science of us

The Lonely Terror of Postpartum Anxiety

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I’m lying awake, gazing at the gentle rise and fall of my 3-month-old’s chest. He’s a delicate infant, constantly surprising me with his smallness, like his sister did when she was born four years earlier. In recent weeks, my son has begun stretching out the number of minutes between nursing sessions. He can go for two hours without eating now, or two and a half if I’m lucky. This means I have more of a chance to sleep, at least in short spurts. But every time I drift off, I jolt awake in a sweaty panic.

I am on high alert all the time these days. I tell myself that this panicky feeling is normal — I have a new(ish) baby, after all. But it doesn’t feel normal. I have constant visions of my son suffocating in the night. I think of waking up to his cold body. I spend nights imagining a thousand unlikely, tragic things that could happen to him.

This happened the last time, too. A few months after my first child’s birth — months filled with panic, a chest full of pressure, and heart palpitations — a doctor finally explained that no, there was nothing wrong with my heart. I had postpartum anxiety, and the intrusive, horrifying thoughts were one more symptom.

According to social worker Karen Kleiman, the founder and director of The Postpartum Stress Center, around 15 percent of new mothers experience anxiety severe enough to interfere with their day-to-day functioning — but many are unaware that there’s a name for what they’re going through. In her book Dropping the Baby and Other Scary Thoughts, Kleiman and her co-author explain that postpartum anxiety — a separate condition from postpartum depression, or PPD — often goes undiagnosed, because everyone, even doctors, expects new mothers to experience heightened anxiety.

It’s a natural instinct, after all, to worry about our young. But too often, what gets shrugged off as “new mom worry” feels crippling to the woman experiencing it. To a new mother with postpartum anxiety, her whole world can begin to feel like a battlefield. In her book, Kleiman refers to this as “excessive worry,” otherwise known as “toxic worry.”

“The period following the birth of a child is a transitional time that can challenge a woman in profound ways,” she writes. “She is deprived of precious sleep, she is hormonally compromised, and sometimes she is thinking things she cannot believe are crossing her mind. If a new mother experiences thoughts that are uncomfortable to her during a time when her family, friends and society expect her to feel blissful, she is likely to be overcome by guilt and a crushing sense of failure.”

On a neurological level, a pregnant woman’s brain undergoes a number of changes that, as they work to prepare  her for motherhood, can also contribute to the onset of anxiety. For example, levels of oxytocin rise during pregnancy; the hormone, which promotes bonding, also triggers heightened levels of activity in areas of the brain linked to empathy and, yes, anxiety.  And according to a 2016 study in the journal Nature Neuroscience, those changes can far outlast the postpartum period. In essence, a new mother is hard-wired to listen closely to, respond to, feed, and fend for her baby. But sometimes, the stress of doing so can turn toxic.

There are certain risk factors for postpartum anxiety, Kleiman explains, including a family history of anxiety, genetic vulnerability to psychiatric disorders, environmental stressors, hormonal changes, and even thinking styles that tend toward worry. But the condition doesn’t really discriminate, either. Postpartum anxiety can happen to any woman who gives birth. In fact, a 2016 study out of the University of British Columbia found that it may be far more common than previously thought, and up to three to four times more common than postpartum depression.

Kleiman says that when it comes to treating postpartum anxiety, it’s important not to dwell on your symptoms, which can actually worsen them. But denying them won’t make them go away either.
“Acceptance is hard but essential,” she says. “Negative intrusive thoughts are scary, but they will not hurt you and they respond to treatment,” which can take the form of psychotherapy, medication, or cognitive-behavioral therapy (CBT).

There is no one-size-fits-all cure for postpartum anxiety, but with better screening tools and increased awareness, more mothers are bound to find relief in whatever form works for them. Part of the process is understanding the condition and finding a care provider who does, too. While there may be no way to fully prepare for developing postpartum anxiety — a fact I learned firsthand — there are proven ways to cope with it.

The Lonely Terror of Postpartum Anxiety