Tips for Distinguishing Between Normal Worrying and Postpartum Anxiety

As I hurriedly scanned through the symptom checklist peering up at me from yet another post-partum screener, very few of the questions seemed to convey how I felt.

Have I “been so unhappy that I have had difficulty sleeping?” Nope.
Was I feeling “sad or miserable?” Also no.

Holding my baby daughter, I was the happiest I had ever been and certainly did not feel depressed. But something was definitely off as I couldn’t just relax and soak up that post-baby bliss everyone seemed to talk about. The cloud of worry that swirled around us seemed to intensify like a hurricane, gusting away the feelings of joy and churning up the constant dread of something happening to my baby.

In hindsight, I realized I was one of the approximately 10-20% of mothers who experience Postpartum Anxiety, (PPA) according to the International Journal of Women’s Health. However, this number is likely higher, partially because it only conveys reported cases and also because there isn’t a common screener or tool currently used to diagnose anxiety after childbirth. (The widely used Edinburgh Postnatal Depression Scale, or EPDS, screener is only designed to detect depression, but not anxiety.)

Knowing the signs of postpartum anxiety, and how to distinguish between normal worry and PPA can help you or a loved one from slipping through the cracks of a diagnosis, treatment, and ultimately, relief.

What Exactly is Postpartum Anxiety?

Mothers of countless species feel the same fierce instinct to protect their young at all costs, but how much worry is considered “normal”?

As parents, some amount of anxiety is a good thing to help protect our children and anticipate dangers to prevent them from happening. For example, researching safe sleep practices, applying sunscreen to our children, putting on life jackets or floaties, or double-checking to make sure the car seat is installed correctly are all positive, proactive measures that can stem from a healthy dose of worrying.

A sign of excessive anxiety occurs when intrusive, troubling, or catastrophic thoughts about something happening to your child are so regular that you find yourself in a consistent state of mental distress. In my experience with PPA, “sleep when the baby sleeps” was almost impossible for me as a new mother. Checking on the baby once or twice a night is one thing. Being unable to sleep or rest due to constantly making sure the baby was breathing when I was already bone-tired was quite another.

What Are the Symptoms of PPA?

The most common type of PPA is Generalized Anxiety Disorder, or GAD (because I love a good acronym as much as the next gal.) Symptoms of severe generalized anxiety may include but aren’t limited to the following
examples:

Constant catastrophizing (thinking about worst-case scenarios, however unlikely)
A chronic feeling of something bad about to happen
Being extremely self-critical over parenting abilities or any small mistake
Spiraling thoughts of any dangers or potential harm to the baby or meeting milestones
Consistent irritability, especially when bottling up or not being able to identify what’s wrong
Hypervigilance (checking on the baby excessively)
Lack of trust in anyone else caring for the baby
Requiring constant reassurance about the baby’s well-being
Avoiding common or seemingly harmless scenarios out of concern for the baby’s safety
Obsessing over the future, such as constant “what ifs…”
Experiencing severe anxiety when separated from the baby, even for a short time

This anxiety can also manifest in physical symptoms, such as:

Insomnia (either falling asleep or staying asleep)
Extreme muscle tension
Upset stomach
Shallow or rapid breathing (I find that I hold my breath when I’m hyper-anxious, even without realizing it.)
Changes in appetite
Increased or racing heart rate
Panic attacks
Dizziness
Increased sweating

It’s important to note that these symptoms can also happen before the baby is born. Perinatal anxiety occurs when excessive anxiety begins during pregnancy, rather than postpartum. Women who previously experienced miscarriage or stillbirth are also at a greater risk for perinatal anxiety. (Sending you a hug – I have also been there and you are not alone on that long and scary road.)

Why Am I Experiencing So Much Anxiety After Becoming a Parent?

There are a variety of reasons that can come into play. Major hormone changes after childbirth, lack of sleep, and a predisposition to anxiety or Obsessive-Compulsive Disorder (OCD) are all ingredients that can make a recipe for heightened postpartum anxiety.

Another factor is the extreme vulnerability that goes hand-in-hand with loving a child so much. With that love, there is also great fear of something terrible happening to the child. Parents may find themselves visualizing or
“dress-rehearsing” tragedy as a defense mechanism to try to prepare themselves should the unthinkable happen.

Researcher, speaker, professor, and best-selling author Brené Brown, Ph.D., explains why so many parents may have catastrophic thoughts about their children: “I now know from my research that 95 percent of parents can relate to my constant disaster planning. When we’re overwhelmed by love, we feel vulnerable – so we dress-rehearse tragedy. Though I study scary emotions like anger and shame for a living, I think the most terrifying human experience is joy. It’s as if we believe that by truly feeling happiness, we’re setting ourselves up for a sucker punch. The problem is, worrying about things that haven’t happened doesn’t protect us from pain. Ask anyone who has experienced a tragedy; they’ll tell you there is no way to prepare.”

I used to view my anxiety as a cross I chose to bear if that meant that if I could just worry enough, it could somehow prevent any and all dangers and ultimately keep my kids safe. The truth is that over-worrying only accomplished zapping me out of the present moment.

How Can I Help My Postpartum Anxiety?

Here are some things that helped me with my PPA.

1. Tell A Trusted Person

The good news is that Postpartum Anxiety is highly responsive to treatment. The first and most crucial step is not to feel shame or embarrassment for your feelings. During follow-up appointments, tell your doctor or your child’s pediatrician if you are feeling intensely anxious. They can recommend support groups, therapists, or medicine that is safe for you and the baby.

Going to a therapist for my PPA was life-changing. Just saying all of my anxious thoughts out loud deflated the power they had in my mind, like an old balloon drifting to the ground. Several sites like Psychology Today offer an easy tool for you to search by zip code, symptoms, and other preferences for a therapist that’s the right fit for you.

Remember that seeking help doesn’t reflect what’s wrong with you; it’s what’s right with you as you strive to be a better version of yourself. Recognizing hurdles and empowering yourself to climb them is one of the most selfless things you can do for yourself and for your family.

2. Embrace Joy When It Is Actually Occurring

Brené Brown also elaborates on how to pivot from disaster planning to soaking up the joyful moments while we have them: “Catastrophizing, as I call it, squanders the one thing we all want more of in life. We simply cannot know joy without embracing vulnerability – and the way to do that is to focus on gratitude, not fear. The good news is that joy, collected over time, fuels resilience – ensuring we’ll have reservoirs of emotional strength when hard things do happen.”

When we think about the trajectory of our children’s lives and all of the experiences they will accumulate, it can be terrifying. Ruminating and catastrophizing might seem like a way to control certain outcomes and protect our children, but is usually only useful for robbing us of the joy of the present moment and creating memories with our children.

There are wonderful, major life events that create memories, such as weddings, births, or vacations. But it’s usually those mundane, ordinary occurrences that we’ll grow to cherish the most one day: walks around the neighborhoods, bedtime stories, and cuddles with our kids. Allowing myself to experience those occurrences fully – without waiting for the other shoe to drop in a fit of worry – helped me to stop regretting all the time that anxiety had snatched from my life. Instead of wasting so much time constantly over-worrying and trying to prevent bad things from happening, I was actually experiencing, embracing, and enjoying the life I already had right in front of me.

3. Being Mindful of How Our Children May Unintentionally Interpret Our Anxiety

After seeing a therapist for PPA, she also pointed out how my facial features, body language, and mood can visibly sway after being hit with a lightning bolt of anxiety, as much as I’d try to hide it. My demeanor could turn from cheerful to tense as a terrible, worst-case scenario suddenly flashed through my mind.

As hard as I would try to shield my kids from my internal turmoil, even babies at a young age are highly intuitive and can detect negative emotions, creating an opportunity for them to unintentionally internalize my sudden emotional shift as something they did wrong or think “Mama doesn’t want to play with me,” or “My mom isn’t happy when she’s with me” as they gazed up at my “resting worry face.” (RWF if you will, since we are on an acronym roll.)

My therapist rightfully explaining this to me was a tough pill for me to swallow, but necessary to motivate me to not be a captive to my toxic thoughts. (As Kate Winslet would day in The Holiday after sweet 90-year-old Arthur provided her with a moment of clarity: “That was brilliant. Brutal, but brilliant.”) Fighting the anxiety was beneficial not only to my mental health, but my children’s as well to ensure they weren’t misinterpreting my distraction as something that was their fault.

4. Differentiate Between Productive and Unproductive Worry

I can clearly remember a time when my baby was in a tizzy of belly laughs and gummy giggles (the best.) Suddenly, my brain recalled a high-profile news story about a campus assault, and a wave of anxiety transported me from soaking up that moment to fretting over her safety in college, something that literally wouldn’t take place for decades.

Sure, there were measures that I could and would eventually take to try to instill safe habits in my children as they get older, such as not walking alone at night, not leaving their drinks unattended, etc. But these conversations were years and years away, so agonizing over those scenarios at that moment was completely unproductive.

When you find yourself spiraling, try asking yourself: Is this thought productive and something that is actually in your control, such as making sure a playroom is safely babyproofed when your baby starts crawling? Or is it a thought about something entirely out of your current grasp and well into the future, such as worry over your child driving? If it’s the latter, simply calling a spade a spade and recognizing that it is a catastrophic thought is helpful to prevent falling down a rabbit hole of unhelpful worrying.

Just be aware that productive worry can disguise itself as a wolf in sheep’s clothing with severe anxiety masquerading as logic. Perhaps me cutting up my baby’s food was well-intended, but dividing a blueberry into sixteenths and still catastrophizing about choking crossed over into the dark side.

There Is Hope

I experienced PPA after my first two childbirths. Going into my third delivery, simply being armed with the knowledge of how anxiety can impact new mothers was enormously helpful to protect my mind from a barrage of constant worry and ultimately overcome PPA. While giving myself grace, I still wish I could go back to that time with my first two children and soak up those priceless baby snuggles without anxiety looming over us.

As mothers, we tend to put everyone else’s needs before our own. Keep in mind that we can’t pour from an empty cup, and taking care of ourselves is an extension of taking care of our families. If you feel like anxiety is overshadowing your experience with motherhood, please know that you aren’t alone and there is hope.

The signs of postpartum anxiety can be easily confused with normal worrying, but hopefully this helps.

Have you dealt with postpartum anxiety? If you have a helpful tip for distinguishing the two, be sure to drop it in the comments below.

Our next reco: Intrusive Thoughts and the Postpartum I Never Envisioned