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• significant hormonal shifts

• physical recovery process and/or pain

• body changes

• sleep deprivation that makes it difficult to think clearly and respond to stress effectively 

• major life transition 

• influx of intense responsibility 

• loss of your old structure and routine 

• lots of time to think and ruminate but no true “down time” 

• uncertainty

• social isolation

• relationships under stress (ie. learning how to co-parent with your partner, learning how to navigate grandparent dynamics)

• loss of control

• career and identity shifts (ie. "I have to adjust to this mom thing but I also have to return to work shortly” or "I have mixed feelings about the fact that I'm not returning to work" or "Why am I so excited to return to work?" or "I'm dreading returning to work, I need more time")

• endless questions, often without immediate clear answers (ie. Why is my child not eating? Why is he crying more than he usually does? Why did she sleep a three hour stretch yesterday but today only a two hour stretch? Is my baby happy? Am I happy? Why does my baby hate being in the car? Is my baby gaining the right amount of weight at the right speed? Is this normal?)   

 

Some parents may be simultaneously dealing with birth trauma. Others are navigating an infant’s health challenges or facing other ongoing life stressors. 

 

While there can be so much joy and wonder during the postpartum period,  all of above conditions can also create fuel for anxiety. This can make this time feel so uniquely overwhelming. 

 

Having some anxiety as a new parent is adaptive. Anxiety motivates us to take precaution and helps us remain vigilant when caring for a vulnerable infant. Anxiety keeps sick visitors away from a new baby and pushes us to call the pediatrician when something is not right. We almost need to be at least a little bit anxious as we adjust to parenthood. As a new parent, it is expected that your thoughts, feelings, and energy will be focused on keeping your tiny human(s) alive and well. You are fine-tuning your “alarm system.” You are learning what is normal and what is not normal and you are developing a whole new body of knowledge. 

 

At the same time, sometimes people find that their anxiety is starting to feel unmanageable or interfering with their functioning and quality of life. Sometimes anxiety becomes so consuming that a new mom finds herself crying throughout the day for several weeks at a time or not having an appetite even when she has a few moments to eat. Or a new dad is having persistent, intrusive thoughts about the safety of his child, thoughts that are unwanted and distressing. 

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Postpartum anxiety

 

Postpartum anxiety is characterized by persistent worry, fear, or dread that impacts quality of life or ability to function on a regular basis. Some symptoms of postpartum anxiety include:

• feeling restless, keyed up, or on edge

• feeling irritable (or angry or enraged)

• a sense of dread or hypervigilance

• appetite changes (eating more or less than usual)

• difficulty sleeping or resting, even when opportunities to sleep are present

• rumination or relentless thought loops with no clear resolution

• a sense that "something is wrong" or "something bad is going to happen" even when everything seems to be ok

• worry interferes with being present and enjoying time with children or family​

• some new parents develop depression secondary to their anxiety because they feel so trapped in worry, fear, and dread. 

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This kind of anxiety can also be experienced during pregnancy. Some parents report that anxiety began before the baby was born, while others report symptoms truly began in the postpartum period. 

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Those struggling with postpartum anxiety may find that their worries and fears seem to jump from topic to topic. These worries and fears often focus on the wellbeing and safety of the child. For instance, a new mother may find herself worrying about the baby’s breathing, the temperature of the nursery, whether or not the baby will sleep and for how long, how serious a diaper rash is—all in the same afternoon. Many parents are concerned about these things, but it is the duration and severity of the worry, the relentlessness, that distinguishes postpartum anxiety. 

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​Postpartum OCD

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Postpartum OCD is characterized by intrusive thoughts, images, or impulses that are unwanted and distressing. We call these intrusive thoughts obsessions. The sufferer responds to these obsessions by engaging in compulsions to try to get rid of distress. (Note: you can also struggle with any and all of these symptoms during pregnancy and even for long periods after the birth of your child.) Intrusive thoughts during pregnancy and postpartum are very common and having intrusive thoughts does not mean you have OCD. However, if you begin to respond to the intrusive thoughts in ways that make your life smaller (ie. avoiding activities, engaging in compulsions to prevent harm, or repeatedly seeking reassurance) and if you find the intrusive thoughts to be highly disruptive and pervasive, you may be struggling with OCD. 

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Anxiety, fear, and efforts to resolve uncertainty are all huge parts of OCD. The following are just a few examples of how OCD can manifest during pregnancy:

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• Obsessions about chemicals and cleaning solvents impacting the health of the baby

• Obsessions about environmental contaminants (third-hand cigarette smoke, pesticides in the park, etc.) impacting the health of the baby 

• Obsessions about eating food or ingesting substances during pregnancy that contaminate the baby (listeria, toxoplasmosis, etc.) 

• Obsessions about inadvertently sending “bad energy” or negative emotions to the baby 

• Obsessions about whether or not the pregnant person or partner will be “good parents”

• Obsession with maintaining order or engaging in superstitious rituals to protect the health of the baby 

• Obsessions about harming the baby in some other way (accidentally consuming alcohol, encountering germs, contracting Zika virus, taking harmful medication, etc.) 

• Obsessions about what the child will be like or intrusive thoughts about whether or not the child is truly your child, despite knowing rationally that the child is yours 

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After birth, OCD sufferers may experience other kinds of intrusive thoughts such as:

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• Obsessions about unintentionally harming the child (fears of dropping the child on a hard surface or tripping down the stairs, fears of the child choking or fears of feeding the child incorrectly, etc.) 

• Obsessions about intentionally harming the child (note: these obsessions are experienced as distressing and against the person’s values, though OCD will make you doubt your values and intentions! Some examples might include intrusive thoughts about throwing the child out the window or veering the car off the road, intrusive thoughts about “snapping” and hurting the child in some way, or fears of touching the child inappropriately)  

• Obsessions about the physical health and safety of the child  

• Obsessions about whether or not the child is happy and doing well emotionally  

• Obsessions about whether or not one is doing parenthood correctly/feeling the right feelings about parenthood/making the right decisions in parenthood

 

If you are experiencing any of the symptoms above, know that a) this is not your fault, b) you are not weak or damaged for struggling in this way, and c) there are treatments available to help you find your way through this major life transition. This all applies whether this is your first experience with parenthood or whether you find yourself struggling the second or third time around. 

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Seeking Treatment?

 

I use CBT-informed, evidence-based treatment, including Exposure and Response Prevention and Acceptance and Commitment Therapy, to help clients with perinatal mental health concerns. These treatments balance structure and concrete tools with space to explore and sit with the complexities of becoming a parent. You will learn how to change your relationship to your anxiety and pull back on behaviors that make anxiety worse. I am committed to creating a space where you can say any thought (even the scary, intrusive, disturbing ones) or share any feeling about parenthood out loud without fear of judgment. I take a holistic perspective that integrates your many identities and values and I honor the fact that becoming a parent and parenting a child can take so many different forms. There is no one right way, but new parents should not suffer with overwhelming anxiety and intrusive thoughts alone. 

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