Historically, anxiety is understood to be an ally; it is an internal signal that can serve to protect us, motivate us and alert us to danger. In these ways, anxiety reactions are understood to be adaptive and to a large extent, primal and instinctive. When people experience a dangerous or threatening situation, the fight-or-flight response kicks in. This survival response pumps adrenaline throughout the body, setting off a surge of physical changes such as rapid heart rate, palpitations or increased blood pressure. The purpose of this response is to prepare us for action. Most of us can recall a time in our lives when we responded this way, either to a very real threat or to a situation that we perceived as threatening to our well-being.
When we take a closer look into the restless mind of a new mother, we find an array of anxious responses that generally fall into three categories. First, there is the “all new mothers feel that way”, e.g. I wonder if she’s getting enough milk. These are anxieties that fit comfortably within a socially acceptable definition of “new mother anxiety.” Secondly, there is the “something must be wrong with me” axiom perhaps expressed as, I cannot leave the house until the baby is 6 months old. I heard that before they are 6 months old they are susceptible to mega-germs that can cause fatal diseases. I’ve tried to leave but I can’t breathe when I go outside, my chest starts pounding and tears pour out of my eyes. It’s just not worth it. These represent anxieties that interfere with functioning and require professional attention.
And third, by far the most common scenario, “Is this normal for me to feel this way?” are those anxieties that teeter between the two ends of the continuum.
The majority of women who seek professional support for symptoms of postpartum anxiety and depression are ones who find themselves wavering between the two extremes: Is what I am thinking normal or could I be going crazy? They know they are far more anxious than they’ve ever been before and wonder how much is too much anxiety. They worry that they are way too nervous, hypervigilant or obsessive, so much some days that they fear they might really be going mad. Thus, if we view this on a continuum, with “normal” anxiety at one end and severe, incapacitating anxiety at the other end, the preponderance of postpartum women who struggle with symptoms of anxiety fall somewhere between the two points, leaving a great deal of room for doubt and uncertainty.
It stands to reason that motherhood and anxiety would go hand in hand. The awesome responsibility and unpredictable nature of the role can combine in combustible fashion, leaving many women feeling vulnerable and unprepared. Nearly everyone, including the new mother and her surrounding loved ones and healthcare providers, expects some degree of anxiety to go with this territory. But this is a crucial part of the problem. It is often difficult to distinguish “normal” anxiety from that which may be a symptom of an anxiety disorder or an expression of postpartum depression. Most are not surprised or terribly concerned when the mother of a one week old infant reports that she is nervous about her baby’s well-being, or worried that he’s not eating enough, or wondering if he’s going to die from SIDS if she doesn’t go check on him throughout the night.
Another part of the problem is that healthcare providers more often than not dismiss early expressions of anxiety as par for the course. In addition, in spite of the current focus on postpartum mood disorders, the emphasis primarily remains on depressive symptoms. Women remain reluctant to express anxiety in general partly because it can feel so “whiny” or irrelevant. A woman’s urgent desire for relief is too often construed as neediness, a label that serves no purpose to a weakening spirit. Regrettably, many doctors reinforce this by referring to anxiety as merely a nuisance for the postpartum woman; something she just needs to get used to.
But make no mistake about it, at its worst, anxiety can be crippling, and within this context of postpartum women, it can be an crucial signal that requires further attention.Women should not be afraid to talk about it and seek help. Family members and healthcare providers must take the expression of anxiety seriously, they must stop responding with dismissive comments and they should feel obliged to help the mother find symptom relief either through self-help measures or professional support.
Posted with permission. Adapted by Karen Kleiman, MSW, LCSW, from "Dropping the Baby and Other Scary Thoughts" (Routledge, 2010) by Karen Kleiman and Amy Wenzel
Posted by Dr Renée Miller