, weight training, and playing sports all count as exercise.
• Find a few minutes each day for self-care. Whether you choose to take a bath, read a book, or meditate, cultivating time for yourself to do a relaxing activity is beneficial.
• Try to get at least eight hours of sleep per night. If your baby’s sleep schedule is significantly interfering with your sleep, enlist help by speaking with your child’s pediatrician. If you continue to struggle with sleeping problems, speak with your healthcare provider and consider seeing a sleep specialist.

Avoid these strategies for coping with postpartum anxiety:

• Use tobacco, alcohol, or other substances to cope with your feelings.
• Over consume caffeine products, including coffee, certain teas, soda, and energy drinks. Limit your caffeine use to one to two caffeinated beverages per day and avoid energy drinks altogether, since these often contain large amounts of caffeine.
• Spend long amounts of time on electronic devices like your cellphone or television. Instead, try to spend more time outdoors or in any activity where you can practice being fully present.

Can Postpartum Anxiety Be Prevented?

Having a good support system during the postpartum period is linked to lower levels of anxiety in women.¹² Support systems can be beneficial because they provide an opportunity to talk about how you are feeling, listen to other women who may have experienced something similar, and give and receive advice. Support systems may also assist with childcare or household chores, which can alleviate some of the burdens on you during this time. To help prevent postpartum anxiety, make an effort to remain connected to your support system throughout your pregnancy and the postpartum period. If your support system is limited, you can consider joining an existing support group, mommy-and-me class, or creating your own group.

Taking care of your body and mind can also help prevent postpartum anxiety. This includes eating a healthy diet, exercising (after you are cleared by your healthcare provider), and getting adequate rest. If you are having trouble sleeping, you can speak with your provider, who may be able to offer you some options. If your lack of sleep is related to your baby, you can speak with your child’s pediatrician, who may be able to provide tips, or ask your support system for help so you can get more rest.

If you believe that you are at risk for developing postpartum anxiety, you should consider telling your OBGYN or midwife during your pregnancy. If they are aware of your risk, they may be more likely to check in on you and schedule your postpartum visit earlier.