Genevieve Ryczek, a mother of two in Minneapolis, experienced what she describes as a “birth high.” After a short, but physically intense labor, she was elated with new motherhood and full of energy. While recovering in the hospital, she didn’t sleep a wink. She didn’t feel she needed to.
But by day three postpartum, Ryczek experienced a complete crash. Still sleepless, the feelings of energetic euphoria were suddenly replaced with exhaustion and agitation. This abrupt change quickly spiraled into full-blown panic.
“It hit me like a ton of bricks,” Ryczek says. “It was like nothing I’d ever experienced before. Everything felt strange and unreal. My husband seemed different. My house seemed different. I seemed different.”
Terrified, she went to the emergency room, but the chaotic environment only intensified the anxiety, as did the triage nurse’s persistent questioning as to whether Ryczek felt she was a threat to herself or her baby. Though dark thoughts were not yet a part of the picture, they caught like wildfire with each well-meaning question.
She ended up leaving the hospital without a complete assessment, somehow managed to struggle through the night and sought help from her psychotherapist the next day. Given the sudden severity of Ryczek’s condition, medication was recommended immediately.
Throughout pregnancy, Ryczek had “done everything right.” With a history of anxiety, she dutifully went to preventative talk therapy. She practiced yoga and meditation. She ate a balanced diet. After all of this, the suggestion to medicate felt like failure. The health that she worked so hard to maintain had slipped away somehow, and she worried about the implications of taking psychotropic drugs. Would they interfere with breastfeeding? Would she be on them forever? Would they change her personality?
Now she was not only experiencing the shortness of breath, dizziness and relentless worry associated with anxiety, but doubt over treatment as well. The yoga, medication and years of therapy seemed lost on her the second she experienced this episode and felt incapable of making a decision.
Misdiagnosed and misunderstood
One of the reasons Ryczek found this situation so frightening was that she truly had no frame of reference for this sudden onslaught of extreme anxiety. Although she had struggled with general anxiety and panic before becoming pregnant, she remained unaware of the specifics of this perinatal mood disorder.
The general public now has a significant awareness of postpartum depression, but that awareness tends to be somewhat misguided and confused. Furthermore, other postpartum mood disturbances are rarely a part of the conversation. Add to that the media’s tendency to sensationalize extreme and violent cases of highly rare postpartum psychosis, and you have a murky picture of “what might happen” to a woman after giving birth.
Women often hesitate to mention symptoms of anxiety because they have heard about only depression. They further hesitate because the dark thoughts that sometimes accompany postpartum anxiety bring about a fear of those extreme cases of postpartum psychosis. They fear being perceived as a bad mom. They fear that their baby will be taken away. And that fear spirals into panic.
When they finally find the courage to mention the symptoms, they’re likely to be told, “You’re a new mom! Of course you’re nervous!”
Further confusing the situation is the fact that this experience presents itself differently for each person. Though there are common characteristics, the anxiety can come on suddenly—as with Ryczek—or it can slowly build. A mother may develop obsessions and compulsions (postpartum OCD), or she may experience chronic panic attacks (postpartum panic disorder). Both fall under the umbrella of postpartum anxiety. What’s more, it is not uncommon to suffer from both postpartum anxiety and postpartum depression. The two conditions share several known symptoms and are—in a way—two sides of the same coin.
So we have this perfect storm: a mother unaware of postpartum anxiety as a real condition, a hesitation to seek help for fear of medication or accusation, the tendency to write off anxiety as new parent nerves, and a general inability to distinguish between postpartum anxiety, depression and everything else on the spectrum.
Is it anxiety, or is it depression?
Susan Rannestad, LM, CPM, CM, a midwife practicing in Gardiner, New York, suggests that the one common thread she sees amongst women suffering from postpartum anxiety is the inability to make decisions without guidance. “This mother always fears she is doing it wrong,” Rannestad says. It’s important to remember that the “classic” symptoms differ in each individual. An obsession could be an intense and disturbing fear of kitchen knives, or it could be a constant worry over the temperature of the room. Obsessions often lead to compulsions: hiding the knives, fussing with the thermostat repeatedly or perhaps overusing hand sanitizer.
Some of these behaviors fall into the category of new parent worry, but the frequency and intensity will be higher with true postpartum anxiety.
Remember, some of the symptoms of postpartum anxiety are similar if not identical to those of postpartum depression, and the two mood disturbances can comingle within the same individual. It is important to seek counsel from a trained professional experienced in evaluating postpartum mood disorders specifically.
By the numbers
Statistically, postpartum depression is still more common than postpartum anxiety. Postpartum Support International—an organization devoted to providing information, resources and connection for women dealing with perinatal mood disorders—estimates that 15 percent of new mothers will experience postpartum depression while 10 percent will experience postpartum anxiety. These numbers might be inaccurate, however. With postpartum depression often being used as a sort of blanket diagnosis for postbirth malaise, we might be underestimating incidents of postpartum anxiety. Of course, when women don’t seek help or—even worse—fail to realize that they are struggling with a mood disorder to begin with, the number becomes further distorted.
In her midwifery practice, Rannestad perhaps sees a smaller percentage of perinatal mood disorders than larger hospitals and obstetrics practices. This, she believes, is due to the nature of the midwife-patient relationship. She spends more time getting to know each woman both before and after birth. With greater support comes stronger mental health, as well as a tendency to screen for and catch possible problems early on.
Still, Rannestad has noticed a spike in anxiety issues. “This is climbing,” she says. Now, she sees it more than any other perinatal mood disorder.
New life, changed identity, increased responsibility, overwhelming love … bringing a baby into the world is a big deal for any parent. Hormonal highs and lows and exhaustion add intensity to an already heightened state of being. The situation is rife for mood disturbance.
The mounting pressure for women to have it all and do it all is also a contributing factor. Often, women return to work while still recovering from the physicality of childbirth. They are reading every parent-ing book, doing mommy-and-me yoga, running the PTA and putting in a 60-hour workweek. They are always on, always available—by text, email and social media. The standards have changed, and the “new normal” is taking a toll. Stay-at-home moms are not exempt from this sort of superwomen mentality. All new mothers tend to bite off more than they can chew. On top of that, extended families are fractured—both literally and metaphorically at a greater distance from one another than they were 50 years ago. The aunts and grandmas who used to come over with casseroles and burping tricks live in another state or are busy with their own careers.
Help me, help you
For the women in the throes of postpartum anxiety, immediate treatment is a must. In Ryczek’s case, that did not include medication—but not for long. This route isn’t recommended for everyone, and it is important to understand that relief comes in a different package for each individual, whether through talk therapy, exercise, support groups, sleep aids, caffeine elimination, spirituality, nutrition or various medications. There are many paths to wellness, and a therapist specializing in perinatal issues can help figure out the right combination.
Beyond the acute treatment of the individual, our culture—as a whole—could benefit from greater awareness, compassion and understanding. Knowing the signs and symptoms of postpartum anxiety can help a loved one get the treatment she needs. Avoiding judgement and lending a hand can help make a dark day seem brighter. Most importantly, working–as a society–to lift the stigma form mental difference and treatment and educating parents-to-be about the full spectrum of mood disorders will help new mothers feel unafraid to speak up and reach out.