Postpartum anxiety disorders in new mothers are often missed. Read why. Also symtoms, strategies for managing postpartum anxiety.
To understand the various kinds of anxiety disorders that may accompany pregnancy and the postpartum period, it is helpful for you to first understand the kind of anxiety that nearly everyone experiences. People with anxiety disorders often report that others minimize, or brush off, their problems. This may occur because all people experience anxiety. Most people do not understand the difference between anxiety disorders and normal anxiety.
Anxiety is a part of our lives. It is a normal and protective response to events outside the range of everyday human experience. It helps us concentrate and focus on tasks. It helps us avoid dangerous situations. Anxiety also provides motivation to accomplish things that we may otherwise tend to put off. As you can see, anxiety is essential to our survival.
Anxiety is often described as a spectrum of feelings. Just about everyone experiences mild or moderate anxiety as we go about our work and play. When we have moderate anxiety, our heart rates increase minimally so that there is more oxygen available. We are alert so we can focus better on a task or problem. Our muscles are slightly tensed so we can move and work. Our production of hormones, such as adrenaline and insulin, is slightly elevated to help the body react. We can study for a test, prepare a report for work, give a speech, or hit the ball when we are up to bat. If we were completely relaxed, we could not concentrate or accomplish these tasks. Anxiety helps us meet the demands made on us.
relaxed/calm -- mild -- moderate -- severe -- panic
The subjective feeling we call anxiety is accompanied by a predictable pattern of bodily responses summarized in the continuum above. People with anxiety disorders have reactions, designed to help us escape danger, in situations that are not life threatening. The normal mechanism for initiating these responses goes awry for reasons we do not fully understand. When we have severe anxiety, we do not think well and cannot solve problems. Production of adrenaline is so high that it causes a sensation of a "pounding" heart, shortness of breath, and extremely tense muscles. We feel a sense of danger or dread. This fear may or may not have a focus. If we were facing a tiger, this level of anxiety would be helpful to us to fight or flee. However, if this level of anxiety occurs without a dangerous stimulus, this response is not helpful. Anxiety disorders differ from anxiety in general in that the experience or feelings are more intense and last longer. Anxiety disorders also interfere with the normal functioning of people at work, at play, and in relationships.
When we are faced with real or imagined threats, our brain signals the body that we are in danger. Hormones are released as part of this general alarm call. These hormones produce the following changes:
- the mind is more alert
- blood clotting ability increases, preparing for injury
- heart rate increases and blood pressure rises (there may be a sensation of the heart pounding and a tightness in the chest)
- sweating increases to help cool the body
- blood is diverted to the muscles to help prepare for action (this may lead to a light-headed feeling as well as a tingling in the hands)
- digestion slows down (this may lead to a heavy feeling like a "lump" in the stomach, as well as nausea)
- saliva production decreases (which leads to a dry mouth and a choking sensation)
- breathing rate increases (which may feel like shortness of breath)
- liver releases sugar to provide quick energy (which may feel like a "rush")
- sphincter muscles contract to close the opening of the bowel and bladder
- immune response decreases (useful in the short term to let the body respond to a threat, but over time harmful to our health)
- thinking speeds up
- there is a sensation of fear, a desire to move or take action, and an inability to sit still
Is Anxiety Normal for New Mothers?
All new mothers are somewhat anxious. Being a mother is a new role, a new job, with a new person in your life and new, responsibilities. Anxiety in response to this situation is very common. Pediatricians, obstetricians, and nurses are used to worries, concerns, and questions like yours.
However, for reasons we cannot explain, some mothers have excessive worries and experience a severe level of anxiety. Dori, a new mother, describes her anxiety:
I could not sit still or relax at all. My thoughts were racing, and I couldn't focus on anything at all. I worried constantly that something was wrong with the baby or that I would do something wrong. I had never felt this kind of anxiety before, but I didn't know if it was normal for new mothers.
As with Dori, mothers with severe anxiety have difficulty enjoying their new babies, and they are overly concerned about minor problems. They have unrealistic fears about doing something wrong to hurt the baby. Mothers with severe anxiety cannot relax when there is an opportunity to do so. Anxiety disorders are often missed in new mothers because of the belief that all new mothers are excessively anxious. If you find yourself meeting the criteria for any of the anxiety disorders described in this chapter, or if you are very uncomfortable for prolonged periods such as several hours, talk to your health care provider. Take this book with you and share your concerns, because not all health care providers are familiar with the criteria for anxiety disorders.