How to Know if You Have Postpartum Anxiety: Red Flags to Watch for in Pregnancy, Birth, and After Baby

Are you confused about how to know if you have postpartum anxiety? For many moms, this is a difficult question. Postpartum anxiety symptoms are often dismissed as normal worries or first-time mom jitters. Many moms also feel a sense of fear about acknowledging their struggles. To top it off, postpartum anxiety is often misunderstood and understudied. 

But undiagnosed and untreated anxiety during pregnancy and the postpartum period can leave many moms overwhelmed and lost. Today, I’m joined by reproductive psychiatrist Dr. Oreck to discuss why perinatal mental health is overlooked, how to know if you have postpartum anxiety, and what treatment methods might be right for you.

Perfectionism or Anxiety? 

I’ve always been a perfectionist. For as long as I can remember, I’ve liked things predictable, and routine—I’ve loved to be in control of my own life. 

But when I became a mom, there was so much that I couldn’t control—my babies’ temperaments, the breastfeeding process, sleep. It was very hard for me to accept. 

The more control I lost, the more I tried to gain back. I took on as much of the care work as I could, sure that nobody else could do it as well as I could. 

Looking back, it’s clear to me as a therapist that I was exhibiting classic signs of postpartum anxiety (along with undiagnosed postpartum depression). 

Just like so many moms, I pushed aside my concerns and kept putting pressure on myself.

But when you’re in the throes of it, it can be almost impossible to see. You’re entering into a brand new, unchartered situation. It makes sense that you would develop new worries and stresses. Just like so many moms, I pushed aside my concerns and kept putting pressure on myself, not realizing that my mental health was playing a major impact on my enjoyment of motherhood. 

Moms everywhere are struggling with this burden, but they don’t understand what’s normal, what’s a cause for concern, or what to do about their anxiety. 

I was excited to connect with Dr. Oreck and hear what she had to say about how to know if you have anxiety, the role of intrusive thoughts, and the best methods for treatment. 

What Postpartum Anxiety Is (and Why It’s Underdiagnosed)

Postpartum anxiety is still very understudied. Awareness is growing, but it can still be very difficult for moms to receive care or support. 

Dr. Oreck pointed out that while research has shown that 1 in 5 moms might struggle with postpartum anxiety, the numbers aren’t necessarily accurate. Not only has the pandemic greatly increased PPA, but most of the research and numbers focus more heavily on postpartum depression. Dr. Oreck believes that PPA is much more prevalent, but it often falls through the cracks. 

Moms assume that their anxiety is normal and natural. They are so focused on protecting their babies that they often don’t focus on their own struggles. 

Dr. Oreck also pointed out that part of the reason we don’t know enough about it is because perinatal anxiety is a big umbrella. It often begins earlier than we realize—50% of cases start during pregnancy. Perinatal anxiety also includes perinatal OCD and PTSD, both of which have anxiety components. 

50% of perinatal anxiety cases start during pregnancy.

However, the most common form is postpartum anxiety, which is similar to generalized anxiety. Despite the fact that moms are at risk for these mental health concerns, PPA is not screened for in pregnancy. 

Anxiety can range from mild to paralyzing, often having a significant impact on moms’ functioning both in pregnancy and postpartum. 

How to Know if You Have Postpartum Anxiety

Dr. Oreck said that ultimately anxiety is worry that impairs functioning. If you find that your worries are impairing your functioning or debilitating you, it’s time to speak to a medical professional. 

For example, if you’re too worried to go out to dinner during your pregnancy because you’re afraid to eat something that might harm your baby, or if you can’t sleep because you are too anxious about something happening to your baby during the night, anxiety is a likely culprit. 

However, Dr. Oreck also pointed out that anxiety doesn’t have to be debilitating. If it’s occupying your mind, constant, or keeping you from being present and enjoying your pregnancy or your baby, it’s still a sign that you might need help. 

There are many symptoms and signs to look out for with postpartum anxiety—including frequent worrying, thoughts that something bad is going to happen, sleep disturbances, fatigue, appetite changes, or difficulty bonding with a baby. 

During the perinatal period, some of these signs go overlooked because your body is going through so many other changes.

But one of the biggest factors that is often unique to perinatal anxiety is intrusive thoughts—especially of something bad happening to your baby or of you harming your baby. 

An example of this might occur if as you are walking with your baby down the stairs, you suddenly envision dropping them. These thoughts come from nowhere and can be disturbing and hard to dismiss. 

Intrusive thoughts can be particularly scary for new moms. In fact, they are often afraid or ashamed to admit they are experiencing these thoughts. It’s important to remember that intrusive thoughts are not a reflection of your real feelings or behaviours. 

Dr. Oreck pointed out that intrusive thoughts are rooted in a biological drive to protect your baby—but that drive is turned too far up when you experience perinatal anxiety. 

How Perinatal Anxiety Shows Up in Pregnancy

Dr. Oreck pointed out that it’s concerning that despite having many visits with doctors during pregnancy, the anxiety red flags are just not popping up. 

Part of this may be that there are already so many changes happening in a mom’s body that it’s easy to assume physical signs of anxiety, like a clenched stomach or a racing heart, are just par for the course. 

Additionally, so much of pregnancy involves moms monitoring for potential things to go wrong, which can be hard if they are already anxiety-prone. Dr. Oreck mentioned kick counts as an example—we are told to do these as a precaution but it can actually be a major stressor. 

So much of pregnancy involves moms monitoring for potential things to go wrong.

Some moms will go to greater extremes, like purchasing at-home fetal heartbeat monitors, or doing kick counts more frequently than suggested by a doctor. 

Many pregnant moms find themselves consumed with worry about what might go wrong with pregnancy or what might happen to the baby, especially if they have already experienced a loss or struggled with infertility. 

Dr. Oreck said that perinatal anxiety during pregnancies often presents as over worrying about what you eat, what you put on your skin, or your daily activities.

We all want our babies to be safe, but if moms find themselves constantly worrying, to the point where they can’t enjoy the pregnancy, it might be a red flag. 

How Anxiety Impacts Moms in the Postpartum Period

Perinatal anxiety can also manifest during the birth or the preparation for the birth. The birthing process can bring up so many different worries. Moms often struggle to cope with the lack of control. 

Many moms also experience birth trauma, which can set the stage for anxiety during the postpartum period. 

In the postpartum period, common ways that anxiety presents are concern about baby’s well-being, eating, and sleeping. Our anxiety can become so strong that it skews our sense of safety and our ability to assess realistic risk. 

For example, if you experience an intrusive thought about accidentally letting go of your baby’s stroller, you might suddenly feel that going for walks is unsafe. Or if you are worried about SIDS, you might be unable to get any rest, despite it being a rare tragedy. 

We might cling to extremely rigid schedules or weigh baby before and after every feed because we are so worried about what is going to happen to them. 

Sometimes, moms either cling to control or they avoid. They might be unwilling to let anybody else care for the baby because they fear for their safety. Or they might not trust themselves with the baby and be too afraid to care for them. 

Anxiety stems from an alarm system in our brains that grows when we have a baby.

Anxiety stems from an alarm system in our brains that grows when we have a baby. This makes sense within normal limits, but for some of us, the volume goes too far up. The perceived sense of threat is so high that we can’t quiet the alarm system and function. 

Dr. Oreck pointed out that this often becomes a vicious cycle—our anxiety keeps us from taking care of ourselves, especially when it comes to sleep. But sleep itself can be one of the best medicines for anxiety. 

If unchecked, anxiety can even contribute to postpartum depression, low mood, and withdrawal. It’s important to notice the signs and seek help if we’re struggling.

What to Do if You Suspect Postpartum Anxiety

Dr. Oreck said that the first step should always be to talk to a mental health professional. Unfortunately, therapy isn’t always accessible to everyone—however, there are resources that can connect you with somebody who can help. 

When you connect with someone who specializes in perinatal mental health, they can help you determine if you have postpartum anxiety and start a treatment plan to cope with intrusive thoughts and begin to heal. 

Dr. Oreck pointed out that a holistic approach to treatment is the best course of action—this might include lifestyle changes such as supplementing with formula or creating a plan for your sleep.

Mom's well-being is important too.

It’s important to look at your well-being. The acronym NESTS (nutrition, exercise, sleep, time for self, and support) is a good place to start evaluating where you might be able to make changes. 

Medication might also be right for moms with postpartum anxiety. Dr. Oreck views it as one tool in the toolbox—it won’t instantly fix everything, but it is sometimes an important part of the puzzle. 

Dr. Oreck also encourages moms to find a support system—a community of other moms or people to talk to. You are not alone. Anxiety doesn’t mean you aren’t a good mom. In fact, checking in and taking care of yourself can allow you to heal and show up as the best version of yourself.