Perinatal Mood and Anxiety Disorders

Understanding how you feel after birth: Postpartum depression, baby blues, and more.

Many first-time mothers expect to feel overwhelmed with joy and excitement when they meet their new baby. While this may be the case for some women, between 50 and 85% of postpartum women experience the “baby blues” within the first few weeks of giving birth. During this time a woman may feel sad, anxious, irritable, and tearful. This experience can be confusing for both her and her partner, since we are often led to believe that the postpartum period is filled with nothing but newborn bliss. 

The baby blues are completely normal and typically subside within the first month. In some cases, though, symptoms may continue beyond this time frame or briefly go away and then later return. When a woman’s experience surpasses the baby blues, she may develop a perinatal mood and anxiety disorder. Read on to learn more about the different types of perinatal mood and anxiety disorders. 

Depression

Postpartum depression (PPD) is one of the most common conditions experienced by postpartum women. Up to 10% of women develop PPD after the baby blues. Symptoms of PPD may include:

  • Feeling sad and tearful 
  • Loss of interest in activities that were once pleasurable
  • Feelings of guilt or worthlessness
  • Feeling anxious or on edge
  • Excessive worry about the baby’s health
  • Difficulty concentrating
  • Changes in appetite
  • Fatigue
  • Feeling overwhelmed or unable to cope with having a new baby
  • Suicidal thoughts

While many women experience one or more of the above symptoms during the baby blues, in order to qualify for a diagnosis of PPD, symptoms must last at least 2 weeks. Typically symptoms of PPD begin within 2 to 3 months of giving birth, but they can arise at any point within the first year. 

Anxiety

Postpartum anxiety can include generalized anxiety disorder, panic disorder, obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). 

Generalized anxiety symptoms that arise after birth may involve excessive worry or fear about a number of different things, including the baby’s health and safety. These symptoms can have a significant impact on a woman’s ability to function and experience pleasure.

Women with panic disorder may experience chest pain, difficulty breathing, shaking, sweating, numbness, tingling, and feel lightheaded, dizzy, and out of control. The symptoms of a panic attack can be so alarming that some people mistaken them for a heart attack. Panic attacks frequently accompany other types of anxiety disorders. 

OCD is another postpartum anxiety disorder that involves repetitive and distressing thoughts or images (obsessions) and urges to engage in repetitive behaviors (compulsions). The compulsions can help alleviate anxiety from the obsessions.  Postpartum women with OCD may feel consumed by obsessions related to the baby’s health or safety. 

Women may develop PTSD after a traumatic childbirth. What constitutes a traumatic birth can vary from woman to woman, but an unplanned C-section, delivery involving forceps or a vacuum extractor, or preterm birth are all examples of possible traumatic events. PTSD symptoms include re-experiencing the trauma through intrusive thoughts, flashbacks, or nightmares, avoidance of thoughts, feelings, or reminders of the event, and feeling more tense or on edge, which can impact quality of sleep.  

Postpartum Psychosis

A small number of women, approximately 1 to 2 out of every 1,000, may develop postpartum psychosis. This can involve seeing or hearing things that are not real, paranoia, feeling disconnected from reality, and unusual beliefs that may feel real. In many causes the unusual thoughts are related to motherhood and the baby and can be very distressing. Postpartum psychosis is a serious condition that requires immediate medical attention. 

How can I get help?

Psychological treatment, including psychotherapy and medication, can be helpful for women experiencing postpartum mood and anxiety disorders. Individual psychotherapy, where you sit down with a professionally trained therapist or counselor, can help you process what you are feeling and learn ways to cope. Group therapy can also be a powerful option for women who have given birth, since connecting with other mothers can help you realize that your feelings are normal, allowing you to feel less alone. Many hospitals and birthing centers offer support groups for postpartum women. 

Psychotropic medication can be beneficial in some cases for women who are experiencing postpartum depression, anxiety, or psychosis. Whether or not medication is right for you will depend upon the severity of your symptoms, your mental health history, and whether or not you are breastfeeding or intend to conceive again in the near future. For more information about whether you are a candidate for medication, consider reaching out to your primary care doctor, ob-gyn, or psychiatrist. 

How can I help myself?

Self-care is essential for new moms to prevent and help cope with postpartum mood and anxiety disorders. But how do you attend to yourself when you have a newborn and possibly other children to care for? It can be challenging to find the time, energy, and motivation to make yourself a priority during the postpartum period. 

While your self-care may have looked very different before children, you need to get creative and flexible when finding opportunities for yourself to recharge and relax. Sometimes this may mean postponing the housework or other non-essential responsibilities to a later time and using the baby’s nap or bedtime to take a bath, watch television, spend time with your partner, or do whatever it is that interests and calms you. 

Mothers experiencing the baby blues, postpartum depression, or other perinatal challenges can also benefit from mindfulness meditation. Spending a few minutes a day practicing mindfulness can help ease anxiety and stress. Consider taking a few minutes to close your eyes and observe your breathing. You may notice sadness, anxiety, or other emotions come up. Simply notice these feelings and return to your breathing. This simple practice helps you center yourself in the moment.

If you think you might be experiencing the baby blues or a postpartum mood or anxiety disorder, consider talking about your experience with a trusted person, whether it is a family member, friend, or medical or mental health professional. Oftentimes women may feel ashamed of struggling after child birth, but speaking about it can open the door to support. The truth is that parenting is hard and it takes a village to help you care not only for your baby, but for yourself as well. 

Sources:

Center for Women’s Mood Disorders, Department of Psychiatry, UNC School of Medicine. (2019). Perinatal mood and anxiety disorders.

Byrnes, L. (2018). Perinatal mood and anxiety disorders. The Journal for Nurse Practitioners. 14(7), 507-513.

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The Mindful Mommy

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