Postpartum anxiety is common yet we don’t hear of it as often as we do postpartum depression even though it results in “highly detrimental” and long-term effects on a mother and child. A woman is more susceptible to anxiety in the postpartum period than at any other time of her life. Rates of postpartum anxiety during the first six months postpartum range from 6.1 per cent to 27.9 per cent but the treatment rate is low because women aren’t being properly screened due to a lack of trained health care professionals and anxiety-specific screening tools.
According to a recent literature review by Elena Ali from the Faculty of Nursing at the University of Calgary that was published in the International Journal of Women’s Health, more studies are needed on postpartum generalized anxiety disorder (GAD), postpartum panic disorder (PD), postpartum obsessive compulsive disorder (OCD), and postpartum post traumatic stress disorder (PTSD). Ali reports that most women in the studies suffered from more than one anxiety disorder in addition to postpartum depression.
Women with postpartum depression often have symptoms of extreme guilt and sadness, low mood and loss of motivation that persist longer than two weeks. The most common symptoms of women with postpartum anxiety include loss, frustration, and guilt as well as physical tension.
For her review, Ali searched for qualitative and quantitative articles using MEDLINE, CINAHL, PsycINFO databases as well as reference lists. She searched for articles dating all the way back to 1803 and up to 2016 and found 795 articles, of which, only 14 met the criteria for her review. Thirteen of the fourteen articles were published after 1998.
To meet the criteria, articles had to be in English, include postpartum mothers with anxiety disorders, be qualitative, quantitative or mixed-method studies. They couldn’t be included if they focused on postpartum psychosis, postpartum depression or prenatal anxiety and didn’t include women’s experiences of postpartum anxiety. In the end, the experiences of 2,407 women in the 14 articles were collected via a survey or interview.
Women with postpartum anxiety were found to breastfeed less, and form less of an attachment with their infant. Children of mothers with postpartum anxiety were also found to be more at risk of infant abuse, delayed cognitive and social development, and to be at an increased risk of developing anxiety themselves. The women in the studies reported that they felt overwhelmed with the responsibilities of motherhood.
Women across the 14 studies said they felt misunderstood and alienated by health care practitioners because their symptoms didn’t fit the more commonly recognized postpartum depression diagnosis. Access to treatment was an issue they said, and peer support, when they could get it, was beneficial.
“When participants were able to speak to other women in similar situations,” reports Ali, “they found it invaluable: ‘not to feel like you are the only one who’s completely mad having a baby,'" reported one woman.
The prevalence rate of postpartum PD among women according to one study used for the review was 11 per cent but only 1.5 per cent were diagnosed with a panic disorder using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (version IV). Symptoms across the range of studies for postpartum PD included chest pain, palpitations, dizziness, tightening of the throat, blurry vision, amplified sounds, tingling in the extremities, sweating, trembling, feeling as they were going to die, and choking. One woman described it as feeling as if “somebody injected Coca-Cola into my veins”.
As for postpartum OCD, women who experienced this type of anxiety tended to have intrusive thoughts about intentionally or accidentally harming her baby and were afraid to come forward with their symptoms. In one study, as was the case with postpartum PD, 11 per cent of women screened position for postpartum OCD at two weeks postpartum but it can also develop months later. That same study showed an additional 5.4 per cent of mothers developed postpartum OCD six months later.
Many women with postpartum OCD are terrified of harm coming to their baby and either frequently bring them to the doctor for a check-up or refuse to let anyone else hold their baby. In one of the studies used for the review, a woman said, “I wish he (baby) was back in my belly.” Other women with postpartum OCD in the studies had frequent repetitious behaviour such as hand washing for fear of germs infecting the baby.
Postpartum PTSD most commonly occurred in women who felt extreme pain during labour or who experienced a loss of control. Symptoms included “panic, anger, thoughts of death, mental defeat, and dissociation during birth, as well as painful and intrusive memories during the postpartum stage.” Interestingly, childbirth does not make the criteria in the DSM-V for a traumatic event that could result in PTSD.
Ali found that studies to date have only been concerned with prevalence rates of postpartum anxiety and that more research by way of “robust longitudinal studies” is needed for postpartum anxiety in all its forms including its effects on on parenting and child development.
"Universal assessment for anxiety disorders has not been implemented as a routine part of postpartum care," concludes Ali. "Raising public awareness about postpartum anxiety disorders is also beneficial, so that new mothers can seek appropriate help should they develop symptoms of anxiety during the postpartum period.”
Patricia Tomasi is a mom, maternal mental health advocate, journalist, and speaker. She writes regularly for the Huffington Post Canada, focusing primarily on maternal mental health after suffering from severe postpartum anxiety twice. You can find her Huffington Post biography here. Patricia is also a Patient Expert Advisor for the North American-based, Maternal Mental Health Research Collective and is the founder of the online peer support group - Facebook Postpartum Depression & Anxiety Support Group - with over 1500 members worldwide. Blog: www.patriciatomasiblog.wordpress.com