Postpartum anxiety is probably the most common beast in my office. There are certainly differing shapes that this big, furry, gnarly-clawed beast takes—general anxiety, panic, OCD for example—but usually the annoying, mean, and seemingly relentless monster has a big “A” stamped on his forehead. And this monster is ferocious at times, making it impossible for moms to sleep, eat, breathe, and think clearly. He is on a serious mission, no doubt. Sometimes he is so big and impending that I get a sense of his foul breath from my chair. Even though it is not me who he is chasing, I get a glimpse of what it must feel like to be the mom who is living in his humongous shadow. Not good.
The moms who come into my office in an effort to get the heck out of this guy’s path have no idea of how on earth to do this, or if it’s even possible. For these moms, this snaggletoothed misery called postpartum anxiety is all that they can see. He makes it this way because he seems to know exactly how to get back into their line of sight when they begin to turn away.
Annoying, to say the least.
So, I thought I’d take a minute to explain, from my chair, what goes into getting postpartum anxiety off your back. So that, if you don’t already, you have a sense of how you might overpower him. The truth is that he is actually not as strong and lethal as he looks. I know he feels strong and invincible—he is really, really skilled at that—but the truth is that he does melt when you throw the right kind of water on him.
When I work with moms who are in battle with postpartum anxiety, I break the treatment down into four parts:
- Looking at treating the symptoms and managing crises
- Understanding the role that thoughts play in anxiety
- Understanding the non-biological causes of the anxiety
- Learning to tolerate anxiety and distress when it occurs
If you want to stick with the monster metaphor, the four things look like this:
- Treating his bite
- Understanding the role that your fear in him plays in his strength
- Understanding why he is pestering YOU of all people
- Learning how to be okay even when he is knocking at your door
Four Tips for Reducing Postpartum Anxiety
Treating his bite (or treating the symptoms): First and foremost, we have got to stop the bleeding, right? If a mom is anxious all of the time and, because of this, unable to meet her body’s basic needs, if she is suffering from panic attacks, or if she is having the intrusive thoughts of postpartum OCD, we need to take care of the brain so that it can be healthier. For many moms, this will involve medicine because, truthfully, when these things happen it lets us know that your brain is sick and needs to become more resilient. SSRI medication (like Zoloft) and benzodiazepines (like Klonopin) are usually very, very helpful in this (and also known to be safe for breastfeeding moms, by the way).
We also know that things like sleep, healthy nutrition (especially protein because amino acids found in proteins are building blocks to Serotonin, the feel good hormone in the brain), water, and oxygen are important in brain health. So I always have conversations with my moms about how to make sure that they are getting these things. Help at night and/or other strategies for sleep as well as protein-based snacks and water in her diaper bag, car, bedside table, and desk at work are imperative.
As is learning how to breathe effectively. Did you know that when we are anxious, we are usually breathing in our chest and actually only using about a third of our lung capacity? Think hyperventilation to the extreme. In order for our brains to settle rather than react, they need enough oxygen to do so. The moms who I see get a lesson or 20 on how to take a deep diaphragmatic (or belly) breath because this will literally change their physiological reactions to stress. Exercise also helps the brain to be strong, as it has been shown to lower cortisol levels in folks who do it.
Understanding the role that your fear of this monster plays in his strength (or understanding the role that thoughts play in postpartum anxiety): Anxiety, like monsters, loves when you are afraid. Anxiety gets more power from this fear; it seems to increase tremendously when you are afraid of being anxious, afraid of having a panic attack, or afraid of the power that your intrusive thoughts have. This is the basis for cognitive behavioral therapy (CBT), and there is a huge amount of research on the positive effects that CBT has on pregnant and postpartum moms who are anxious.
In my office, I use cognitive therapy components often, teaching moms how to identify negative thoughts (such as the “shoulds,” all or nothing thinking, catastrophic thinking, discounting the positives, overestimating the threat, “what-if” thinking, and overgeneralization, and helping them learn to replace these thoughts with something more useful (and true). What these moms find is that when they take away the nourishment for that big bad monster, he begins to get weaker. He may still be there when all is said and done, but more times than not he is shaking at the knees. There is a great book, by the way, that helps moms to use these techniques called The Pregnancy and Postpartum Workbook, by Pamela Weigartz and Kevin Gyoerkoe.
Understanding why he is pestering YOU of all people (or understanding the non-biological causes of the anxiety): We know that anxiety is a physiological response to a stressful event and that symptoms like elevated heart rate, shallow breathing, dizziness, and sweaty palms are all physical responses to hormones (like cortisol) that are released in the limbic brain.
But what, exactly, is triggering this brain reaction? Sometimes there seems to be no apparent cause.Often moms will say that “on paper everything is going well” and anxiety (that darned monster) just lingers anyway. Usually, though, there is something that is being triggered that causes the brain to assume that there is reason to panic. Does your crying baby remind you of a time when your needs were not met? Does the reality of being responsible for a baby stir up memories of needing to be overly responsible as a child? Do you hold expectations of yourself in motherhood that are unrealistic and provided by people and books rather than yourself? Has the shift in becoming a mom created identity changes that feel unfamiliar (and therefore disconcerting) to you?
Once we understand why we feel so anxious, we can begin the process of validating and empathizing with ourselves because of course we would be feeling anxious given many of the triggers that motherhood initiates. Once you get why that big guy is following YOU around, you just might be able to forgive him a bit. Want him to stay? Definitely not, but understand his crush? Perhaps.
Learning how to be okay when he is knocking at your door (or learning to tolerate postpartum anxiety and distress when it occurs): The truth is, folks, that if those of us who treat postpartum depression and anxiety told moms that we were curing them of their anxiety we would be setting them up for disappointment. Being a mom is overwhelming and it is, at a certain level, entirely normal and appropriate for moms to be anxious from time to time.
What is not normal or appropriate is for moms to be anxious all the time or for anxiety to interfere with daily life. When this happens, it tells us that there is something else going on outside of the normal strains of being a mama. For moms who suffer from an anxiety disorder, any level of anxiety becomes distressing because they have learned that anxiety is dangerous. So, we need to teach moms how to know that they will be okay even WHEN they feel this way.
This does not mean, by the way, that moms need to ignore the anxiety, push it away, or pretend it’s not there; this would be no more possible (or helpful) than telling your ears not to hear the loud banging at the back door. But what I do focus on in my office is helping moms learn to acknowledge their anxiety at the lowest level that it exists, give themselves a big huge hug around the fact that they are feeling anxious (usually for very good reason, even if it is just the fact that they are caring for a little tiny person) rather than judge themselves for it, and then take super duper good care of themselves in that moment so that their anxiety rests there (take some deep breaths, eat something protein-based, go for a walk, call a friend, take a break etc). We actually don’t need to fix anxiety every time it comes up… but what we can do is acknowledge it, understand it, and then be really, really kind to ourselves.
None of this is easy. Often, it takes an army to fight off this unrelenting beast. But it is possible, even when it feels like it is not.
~ Kate Kripke, LCSW
Slight misspelling – The Pregnancy and Postpartum Anxiety Workbook is by Kevin Gyoerkoe and Pamela Wiegartz (not Pamela Weigartz)
Thank you! this is a wonderful post and explanation!
Thank you! This is very helpful to me, given that I am in the midst of PPA.
I liked hearing the strategy of dealing with PPA. I’ve just changed therapists (and didn’t really know where I was going with the treatment). Hopefully now I’m in more experienced hands. But, I love having the “overall picture” of what I’m doing here. Thanks.
I love your analogy, Kate… In fact, I use a similar one in dealing with what I call my Postnatal Depression Monster (or PND-M for short). And like your monster, mine too is of the male gender – interesting? 🙂 Thanks so much for a wonderful and very helpful post. None of these experiences are easy and I for one am so glad to have found such an amazing support network online. Who would have thought! Enjoy your day.
You know it’s funny, I thought twice about the gender of this monster… I worried that using a “he” would be too stereotypical but also really wanted to differentiate the anxiety monster from the “self”- and thought that if it were a “she” it might just be too close to home. Thanks for sharing 🙂
10 months after I have had my beautiful son and I am still dealing with the anxiety part. I woke up this morning and had a chat with myself in the kitchen…that yes, infact your son will be okay on your trip down to Boulder tomorrow and no he won’t all of a sudden stop sleeping through the night. I knew it was time to once again find support. This article was AWESOME and really helped me to take that deep breath and be okay with the anxiety and also know that I still need some help. Thank you for normalizing it and for sharing that as a mom the anxiety really never goes away…but it’s important to recognize the different levels. Thanks for the deep breath!
So glad it was helpful Emily! Deep breath indeed.
You’re welcome Emily. And next time you are in Boulder, come and say hello 🙂
I know this was posted a year ago but This website and article are making a lot of things clear for me. I think I had Pregnancy Anxiety (not sure what the clinical name is) then Postpartum Anxiety but did not get help for it and it continued into having anxiety and intrusive thoughts which is what I deal with now. Is that possible? I am currently getting help because the intrusive thoughts were just too much to handle. Can Postpartum Anxiety progress like this if you don’t get help? My son just turned two.
Tanzi, it sounds like you may have postpartum anxiety/OCD for sure. If it wasn’t treated in your first year it could continue on. It’s a great thing you did by reaching out for help. Good for you! Just keep going and don’t give up – you will get better! ~ K
A-may-zing. Thank you! I’m at 25 weeks, 2 days and my anxiety can be so debilitating…as also the intrusive thoughts. This post and many others have helped me a great deal. Xoxo
Glad you liked it Tracy!!
I am not sure if this is even possible but I almost feel as though I may have some sort of PTSD from my child’s birth. I was induced due to high blood pressure but it was no where near that simple. To make a long story short they tried multiple doses of 3 different types of dialation meds to finally use 2 different sets of foley balloons, pitocin, 4 epidurals, a vacuum birth after 3 hours of pushing, an infected IV site, and a severe reaction to medical tape (any where the tape touched me my skin peeled off with the tape, you can imagine what my back looked like after 4 epidurals!). Start to finish was 72 hours. I was so severely exhausted that breast feeding wasn’t an option. My son is now 5 weeks old and I feel like I don’t care for him enough, its a constant internal battle. My husband is very involved and loves to do everything for him. We have a wonderful family who is constantly around and they would like to everything for him as well. I feel like he doesn’t even know who I am because there are always so many people around caring for him. I feel like everyone is judging me that I don’t care for him enough but I literally have to ask people “Can I please feed my baby?” I realize I am lucky and I don’t want to seem ungrateful but it is beginning to make me question myself. I am 30 years old and this is my first child, I work with young children so everyone is always praising my previous experience with babies, but do they think that because of that I don’t feel the need to care for my own child? I am really at a loss and I am beginning to withdraw from everyone. My son is absolutely perfect and I just don’t want to miss anything. I am not sure if my feelings are created by some post partem condition or if it is just a simple case of my surroundings….
I can relate in some ways. I have been anxious my whole life. I let the what i fs rule my world. I still worry about my 6 year old and wgat if something would happen instead of enjoying him in the present. I planned with my little girl who is 7 weeks to have a VBAC however my body didn’t comply and again another section. I am a nurse so I over analyze everything and completely freak myself out instead of being excited. We moved just before her arrival to so no nesting for me. Following her birth I had a nasty urinary tract infection then my wound opened and I had 3 differing treatment plans none from my doctor who was not available next the stomach flu hit and on top of all of this contractors in and out of my home with lots of family organizing my new house and tending to my new baby. All of this in 5 weeks time. My children are beautiful and my husband so carrying and I ask myself why me it was not supposed to be this way. I now cant be alone because I am so afraid. ..I am unable to drive…itis
Oh my goodness Danielle. You have certainly been through a lot in just a short period of time. It’s no wonder you have symptoms of anxiety. I hope you will be willing to talk to your doctor about this and let him or her know what your symptoms are. Postpartum anxiety is temporary and treatable with professional help. You definitely don’t have to keep living with these symptoms. ~ K
Thank you for this.
The language you use here is so refreshing, eye opening, and real. Thank you so much. This has been so helpful to me.
I keep having to come on this site to remind myself that I am going to be okay and get through this. I am about to give birth to my 3rd child and having horrible anxiety , constant what ifs, and some depression following all the intense anxiety. Right after birth I am getting on medication and counseling. This site is definitely making me feel better when I have those moments.
I jst read this article and m glad 2 knw and understand that im not mentally unstable… strtd having enxiety 2 months after my baby ws born and the visions I hv are so intense that I cry all the time they creep into my head m scared of being with my baby because of these thoughts; I find myself wanting to kill myself dan act on these thoughts an visions I kip having abt my baby im always enxious every tym sometimes convienced that im luzin my mind; spoke to the doctor and was ref to see a psychatrist and my hope lies there now bt thnx to your article I hv a little clear vision that im gonna be ok… nw I want to know is does this mean im gonna hv to live my life using enxiety med??
Cherity, I too experienced that with my second and third child. Scariest time of my life. I hate the postpartum period. When you are stable and confident enough and you and your Psychiatrist feels that you can wean off of meds then you will he able to determine how you feel afterwards. Many woman get off meds and do just fine. I was on meds for a year and got off them fine with occasional anxiety. Just recently had a new baby and got back in meds due to scary thoughts, anxiety and so on. Anyways my doctor told me because I have had anxiety my whole life that I would probably live longer if I stayed on meds because it would make me less stressed and worried lol. You’ll be just fine though…hand in there you will start yo feel better just be patient and take it day by day or minute by minute <3
What Meds are you taking? Did they work? Im scared of this medication thing but hate feeling like this everyday.
I am on Zoloft 100mg. I was scared of medication at first but once you start taking it you realize that it helps a lot and you become less afraid if it. Talk with psychiatrist about how long to take the medicine. You won’t have to be on it that long of you are stable.
What a great article! I just had my 3rd child on Sept 30, 2014, and I have my first ever postpartum anxiety. For those who know me, I’m the least anxious person ever. So this is incredibly difficult for me to swallow. I somewhere developed a fear of death (mine) after having this baby which is something I’ve never had. I also just graduated nursing school in May. This doesn’t help because i know the signs and symptoms of everything and have convinced myself I have everything in the book. I do have Xanax 0.25 to take as needed…trying not to use it though! I am really struggling lately. I just want this anxiety gone!
Love this article and the comments from the other moms. Just had my third baby two weeks ago and the anxiety I am feeling is beyond anything I have ever experienced. It is making caring for the baby and my other kids almost impossible. I try to get through the day and I have one beer at night and for some reason even a few sips of the beer makes the anxiety go away but then in the morning it is there again. I am nursing and was told by my OB that she cannot prescribe anything while I am nursing. Not sure how much longer I can keep this up but I nursed my first two children and will feel awful not nursing this one.
AnnMarie – I’m so sorry you’re feeling this way. I suffered from severe postpartum anxiety and it was terrible. It’s actually not true that you can’t breastfeed on medication. There are several antidepressants that can be taken safely while breastfeeding. Unfortunately, many doctors do not stay up-to-date on the research and tell moms they can’t take meds while breastfeeding. I urge you to talk with another doctor…perhaps a primary care doctor, or a psychiatrist (it usually takes longer to get in with them though), to see what options you have. Here’s just one article on the topic: http://www.motherisk.org/prof/updatesDetail.jsp?content_id=1000
My psychiatrist said its safe to breastfeed my child on no more than 100mg of Zoloft. My baby is 5 month’s old and we are still nursing and I am on meds. You should def talk to another doctor. Goodluck. The medicine will help big time.
this really helped me , sometimes i have ugly thoughts like this and im afraid to say them cause what if they happen
I love this! I have recently found out that I have postpartum anxiety! It came as a suprise, really! I had an awesome pregnancy, very doting on my baby bump. I was so in love with my baby girl #2, breastfeeding & just perfect. She is a little clingy to me though. I co-sleep so I cannot sleep at all. I used to be a deep sleeper before this pregnancy, now, not so much. I started getting symptoms of PPA after about 4 or 5 months postpartum, but didn’t really know what was going on. I started a green smoothie kick around that time & thought maybe it was protein or iron deficiency related, but my levels were fine. Around 6 or 7 months postpartum, I felt as if my heart was going to explode right out of my chest! Was I having a heart attack at only 25 years of age?! No, this was the postpartum anxiety monster rearing his ugly head. From then on, my attacks happened daily, ALL day. After a while, I had them under control while doing 5,7,9 diaphragm breathing exercises, but soon, that didn’t even work. 9 months postpartum & i started getting insomnia, i havmd anxiety attacks so bad at night that it’s impossible to sleep. Racing thoughts, shallow breathing, sleep paralysis, afraid of dying in my sleep & leaving my daughters motherless & my husband a wifeless. These thought are out there, I know, but I cannot stop thinking this way. It’s now almost been 10 months postpartum & I am finally reaching out for help. I have an appointment on the 1st of June with a psychologist. I hope i get the help I desperately need, because even after this monster took my breath away, I still have baby fever & want another . Any advice for me? Insomnia still hits me hard. I go to bed at 9 and fall asleep at 3am after over exhausting myself.
Casandra, I’m so sorry this is happening to you, but you’re doing the right thing by reaching out for help. Once women seek treatment, these illnesses can and do go away. Keep fighting, mama, you will feel better soon.
Ahhh I am sorry you are going thru that. Once you start reaching out and getting to understand PP anxiety its starts to decrease very much. Take it day by day. It will subside and you will feel back to normal . <3
I love the article. The only thing that bothered me, as a private vocal coach and opera singer, is the belly breath part. Diaphragmatic breathing is not belly breathing. In fact, when directed to breathe into the belly, a client usually completely surpasses their diaphragm, which stunts the positive effects that breathing correctly gives. The diaphragm is connected to the circumference of thw ribs, much like a trampoline in the middle of the body (sort of). A true expansion should be felt in the lower rib cage in the middle of the body. When this is done correctly, the diaphragm pushes on the guts making it feel like their is pressure in the belly. This is why so many people who are instructed to belly breath do not feel the true benefits of brearhing from the diaphragm.
Sorry for the breathing lesson. But I too suffered chronic post partum illness and belly breathing is a dangerous term to someone who doesn’t know the mechanism and is trying not to hyperventilate.
With that said, I love your work and your article. I just felt compelled to explain this aspect. I wasn’t trying to be negative or combative. Just trying to help.
Idk if I’ll get a response being that this was written a while back but my baby is now 5 months old and I am still experiencing horrible anxiety. I will feel great for a couple weeks then something will happen that will trigger a panic attack and I feel like I have to start from zero back again. I had really bad anxiety about 2 years ago and my child’s birth triggered it again…. the first time around I was able to Get over it without medication but this time around its seems much harder because I am even afraid of staying home alone or driving out of town. I need HELP soon!!! I do feel depressed from time to time because of the anxiety. I want to feel normal again!
Have you spoken to your doctor about this? It sounds like you could use some help and a treatment plan with a trusted team is key. We all need this help sometimes, and there is no shame in taking medication should that be what you and your provider decide. There are excellent therapists and psychiatrists out there that specialize in postpartum anxiety and depression. I want you to feel normal too! You should not have to feel like you can’t stay home alone or driving. You can get better, with help! It will get better with help. Peace to you, mama.
I’ve struggled with aniexty my whole life. Since I had my baby and have number two on the way I feel completely hopeless when PPA steps in. I’m flooded with tears a couple of times a week. This post has great tips to help me cope. Thanks.
This is amazing! It has given me a bit of light in my anxious state.
I love and appreciate this article! My postpartum anxiety hit when my daughter was 11 months and I’ve been fighting the beast ever since – medication, therapy, exercise, meditation…even TFT, hypnosis, you name it, I’ve tried it! I’m definitely feeling better on a daily basis, although the triggers are still strong. As someone who never had anxiety prior, you feel very alone in the world when this is happening, so it’s wonderful to see that there’s more of us out there that are fighting (and hopefully winning!!) I can’t wait for the day when I can say that I’ve tipped the scale and the anxiety is not as frequent- but the fact that I KNOW that the day will eventually be here is in itself a success.
What kind of doctor should I go see for this?
You can see your OBGYN, your family doctor, and ask for a referral to a psychiatrist if they feel that is needed. We have a resource list of providers around the country that specialize in postpartum mental health – that is found under “find help” at the top of the page.
Much peace to you
Great Article! Thank You.
I bearly started with this 2 weeks ago does it go away? I just cry and cry because I want to be the old me again!!!
Lorena, YES, it goes away. I promise. It does take some time, your body is going through a lot, it’s recovery like from anything other trauma. But you can get better if you get some help–reach out to a professional that you trust–a therapist or doctor, or check our list for a specialist – http://postpartumprogress.com/womens-mental-health-treatment-programs-specialists-us-canada-australia
You will get better! Peace to you…
Hi, even I am suffering from postpartum anxiety for almost a year now. I want to know whether still our hormones are yet to level back n thats the cause for the anxiety? I m still breastfeeding my baby. I never used to be like how I am now. Constant worrying thoughts and having anxiety symptoms. Once after stopping breast feeding will the hormones level back to normal?
It’s different for everyone, but yes, your hormones can certainly still be fluctuating and contributing to your anxiety. Some women have a period of worsening depression and anxiety when weaning. Others feel much better after weaning. I wish there were for sure answers for you on how it will go, but there are not. It’s best to stay in close touch with people who support you, professionals who know about postpartum mental health, when you decide to stop breastfeeding, and now, as you are still anxious. Peace to you!
Brilliantly explained. I think it’s also made me aware of what it is i’m anxious about as i couldn’t control my head to think clearly. Medication to stop it in it’s tracks then lots of self care, self love, essential oils, DIY Spas (at home), Mindfulness (i found this only worked once i was medicated). Have seen Reflexology and Yoga is helpful (i’m a larger lady). Having support from my circle, even when i didn’t think they were. All these things so far are helping. Speaking to my GP and cancelling anything i’ve signed myself up for too, no stress! Just time to focus on me and the kids/hubby. Five weeks in and it’s all helping. This site included xx
I am so glad I found this site and can identify what I’m struggling with as PPA. I have had generalized anxiety for the past 3.5 years or so, but it always came and went and was never so bad that I was focusing on it all the time. I thankfully had a non-anxious pregnancy and was mostly fine for the first 2 months postpartum. Then around 2.5 months postpartum, this thing hit me like a freight train. I am 10x more anxious than I’ve ever been before, have intrusive thoughts, and have recently become preoccupied worrying about my own death (was grateful to see this was a symptom for some other commenters here, because it makes me feel absolutely ridiculous and ashamed) I hate that this anxiety is making me feel like an inadequate wife and mother. I started seeing a therapist 4 weeks ago, and have an appointment with my PCP next week and hope to begin on Zoloft. I am also returning to yoga after a 6 month hiatus. I hope all of these things help, because right now I feel extremely hopeless and 100% not myself.
The anxiety can be really tough to deal with at the start. I’m starting to accept that its just a part of who I am now so when it happens I don’t over panic and over think it too much which helps. It does get easier with time.
This is really an excellent article.