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The Facts About Pregnancy and Postpartum Anxiety

by Dr. Sarah Allen
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There has been a growing awareness about Postpartum Depression over the past decade and doctors offices now routinely screen moms for it but I think anxiety, during pregnancy and after having a baby, is nearly as common and just as debilitating. It is time to focus on how many women are effected by anxiety and educate our community so we are all aware of the symptoms and how to access appropriate help.

Approximately 6% of pregnant and 10% of new moms experience anxiety, and remember that statistic comes from the number of women actually reporting it so imagine how many women go through anxiety and don’t mention it to their doctors or reach out for help. You are definitely not alone in going through this and treatment is available and really can help.

Pregnancy Anxiety

Let’s start with pregnancy. Pregnant women get a lot of advice about what they should do or not do from everyone and their dog. It can make you a little paranoid. The process of trying to get pregnant, fear of miscarriage, especially if there is a previous loss and what is going to happen to your life can all cause anxiety or exacerbate pre-existing anxiety. A lot of my clients say that they have always been a worrier and others say they weren’t anxious until getting pregnant.

Postpartum Anxiety

When the baby arrives every new parent worries that they don’t really know what they are doing and somehow, inadvertently, they may do something, or not do something, that causes harm to their baby. Are they getting enough milk, sleep, developing okay???

Until a baby arrives, you don’t realize how totally vulnerable a little human is and now you are totally responsible for it! This can be scary sometimes but these worries are totally normal and everyone gets them occasionally.

What we are talking about here though is something quite different, postpartum anxiety is more intense and persistent than typical new parent concerns. If you have any of the symptoms below for most of the day, you probably have postpartum anxiety. If they persist for more than a couple of weeks after the birth (the baby blues effect 80% of women but within 2 weeks mood swings typically calm down) or come on anytime in the first year and last two weeks or more, then it is important to seek support.

Symptoms of Pregnancy & Postpartum Anxiety

Racing thoughts – they go round and round in your brain with no off switch.

Worrying – it’s constant, you know the concerns are excessive but that doesn’t stop the worries and when you stop worrying about one thing, your mind jumps to another. Worries often surround the well-being of the baby or your other children, partner and yourself. Women worry they are going crazy and have a feeling of dread in the pit of their stomach.

Lack of concentration – your focus flits from one thing to another and memory is poor.

Restlessness – you are exhausted but so agitated you can’t settle or relax.

Sleep disturbance – you can’t sleep even if the baby is sleeping and when you drop off you don’t wake up energized.

Irritability – you may be able to hide it from friends, your partner will probably be getting the brunt of it.

Physical tension – your muscles are balls of tension, possibly leading to neck, shoulder and backaches.

No appetite – women want to lose the baby pounds but this isn’t the way to do it. Even though you know you should be keeping hydrated and your energy up, you have no appetite for food and may feel nauseous a lot of the time.

There are subsets of anxiety symptoms that are important to differentiate.

Panic Attacks

Panic attacks are like anxiety multiplied by 10. They have a sudden onset and are accompanied by intense fear of something bad happening.

Physical symptoms include shortness of breath, chest pain, dizziness, heart palpitations (people often think they are going to have a heart attack), sweating and gastrointestinal upset.

Emotionally you may feel that you are going to somehow lose control, go crazy and may start to avoid situations where you have experienced panic attacks for fear of one happening again.

Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you and there are techniques to calm your mind and body down.

The Difference Between Postpartum OCD & Psychosis

OCD is the short name for obsessive compulsive disorder. Obsessions are unwanted thoughts that pop into your head totally uninvited and during pregnancy or after childbirth these thoughts typically revolve around some harm coming to the baby. The thoughts, images or visions can be really horrific and seem very real. Women tend to not tell anyone they have these thoughts for fear of what others may think of them. When we keep thoughts in our head though, they grow more severe and even more frequent.

A lot of time (but not always) the thoughts are accompanied with a compulsion (an overwhelming belief that you MUST do a certain behavior or think certain thoughts in the belief that this will stop the bad thing from actually happening).

Women worry that having these types of thoughts means they are going crazy. When stories get in to the news about postpartum women it is usually because the woman has postpartum psychosis and has done something horrific like harm her baby or driven off a bridge. Those stories are so horrible that the news media jump all over them but only 0.1% of new moms experience postpartum psychosis ( termed PPP). IT IS RARE! Furthermore, only about 4% of this 0.1% harm actually harm themselves or their baby so the likelihood that you are having a psychotic episode (i.e. are not in touch with reality) and will actually cause harm is EXTREMELY RARE but it makes headlines.

About 3 -5% of women experience postpartum OCD so although it is not talked about as much as postpartum depression, it is pretty common and the most important thing to remember is that if you know these thoughts would be a bad thing to do, you are experiencing OCD, not psychosis.

The main symptoms of PPP include delusions or strange beliefs, hallucinations (seeing or hearing things that aren’t there), feeling very irritated & hyper, decreased need for or inability to sleep, paranoia and suspiciousness and rapid mood swings. In a psychotic state, a woman’s delusions and beliefs make total sense to her (but would be irrational to others) and feel very meaningful. Risk factors for PPP are a family history or previous personal history of psychosis or bipolar. Treatment needs to be immediate and requires hospitalization. You see, it is very different from having anxiety-provoking horrible thoughts and still being in touch with reality.

PTSD After Childbirth

Postpartum post-traumatic stress disorder (PTSD) following a difficult childbirth is more common than you think. It is triggered by a real or perceived trauma during delivery and can effect up to 6% of mothers. The traumatic experiences usually leave a women feeling that either her life or the life of her baby is at risk during the labor or shortly thereafter.

Symptoms of fully fledged postpartum PTSD might include intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself, shortly after or events leading up to going to the hospital), flashbacks or nightmares, avoidance of stimuli associated with the event, persistent increased arousal (irritability, difficulty sleeping, hyper-vigilance, exaggerated startle response), anxiety and panic attacks, and feeling a sense detachment.

What I often see in my practice is that women who have had a difficult labor don’t necessarily have the flashbacks and nightmares but they are left with persistent anxiety and hypervigilance about potential harmful things happening in the future or guilt and regret about how labor turned out.

After reading this article do any of these feelings seem familiar? What I really want you to take away from reading this is that pregnancy and postpartum anxiety is much more common that you think it is. Many of the women you know have probably experienced the same thing but just don’t talk about it and struggle on.

Anxiety is very treatable though. You don’t need to struggle by yourself. In particular, I find that cognitive therapy is the most effective way to get on top of anxiety. Also known as CBT, it is a problem-solving type of therapy and helps you learn ways to calm down quickly, develop coping strategies and think about things in a different, more helpful way. I use CBT anxiety-reducing treatment strategies and combine them with 20 years of experience of working with new moms and the knowledge I gained raising 3 children of my own.

If you have had therapy before you might find this type of counseling to be more directive and problem-solving than you are used to but I have found to be the most effective way. No lying on my couch while I say “Hmm, how does that make you feel.”

I have two free booklets that are full of information which will be useful to you.

A Guide To Pregnancy & Postpartum Stress, Anxiety & Depression has more information about symptoms, risk factors, how to look after yourself and treatment options.

THE GUIDE TO PREGNANCY & POSTPARTUM STRESS, ANXIETY & DEPRESSION ebook

 

To get your FREE copy of the booklet click the link below

Guide To Pregnancy & Postpartum Stress, Anxiety & Depression

 

 

 

Simple Steps To Overcoming Anxiety & Worrying can be downloaded below and is full of practical tips and exercises to get anxiety more under control.

SIMPLE STEPS TO OVERCOME ANXIETY & WORRYING ebook

 

To get your FREE copy of the booklet click the link below

Get Simple Steps To Overcome Anxiety & Worrying

 

 

 

I see clients in my Northbrook office or for your convenience, via telephone or internet sessions

If you have any questions after reading this article or want to know more about anxiety treatment

please contact me at 847 791-7722 or

email me below

Unfortunately Dr. Allen's professional license does not allow her to give advice via email or work remotely with clients who do not live within Illinois unless they travel to her Northbrook office.

 

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Filed Under: Pregnancy and Postpartum, Uncategorized, Women's Issues

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  • Testimonials

    I began seeing Dr. Allen when my first child was around a year old. I had experienced a very traumatic birth, after a difficult pregnancy where I was on bed rest for a good portion of the time. The first year of my son’s life was spent worrying constantly. I also experienced flashbacks to the birth, which was an emergency C-section under general anesthesia. My son was in the NICU for several days following his birth, and I was not given very much information as to why. I remember thinking that he would die, or that something awful was going to happen. I experienced a great deal of anxiety that first year, and I thought that it was due to being a new mom. I wasn’t sleeping, I wasn’t eating as normal, and I remember being worried about leaving the house or taking my baby with me anywhere. I worried constantly about illness, germs, etc. The first day that I saw Dr. Allen, she gave me some questionnaires to fill out before we started talking. Then we sat down and talked about my experiences with my son’s birth and the early days of his life, and the year or so since then. I remember to this day the relief that I felt when she looked at me and said that I had PPD and PTSD, which was a result of the trauma I experienced during and immediately after the birth of my son. She explained how my brain had reacted to the stress of these events, and related it to why I was feeling the way that I felt. It made so much sense. Then, she described ways that I could get over the trauma, work through the feelings, and recover from PTSD and PPD. I felt so empowered, and so happy that the way I felt had a name, and that it was treatable. It also made me feel so validated in the ways that I had felt and reacted following my son’s birth. I wasn’t going crazy. My reaction was normal and natural. And with the help of Dr. Allen, and the type of therapy that she uses, I knew I could recover. It is over five years since that first visit with Dr. Allen, and I still use the tools that she taught me today to deal with stress. I credit her with helping me to become a more empowered, happier person.
    Elizabeth
    When I had my first baby I had what I now know was postpartum depression but I didn’t get any help. It did go away after about 18mths but it was a miserable way to begin motherhood.  When I was pregnant with my second child I started to become depressed again and this time told my OB/GYN how I was feeling and she referred me to Sarah. By starting to deal with how I felt and change the way I was handling the stresses in my life, I was in a much better place when my baby was born. The second time round my PPD was much less severe and didn’t last as long. Sarah was also really helpful in teaching me ways to make the transition of becoming a big sister easier for my oldest one too.   My husband came with me for some sessions and that really helped our relationship and we started working on parenting issues together.  Sarah’s counsel and support really helped our family transition to the good place we are all in today.
    Sara D.
    I refer as many patients as I can to Dr. Allen. She is an expert in treating perinatal mood disorders, and a well-trained and experienced therapist who is committed to working with her clients to develop a treatment plan designed for each individual. She exhibits genuine warmth, kindness and compassion for each of her clients. Dr. Allen has been a colleague of mine for more than 20 years, and I have great confidence when I refer patients to her.
    Leslie Lowell StoutenburgRNC, MS, FACCE Director, Pregnancy & Postpartum Mood & Anxiety Disorder Program and President of Postpartum Support International
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