Postnatal anxiety

What is postnatal anxiety?

Many people who have given birth will experience mild mood changes after having a baby. This is sometimes known as the ‘baby blues’ and usually only lasts for a few days.  

Having anxious thoughts and worries now and again are natural, particularly in the early weeks after having a baby. For example, you may worry that something will happen to the baby or that you will do something wrong. However, these feelings tend to get less intense as you start to get used to taking care of a newborn, usually after 2 or 3 months. Postnatal anxiety is different in that it tends to be more distressing and persistent (doesn't go away).

Many new parents find it hard to talk about any negative feelings because they feel under pressure to be happy and think that everyone else is doing fine. But postnatal anxiety is a common mental health condition that needs treatment and non-judgemental emotional support. It’s important to talk to someone about how you feel. This could be your midwife, health visitor or GP. 

Anxiety is a feeling of unease, worry or fear, that can be mild or severe. People with anxiety often (but not always) have thoughts and worries that things have or may go wrong in some way.

Everyone feels anxious sometimes, but some people find it hard to control their worries. Some people with anxiety also have panic attacks, which can be very frightening.  

Some parents may develop other types of anxiety conditions such as post-traumatic stress disorder (PTSD), perhaps because they had a traumatic birth.

Some people develop obsessive thoughts and compulsive behaviours because of their worries or anxieties. They may also have intrusive thoughts of accidental or intentional harm coming to the baby. This is known as obsessive-compulsive disorder (OCD). 

Anxiety can also be part of postpartum psychosis, although this condition is rare and involves lots of other symptoms that are not found in anxiety problems.  Find out more about postpartum psychosis.

How common is postnatal anxiety?

You may already know that you can become depressed after having a baby (known as postnatal depression). But postnatal anxiety is also very common. In fact, recent studies have shown that it may be even more common. Up to 1 in 5 women develop mental health problems during pregnancy or in the first year after childbirth, including anxiety.  

Some people may also assume that it’s only the parent who gave birth that can be affected. But dads and partners can develop anxiety during their partner’s pregnancy and afterwards too. Having a new baby is a huge life change that can affect any parent in both positive and negative ways. Don’t be too hard on yourself if you’re finding it difficult to adjust.

What is the difference between postnatal anxiety and postnatal depression?

Postnatal depression involves feeling constantly sad or low for more than 2 weeks. You might also find it hard to concentrate, lose interest in things you usually enjoy, or have feelings of guilt, hopelessness, self-blame and no confidence in yourself. If you have anxiety, you are more likely to have persistent and excessive worries and physical symptoms, such as an inability to relax or panic attacks.

Although things have improved, there can still be issues with health professionals identifying this type of anxiety. Research by the Royal College of Obstetricians and Gynaecologists (RCOG) reported that many women have felt that their healthcare professionals dismissed their symptoms because they didn’t fit into the traditional classification of postnatal depression.  

It is possible to have depression and anxiety at the same time. But if you have postnatal anxiety, it is important that this is recognised and that you have the support you need to manage your symptoms. 

What are the symptoms of postnatal anxiety?

It may be difficult to spot some symptoms of anxiety because they are like common things most new parents feel. For example, you may have trouble concentrating or sleeping.

If you have anxiety, you may also feel:

• anxious all or most of the time and not be able to control it
• restless or worried
• a sense of dread
• irritable
• constantly on edge. 

Anxiety can also affect your behaviour. For example, you might avoid certain places, doing certain things or even denying certain feelings because they feel threatening. You may be being overly careful or asking for reassurance again and again from loved ones or healthcare professionals. 

Some people who have anxiety can also have panic attacks. These can come on very quickly and for no apparent reason. Most panic attacks last for between 5 and 20 minutes. They can be very frightening, but they are not dangerous as anxiety is a normal emotion.  During a panic attack, you get a rush of intense mental and physical symptoms. These can include: 

Symptoms of a panic attack can include:

• a racing heartbeat
• a feeling of dread or fear of dying
• chest pain
• shortness of breath
• dizziness.

Anxiety UK says that if you can answer yes to most of the following questions you may be affected by postnatal anxiety: 

• Have you found yourself overly worrying that your baby is in danger?
• Have you found yourself imagining your baby coming to harm?
• Have you found your concerns over your baby’s safety are affecting your daily life?
• Have you experienced repeated panic attacks?

If you feel your anxiety is having an impact on your wellbeing and is excessive it is worth asking for help from your GP or health visitor.

What causes postnatal anxiety?

Anybody can develop anxiety. But if you already have an anxiety disorder or you are someone who worries a lot, you may be more likely to develop anxiety in pregnancy and/or after the birth because this can be a particularly stressful time. 

As new parents, you are likely trying to cope with things like:

• learning how to look after your new baby
• being responsible for your baby’s health and wellbeing 
• a lack of sleep
• a changing relationship with your partner
• financial pressures.

Learning to adjust to life as a new family can also be harder if you don’t have good support networks in place, such as friends or family living nearby. You might be dealing with particular stress such as an unwell child or other life events. This does not mean that your anxiety is not real or that support will not help.

You are also more likely to experience anxiety if you:

• are female
• have a family history of anxiety
• had problems in childhood, such as parental problems or bullying
• have experienced physical or emotional trauma or abuse
• have a long-term or painful condition
• have been under extra stress due to things like relationship problems, money worries or unemployment 
• had a complicated pregnancy or birth. 

If you have lost a baby before, this can also increase your chances of developing postnatal anxiety and postnatal depression. 

What can I do if I think I have postnatal anxiety?

It may be helpful to talk to a partner, family member or friend about how you feel. They may be able to support you emotionally and practically. For example, they may be able to look after the baby so you can try and sleep.

It may also be helpful to talk to other parents. Sometimes this can be reassuring and help you put your feelings in perspective. It can also help some parents realise that what they are feeling is more severe and that they need more support.

It’s also important to tell your health visitor or GP how you feel. It can be hard for some people to talk about this but try to remember that your healthcare professionals won’t judge you. They understand that anxiety is a mental health condition. It is not your fault, or something that you just need to ‘get over’ or move on from. They will focus on helping you find the right treatment and support so you can take care of yourself and your baby. 

If you find it difficult to talk about your thoughts and feelings, you could write down what you want to say first, or you may want to have someone with you during the appointment. The important thing is to let someone know so that you can get the right help as soon as possible. If you prefer, you can refer yourself for an initial assessment with talking therapies services without seeing your GP. There is more information about this below.

Some parents worry that if they ask for help for their symptoms, people will think they can’t care for their baby and they will be taken away. 

These are natural feelings and any anxiety is understandable. But social services try to work to keep families together. They will never take a baby into care just because a parent has a mental health problem. Just because you have anxiety does not make you an unfit parent. Don’t be afraid to tell your doctor or health visitor how you’re feeling at any time. 

Your relationship with your baby

If you have anxiety, you may worry that this will affect your ability to bond with your baby. There is no reason to believe that anxiety will do this. If you are struggling, this usually improves with treatment.  

It’s important to know that some parents bond with their baby immediately, while others find it takes more time. Try not to put too much pressure on yourself. Talk to your health visitor or GP if you’re still finding it difficult after treatment. They can help you get the best support for how you’re feeling.

Find out more about bonding with your baby.

What are the treatments for postnatal anxiety? 

The main treatments for mental health difficulties such as postnatal anxiety are talking therapies, self-help, medication or a combination of these. What you are offered will depend partly on what your symptoms are, how severe they are and what’s available locally.

Applied relaxation

Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique needs to be taught by a trained therapist.

If you live in England, your GP or midwife or health visitor can refer you for talking therapies and applied relaxation. Or you can refer yourself directly to an NHS psychological therapies service (IAPT). Self-referral is not available in every part of the UK, but your GP or health visitor will be able to tell you what’s available where you live.

Talking therapies

Talking treatments are psychological therapies where you talk about your feelings with a trained therapist. This may be one-to-one, in a group, over the phone, with your family or with your partner.

Cognitive Behavioural Therapy (CBT) is an effective therapy for all anxiety problems. CBT helps you to learn tools to understand and challenge your negative or anxious thoughts and ultimately to do things you'd usually avoid because they make you anxious.

Guided self-help

Your GP or psychological therapies service may suggest trying a guided self-help course to see if it can help you learn to cope with your anxiety. You may be offered a CBT-based workbook or computer course in your own time with the support of a therapist.

Medication

If talking therapies don’t help, or if you’d prefer it, your GP may offer you medication. In most cases, the first medication you'll be offered will be a type of antidepressant (despite the name, these are also the main medication for anxiety problems).  

Most medicines, including antidepressants, can be taken while you're breastfeeding without harming your baby.  But it's always best to tell your doctor if you're breastfeeding before you start taking any medication. Your GP may also refer you to a more specialist service.

How can I manage my postnatal anxiety symptoms?

It’s easy to forget about yourself when you’re caring for a new baby, but it’s important to look after yourself too. Try to:

• accept and ask for help from those around you, such as friends or family
• do some gentle exercise, such as walking or swimming
• rest and sleep when you can – this can be difficult when you are trying to cope with sleepless nights but there are some things you can try
• talk to someone you trust, such as your partner, family or a friend about how you are feeling
• try not to smoke, which can make anxiety worse
• recognise that these feelings are not your fault
• avoid having too much caffeine as this can make you more anxious than normal and can also make your baby restless if you are breastfeeding  – try to limit your caffeine as much as possible.

More advice and support

There are charities that provide more support, advice and information for people experiencing anxiety. These include:

• Mind
• Anxiety UK
• Rethink Mental Illness
• No Panic
• PANDAS
• Birth Trauma Association
• Maternal OCD
• Maternal Mental Health Alliance

You can also ask your GP about local support groups for anxiety in your area, or search online for mental health information and support services near you.