Worry Overload

Identifying postpartum anxiety



Illustration by Emma Moreman

Life constantly challenges us to deal and adapt, but few events deliver quite the same wallop as the birth of a child. Many new mothers understandably feel exhausted, stressed and overwhelmed, but for some, days and nights of onesies, diapers, feedings and time with baby are shadowed by extreme worry and self-doubt — anxiety that can leave the mom distracted, emotionally distraught and on the verge of clinical depression.

It’s normal, even healthy, for a woman to fret, at least to some degree, about her new baby’s well-being. “Anxiety is what gets us up in the morning and gets us motivated to do things,” says Jennifer Tawa, APRN, PMHNP-BC, a nurse practitioner who specializes in obstetric psychiatric care at Southern New Hampshire Health. Anxiety that is all-consuming, of course, is a different story.

Women who suffer from postpartum anxiety typically question their capabilities as a mother and obsessively worry about the welfare of their child. They might frequently double- or even triple-check on their baby, and experience frightening thoughts of dropping the baby or of some other terrible fate befalling the child.

Postpartum anxiety can go hand in hand with its better-known counterpart, postpartum depression, but it also occurs alone or as a precursor to depression. It is seen most often in first-time moms, but can be a problem for experienced mothers who struggle with the transitions that additional children bring, says Amy Chouinard, MA, LCMHC, a mental health counselor at Perinatal & Women’s Mental Health Counseling in Windham.

A number of factors can influence a woman’s likelihood of experiencing postpartum anxiety. Individuals who struggle with anxiety prior to becoming pregnant, for example, face greater risk. The hormonal cascade set off by pregnancy and giving birth can contribute to irritability, depression and increased anxiety, Tawa says, and so can a slew of other stressors that can come with a new baby, such as having to deal with exhaustion, recovery from a difficult birth, a particularly challenging baby, a sudden lack of predictability and major changes in family dynamics.

Women who don’t have a lot of support are more prone to anxiety trouble. Being the sole caretaker of an infant is enough to wear anyone down, but it’s an even tougher job if you have no one to talk to. Compared to previous generations, today’s families are more likely to be geographically scattered, making it harder for extended family members to provide a sympathetic ear, along with respites from childcare. Without regular support, “[women] don’t know who to turn to,” Tawa says. “They feel isolated, and that will foster anxiety.” In contrast, being able to ask someone you trust, “‘Am I overreacting to this? Is this normal?’” Tawa says, contributes to feelings of well-being, and helps soothe anxiety.

And perhaps counterintuitively, social media does not always help matters. “Social media makes it look like a lot of moms are doing a way better job than they actually are — posting pictures, doing all these little Pinterest crafts,” Chouinard says. The posts and photos add up, leading some women to think, “‘That’s what I need to be doing,’ and ‘That’s what I need to be keeping up with,’” Chouinard says. Struggling moms can wonder why no one else appears to be having difficulty, and begin to view themselves as “not good enough.”
In addition, the new role and life transition that comes with having a baby makes many women feel emotionally off-balance. The day you have a baby, “your whole identity shifts,” Chouinard says, “and you’re trying to figure out what your value is, who you are as a person. You’re trying to figure out your sense of self again because you think, ‘Oh, being a mom, that’s not everything. That’s not who I was yesterday. I was an employee and I had friends and I socialized.’” Moms who return to work might feel guilty and upset about leaving their child, while moms who don’t go to an outside job can feel increasingly stressed because they have no adults to talk to and little social support, possibly along with a hard-earned career that is now on hold.

Trying to stifle or ignore the anxiety often exacerbates the problem. “Anxiety grows when we don’t want it,” Chouinard says. And ruminating over unrealistic thoughts and expectations of ourselves as parents, she says, can cause anxiety-promoting brain chemicals and hormones to surge.

Aware of the stigma surrounding emotional difficulties, however, and feeling pressured to be a “good” mother, many moms keep their troubles to themselves. “They really don’t know what’s normal,” Chouinard says, “and they’re afraid to talk to people sometimes because it looks like everyone else is managing it fine.”

New moms can get a significant emotional boost when they communicate openly, be it with their spouse or partner or other trusted family member, or a friend, doctor or support group. Being able to talk to someone without fear of being judged “is crucial,” Tawa says. “That’s one big thing I hear [from patients] over and over again: ‘I can’t tell anybody how I’m really feeling because they’re going to think I’m a horrible mom. They’re going to take away my baby because they’re going to think I’m a nut job.’”

In addition to engaging in honest conversations about their concerns and struggles, moms need to take care of themselves in general. They should resist thinking that they must relinquish their identity and their self-care, Tawa says. “Go on your walks, go to yoga, go do other things you really enjoy, go to a movie with a friend,” she says. Exercise, in particular, provides many benefits, and can be an effective way to combat anxiety because it stimulates endorphin and dopamine release, which helps soothe and uplift emotions. “Being physically active is phenomenal,” in terms of the payback it brings, Tawa says.

And importantly, anxious mothers should not delay in getting the help they need, for their sake as well their baby’s; addressing the problem early can stave off depression and worsening emotional difficulties. From one-on-one counseling to mom-and-baby gatherings and support groups, many forms of assistance are available, Tawa says, and they can help women realize that other mothers, in fact, share some of the same emotions and concerns.

Help for Anxious Moms

All by itself, the day-to-day (and night) grind of motherhood is hard. Coming as it does — with a bevy of significant life changes and super-mom goals, such as cheerfully keeping up with housework while churning out crafts, whipping up nutritious meals and spending quality time with the kid(s) — can make it feel downright impossible. Some women obsess over their perceived inability to get it right, especially while so many people on social media seem to find motherhood a breeze, and excessively worry about the well-being of their baby.

But whether you are an expectant mom, a newly minted mother or an experienced mom who is expanding her brood, there are steps you can take to help safeguard your well-being as you navigate what can feel like the emotional minefield of motherhood. The following are tips from Amy Chouinard, MA, LCMHC, a mental health counselor at Perinatal & Women’s Mental Health Counseling, and Jennifer Tawa, APRN, PMHNP-BC, a nurse practitioner who specializes in obstetric psychiatric care at Southern New Hampshire Health:

Communicate openly with your obstetrician or your child’s pediatrician, Tawa says. Let him or her know your concerns.

Join a new mom or new baby group, take your kid(s) to story time at your library or go to the playground so that you can commiserate with other mothers, and/or likely see that other people are not having a perfect motherhood experience either. Realizing that you’re not the only one struggling can help calm your fears and normalize your expectations, Chouinard says. Plus, just getting out of the house can help you feel better.

If you can’t find a group or get to a place where moms congregate, reach out to a trusted friend or family member and let them know if you are struggling. “[Moms] who don’t talk to people and try to manage it all by themselves are probably most at risk” of having ongoing anxiety trouble, Chouinard says.

Set yourself up for success by having realistic expectations and support measures in place. Whether you’re expecting or already have a child, figure out who and what is available to help you cope. Arrange for a regular babysitter, enlist help from your partner or family and get proper sleep when possible.

Be physically active. You might not think you have time for it, but exercise eases tension and anxiety. If you can’t get to a gym, pack up the stroller and head out for a brisk walk.

Get help if you need it. Many insurance plans cover therapy, Chouinard says.

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