There is no doubt that new mothers experience a plethora of issues during the postpartum season. These issues and societal pressures can lead to postpartum mental illness, including postpartum anxiety. Not only has her entire body gone through extensive changes, and dare we say, damage, during the stages of pregnancy and birth, she is often expected to “bounce” right back to her old self after the baby is born.

But most, if not all, mothers will tell you that that doesn’t happen. Unless the mother has a night nurse and a day nanny, and she can focus on recovery and her personal health, having a baby is a huge lifestyle change. And even then, no amount of money can change the fact that her life is forever changed while taking care of this new human. No matter what, mothers’ bodies, health, and hormones all go crazy and completely erratic once the baby is born. And that is an adjustment for everyone- even if you are a celebrity or royalty that has 24/7 help.

We have probably all heard of the term 'postpartum depression.' This is a common ailment that plagues many mothers after their baby is born. It can happen with each birth, or it can happen with one and not the other. Many mothers don’t talk about their experiences with postpartum depression because of the societal stigma behind it.

Mothers in American culture are expected to quickly come back from having a baby as if their minds and bodies aren’t experiencing trauma. They are expected to return to work, still complete all household duties and regular tasks, and get back to their old selves without missing a beat.

And I know what you’re thinking: “People don’t actually think that way. Many families help mothers after they have a baby.” And yes, that is often true. Many families do step up, help around the house, and know that a new mother needs rest. Neighbors will do meal trains and offer to fold laundry or watch other children.

But as a society, we function in a state of mind that the mother should be able to handle it all. Although we may not outright think of it this way as individuals, the way our capitalistic society runs is that mothers are largely left on their own after a baby is born.

If a mother works outside the home, or even from home, she is given 6 weeks of unpaid maternity leave with a few exceptions (and let’s not even get into the fact that this is abhorrently and significantly less time and benefits than mothers in other first-world countries- that’s an article for another time). After that time she is expected to return to work as if she is a functioning member of society- not someone who is sleep-deprived, still recovering physically from major trauma, and experiences one of the biggest life changes ever.

And if a mom is a stay-at-home parent, her partner is expected to return to work with minimal time off. My husband had 10 days at home with me, and that included weekends. The day he went back to work after my second child, I cried. I didn’t know how I was going to function on my own.

In addition, in today’s society, we no longer function as a “village mentality.” In other words, the cliche of “it takes a village” no longer applies. We often do not live close to family like people did even a few decades ago. Our culture is so fast-paced and hustled that we can’t ask other families to help us when we are in need. Many mothers work outside or from home, so the idea that we have other caregivers whose sole purpose in the home is to manage the children and the home is pretty much non-existent. Even those moms who stay at home are often volunteering or playing chaffier for all of their children’s after-school activities.

In large part, many mothers are left to their own devices, being told, or shown through cultural norms, that they will have to function on their own day in and day out.

Situations and societal pressures like this can not only lead new mothers into the rabbit hole of postpartum depression, but it can also lead to other postpartum illnesses such as postpartum anxiety or even postpartum psychosis.

What is postpartum mental illness?

First let’s explore what postpartum mental illness actually means. According to the MGH Center for Women’s Mental Health, “…about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety. Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis.”

  • Postpartum Blues-Postpartum blues is the most common type of postpartum mental illness. It usually occurs after the first week following the birth of a child and is attributed to the rapid change in hormones after pregnancy. According to MGH Center for Women’s Mental Health, “Rather than feelings of sadness, women with the blues more commonly report mood lability, tearfulness, anxiety or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery. While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function.”
  • Postpartum Depression and Postpartum Anxiety Postpartum depression and postpartum anxiety are often coupled together under the postpartum mental illness umbrella. Postpartum depression includes symptoms such as:
    • Depressed or sad mood
    • Tearfulness
    • Loss of interest in usual activities
    • Feelings of guilt
    • Feelings of worthlessness or incompetence
    • Fatigue
    • Sleep disturbance
    • Change in appetite
    • Poor concentration
    • Suicidal thoughts

These symptoms usually occur two to three weeks after the birth of a child, but they can occur anytime within the first year after a child is born as well. Many mothers experience the peak of their depression during the 4 month or 9 month sleep regressions that most babies experience.

Postpartum anxiety is a huge part of the postpartum depression/mental illness umbrella. It is more prominent in women who have had experience with depression and/or anxiety before. MGH Center for Women’s Mental Health states that, “Generalized anxiety is common [in postpartum women], but some women also develop panic attacks or hypochondriasis. Postpartum obsessive-compulsive disorder has also been reported, where women report disturbing and intrusive thoughts of harming their infant.”

Postpartum anxiety symptoms include:

  • The usual postpartum anxiety symptoms include:
  • Increased heart rate
  • Sore stomach
  • Tight chest and throat
  • Muscle tension and twitching
  • Shallow breathing
  • Loss of appetite
  • Trouble falling or staying asleep
  • Racing thoughts about the future
  • Imagining worst-case scenarios
  • Ruminating
  • Excessive worry
  • Obsessing
  • Trouble concentrating
  • Memory problems
  • Avoiding everyday situations because you fear for your baby
  • Being over-controlling
  • Needing constant reassurance
  • Checking things repeatedly
  • Hypervigilance
  • Panic attacks

The symptoms of postpartum anxiety do not go away even with strong effort. Like postpartum depression, postpartum anxiety usually develops four to six weeks after a baby is born, but it can creep up any time up to a year postpartum. Postpartum anxiety is different than regular motherhood worries as it is often debilitating or potentially harmful to the mother or baby.

What causes postpartum anxiety?

There are several reasons why a mother might experience postpartum depression and/or anxiety. Some are based on the changes a mother is experiencing in her body (changes in hormones) or her lifestyle (lack of sleep). Previous experience with depression, anxiety, or other mental illnesses can also play a large part in whether or not a mother experiences postpartum anxiety.

For the mother, rapid changes in estrogen and progesterone

  • Sleep deprivation
  • Relationship changes
  • New responsibilities
  • Societal expectations, like the idea that you should be a perfect parent
  • Personal or family history of anxiety
  • Personal history of depression
  • Personal history of PMS symptoms like feeling weepy or agitated
  • Past miscarriage or stillbirth
  • History of obsessive-compulsive disorder (OCD)
  • History of eating disorder

Treatment for Postpartum Anxiety

The treatments for postpartum anxiety are heavily dependent on each person’s needs and feelings. While medication may be the answer for one person, another person may find that lifestyle and behavioral changes help instead. Some treatments for postpartum anxiety include:

  • Cognitive-behavioral therapy
  • Lifestyle changes- more sleep, less caffeine, healthier diet
  • Relief from parenting duties
  • Meditation and mindfulness
  • Regular exercise

Postpartum Psychosis

Postpartum psychosis is an extremely dangerous mental illness and should be considered with utmost seriousness. MGH Center for Women’s Mental Health states, “[Postpartum psychosis] is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth…onset of symptoms as early as the first 48 to 72 hours after delivery. It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.”

Postpartum anxiety, depression, and psychosis are all serious postpartum mental illnesses. If you feel that you or someone you know are experiencing any of the symptoms listed above, contact your mental health professional or your OB/GYN right away.

If you ever feel you need immediate support or help, you can contact The Substance Abuse and Mental Health Services Administration.