Postnatal anxiety

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How is postnatal anxiety identified and diagnosed?

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Feeling some levels of stress and anxiety is likely when managing a new baby, but generally these feelings pass over time.

Ongoing disturbing thoughts or feelings of worry and tension that affect your ability to cope day to day, however, may indicate you are experiencing postnatal anxiety, which affects around 1 in 5 Australian women.

What is anxiety?

Anxiety is the broad term used that refers to range of conditions with a number of common symptoms:

Feelings of fear and worry which begin to ‘take over’ your thinking
Feeling irritable, restless, tense or constantly ‘on edge’
Racing heart/strong palpitations, sometimes panic attacks
Reoccurring worrying thoughts, such as that you are not doing things right, or that something terrible will happen
Unable to sleep – even when you have the opportunity
Avoiding situations for fear that something bad will happen

What anxiety can feel like

Many people with postnatal anxiety disorders often describe feeling like they are ‘going crazy’ or ‘losing their mind’. Racing thoughts can cause them to feel a range of physical and emotional symptoms. This can be exacerbated by a lack of sleep that can come with anxiety and also with a new baby.

Women experiencing anxiety may try to get everything in order and under control to ensure they’re doing things ‘the right way’ or avoid ‘something bad’ from happening. For example, they may check on the baby continually (even when asleep) for fear that they will stop breathing, or have visions of something harmful happening to the baby.

My symptoms were so different to what I knew was normal. For one – I never felt like killing my baby – but I was constantly having visions of accidentally harming him – they filled my mind. I thought I was just being an over anxious mother and I never mentioned it to anyone. Also, my lack of connection with him was difficult to put into words for ages because I didn’t really know what it should feel like.

How common is anxiety?

Anxiety is the most common type of mental health problem. It affects one in four people in their lifetime, and up to 1 in 5 Australian women in their first year after giving birth.

Anxiety is even more likely to occur among women in the year following the birth of a baby, particularly if you have experienced anxiety in the past. However some women may only experience anxiety for the first time in the perinatal period.

Postnatal anxiety and postnatal depression co-occur in up to 50% of cases.

Thankfully, treatments for postnatal anxiety and depression are similar and can treat both conditions at the same time.

What causes anxiety?

There is no single cause of anxiety. It is likely to be a result of:

Your genetic makeup and family history
Your personal way of thinking and coping
Environment influences on your mental and emotional wellbeing

A combination of these factors may increase your risk of developing anxiety.

There are also some factors that protect you, such as having good support networks.

Also, women who have experienced anxiety in the past may find that their symptoms return or get worse during pregnancy or early parenthood.

I struggled to get out of the house for fear someone would take my baby. Ridiculous to a normal person but in the state I was in I couldn’t tell anyone for fear they would think I was crazy! I think depression is talked a lot about but anxiety is just as bad.

Types of anxiety conditions

There are a number of different types of anxiety conditions, each of which has a different set or cluster of symptoms:

Type of anxiety disorder	Description
Generalised anxiety disorder (GAD)	Feeling worried about perinatal issues on most days over a long period of time (e.g., six. months). Some common topics of worrying include: - The infant’s wellbeing, safety and possible threats (e.g., SIDS) - Getting one’s life in order, having everything planned and sorted - Constant worry about how they will cope - Breastfeeding worries (e.g., had the baby had enough milk, will their milk supply run out) - Keeping the household chores attended to - How they will manage work and parenthood - How to give their other children enough attention while meeting the needs of the new infant
Panic Disorder	Frequent attacks of intense feelings of anxiety that seem like they cannot be brought under control. These attacks can occur when: - Thinking about leaving the house with their new baby - Attending mother's groups - Worrying about sleep and settling issues - When transitioning their infant to solid food (fear of choking)
Social phobia	Involves an intense fear of criticism, being embarrassed or humiliated, even in everyday situations. Some common examples in the perinatal context include: - Invasion of their personal space - People touching their baby - Worries about involvement of friends and family and different opinions on baby’s needs - Infant drawing attention to them publicly - Worries about mother’s groups - Worries about people judging their parenting (e.g., crying baby in supermarket)
Specific phobia	Fearful feelings about a particular object or situation. This can commonly include vomiting (babies often vomit), body changes (eating disorder traits/anxiety), death of a loved one, coprophobia

Symptoms can develop gradually over time, or come on suddenly and intensely. If not identified or treated, symptoms can worsen over time – even to the point where the anxiety has ‘taken over’ and you cannot function. This can make life difficult to manage, especially with the demands of a new baby.

I remember times of sitting on the couch watching TV and just feeling overwhelmed with grief. I just felt so sad and anxious about everything… I’d lie awake at night waiting for her to cry… the sleeplessness, the anxiety, not being able to watch the news because everything made me so sad.

How is postnatal anxiety identified and diagnosed?

Your doctor or maternal and child health nurse may offer you screening with the Edinburgh Postnatal Depression Scale and/or the Antenatal Risk Questionnaire (which is used both antenatally and postnatally).

Edinburgh Postnatal Depression Scale (EPDS)

The Edinburgh Postnatal Depression Scale is a series of 10 questions about how you have felt in the last 7 days. For each question, you choose the response that describes your feelings. While this tool was developed to assess women for depression, it can also help your doctor or midwife identify anxiety symptoms.

Antenatal Risk Questionnaire (ANRQ)

The Antenatal Risk Questionnaire asks questions about your life more generally and helps to identify factors that may place you at greater risk of experiencing anxiety.

If you think you might be experiencing anxiety, you can ask your doctor or maternal and child health nurse for these screening assessments. Your score(s) will tell you and your doctor or maternal and child health nurse if further mental health assessments would be helpful.

A GP or trained mental health professional can diagnose anxiety. They do this by asking whether you have had certain symptoms over a period of time (usually 2 weeks or more)

I never got to the point of not being able to get out of bed. I remember times of sort of sitting on the couch watching TV and just feeling overwhelmed with grief. I just felt so sad and anxious about everything… I’d lie awake at night waiting for her to cry… the sleeplessness, the anxiety, not being able to watch the news because everything made me so sad.

Thankfully the treatments for both postnatal anxiety and depression are similar and can treat both conditions at the same time.

Treatment of postnatal anxiety

There are many safe and effective treatments available for postnatal anxiety. The right treatment for you will be determined by your personal history, and how severe your anxiety condition is.

Treatment for mild to moderate anxiety

Mild to moderate anxiety usually means you are experiencing a few symptoms and, while affecting your quality of life and ability to get things done, you are still likely to be able to function generally. Emotional and practical support, plus support counselling and/or psychological treatments can be very effective.

Support Counselling

Support counselling for postnatal anxiety can be provided individually or in groups. This can allow you to talk through how you are feeling and thinking with someone who can support and listen in a non-judgemental way. Support counselling can help you to develop strategies to deal with challenges that may be contributing to your feelings of anxiety generally, or in specific situations.

Psychological treatments for mild to moderate anxiety

Two types of psychological treatments can be effective for treating mild to moderate anxiety – cognitive behaviour therapy (CBT) and interpersonal therapy (IPT).

These treatments can be conducted one-on-one, in groups, or online, and are generally delivered by a trained health professional with expertise in mental health.

Therapies can involve you and your infant together, focussing on your relationship and bonding as you also learn to manage anxiety.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy is a structured treatment that targets your way of thinking (cognition) and acting (behaviour), which can impact the way you feel – in this case by reducing your feelings of fear and anxiety.

It is common for people with anxiety to view things catastrophically, leading them to believe that the worst will or has happened.

Cognitive behaviour therapy can help you to identify these thinking styles, rationalise your thinking, and look at things more objectively. Once these thinking patterns are recognised, you can begin to consciously and deliberately challenge and replace these thoughts to help reduce anxiety and control its symptoms.

CBT can also help you to reduce the intensity of physical feelings of fear and anxiousness and/or panic, and manage symptoms through a range of strategies, including deep breathing and muscle relaxation. Because anxiety can cause people to avoid situations that cause them distress, cognitive and behavioural techniques can also help you approach situations you may have been avoiding.

Interpersonal therapy (IPT)

Often, anxiety may be caused by tensions with others, personal losses, changes and/or conflicts in relationships.

Interpersonal therapy (IPT) helps people to find new ways of approaching and dealing with particular situations that may lead to ongoing feelings of anxiety.

Treatment for moderate to severe anxiety

There are safe and effective medications that can be used to help bring the often overwhelming symptoms of anxiety under control.

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)

Although commonly associated with the treatment of depression, antidepressant medications can be very helpful in treating anxiety disorders. In particular, two types of antidepressants are recommended – selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). These medications can be safely used to manage anxiety (and depression) symptoms, and can be safely used when breastfeeding.

These medications can take up to three weeks to have an effect, and may cause some side-effects. It’s a good idea to talk to your health professional about the prescribed medication.

My doctor let me know, ‘Hang in there for 4-6 weeks – at least you know there will be an end.’

Benzodiazepines

When anxiety symptoms are very severe and/or that person is experiencing panic attacks and faster relief is required, a class of medication called benzodiazapines may also be prescribed while antidepressants take effect. Benzodiazepines should only be used for a short period (up to three to four weeks) as they are addictive.

Benzodiazepines vary in the amount of time it takes for the body to eliminate them. Those that are eliminated more quickly (short-acting benzodiazapines) are the type that can be used, while long-acting benzodiazapines should be avoided. Again, discuss medical treatment with your health professional to clarify the nature, type and action of the medication you are being prescribed, as well as common side effects.

Taking medication may feel concerning, but it’s important to weigh up the pros and cons. Medication can help give you the resources to manage the symptoms and get on top of anxiety so you can benefit from other psychological or supportive therapies.

Download our Postnatal Anxiety Fact Sheet

Real stories: What it is like living with postnatal depression and anxiety

Learn about the range of emotional challenges that Renee and Stevie each experienced on their journey to motherhood, and how their friendship helped them through.

Getting anxiety under control can improve your quality of life and overall experience of parenthood with your new baby.