Most new mums have never even heard of postnatal anxiety, but it could be more common than postnatal depression, says Becky Dickinson
It doesn’t matter how many books you read, or how many antenatal classes you attend, nothing can really prepare you for the responsibility of keeping another human being alive – of caring for a tiny, vulnerable person whose primary means of communication is crying.
And while the sleepless nights, sore nipples and physical effects of delivery can be painfully tangible, often it’s the inner churnings of the mind, those nebulous, corrosive thoughts that can leave us feeling overwhelmed and psychologically exhausted. Because however much you love your baby, looking after one can be, frankly, terrifying.
For some women, natural worry can quickly spiral into full-blown postnatal anxiety. This can manifest itself in many ways, such as not being able to sleep when your baby is sleeping, for fear they may stop breathing. Or avoiding contact with friends and family in case they pass on any germs. Even refusing to let your child travel in a car for fear of there being an accident.
Postnatal anxiety is something 41-year-old Sophie, mum to six-month-old Albie, can identify with only too well.
“About a week after the birth, I began worrying about my partner going back to work. My stomach was in knots, and I was retching all the time,” she says. “I lost loads of weight and felt like I couldn’t cope. I didn’t think I could look after him and thought he was going to die.”
Of course, most of us fret about whether our baby is warm, happy and healthy. But when these worries become an all-consuming world of worst-case scenarios, this can be a sign of something more serious.
Unlike postnatal depression (PND), many mums don’t even realise postnatal anxiety is a recognised condition, perhaps believing it’s a normal part of motherhood. But recent studies suggest it may be even more common than PND. According to the Royal College of Midwives (RCM) around 20% of women experience perinatal mental illness during pregnancy and the first year of their babies’ lives, and for many of these women, the main problem is anxiety.
Janet Fyle, midwife and professional policy advisor for the RCM, says there is a need for much greater awareness: “Postnatal anxiety is commonly overlooked by society and health professionals. There’s a lack of intervention, but the toll on women’s lives can be crippling.”
In her darkest moments, Sophie wasn’t even sure if she wanted to keep her son. “I bonded really well and loved him, and didn’t want anything bad to happen to him,” she says. “But I didn’t realise it would be so life-changing, I didn’t know if I was built for motherhood.”
Many mums will relate to the fear of not being able to protect their baby from harm – because only when we love someone so immeasurably, do we realise that love and fear go hand-in-hand. Yet when these worries interfere with everyday activities, it’s important to seek help.
Dr Christine Langhoff is a Dulwich-based psychologist, who specialises in perinatal therapies. She says: “It’s really normal to have an increased level of anxiety postpartum, and also during pregnancy. There is a change in responsibility and roles, and the lack of sleep can also impact levels of anxiety. But if it gets in the way of life or family life, causes significant distress, significantly decreases enjoyment or parenting, or impairs functioning, then it is recommended to seek help.”
Unfortunately, postnatal anxiety has received little attention, and is often mistakenly diagnosed as PND. But Dr Langhoff points out there are essential differences.
“In PND, often energy levels may be very low, there may be an overwhelming sense of sadness and it could be hard to do things, even getting out of bed could be tough. Anxiety is often more characterised by high energy levels, as in an inability to relax, restlessness, constant worries and often an array of physiological symptoms of anxiety such as shakiness, butterflies in stomach and sometimes even panic attacks.”
The key thing is not to suffer in silence, but to speak to friends, family and other mums. This can help normalise the feelings you’re experiencing. But if your worry seems excessive compared to that of others, speak to your midwife, health visitor or doctor.
The good news is much can be done to manage, or even eradicate the symptoms. For some women, medication helps. Sertraline, for example, can be prescribed for both postnatal depression and anxiety, and is compatible with breastfeeding.
Dr Langhoff also recommends psychological therapies. “Cognitive Behaviour Therapy (CBT) is very effective for anxiety disorders,” she says. “Moreover, the NICE guidelines would use this as a gold standard treatment approach. Other forms of psychological intervention also have good results for postpartum difficulties, such as compassion-focused therapy, acceptance and commitment therapy and group therapies. I generally see results with short-term therapy of six to 12 sessions, where postnatal anxiety is either resolved or manageable.’’
Meanwhile, Janet Fyle is passionate about debunking the myths and stigmas that surround maternal mental illness.
“Women play down their anxieties for fear of being judged. They want to be seen as ‘tough’ but women really do need to report these issues. They won’t be judged; they will be helped and pointed in the right direction so the condition doesn’t get worse.”
Fortunately, Sophie did seek help. Her symptoms have dramatically improved thanks to a combination of medication, CBT and mindfulness exercises, which have helped her to come to relish motherhood – despite the sleepless nights.
