For many new mothers feeling anxious is more common than feeling blue. By Kirsten Braun.
Most of us have heard of antenatal and postnatal depression (PND) where women develop depression during pregnancy or after the birth of a child. What is often not as well known is that women can also experience symptoms that are more anxiety-related rather than depression-related. In actual fact more women are affected by anxiety than depression during this time.
Anxiety is a normal human emotion that plays a vital role in dangerous situations. When we sense a threat our body undergoes a number of physiological changes including the release of large amounts of adrenaline and an increased heart and breathing rate. These changes prepare the body to fight or take flight from the threat. People who suffer from anxiety, however, experience these changes when there is no real threat present or alternatively the anxiety is out of proportion to the actual threat.
While it is normal for women to feel some apprehension about their role as a mother, for women with anxiety, these fears and concerns reach a point where they become disruptive to everyday living.
Women who have anxiety during pregnancy or after having a baby typically feel on edge, restless, irritable and have difficulty concentrating. Sleep disturbances (difficulty falling asleep or staying asleep), muscle tension, changes in appetite and/or weight are also common. Women may excessively worry about things including their health and/or the health of their baby and this may result in behaviours such as obsessive cleaning and/or checking on the baby. Women can also be affected by panic attacks, which are characterised by heart palpitations, sweating, hot flushes or chills, trembling, dizziness, shortness of breath and chest discomfort.
There are a number of risk factors for experiencing anxiety during pregnancy or after having a baby. They include:
- a personal or family history of anxiety or other mental and emotional conditions
- personality types (those who are nervous, worry a lot, perfectionists, poor coping skills)
- lack of emotional and practical support (from partner, family or friends)
- stressful life events (relationship breakdown, loss of employment/unemployment, moving, financial difficulties, bereavement)
- pregnancy and delivery complications
- challenging baby behaviours (problems with sleeping, feeding, settling).
It is common for women to delay seeking help as the feelings they associate with PND (e.g., feeling down, crying) do not describe their situation. In addition, pregnant women often assume that they will feel better once they have the baby. However, the opposite is usually the case; the enormity of becoming a parent, caring for a dependent infant and sleep deprivation can all exacerbate anxiety symptoms.
It is important for women to recognise that anxiety-related symptoms are also a trigger for seeking help. In fact several questions in the Edinburgh Postnatal Depression Scale (a tool used to assess women's PND risk) specifically address anxiety symptoms. Some women may not recognise there is a problem and so it may be necessary for a partner, family and/or friends to encourage them to seek assistance.
Seeking help early is vital as it can contribute to a quicker recovery. Untreated anxiety can also have an impact on the pregnancy and/or baby. Women can approach their general practitioner, obstetrician, child health nurse or midwife. If the first health professional a woman talks to does not provide the assistance she needs, she should talk to another one. Health professionals will ask the woman questions about how she is feeling, her sleeping and eating habits and general coping ability. They may also do a blood test to rule out other health problems (e.g., thyroid disorder, anaemia).
Maintaining a healthy diet plays an important role in restoring our health, including our mental and emotional health. Takeaway foods and/or processed foods should be minimised as they can be high in saturated fats, salt and sugar and low in essential nutrients. Women and/or their partners can instead look for quick and easy meal options that incorporate lean meats, wholegrains, low-fat dairy products and fresh fruits and vegetables. Choosing healthy snacks (e.g., fruit, low-fat yoghurt, raw nuts and seeds, wholegrain crackers) over highly processed foods such as biscuits, cake and chocolate is also a good idea. Women with anxiety symptoms can benefit from reducing their intake of stimulants such as alcohol, coffee, tea, cola and energy drinks as these can all exacerbate their symptoms.
Regular exercise is a great way to reduce the symptoms of anxiety. Exercise helps to metabolise the chemicals produced by the body when it is anxious, such as adrenalin. Exercise also produces endorphins that improve one's mood and sense of wellbeing. While exercise can improve one's sleep women should avoid vigorous exercise late in the day as this can interfere with night-time sleep.
One of the most commonly used treatments for anxiety is cognitive behavioural therapy (CBT). CBT is based on the concept that negative or self-defeating patterns of thought can affect mood and coping and that these ways of thinking can be unlearned. CBT aims to teach people to examine the thought patterns that contribute to their anxiety, replacing them with more realistic ones.
Medications may also form part of a woman's treatment for anxiety.
Antidepressants are most commonly used and treat anxiety by rebalancing the chemicals in the brain. There are lots of different types of antidepressants available and many are safe to take during pregnancy and breastfeeding. They can take several weeks to start having a therapeutic effect. Side effects of antidepressants include nausea, diarrhoea, sleep disturbance, headaches, dizziness and reduced libido. Many of these side effects will settle within the first few weeks of use.
There are a number of complementary therapies that have been found to be useful for treating anxiety including passionflower, kava and combinations of amino acids, L-lysine and L-arginine. St John's wort, a herbal medicine popular in the treatment of depression, does not appear to be as effective for the treatment of anxiety. Those wishing to use complementary therapies should always inform their health professional as they can have side effects, interact with other treatments (i.e., prescription medications) or be unsafe to use during pregnancy/breastfeeding.
Women often dedicate considerable time to baby preparations such as choosing a stroller and outfitting the baby's nursery. There are, however, equally important preparations that women can do to improve their mental and emotional fitness.
Women can, for example, reflect on what is currently causing anxiety or stress and take steps to reduce these stressors before baby is born. If a woman finds an untidy house a cause of stress she may find arranging for someone to do regular cleaning helpful. Similarly, if finances are a concern, doing a budget can be helpful and can possibly identify areas where savings could be made. People may also wish to discuss putting their mortgage on hold for a length of time, a service offered by some lenders.
Of equal importance is reflecting on which activities are sources of pleasure and/or relaxation. It is very common for new mothers to withdraw from doing activities they used to find enjoyable, due to a lack of time and/or suitable childcare. Women can investigate how some activities may be able to be continued after the baby is born. Participating in activities, even if it is perhaps less frequently than before, allows women time for themselves.
Just Speak Up
Established by Beyond Blue, this website is specifically for antenatal and postnatal depression and anxiety. Women can find information and support and read others' stories.
When I was pregnant with my first child, I was surrounded by information regarding postnatal depression or PND. There were posters at my obstetrician's office and articles in magazines alerting me to the signs and symptoms of PND. What no-one ever told me, though, was to be on the lookout for postnatal anxiety.
The first sign that should have been a red flag for me was my loss of appetite. After I came home from the hospital, I couldn't bear to eat anything other than the sugar biscuits my sister-in-law had sent me in the hospital. I distinctly remember forcing myself to eat each bite of the delicious homemade meal that my mother made for my husband and I for our first night home as a family. I didn't want to hurt her feelings by not eating but my appetite was completely gone.
In addition to the loss of appetite, I was utterly overwhelmed with my new role. I couldn't imagine how I would be able to do this thing called 'mothering' for the next eighteen years and I wondered why anyone would have a second or third child, if this was how difficult parenting was going to be. Those first few weeks at home, I would hole up in my bedroom to breastfeed my son, take a nap, or escape from everyone. I read and re-read the stack of parenting books on my bedside table, in hopes that somewhere I would find the answers for what to do with these thoughts and feelings that consumed me.
The parenting books were really a double-edged sword for me. Instead of being a source of helpful information, they were constantly making me feel as if I was doing things wrong because my baby wasn't responding the way that their glowing anecdotes made it sound he would if I just followed their instructions on sleeping, feeding, schedules, etc.
I also felt like a prisoner in my own home. I was paralysed with fear at the thought of going out to run errands, and so I stayed home wondering if my life would always be like this; never feeling like I could take a leisurely trip to the book shop or the coffee shop or if I would always be a slave to this new life. I worried about the baby crying in public and what I would do if I couldn't calm him. I worried about timing my errands with the schedule that I was trying to create for both of us. I stressed about finding the time to get a haircut, paint my toenails, take a bubble bath. I was too wound up to relax and enjoy my time with my infant son.
If I had been able to receive help, either in the form of counselling or medication, I would have been able to enjoy that precious time. Instead, I look back at that time and remember nothing but intense worry, stress, anxiety and fear gripping my heart and mind as I questioned every move that I made as a new mum and feeling like I was drowning with no-one to help me.
If you find any of the experiences here describe how you or a loved one seems to be feeling as she navigates the world of new motherhood, please reach out for help. My hope is that as mothers, sisters, daughters and friends, we learn more about postnatal anxiety so that we can help ourselves and those around us.
We sincerely thank Christa Connerat from One Cheap Mama for allowing us to print an abbreviated version of her personal story of postnatal anxiety.
Last updated: March 2012
© Women's Health Queensland Wide Inc. This article was written by Kirsten Braun and reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 2 2012.