Postpartum Anxiety: What new parents should know

She brought her daughter in for her four-month checkup. Before I could ask a single question, she pulled out a folder. Inside, she had tracked every ounce, weighing her daughter before and after each feeding to make sure she was getting enough breast milk.

The baby was perfect. She was growing right along her curve, healthy, alert and meeting all her milestones.

When I reassured her, she didn't relax. Instead, she confided, "I go back to work in a few weeks, and I'm dreading leaving her with someone else. I don't think they'll give her the same attention or feed her enough milk."

She also admitted she hadn't slept more than 2 to 3 hours at a time in months, breastfeeding her baby around the clock and then pumping.

To everyone around her, she looked like a devoted, detail-oriented mom. But what she was describing went beyond that. It sounded like postpartum anxiety. And it is far more common than most parents realize.

What is postpartum anxiety?

Postpartum anxiety is excessive worry or fear that is constant, hard to control and gets in the way of daily life after having a new baby. It can start during pregnancy or anytime in the first year after birth. Studies estimate that about 1 in 5 women have an anxiety disorder during pregnancy or after birth. It can overlap with postpartum depression or occur on its own.

Every new parent worries. That's part of loving a tiny person who now depends on you. So how do you tell the difference between normal worrying and postpartum anxiety? Ask yourself:

• Can I turn it off? Normal worry comes and goes. Excessive anxiety is constant and can cause irrational fears about unlikely events. Sometimes it's tied to past experiences. Other times it's more general.
• Is it affecting what I would normally do? You might find yourself avoiding public outings because you're afraid someone will hurt you or your baby, or you turn down help because you're terrified of leaving your baby with another adult you trust.

If either of these sounds familiar, you're not alone. And the good news is that postpartum anxiety is treatable.

Who is more likely to have postpartum anxiety?

Postpartum anxiety can happen to anyone, including parents who have never felt anxious before. But some things can make it more likely:

• A personal or family history of anxiety, depression, panic attacks, obsessive-compulsive disorder or other mental health challenges
• A past pregnancy loss, fertility struggles or a traumatic birth
• Your own health challenges
• A baby with health challenges or feeding problems
• Childhood trauma, like abuse or neglect
• Little sleep or help at home
• Big life stressors, like money worries, a move, relationship strain or going back to work
• A tendency toward perfectionism or needing to feel in control

What can trigger postpartum anxiety?

• Changes in hormones. The sharp drop in estrogen and progesterone after birth may affect your mood and make stress harder to manage. Hormone shifts can also happen when you wean your baby from breastfeeding or when your period returns.
• Lack of sleep. Caring for a newborn is a 24-hour job with little rest.
• Stressful events. A traumatic birth or problems with breastfeeding can increase your risk.

Having one or more of these doesn't mean you will develop anxiety. And sometimes there's nothing you did, or could have done, to prevent it. Either way, it's worth talking with your doctor early, ideally during pregnancy, so you have a plan and know the signs.

Signs and symptoms of postpartum anxiety

Postpartum anxiety can affect your emotional and physical health.

In your mind, it can feel like racing thoughts, trouble focusing or a sense that something bad is about to happen. You may feel on edge, irritable or unable to relax. You might picture worst-case scenarios often, or have panic attacks.

In your body, it can feel like a pounding heart, tight chest, shaky hands, upset stomach or dizziness. Some people also have shortness of breath, nausea, trouble sleeping, loss of appetite or restlessness.

It can also change your behavior. You might check your baby's breathing all night instead of sleeping, avoid crowded places, or refuse to let anyone, even someone you trust, care for your baby.

Intrusive thoughts are common

Many new parents have sudden, upsetting thoughts that seem to come out of nowhere. These are called intrusive thoughts.

They are frightening. They are also common. Most new parents have them at some point. Having them does not mean you want them to happen or that you will act on them. In fact, the fear they cause is a sign of how much you want to keep your baby safe. But if these thoughts come often, are hard to shake, or make you change your behavior and avoid things like bathing your baby or being alone with them, they may be a sign of postpartum anxiety.

Please tell your doctor about these thoughts. We hear about them often. Talking about them is the first step to addressing them.

Why postpartum anxiety goes unnoticed

Postpartum anxiety can be easily hidden or covered up. From the outside, an anxious parent can look like a devoted one. They are attentive, prepared, detailed oriented, always on top of things. Friends and family may even praise them for it.

Most of the conversation about mental health after birth focuses on depression. So many parents never hear the word anxiety at all. If they don't feel sad, they assume they're fine.

And many parents stay quiet on purpose. They worry they'll be judged, or that someone will think they can't care for their baby. That fear keeps people suffering alone.

Here is what I want you to know. Anxiety does not mean you're a bad parent. When you tell your doctor how you're feeling, the goal is to get you the support and care you deserve during this trying time.

How your family physician can help

The first step toward feeling better is telling someone. Family physicians are a great place to start because we often see both you and your baby. You can bring it up at your own visit or at your baby's checkup.

Your doctor will ask about your symptoms and may give you a short questionnaire. They may also check for things that can cause anxiety-like symptoms, such as an overactive thyroid. Then you'll decide on a plan together. It may include:

• Talk therapy. Cognitive behavioral therapy (CBT) works especially well for anxiety. It teaches you to notice anxious thoughts and respond to them differently, reframe negative thought patterns and build healthier habits. Many therapists offer telehealth visits so you can talk to someone from the comforts of your home.
• Medicine. Certain antidepressants, like SSRIs, can also treat postpartum anxiety. They work by increasing serotonin in the brain. They usually start helping within 2 to 4 weeks, with the full effect by 6 to 8 weeks at the right dose. Common side effects, like nausea and headache, often go away after a few weeks. Many SSRIs are considered safe while breastfeeding. You don't need to take them forever. They can help you through a difficult time, and you can taper off with your doctor's help once you feel better. Other types of medicine can also help. Ask your doctor about the best option for you based on your medical history and other health conditions.
• Help from friends and family. Asking for help with childcare, housework and other responsibilities can ease the pressure.
• Sleep protection. A plan where someone else covers even one night feeding can make a real difference.
• Movement. A walk outside, exercise, yoga or meditation can give you an outlet, help you relax and carve out time for yourself.
• Support. A support group, or talking with other parents who have been through it, can make you feel less alone.

Benefits of getting treatment

Getting help is good for you and your baby. With treatment, many parents:

• Sleep better and feel more rested
• Enjoy time with their baby instead of constantly worrying about what could go wrong
• Feel more confident leaving their baby with others
• May lower their chances of developing postpartum depression
• Decrease risk of your baby growing up with emotional and behavioral challenges

Untreated anxiety can last for months or longer. It can make bonding and breastfeeding harder and take a toll on your relationships. The sooner you get help, the sooner you can start feeling like yourself again.

Everyday ways to ease anxiety

These aren't a replacement for treatment. But alongside it, small habits can really help.

• Breathe on purpose. Slow breathing help decrease cortisol and activate your parasympathetic nervous system telling your body it's safe. Try breathing in for 4 counts, holding for 5 and breathing out for 6. Practice a few times a day, not just when you're upset.
• Give worry a time slot. Pick 15 minutes a day to write down your worries. When one pops up outside that time, remind yourself you'll deal with it later.
• Step away from the search bar. Late-night symptom searches tend to feed into your fears, rather than calm it. Write your question down and call your doctor's office or nurse line in the morning instead.
• Cut back on caffeine. Coffee and energy drinks can trigger a racing heart and jitters that feel like anxiety.
• Eat regular meals. Long gaps without food can make you shaky and feel on edge.
• Stay hydrated. Keep water nearby, especially during breastfeeding (if you are breastfeeding), and drink whenever you feel thirsty.
• Wean gradually. If you decide to stop breastfeeding, cut back slowly over several weeks. A sudden drop in hormones can potentially cause anxiety.
• Let go of expectations. You don't need a spotless house or a perfect feeding schedule. A fed baby is a happy one.

What you can do today

If this sounds like you, call your family physician's office today.

If your next appointment is weeks away, ask whether they can see you sooner or set up a phone or video visit. Bring a list of what you've noticed, including how long it's been going on. It also helps to bring your partner or a trusted person along.

Get help right away if you feel you might act on thoughts of harming yourself or your baby, if you see or hear things others don't, or if you feel confused or out of touch with reality. Call 911 or go to the nearest emergency room.

How partners and loved ones can help

Partners, grandparents and friends are often the first to notice something is wrong. Here's how to help:

• Have a conversation. Rather than telling someone to "just relax," try asking, "What are you most worried about right now?" Then be present, and listen without rushing to fix it.
• Don't argue with the worry, and don't feed into it. A calm "That sounds scary. Let's call the doctor together" can help her take the first step toward care.
• Take real tasks off her plate. Offer to cover a night feeding, do the laundry or handle a pediatrician visit.
• Help her get care. Offer to make the appointment, drive her there or watch the baby during therapy.
• Watch for changes. Not sleeping, not eating, panic attacks or talk of hopelessness are signs to call the doctor right away.
• Take care of yourself too. Partners can develop anxiety and depression after a baby arrives as well. Getting help for yourself is part of helping your family.

Remember that you are not overreacting. You are not alone. And you don't have to carry this by yourself.  We are here to help.