Is Postpartum Anxiety a Common Experience After Childbirth?

Congratulations on the arrival of your precious bundle of joy! Amidst the cuddles and coos, the whirlwind of diaper changes and late-night feedings you may unexpectedly notice feelings of anxiety. Perhaps a gnawing feeling in your stomach or racing thoughts that keep you up at night? Have you found yourself grappling with worries about your baby's well-being or feeling overwhelmed by intrusive thoughts? Maybe you’ve heard yourself say, “I’m not sure my baby is eating enough, what if she starves?” or “What if the baby stops breathing during the night? Let me just check to make sure she’s breathing alright.”

New mothers often navigate motherhood with a mix of excitement, love, and overwhelming responsibility. You've likely heard of the baby blues or postpartum depression and may have answered mood questionnaires at your postpartum check-ups. However, anxiety is one of the most common postpartum mental disorders affecting between 11-21% of women in the US in the perinatal or postpartum period (Zappas et al., 2021). In fact, it is even more prevalent than postpartum depression but is often underdiagnosed by clinicians because it can be difficult to tell the difference between normal pregnancy and postpartum symptoms and those that cause important impairments (Cena et al., 2021; Dennis et al., 2017).

These anxieties often manifest as "scary thoughts," unsettling ideas that plague the minds of mothers (Kleinman & Wenzel, 2020). Have you ever felt overwhelmed by concerns for your baby’s health, experienced self-doubt about your new role as a mother, or feared that you may accidentally harm the baby? Many new moms find themselves questioning their ability to care for their baby or fearing judgment from others.

But what exactly are these "scary thoughts," and why do they haunt so many new moms? Kleinman and Wenzel (2020) outline and categorize several scary thoughts that new mothers may experience in their book, Dropping the Baby and Other Scare Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood. Perhaps you can identify with a few or several of these types of scary thoughts.

Accidental Harm: Thoughts like "What if I drop the baby down the stairs?" reflect a heightened sense of vigilance and fear of unintentional harm. While occasional worries about accidental harm are normal, persistent fears may indicate postpartum anxiety.

Baby’s Well-being: Concerns about the baby's health, such as "What if he stops breathing in the middle of the night?" showcase the intense worry new mothers experience about their baby's welfare. While it's natural to be concerned about your baby's well-being, persistent worries may signal underlying anxiety that requires attention.

Intentional Harm: Disturbing thoughts about intentional harm, like "What if I take this knife and stab the baby?" highlight the extreme distress of postpartum anxiety. These thoughts can be alarming and distressing for new mothers, indicating the need for support and intervention.

Self: Feelings of inadequacy, such as "My children would be better off with another mother," underscore the internal turmoil many new mothers face. While self-doubt is common in motherhood, persistent feelings of inadequacy may indicate underlying depression or anxiety.

Others: Fears about the safety of the baby with others, like "What if someone hurts my baby?" reveal the social challenges of postpartum anxiety. These fears can be isolating and distressing for new mothers, highlighting the importance of seeking support and reassurance.

Future: Worries about financial stability or the child's well-being reflect the uncertainties of motherhood. While it's natural to worry about the future, persistent fears may indicate underlying anxiety that requires attention and support.

According to Kleinman and Wenzel’s (2020) research, the scary thoughts reported by women with postpartum depression are not fundamentally different from those reported by women without it. These thoughts can be fleeting or can become intrusive; however, it's wise for expectant mothers to prepare for the possibility of such thoughts and equip themselves with coping strategies. Preparation and normalization are key. Using coping skills can reduce the toll that a high level of anxiety during the postpartum period takes, an important bonding period for baby and mama and a period where the support of partners is important during a period of heightened demands.

Scary thoughts and resulting anxiety can pose a threat to the attachment process between the mother and her baby (Cena et al., 2021). When confronted with such thoughts, maternal instincts can become maladaptive. This can lead to misconceptions about your baby’s behavior, prompting mama to avoid certain tasks in an attempt to keep her baby safe, which can intensify fear and avoidance or lead to overprotection (Kleinman & Wenzel, 2020). Further, behaviors stemming from anxiety during this sensitive developmental period may impact breastfeeding and early mother-infant interactions, resulting in negative outcomes for baby (Cena et al., 2021; Riva Crugnola et al., 2016; Tambelli et al., 2015).

If you're experiencing scary thoughts, it's normal to feel a strong emotional reaction. However, don't let this emotion hinder you from seeking clarification and support. Remember, these thoughts are common, and relief is possible with intervention and seeking help. If fear of misunderstanding from your provider holds you back, consider bringing along supportive resources for guidance during appointments.

We’ll explore differentiating between normal anxiety and clinical concerns in the next blog and then explore what coping strategies exist with or without therapy to help you feel better and bring greater peace to the postpartum period.

References

Cena, L., Gigantesco, A., Mirabella, F., Palumbo, G., Trainini, A., & Stefana, A. (2021). Prevalence of maternal postnatal anxiety and its association with demographic and socioeconomic factors: A multicentre study in Italy. Frontiers in Psychiatry, 12, 737666. https://doi.org/10.3389/fpsyt.2021.737666

Dennis, C.-L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315–323. doi:10.1192/bjp.bp.116.187179

Kleiman, K., & Wenzel, A. (2020). Dropping the baby and other scary thoughts: Breaking the cycle of unwanted thoughts in parenthood (2nd ed.). Routledge. https://doi-org.libezproxy2.syr.edu/10.4324/9780429274657

Riva Crugnola, C., Ierardi, E., Ferro, V., Gallucci, M., Parodi, C., & Astengo, M. (2016). Mother-infant emotion regulation at three months: The role of maternal anxiety, depression and parenting stress. Psychopathology, 49, 285–294. https://doi.org/10.1159/000446811

Tambelli, R., Cimino, S., Cerniglia, L., & Ballarotto, G. (2015). Early maternal relational traumatic experiences and psychopathological symptoms: A longitudinal study on mother-infant and father-infant interactions. Scientific Reports, 5, 13984. https://doi.org/10.1038/srep13984

Zappas, M. P., Becker, K., & Walton-Moss, B. (2021). Postpartum anxiety. Journal of Nurse Practitioners, 17(1), 60–64. doi:10.1016/j.nurpra.2020.08.017.