By Marilee Feldman, LCPC, CADC
When Michelle first sought help after the birth of her first baby, she couldn’t figure out what the problem was. All she had ever heard about was postpartum depression and baby blues. The doctors asked if she noticed sadness or feeling blue, but she didn’t. What she did feel—but didn’t realize she could talk about—was paralyzing anxiety: Uncontrollable worry, racing thoughts, and obsessive thinking filled her days, and she felt overwhelmed and exhausted. She concluded she was the only one feeling this way and must be a terrible mother.
If there’s one issue in mental health that hasn’t gotten the widespread attention it deserves, it’s postpartum anxiety. We frequently hear about postpartum depression, which is indeed a serious problem. But we’ve done a poor job educating woman about the incredibly high prevalence of postpartum anxiety, which is actually way more common and equally disabling.
So what does postpartum anxiety look like? Usually you’re worrying nonstop. Common worries in the postpartum period center on the health or safety of the baby, your own health or safety, whether or not you’re a good mom or bonding with the baby, and breastfeeding issues, among others. Your mind may race and you may be unable to get a break from the intensity of your thoughts. You may feel a sense of dread; be on edge and irritable; have a great deal of muscle tension, insomnia, or difficulty eating or sleeping; or develop panic-like symptoms such as tightness in the chest or difficulty breathing. You may have an overwhelming fear that something bad is about to happen, such as you’ll faint, have a heart attack, or act irrationally. What’s really hard is that these things are happening at a time when you’d thought you’d be so happy. You can really feel like you’re going crazy.
Sometimes the thoughts get scary. Some moms worry that they will harm they baby and are horrified by these thoughts. Or they may get highly distressing imagery in their head. They may fixate on these thoughts or images, worry that they will act on them, and develop compulsions to make sure nothing bad happens, such as repeatedly checking on the baby, avoiding contact with the baby or certain objects, or performing other rituals. But what is really happening is that the mom is suffering from postpartum OCD. The distinction between postpartum OCD, which is common, and the rare cases of postpartum psychosis you hear about on the news, is that in postpartum OCD, is that the mom is horrified by the presence of the thoughts. And what could be worse than worrying you might harm your baby? These moms need education and support in order to understand that what is happening is their brain has gone on hypervigilant mode in an attempt to protect the baby they love so much.
Whether it’s postpartum OCD, postpartum panic, or generalized worry, anxiety in the postpartum period feels awful and paralyzing. It’s important for these moms to understand what is happening to them, that they’re not the only one experiencing these things, that they’re a good mother, and that things will get better. More so than ever, moms feel extraordinary pressure to put on that mask of happiness and competence, and so they need to know they’re not alone. Counseling can a safe space for moms to learn their experiences are understandable and normal, learn tools to cope, and help feel hopeful again. Educating and supporting the dad is also of critical importance. Postpartum anxiety is highly treatable and there’s no need to suffer in silence.