What is Postpartum Anxiety (PPA)

Having a baby comes with natural worries, but postpartum anxiety takes it to another level. It can occur at any time within the first year after childbirth. New mothers face anxiety disorders more frequently than the general population, with a prevalence between 6.1% and 27.9% in the first 6 months after giving birth.

PPA is intense and uncontrollable, filling your thoughts all day and night. Your worrying persists and affects your ability to calm down. People with this condition typically feel constantly nervous, have irrational fears, or worry excessively about unlikely events.

Here are some examples of postpartum anxiety:

● Checking the baby’s crib every few minutes to ensure they’re breathing, even during naps.

● Constantly picturing worst-case scenarios, like the baby slipping during a bath.

● Losing sleep over worries that using the baby swing could somehow lead to harm.

PPA may occur from a significant drop in hormone levels after delivery, sleep deprivation due to constant newborn care, and a strong sense of responsibility for the baby. Challenges in breastfeeding or financial worries can add to the anxiety. 

Certain factors, such as anxiety before or during pregnancy, previous pregnancy loss or child loss, a health condition in the baby, lack of a supportive partner, young age, and much more, can increase the risk of PPA. 

Recent studies have found a potential correlation between the gut microbiome and Post postpartum anxiety (PPA). It has been suggested that alterations or imbalances in the gut microbiota may contribute to the development or worsening PPA.

This can be attributed to the fact that the gut microbiome is crucial in regulating the body's stress response, which can impact mental health. Furthermore, changes in the gut microbiome can lead to inflammation and immune dysregulation, which can further contribute to the development of anxiety and other mood disorders.

Therefore, maintaining a healthy gut microbiome is essential to promoting optimal mental health during and after pregnancy.

PPA can present itself with various signs and symptoms. Physically, you might experience difficulty sleeping, an increased heart rate, nausea, and loss of appetite. Emotionally, it might show restlessness, irritability, racing thoughts, and persistent fears. 

Additionally, you may find yourself avoiding certain activities or checking things repeatedly. These symptoms may be present throughout the day or only at specific times, day or night.

New moms often experience the “baby blues,” a brief phase of worry, mood swings, irritability, disrupted sleep, and sadness linked to a decrease in hormones after childbirth. These symptoms are typically mild and ease within a few weeks.

Postpartum depression (PPD), occurring within the first 12 months after childbirth, brings more intense and persistent symptoms. Many of them, such as difficulty sleeping and relaxing, excessive worry, loss of appetite, and restlessness, often overlap in both PPD and PPA.

Postpartum depression may make you feel very sad, often cry, and doubt your ability to care for yourself and your baby. It can be hard to find joy in parenthood, and distressing thoughts about harming yourself or the baby, as well as of death, can occur.

Postpartum anxiety is more about persistent worrying, not sadness.

Postpartum anxiety is linked to low self-confidence, difficulties bonding with the baby, a higher chance of postpartum depression, less breastfeeding, increased risk of infant abuse, delayed social skills, and a greater likelihood of anxiety in kids.

To diagnose PPA, healthcare providers rely on conversations and questionnaires during appointments to understand and evaluate your symptoms. You should be open and honest for an accurate diagnosis and effective support.

Your doctor will suggest the best treatment plan depending on your symptoms, health history, and whether you’re breastfeeding. Simple changes in the daily routine or talking to a counselor can help in mild cases. Effective therapies like cognitive-behavioral therapy (CBT) are known for treating anxiety disorders. There are other non-medication options. In more severe cases, medications can be helpful.

Now, let’s explore the treatment of PPA in more detail.

For mild to moderate PPA, the go-to treatment is cognitive-behavioral therapy (CBT). It’s a short-term, effective, often one-to-one approach (usually 12–16 sessions) that targets unhelpful feelings, thoughts, and behaviors. 

Through CBT, you can identify triggers for anxiety, avoid them, and develop alternative ways of thinking and reacting. Sessions typically involve a Q&A format to enhance stress and anxiety response. In some cases, sessions may include your partner to improve communication and support.

Getting affordable care and finding a therapist who knows a lot about postpartum anxiety can be a challenge in this situation.

Transitioning from CBT, let’s explore other effective approaches that also don’t involve medications.

Mindfulness is purposefully focusing on the present without judgment. Research supports widely known interventions, like mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) for the management of postpartum anxiety. MBSR combines meditation, body awareness, yoga, and reflection, while MBCT involves CBT and mindfulness meditation.

A systematic review of studies found these effective non-medication interventions against anxiety: yoga, music therapy, partner-performed massage, and CBT during pregnancy; aromatherapy and hydrotherapy during labor; kangaroo care with music therapy and massage postpartum.

In three trials, using lavender oil or bitter orange for aromatherapy significantly improved mood and reduced anxiety.

Here are more recommendations for non-medicated management of PPA:

● Seek help from family or friends with housework or babysitting, and consider joining a support group for new parents to share feelings and find understanding.

● Prioritize self-care through daily walks, yoga, and breathing exercises.

● Maintain a healthy diet and aim for as much sleep as possible, even by taking turns with your partner.

SSRIs (selective serotonin reuptake inhibitors) are widely used for moderate to severe postpartum anxiety, elevating serotonin levels in the brain. Your doctor will assess the risks and benefits before prescribing anxiety medication. Tapering is recommended to avoid withdrawal symptoms when stopping these medications. 

In addition to SSRIs, there are alternative medication options for managing postpartum anxiety. 

Certain medications can be transferred through breast milk; while some are considered safe during lactation, others may not be suitable. If breastfeeding, inform your healthcare provider to discuss the pros and cons of medication for PPA.

Here’s interesting information about breastfeeding. Research indicates that women who breastfeed are less likely to experience postpartum depression, possibly because of the positive effects of the hormones oxytocin and prolactin on mental health.

While stress isn't likely to affect your milk supply over the long term, it can temporarily affect the mechanisms that allow your body to deliver milk to your baby, and very high levels can impact the baby.

A lactation consultant, a trusted professional, can alleviate your worries and anxious feelings about breastfeeding. They are equipped with expert advice, tips, and instructions on making breastfeeding more accessible for you and the baby. 

Recognizing that this is often a significant concern for new moms, a lactation consultant is an invaluable resource for managing PPA. 

Breastfeeding is a beautiful way to foster a bond with your baby, but there may be instances where your medical provider recommends a medication that contradicts this feeding method, or your mental health indicates that you need a break. 

It's important to remember that considering alternative feeding methods is perfectly acceptable and can be a sign of your commitment to your baby's well-being.

Fortunately, many European baby formulas are available that have been carefully crafted to mimic breast milk as closely as possible. Bottle feeding can also promote a loving bond between you, your partner, and your infant.

A2 protein is a form of beta-casein found in human breast, goat, and cow's milk. European formulas containing A2 protein are a good option for supplementing or replacing breast milk.

Check Out Our Product Procurement and Review Process to see how to choose our recommended formulas. 

PPA varies for each person and doesn’t typically fade away on its own. The best way to recover is to seek help from your healthcare provider promptly. Don’t let worries about judgment stop you from reaching out for support. 

Postpartum anxiety is a common and challenging experience for new parents. Both moms and dads can go through it. Supporting each other and openly communicating can make a significant difference. 

Remember, seeking help is a strength, not a weakness. Celebrate small victories together, with The Milky Box, we are ready to support you.  

1. Ali, E. (2018) ‘Women’s experiences with postpartum anxiety disorders: a narrative literature review’, International Journal of Women’s Health, 10, p. 237. doi: 10.2147/IJWH.S158621.

2. Domínguez-Solís, E., Lima-Serrano, M. and Lima-Rodríguez, J. S. (2021) ‘Non-pharmacological interventions to reduce anxiety in pregnancy, labour and postpartum: A systematic review’, Midwifery, 102. doi: 10.1016/J.MIDW.2021.103126.

3. Mikšić, Š. et al. (2020) ‘Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression’, International journal of environmental research and public health, 17(8). doi: 10.3390/IJERPH17082725.

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