Bringing home a new baby is intense. The early days—especially for first-time parents—are full of never-ending questions that range from the weird-but-reasonable to the ultra-paranoid. One scroll through a new mom's Google history, and you'll run across queries like, "My newborn peed in his eyes while I was changing him. Should I be worried?" "Can a super-bumpy stroller ride cause brain damage?" and "Is my baby smiling because he loves me or because he has gas?" (Answer to that last one: Sorry to disappoint, but it's definitely gas).
Worries are a normal, totally expected part of parenting, especially early on. After all, babies are notoriously awful at clearly communicating their needs, so parents are left trying to puzzle it out—which can be overwhelming and stressful. Sometimes, however, the worries don't subside as the weeks pass. For some new parents, the anxious thoughts can get more intense, more frequent, and less rational.
When my son was a newborn, my concerns went far beyond the pale. I was a nervous wreck, convinced I was doing him more harm than good. I refused to put him down because my gut told me he'd spit-up and choke—I just knew that if he were on his back too long, he'd developed a cranial abnormality. I wore him constantly because I knew in my bones that he would die if he wasn't with me. It was beyond intense: Every day, I waited for social services to take him away, and every night, I waited for him to die of SIDS.
I didn't realize that what I was feeling wasn't typical. If new parents find themselves in a fairly constant state of anxiety, unable to sleep because they're afraid their baby will stop breathing, leave the house because they're afraid they'll be in a car accident, or shower because they're afraid to leave the baby alone for 10 minutes—basically, if the worry goes beyond typical new-parent stuff—they might be experiencing postpartum anxiety (PPA).
PPA is super common—more common than postpartum depression, even.
Postpartum anxiety, also called perinatal anxiety, usually manifests during late pregnancy or shortly after delivery, and according to Florida-based psychologist Kelsey M. Latimer, Ph.D., it occurs in up to 15 percent of postpartum women. A study published in 2013 showed much higher numbers of women develop postpartum anxiety than previously thought, and many developed more symptoms as time passed.
"More women suffer from postpartum anxiety than from postpartum depression, but the focus has long been on postpartum depression," says California clinical psychologist, Carla Manly, Ph.D. "Postpartum anxiety does not receive the focused attention it deserves." PPA is usually lumped in with PPD, even though the two manifest with distinctly different symptoms (and you can have PPA without also having PPD).
"Feelings of being on edge, excessive worry, panic attacks, insomnia, and intrusive thoughts" characterize PPA, says Ashley Smith, Ph.D., a psychologist practicing in Kansas. "These feelings can occur even, or perhaps especially, when a baby is cared for," she says. What that means is that a mom with PPA could be doing everything right, but her crying baby will send her spiraling down an anxiety rabbit hole.
It can be especially intense when the mother knows in her rational mind that she is doing everything she should be doing, but the baby still fusses or cries or won't sleep (... which babies tend to do). Her anxiety can convince her she must be missing something or have horrible maternal instincts since the baby is still crying or unhappy or awake.
Hypervigilance is another common sign of PPA. Mothers who stay awake all night watching to make sure baby keeps breathing or who develop OCD-like compulsions are common. "Sometimes the symptoms go beyond thoughts or obsessions and can have compulsions that accompany the thoughts, such as cleaning items repeatedly for fear of germs," Latimer says.
Thankfully, PPA is treatable.
The gold standard is cognitive behavioral therapy (CBT), which helps an individual notice negative thought patterns that emerge and learn to change them. A mom may find herself thinking that social services is going to take away her baby because he refuses to nap (this was one of my personal anxiety spirals). But if she's practicing CBT, she will rationalize the thought, realize she's feeling that way because of her anxiety, and tell herself that social services does not take babies away for being bad sleepers.
The goal of CBT is to change the thought patterns and reroute the way we perceive situations that historically cause us stress. If practiced regularly, CBT has a high success rate in helping women deal with PPA. It's also effective in treating depression and other types of anxiety disorders.
Any perinatal behavioral or personality changes should be reported to your medical doctor first: Take time to review any concerns you might be having during the baby's two-week well-checkup or the 4-6-week postpartum checkup. Once you've been cleared by your M.D., treatments might include CBT, exposure work, medications, or mindfulness meditation practice.
Moms who are experiencing postpartum anxiety also really benefit from a strong support network. Not only is group counseling or a support group a good idea, but having a partner or other loved one to help reinforce rational thinking in a kind and loving way, to talk her down when she is spinning out, is vital.
"It's important for family members to understand that no matter how outlandish her particular fears may sound, to her, they are very real," says Sara Regan, a licensed postpartum doula in California. "Gently encouraging her to leave the house or to put the baby down for short periods of time, authentically offering assistance, and remembering to not minimize her feelings all go a very long way."
Kristi Pahr is a freelance writer and mother who spends most of her time caring for people other than herself. She is frequently exhausted and compensates with an intense caffeine addiction. See what she's up to on Twitter.