Postpartum Anxiety

Postpartum anxiety disorder can be overwhelming and disorienting. Some people may confuse this condition with a form of the “baby blues,” a sadness that can occur for any parent after the birth or adoption of a child (not the same as postpartum depression), or a general sense of confusion due to the hormonal fluctuations surrounding birth.

However, anyone can experience postpartum anxiety, and this condition is a real mental health condition. The symptoms and duration of postpartum anxiety disorder can vary widely between individuals. Often, cognitive-behavioral therapy is helpful as a form of treatment, and sessions can be attended in person or online. Other forms of support can include meditation, mindfulness, quality sleep, and progressive muscle relaxation.

What is postpartum anxiety?

Postpartum anxiety disorder, referred to in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as perinatal generalized anxiety disorder, is not the same as the general nervousness that can accompany pregnancy and birth. Rather, it is classified as a psychological disorder that can manifest with both mental and physical symptoms. Postpartum anxiety may disrupt the lives of those who live with it if left unresolved or unacknowledged.  

Postpartum anxiety disorder can manifest after the birth of any child, whether that child is the parent’s first or one of many. The condition may occur separately or concurrently with postpartum depression and may occur in gestational or adoptive parents, as well as a gestational parent’s partner, and is not exclusive to any one gender or identity. 

Postpartum diagnoses usually have a unique presentation for each person who lives with them. Symptoms may be similar to those that one might expect to see with generalized anxiety disorder or post-traumatic stress disorder (PTSD), as well as other mental health disorders like major depressive disorder and obsessive compulsive disorder (OCD). 

Symptoms of postpartum anxiety disorder

Individuals may experience feelings of anxiety postpartum. A new child is often a significant life change and may alter key regulatory processes, such as sleep schedules and self-care routines.

As you navigate these changes, you may consider self-screening for symptoms of postpartum anxiety disorder. PPA symptoms can vary individually, so you may have an experience that’s unique to you or unrelated to the symptoms on the list below.  

Common postpartum anxiety symptoms can include:

• Increased heart rate
• Gastrointestinal disturbances
• Tightness of the chest and throat
• Chest discomfort
• Muscle tension
• Shallow or irregular breathing
• Loss of appetite
• Heart palpitations
• Trouble falling or staying asleep
• Racing thoughts
• Excessive worry or a sense of doom
• Trouble concentrating or memory disturbances
• Becoming overwhelmed or hypervigilant

Those living with postpartum anxiety disorder may experience disruption in the quality of their daily life. Feelings of worry may be categorized as intense in many with the disorder and could result in panic attacks, and these feelings may be difficult to resolve without therapeutic intervention. If you're concerned you may have postpartum anxiety disorder, speaking with your physician may be helpful in determining your next steps and whether other physical or mental health conditions may be present, such as depression or obsessive-compulsive disorder.

How long does postpartum anxiety disorder last? 

Postpartum anxiety symptoms can start within the first four to six weeks after the child is born. However, in some cases, symptoms can appear before the child is born and last up to a year or more postpartum. Duration and overall experiences may vary for each person and may or may not be influenced by possible contributing factors. 

In some cases, people with postpartum anxiety (PPA) may face stigma and misconceptions. They might be faced with messages from others that postpartum mood disorders “should be” over by the baby's first birthday. However, literature shows that the period for recovery may extend past this point. Embracing a more inclusive timeframe and understanding that variability can occur can lead to increased validation and support for those who currently live with PPA. PPA can vary from mild cases to more severe cases requiring closer monitoring.  

Possible causes of postpartum anxiety

Although there’s generally no single definitive cause of postpartum anxiety, there are several risk factors that may contribute to its development, including the following:

• Hormone fluctuations
• Sleep deprivation
• Relationship changes and strain 
• Previous diagnoses of anxiety and depressive disorders
• Previous prenatal losses or miscarriages
• Societal expectations and social stressors around parenthood
• Family history of anxiety disorder diagnosis 

While these may be possible contributing factors, there can be different causes that may contribute to the formation of postpartum anxiety, and it may manifest independently of environmental factors. Every individual’s experience tends to be unique to them. Some people may not experience any risk factors.

Treatment options and support for postpartum depression and anxiety 

Postpartum anxiety treatment from a licensed therapist can help those experiencing postpartum anxiety symptoms find relief more quickly. Several scientifically supported treatment methods may give those living with PPA a higher quality of life, including but not limited to the following.

Cognitive-behavioral therapy for postpartum anxiety

Cognitive-behavioral therapy (CBT) is a scientifically supported treatment for postpartum anxiety. According to the Association for Behavioral or Cognitive Therapies, CBT can be effective for individuals currently experiencing postpartum anxiety. Cognitive-behavioral therapy can be seen as a specific type of therapy that may focus on supporting clients through reframing their thoughts and learning to regulate and cope emotionally.

In CBT, a therapist may help you identify thoughts that may be perpetuating your anxiety. Then, you might be asked to evaluate the thoughts to restructure and challenge maladaptive (harmful) beliefs that might be underlying anxiety. Cognitive restructuring and identifying potential causes of anxiety may help you move forward, change unwanted behavioral patterns, and connect with yourself, your family, and your child. Each person’s goals for therapy can differ, so a therapist may tailor this approach specifically to you. CBT therapists can also teach coping skills for anxiety, which may guide you through difficult moments at home.

Meditation and mindfulness

Meditation and mindfulness can be effective ways to manage the symptoms of postpartum anxiety disorder for some people. These techniques can call attention away from physical symptoms and redirect energy to breathwork and balance between mental and physical states. 

Progressive muscle relaxation

Progressive muscle relaxation is a technique that may relieve the tension in your body at any time, including during the postpartum period. One technique that may help some people starts with the person lying still on their back. They can then tense the muscles of their toes as tight as they can and hold the tension for several seconds. Next, they can release the tension and relax their toes. These steps can be applied to each muscle group of the body.

Sleep hygiene and support

New parents may find it difficult to get enough sleep when experiencing postpartum anxiety. They may attempt various techniques but find that their anxiety keeps them awake or causes nightmares. Below are sleep hygiene techniques that may be helpful for some people: 

• Consider alternating care of the new child between you and a partner, family member, or loved one so you can sleep at specific times each day or night
• Try to sleep when you're sleepy rather than lying awake in bed when you're not, as trying to push yourself to sleep might cause anxiety or avoidant behavior for some people
• Consider engaging in routine tasks before bed to provide your brain with a foundational routine that can signal the end of your day
• Consider avoiding or limiting caffeine and nicotine
• Consider avoiding alcohol
• Consider keeping work and other “daytime” activities away from your bedroom, as doing so may support your brain in associating the bedroom with restful sleep
• Consider trying breathwork, meditation, or mindfulness before you settle down for the night. A guided meditation app may be helpful if you struggle to do so on your own
• Consider taking a hot bath or shower an hour before sleep

Getting sleep can be challenging with the demands of a new child, as your schedule may change from what you’re used to. If you’re experiencing sleep challenges, you might consider talking to a mental health professional, such as a psychiatrist or therapist, about improving your sleep if typical sleep hygiene practices are not helping. Some parents might find medication helpful after welcoming a new child.

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Support options

Various methods have been developed to treat postpartum anxiety disorder and other anxiety disorders. However, leaving home can be difficult with a little one, and visiting an unfamiliar or “clinical” setting can be overwhelming for some people. Online therapy through a platform like BetterHelp can be a helpful form of support for new parents who are looking for resources and extra help during this new season of life.

Online therapy can remove some barriers to support, potentially connecting you to a resource that you can leverage in the comfort of your own home without disturbing or altering the baby’s schedule. In addition, online platforms may offer access to online support groups, which can be a way to meet with other new parents who may understand your experiences.

While research is still being done regarding the implications and success of online therapy in new parents experiencing postpartum anxiety, a recent Canadian study suggested that the use of online CBT was generally associated with higher and more positive outcomes in the test group, reducing symptoms by an average of 6.24 points, nearly triple of what the control group attained. If you have a new child and are experiencing anxiety, online therapy platforms may facilitate connection with licensed mental health professionals from the comfort of your own home. Any new parent can seek help, whether officially diagnosed with anxiety or not.