by Raichal Reed
Imagine you have just had your newborn child. While you are holding them in your arms, you imagine every bad thing that could possibly happen to them in the outside world. Even worse, you imagine your own death, leaving them to fend for themselves. Then weeks later, you are suddenly having unwarranted panic attacks once going back to work for the first time since the infant was born. Even after taking more time off, the idea of going back to work at all has now become a fear. The idea of leaving the house has become dangerous, and now you have lost the ability to go outside even in the backyard without panic rising in your throat. You’ve been to a doctor (because your partner or family dragged you) but the medication doesn’t work because you aren’t depressed, you are just afraid of everything you can’t control outside of the house.
Some birthing people deal with thoughts like these obsessively and sometimes worse thoughts leading to hospitalization or medical treatment. A certain level of worry is normal due to a changing body, worries about new additions to the family, parenthood for the first time, etc. Due to this, a lot of birthing people are not able to be diagnosed or tested properly until after 6 weeks postpartum where, at that point, they are no longer seeing their physician. Postpartum Anxiety Disorder (PAD), as of the time of this article, does not have a standardized definition nor a proper scale or testing for confirmation of the condition. The closest we have gotten currently has been in the Diagnostic and Statistical Manual of Mental Disorders which defined PAD as, “an excessive worry about a variety of topics that is hard to control and interferes with day-to-day activities”. It is associated with at least 3 physical and/or cognitive symptoms, such as: edginess, restlessness, tiring easily, impaired concentration, and irritability.
Anxiety disorders are actually of a higher incidence rate in the general population than any other mood disorder. Generalized anxiety disorder (GAD) has been found in case studies to be as high as 17.1% and postpartum depression has reduced to 4.8% on average. Just like with depression, a certain amount of “baby blues” is considered normal; there is a certain level of worry that is normal in the pregnancy and postpartum. Some risk factors for GAD in pregnancy specifically are: a history of GAD outside of pregnancy, lower education, personal history of child abuse, and a history of PTSD (which actually doubles your chance of having GAD). According to a 2013 study by Astrid George and their colleagues, “59.3% of the women who were anxious at the prenatal phase remained anxious after birth”.
Currently, there are two ways of testing for postpartum anxiety. The Edinburgh Scale is commonly used for postpartum depression but questions 3-5 ask questions about anxiety. Due to this, some medical providers use those questions as a way of diagnosing postpartum anxiety. A lot of individuals will score low on the Edinburgh test overall, but have very high marks on those questions specifically. So they slip through the cracks because the test is for depression. The Generalized Anxiety Disorder (GAD-7) test is a test of seven questions that is used for diagnosing anxiety in daily life, but now has been used for perinatal and postpartum anxiety. A score of 5 is titled mild anxiety, a score greater than 10 is considered generalized anxiety, and a score of 15 is treated as a severe level of anxiety.
Treatment for postpartum anxiety has been shown to work both in person and via telephone/virtual therapy means. The two types of therapy that have been proven to work in clinical trials have been: cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) with a 95% success rate. IPT is a time limited/cognitive based therapy that focuses on communication and social support (emotional, spiritual, cultural, etc.), which typically lasts for 12 to 16 weeks. Cognitive behavioral therapy is a short term treatment that is more goal oriented and hands-on to change patterns of thinking or behavior. These treatments have been studied at a greater rate because more and more individuals are refusing medications for manageable mood disorders. In a study from the Hong Kong College of Psychiatrists in 2015, about 30.8% of patients refuse prescription medication, which can lead to a large group of birthing people not getting the care they need.
Studies found that any use of coping strategies alone, both before and after birth, declined at 2 months postpartum. When left untreated, postpartum anxiety can continue on to psychosis and/or depression. A case study on the progression of anxiety to psychosis by Vesna Plrec found that a direct link where it moves from manageable to harmful is not clear, but a few things will, in fact, tip the scale. Insomnia has been found in 42% of cases of postpartum anxiety. After an average of ten days without sleep, suicidal ideation begins in a last effort to “get rest”. Oxytocin is a powerful hormone and linked to hormonal homeostasis in the individual. Cessation of breastfeeding can worsen anxiety and progressively lead to paranoia about the infant’s health. If treatment is not enough, then certain serotonin reuptake inhibitors can assist in helping the birthing person find hormonal balance.
Hormonal imbalances are common and in most cases easy to manage with encouragement and understanding. For those who struggle in the perinatal and postpartum period, it is important to advocate for proper testing so they get the help that they need. Screening should be done for depression and anxiety repeatedly throughout the perinatal period and into the postpartum. This is because there are a very low percentile (average of 2%) of people who had no anxiety symptoms at all prior to delivery.
Bina, R., & Harrington, D. (2016). The Edinburgh Postnatal Depression Scale: Screening Tool for Postpartum Anxiety as Well? Findings from a Confirmatory Factor Analysis of the Hebrew Version. Maternal And Child Health Journal, 20(4), 904–914. https://doi-org.atxlibrary.idm.oclc.org/10.1007/s10995-015-1879-7
Chung, J. P. Y. (2015). Interpersonal Psychotherapy for Postnatal Anxiety Disorder. East Asian Archives Of Psychiatry: Official Journal Of The Hong Kong College Of Psychiatrists = Dong Ya Jing Shen Ke Xue Zhi: Xianggang Jing Shen Ke Yi Xue Yuan Qi Kan, 25(2), 88–94. Retrieved from https://search-ebscohost-com.atxlibrary.idm.oclc.org/login.aspx?direct=true&db=cmedm&AN=26118748&site=ehost-live&scope=site
George, A., Luz, R. F., De Tychey, C., Thilly, N., & Spitz, E. (2013). Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy And Childbirth, 13, 233. https://doi-org.atxlibrary.idm.oclc.org/10.1186/1471-2393-13-233
Jordan, V., & Minikel, M. (2019). Postpartum anxiety: More common than you think. The Journal Of Family Practice, 68(3), 165. Retrieved from https://search-ebscohost-com.atxlibrary.idm.oclc.org/login.aspx?direct=true&db=cmedm&AN=31039214&site=ehost-live&scope=site
Pirec, V. (2018). What Can Happen When Postpartum Anxiety Progresses to Psychosis? A Case Study. Case Reports In Psychiatry, 2018, 8262043. https://doi-org.atxlibrary.idm.oclc.org/10.1155/2018/8262043
Raichal Reed – ” So my name is Raichal Reed I am a 24 year old, fourth year student midwife originally from South Mississippi now residing in Central Texas. I’ve always been in love with the birthing world ever since childhood and decided in the second grade I was going to work with women and children. Coming to Texas I found that midwifery was regulated and decided to take that route instead of medical school after receiving my Bachelors in Sociology/Pre-Med. I am the current volunteer director for Giving Austin Labor Support, a non profit of volunteer doulas, and a midwife student to two wonderful Midwives (one CPM and one CNM).”