What Is Postpartum Anxiety?

Postpartum anxiety is anxiety that occurs after giving birth. It is normal to be stressed and have anxious feelings after having a baby. After all, your life has undergone a huge change in taking on the responsibility of caring for your baby, often on little to no sleep.

While some amount of anxiety is completely normal during this period, postpartum anxiety refers to overwhelming anxiety and uncontrollable worry that inhibits your daily functioning. With postpartum anxiety, you may experience intrusive thoughts and physical symptoms, and find it difficult to take care of your baby and yourself.

It is unclear exactly how many people experience postpartum anxiety—estimates of this condition range from 4.4% to 18%. One systematic review of 58 studies on postpartum anxiety found a prevalence rate of 8.5%.

Seeking diagnosis and treatment for postpartum anxiety will not only help you feel better, but it can support your baby's development and keep you involved in your daily life, relationships, and the activities that are meaningful to you.

Definition of Postpartum Anxiety

There are no official diagnostic criteria for postpartum anxiety, but one definition is that it's an anxiety disorder that occurs in the time period from immediately post-birth up to a year post-birth.

Most commonly, postpartum depression presents as generalized anxiety disorder (GAD), but other anxiety disorders such as obsessive-compulsive disorder (OCD) can also occur in the postpartum period.

Symptoms of Postpartum Anxiety

Symptoms of postpartum anxiety can include:

• Intrusive or persistent thoughts
• Excessive worry
• Insomnia
• Avoidant behaviors
• Tension
• Dry mouth
• Nausea
• Irregular heartbeat
• Fatigue
• Shakiness or trembling
• Panic attacks

How these symptoms manifest will look different from person to person. You may find yourself constantly worrying that your baby is breathing and find it difficult to concentrate or focus on anything else as this worry consumes you.

You may avoid breastfeeding due to worry and anxiety about latching. Or you may be overwhelmed with physical symptoms like nausea or even chest pain.

If these symptoms are disproportionate to the situation and prevent you from functioning within your normal relationships, roles, and activities, it is important to have a conversation with your healthcare provider.

Diagnosis 

Diagnosis of postpartum anxiety can be challenging or missed for multiple reasons. First, many anxiety symptoms may be considered "normal" in the postpartum period.

These symptoms include fatigue, irritability, insomnia, tension, and difficulty concentrating. As such, it may be difficult for healthcare providers to identify a clinical anxiety disorder in the postpartum period.

Second, unlike postpartum depression, there is no official postpartum anxiety definition within the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5), which is the handbook of the American Psychiatric Association used by healthcare professionals to diagnose mental health conditions.

Currently, the DSM-5 specifier (a diagnosis extension used to clarify a disorder) "with peripartum onset" can only be used for mood disorders, such as depression, and not for anxiety disorders.

The lack of criteria in the DSM-5 makes it difficult to categorize postpartum anxiety as generalized anxiety disorder (GAD), especially since a GAD diagnosis requires a history of six months of symptoms.

A person who develops anxiety in the postpartum period may not have this history. Therefore, some researchers encourage clinicians to diagnose postpartum anxiety if the criteria for GAD have been met over a one-month period instead.

Third, there has been an under-recognition of anxiety disorders within the peripartum and postpartum populations. This means that anxiety, specifically among people who are pregnant or who have recently given birth, is not well-researched. As a result, there are no anxiety screening tools available that are designed specifically for the postpartum population.

The State Trait Anxiety Inventory (STAI) is a general screening tool for anxiety that has been studied for use in the postpartum population. Research indicates that this tool can accurately diagnose postpartum anxiety with screening at both four and eight weeks postpartum.

A psychological interview, or conversation with your healthcare provider, may also be used to diagnose postpartum anxiety. Your practitioner will ask you questions to determine if your anxiety is causing significant distress or is functionally limiting (inhibiting your ability to perform normal activities) and meets the DSM-5 criteria for an anxiety disorder.

Causes

Like all anxiety disorders, there is not a clear cause and effect for postpartum anxiety. Additionally, there is a lack of research on the causes of postpartum anxiety.

Neurobiological research has found both similarities and differences in brain activity between postpartum anxiety and anxiety in the general population. This may indicate that there is a different set of causes for postpartum anxiety.

In some cases, the natural stressors of the perinatal period may contribute to developing postpartum anxiety. Normal worries and fears around the baby's well-being, the mother's well-being, the partner's well-being, and more all have the potential to grow out of control.

When these worries become persistent and lead to functional impairment (the inability to carry out certain activities in your daily life), postpartum anxiety may be diagnosed.

Unlike anxiety among the general population, pregnancy-related hormonal changes may also contribute to postpartum anxiety. One theory is that postpartum estrogen withdrawal may lead to anxiety.

During pregnancy, estrogen levels increase significantly and then rapidly drop to below prepregnancy levels after childbirth and throughout the postpartum period.

This theory was supported by a 2016 study using mice and a 2020 study using hamsters. However, human studies still need to be performed to draw decisive conclusions.

Treatment

Despite postpartum anxiety's potentially having different causes than anxiety in the general population, it typically is treated in the same way. However, in choosing a treatment plan that is right for you, your healthcare provider should take into consideration your postpartum status, including whether you are breastfeeding.

Psychotherapy

Cognitive behavioral therapy (CBT) is the first-line treatment for mild and moderate postpartum anxiety. Mindfulness training and relaxation techniques also are effective treatments for lowering anxiety levels and symptoms in the postpartum population.

Medication

Medication typically is a second-line treatment for postpartum anxiety and is used in moderate to severe cases. This is due to the possibility of some drugs being transferred via breast milk to the baby.

Your healthcare provider will consider this when prescribing your medication and will usually start with the lowest possible dose before titrating up (raising the dosage gradually).

Medications used to treat postpartum anxiety include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), buspirone, benzodiazepines, or tricyclic antidepressants. Of these, SSRIs are the most studied and frequently used during the peripartum and postpartum periods.

Risk Factors

There are various factors that may make a person more likely to develop postpartum anxiety. Risk factors include:

• High perceived stress
• Low partner social support
• History of pregnancy loss
• History of multiple births
• Diagnosis of other anxiety or mood disorders
• Family history of anxiety disorders
• Early breastfeeding cessation

One 2016 study found that people at highest risk of developing postpartum anxiety are those who are multiparous (have previously given birth) and have an existing psychiatric history and high levels of stress from diverse sources.

Having multiple risk factors increases your chances of having postpartum anxiety, and this can include taking care of multiple children, including your newborn, during the postpartum period. Notably, a different study found that childcare stress, maternal self-esteem, and depression did not play a significant role in postpartum anxiety.

Coping

Take comfort in knowing there are good reasons for experiencing feelings of postpartum anxiety. First, realize that caring for a new baby is hard, and there is nothing you did to cause your postpartum anxiety.

Here are some ways you can cope with your postpartum anxiety:

• Talk to your partner, friends, and family about your worries and need for support.
• Balance caregiving duties equally with your partner or a loved one.
• Recruit family members or babysitters to help.
• Join a support group of new parents, many of which can be found online.
• Try to maintain a balanced diet, which is possible through batch cooking, meal delivery services, and more.
• Engage in mindfulness and relaxation practices, such as clinical aromatherapy or yoga.

A Word From Verywell

Coping with caring for a new baby and all the life changes your baby brings can be worrisome. For some people, these worries may manifest in postpartum anxiety. If you are struggling with excessive fears, intrusive thoughts, insomnia, and physical symptoms such as muscle tension, dry mouth, nausea, and more, then you may have postpartum anxiety.

While it is normal to feel anxious after childbirth, it is not normal for these worries to take over your life. Talk to your healthcare provider about postpartum anxiety and the treatments that are available to you.