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Postpartum Anxiety and Postpartum OCD

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Postpartum anxiety is super duper common. About one in five women experience heightened anxiety to the point of distress postpartum, and it can make a new mom feel like her world is falling apart. 

Postpartum anxiety is not your fault, and it is treatable. So let’s talk about it and what we can do about it. 

The number one most common complication after giving birth is postpartum anxiety, but almost no one is talking about it. It’s more common than infection, hemorrhage, or postpartum depression, but no one mentions it. 

When you’re in the hospital after giving birth, they take all of these measures to prevent a baby from getting stolen — which is great; that would be awful, but it’s also an exceptionally rare situation — and they educate you on car seats, safe clothing and bedding for your child. 

They teach you about purple cry, and they teach you about taking care of your postpartum body. They even address postpartum depression. But I never heard a word about postpartum anxiety in the four times I gave birth, not at my hospital, at my OB, or at my pediatrician — all of whom do regular screenings for depression, by the way. 

But postpartum anxiety is super duper common. About one in five women experience heightened anxiety to the point of distress postpartum, and it can make a new mom feel like her world is falling apart. 

Postpartum anxiety is not your fault, and it is treatable. So let’s talk about it and what we can do about it. 

What Is Postpartum Anxiety?

Your brain physically and chemically changes when you have a child. I became more tender, more sensitive to other people and situations after my first child. I remember I was surprised at how the sound of her crying elicited this physical reaction inside of me, but I also became more anxious. 

I was never really a backseat driver or an anxious passenger before I had kids, but after having my first child I felt so much fear about something bad that could happen to her. I think that my anxiety jump was within normal levels. I I don’t think it led to a disorder for me. But it was absolutely noticeable, and there were times when I felt sure that something terrible was bound to happen. 

Now, it’s normal to have new worries when you become a parent. You worry if you’re a good parent. You worry if your child is safe and healthy. You worry if they’re hitting their milestones. But when anxiety becomes extreme, it can make it really hard to take care of yourself or your baby. 

I have friends and family members who have struggled with severe anxiety after giving birth, even when they didn’t have any change in their anxiety when they had other children. 

Another person I know felt constantly on edge after having her fourth child. She couldn’t sleep, she couldn’t eat. And in some ways it tipped her over the edge into an anxiety disorder, and for a while she just really struggled to function. 

I recently read the story of another mom who said, “After the first few weeks I began to worry more intensely. I had read about SIDS, which is sudden infant death syndrome, and now I constantly worried that he would die in his sleep. 

“I never let him out of sight. Even while he was sleeping I checked on him every five minutes to make sure he was breathing. I couldn’t sleep at night because I had to constantly watch him, and that lack of sleep led to spiraling anxiety. 

“I was convinced that he would die or have cancer or that social services would get called on me because he was a bad sleeper. And I cried a lot. I worried about everything. 

“And this whole time, his entire first year, I thought this was perfectly normal. I thought all new moms worried like me. I assumed everyone felt the same way and had the same concerns, so it never crossed my mind that I should talk to someone about it. I didn’t know I was being irrational. I didn’t know what intrusive thoughts were. I didn’t know that I had postpartum anxiety.” 

One study showed that at least 18% of women experience postpartum anxiety, and it’s probably much higher than that because it’s underreported. And of the women with anxiety, 35% of them had postpartum depression as well. 

So let’s help people learn the signs of postpartum anxiety so that they know to get the support that they need. 

What Are the Signs of Postpartum Anxiety?

So here are the signs and symptoms: 

  • Constant worry or dread. Worry about the baby’s safety, health, and development. 
  • Feeling on edge, like something’s about to go wrong. 
  • Excessive worry about your ability to handle being a parent. 
  • Irritability. 
  • Sleep disruption. You can’t sleep because you’re worried, not just because the baby wants to wake up every 45 minutes for a snack. 
  • Racing thoughts. 
  • Intrusive thoughts. So that includes thoughts like, “What if I hurt my child? What if I drop my child?” Things like that. 
  • Physical symptoms, like feeling shaky, trembling, jittery, stomachaches, headaches, sweating, shortness of breath, etc. 

And all of this usually occurs within the first couple weeks after birth, but it can be triggered much later, even after you wean the baby. And some women experience symptoms of panic attacks or OCD. 

Now, over 50% of new parents have recurrent intrusive thoughts, fears of them harming the baby, like “What if I drop the baby?” So this is pretty normal. But for some people this can lead to postpartum OCD, where obsessive thoughts and compulsions become overpowering. 

Compulsions are actions that are repeated to stop the anxiety. So these might include things like frequent checking, frequent cleaning, or ordering things. 

Lots of new moms feel more anxious after having a baby. But it becomes a disorder when it’s very intense, when the fears are irrational and the anxiety actually interferes with your ability to function. 

So for example, the thought, “I have to stay awake at all times to watch my baby,” that can lead to severe sleep deprivation, and that’s going to make it harder to take care of yourself and the baby. 

What Causes Postpartum Anxiety?

Let’s talk about what causes postpartum anxiety. Your brain physically changes during pregnancy, after birth, and with nursing. And I personally think that these changes serve important functions. 

During pregnancy your brain shrinks, especially the verbal part of your brain. And this change may help you communicate with your new, non-verbal little cute thing that you’re taking care of. 

When you nurse or nurture your child, prolactin and oxytocin flow, and this helps you create a bond, an attachment. If we didn’t have that heart and soul and body bond, some days it would be easier to abandon than to raise a child. 

And I personally believe that the heightened anxiety postpartum that so many women experience, that these brain changes may be an evolutionary response to transform a woman into a more protective figure. 

Being anxious about your kids does serve a function. Anxiety isn’t just something bad that happens to you. The function of fear and anxiety is to help you keep yourself and others safe. 

So if a mom worries about her child choking on hard food, she’ll avoid giving them that food. If a mom imagines her child being harmed by being too cold or too hot, she’ll help regulate the temperature. And when a baby cries and a mother feels anxious and then responds with more nurturing and soothing and feeding, then the baby learns that the world is safe and that people are safe and that they’re lovable. 

So imagine a completely unanxious mother. She doesn’t care when her baby cries. She doesn’t worry when her toddler is left unsupervised by a busy road. She feels no anxiety about him getting too cold alone in a car. That child is in danger. 

So anxiety serves a function. But when it becomes too overwhelming, it can suck away your joy, it can interfere with your ability to bond with your child, or it can lead to avoidance behaviors, like never going out, not letting your child play, or not getting normal life experiences. It can lead to feeling physically or emotionally sick, and it can contribute to overwhelm and depression. 

So do hormones cause it? Hormones may be one factor that contributes to postpartum anxiety. Estrogen and progesterone levels increase 10 to 100 times their normal levels during pregnancy, and then they drop to essentially zero within 24 hours of delivery. And this can make you more sensitive to stress and can cause you to feel overwhelmed, fearful, or panicky. 

But it’s not just hormones. Every woman goes through crazy hormonal changes with pregnancy, so why do some people get anxiety and others don’t? 

Well, we don’t know all the answers, but if you have a history of mood changes around your period you’re more likely to have anxiety postpartum. So that does indicate that hormones play a role. 

Other factors that contribute to postpartum anxiety include a history of losing a baby to miscarriage or another loss, a family or personal history of mood disorders, and life stressors. 

I mean, having a baby is stressful. There’s new roles, there’s more strain on your time, and there’s more strain on your finances. But any life stressors can contribute to you being more likely to develop an anxiety disorder. 

There’s also the issue of social pressure. You might feel pressured to be the perfect mom or to look a certain way or to recover within a certain time. 

There’s also certain personality types that are predisposed. And these include people with rigid or type A personalities, perfectionists, and highly sensitive people.

What Can You Do About Postpartum Anxiety?

So what do we do about it? Going through intense mood changes is pretty normal within the first few weeks after having a baby, but if intense new symptoms persist for more than a few weeks, definitely get some support. Anxiety really is treatable, and if it’s left untreated then it can hang around indefinitely. 

I would say start by talking with a friend or family member who understands and can help you. This could be a spouse, a sister, a friend, or an aunt. 

The next piece of advice is advice that I hate. I kind of hate it when people tell me this. But you’ve got to get some sleep. And this is hard when you have a baby. You’ve got to ask someone else to watch your baby while you sleep, and you’ve got to find chunks of sleep that are as long as possible. Like, if you can get one four-hour period of sleep per day, that can help with this anxiety because anxiety and mood issues really are closely connected to a sleep deficit. 

The next thing that’s important is to try to get good nutrition. Keep taking your prenatal vitamins. Consider other ways to get lots of fruit and veggies into your diet because your body is pretty depleted after being pregnant and having a baby. 

And then I would say get professional support. Your doctor, your pediatrician, your OB, or a therapist can all help you find the support that you need. 

In my area there’s a practice that treats women during the postpartum period, and they have these support groups and education groups and they also have individual therapy. And the nice thing about them is they’re catered to new moms, so you can bring your newborn. And they also have childcare for the older kids as well. 

So that’s like a best-case scenario. But even just getting any support from your doctor or therapist is going to be really helpful. Therapy can change how you respond to anxiety, and that can lead to lasting positive changes. 

Medication can also be a good option. SSRIs are generally considered safe while breastfeeding, and the benefits of having a healthy mom for the child might outweigh any possible side effects. 

There’s other effective treatments for anxiety, and these include exercise, mindfulness, relaxation techniques, yoga, and acupressure. 

And this last point is really important: it’s important to get some social time. Transitioning to being a mom can be really isolating, so make an effort to hang out with other people, to hang out with other moms. They can give you a lot of support. Being social also can really help with your mood. 

Now, transitioning to being a new parent can be really difficult, but you really can get feeling better. So don’t beat yourself up for having anxiety. Have a little self-compassion. Be gentle with yourself, and reach out for a little support to help you get through this. I know you can do it.re

 

Here are a few resources to help: my free guide to managing anxiety and if you need more help transitioning into motherhood check out our Mom-me course. 

More To Explore

How Genetic is Mental Illness Actually? Heritability Estimates for Mental Health The Role Genes Play

Sources (1) https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.157.10.1552 (2)https://www.nature.com/articles/s41398-022-01868-3 https://www.researchgate.net/figure/Heritability-estimates-of-selected-psychiatric-disorders, https://www.nimh.nih.gov/health/publications/looking-at-my-genes, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421104/ https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204765 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070789 https://www.news-medical.net/health/The-Genetics-of-Mental-Disorder.aspxhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/204765 (3) https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070789 (4)https://www.nimh.nih.gov/health/publications/looking-at-my-genes

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