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What is pre and postnatal anxiety? Understanding perinatal mental health

Most people know that we often feel anxious during pregnancy and after having a baby but very few people will tell you why this happens and how you can look after your mental health in the perinatal period as you live with this anxiety. In this article, we look at the good reasons you have to feel anxious in the perinatal period and how you can make sure this anxiety stays in perspective.

A woman struggling with perinatal anxiety slumped against her sofa looking worried

Why do we get anxious in pregnancy and early parenthood? Understanding perinatal mental health

There are lots of jokes about over anxious new parents checking everything a thousand times and the most common piece of advice I was given before having my first baby was “relax and try to enjoy it”. The reason everyone says this is because they know from their own experience that it is impossible to be truly relaxed when you first bring a tiny, mewling, helpless little life home with you. In those first few days and weeks most people know that you have to make an effort to take a few minutes away from googling “ways to prevent infant death” to breathe in the new baby smell.

What most people annoyingly do not acknowledge is that your anxiety as a new parent is not irrational. You are not hysterical, you are not suffering from “panic disorder” even though you may be showing many of the clinical symptoms of panic while making your morning cup of tea. You are actually completely, sensibly aware of the ridiculous vulnerability of your newborn and that is terrifying. Here are some good reasons to feel very anxious after having a baby.

Good reasons for perinatal anxiety

1. They are unable to protect themselves from harm so you have to do it. That means mastering a whole host of new skills while sleep-deprived. Everything from car seats to safe sleep protocols is on you. If they have siblings it is also your job to thwart toddler assassination attempts. First time parents may laugh but anyone else whose ever had to do the A&E walk of shame with their newborn after a toddler has smacked them on the head with a full beaker (thankfully she missed the soft spot) will know the horror that I’m talking about. In order to achieve your goal of keeping your new born alive it is therefore helpful during the first few days to develop “hyper vigilance.” This basically means constantly having your threat detection system turned up to maximum levels, all of your senses focussed on looking for anything that could possibly cause your child harm. Usually hyper vigilance is considered a symptom of “disorder” as if you have become really good at it you will find it is impossible to relax, sleep evades you even when the baby is sleeping peacefully, going out is far too overwhelming to contemplate with the myriad of new hazards that exist in the outside world and you are likely to become irritable and exhausted. Immediately after having a baby however this unpleasant state of being is a requirement.

2. They are completely dependent on you for EVERYTHING. So if you die they will die. So you had better not die. There is something about bringing new life into the world which reminds you of the transience of our time on earth. Certainly for me watching my babies enter our world reminded me that one day I will have to exit it. Unfortunately, at the same time you have become acutely aware of the first point in this list. You are therefore unlikely to be in the mood to accept that your death is all “part of the flow of life” etc. Instead you are more likely to obsess over what would happen to your babies if you died in x, y or z horrific manner. Once again, dwelling on death would often be seen as pathological but it  is kind of sensible as a new parent. You need to get your life insurance and will in order and you need to take good care of yourself. Now is not the time to go bungee jumping. Now is the time to drive at 60 mph on the motorway.

3. They don’t have an immune system. I have acute experience of this one.  In his fist two months my son contracted two separate and apparently unrelated viruses that caused his tiny little system to falter. I am so grateful for the fact that the swift and thorough actions of the NHS have meant that I currently have a healthy, chubby little boy sleeping in his bouncy chair beside me as I type this morning. It is clear to me however that, at least for the next few weeks, anxiety is my friend as it is my anxious mind that reminds me to take Leo’s temperature when he seems a bit fractious and it was this instinct that prevented him from getting much more seriously ill.

4. Trauma leaves us anxious. Lots of parents experience some kind of trauma either during the birth of their babies or in a the first few weeks after having a baby. We often feel traumatised by events that shatter our view of ourselves, the world or other people. We are especially likely to be traumatised by events that felt out of our control or that we didn’t understand. I am a little bit traumatised by Leo’s hospital experiences. Watching him looking so poorly in his hospital bed, his temperature and heart rate inexplicably rising in front of my eyes, his refusal to feed when my instincts were telling me he must really need milk, hearing his screams as he was injected and sampled. All of this laid his frailty bare to me and called into question my belief that I could keep him safe. I realised that underneath his adorable fox baby gro he is just a tiny little man trying to stay alive and there are some hazards I can’t protect him from. As a result I have been experiencing some of the common symptoms people go through after a traumatic event. These include hyper vigilance (old friend, never really left me), difficulty sleeping, avoidance of triggering situations and uninvited memories that feel like “reliving” the incident. For me I think these symptoms are likely to go away within the next few weeks. The memories are already fading and they no longer transport me straight back to the worst moment and leave me there. Instead I can see them as the middle of a story with a happy ending. For many people however it can be hard or impossible to get rid of the effects of trauma on their own, especially if they were not helped to understand what happened and why. Our brains like our memories to make sense as stories and it can’t feel them away properly if we don’t understand what happened to us. These people are often diagnosed with PTSD. Thankfully we have some extremely effective therapies for PTSD at our disposal. I have training in both EMDR and Cognitive Behaviour Therapy for PTSD and I just wish more new parents who have experienced trauma were aware of the benefits of these therapies. You can read more about I offer here. For more information about trauma treatment in general check out this information provided by MIND.

The body and mind actually work together to make sure that you do feel some of the "symptoms" of anxiety more frequently during pregancy and the postnatal period. Hormones that we produce at this time help us to feel more vigilant, alert and protective while we and our babies are vulnerable. There is also plenty of evidence that "The Body Keeps the Score" and when we go through something traumatic, such as a difficult pregnancy or birth, the body may keep responding with its fight or flight response. Therapies that help your body to realise that you and baby are safe in the present moment may also be helpful. Interventions such as yoga, somatic exercises and deep tissue massage have an emerging evidence base. Although as a Clinical Psychologist I can't recommend these until we have a stronger evidence base the theoretical link between the body and mind makes perfect sense to me so if you generally find touch and/or movement soothing then adding yoga, massage or something similar into your self-care routine may be worth exploring too. Here is an example of a promising study.

I don’t like my perinatal anxiety. What can I do about it?

So knowing that anxiety is natural and helpful at times is one thing. But it can also be unhelpful, unpleasant and at times debilitating when it gets out of control. You do not have to live in an anxious miasma just because you are now a parent. You can use your anxious parent super powers for good while feeling strong and confident it just might take a bit of work. Here are some suggestions:

  1. Perinatal mental health first aid 1– you need to switch off your threat system and calm down the fight or flight response. A shortcut to doing this in stressful situations is through your breathing. Close your eyes and imagine you are looking at a traditional clock face clock face with both hands set to 12. Breathe in through your nose to the count of six, breathe out to the count of six through your mouth and as you do imagine the big hand is moving to number 1 on the clock face. Continue watching the hand move with each out breath until both hands are back at 12. You will feel calmer because your body knows that you are not under physical threat if you are focused on your breath so will stop pumping you full of stress hormones.

  2. Perinatal mental health first aid 2 – reach out to someone you trust for a hug and a chat. We are designed to raise children in groups (more on that in my next blog) and anxiety rises when we feel isolated so get yourself some emotional support if you can. It can be hard to break out of the cycle of nappy changing, sleeping, washing etc to make the effort to be social but your anxiety will reduce if you can manage it.

  3. Consider Therapy - I am a firm believer that a little bit of time to talk, reflect and take charge of our lives helps us all. You don’t need a diagnosis to benefit from therapy just the desire to change something about your life or the way you feel. If you aren’t enjoying parenthood as much as you would like to, whatever the reason, therapy could really help. If you are in the UK then speak to your GP about what is available through NHS services. If you would prefer private therapy I offer in person and remote sessions so please get in touch. It is important that you get the right therapist for you so after having a chat I will help you work out whether I can help or whether I can recommend something else.

  4. Still pregnant? Tune up your mental health for the challenges ahead. My free substack offers practical exercises and mental health tips specifically for pregnancy.

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