By Damian Ternullo, M.D., F.A.A.P. — Pediatric Alliance, St. Clair Division
Clinical Spotlight: Postpartum Anxiety
Recently, I received an email from a close friend and parent of children that I follow and care for. In it, she described to me some symptoms that she was feeling after the birth of one of her last children that I hadn’t discussed with her at any of our regular well-child visits. After I received her email, I felt it was important to discuss postpartum anxiety, which affects many women after childbirth.
Perinatal/Postpartum Depression (“Baby Blues”) is the most common complication of pregnancy. Perinatal refers to around the time of birth and postpartum means after the delivery of an infant. An estimated 10% to 20% of women struggle with depression during pregnancy and after delivery. Some reports state that more than 80% of women will experience a mild form of sadness, fear, or anxiety after delivery. The American Academy of Pediatrics strongly encourages pediatricians to screen for postpartum depression. Although postpartum depression is common, the significant event of childbirth and changes in care/provider roles afterwards can very much be anxiety-provoking as well.
At Pediatric Alliance, we perform regular screenings for various issues, including postpartum depression, autism, lead exposure, tuberculosis risk, cholesterol screening, and standardized developmental screenings for certain age groups. The purpose of these screenings is to identify families and children at risk: those who may need further evaluation and intervention for the specific issues mentioned. We use a modified version of the Edinburgh Postnatal Depression Scale in our offices to screen for postpartum depression.
Postpartum Anxiety may actually be more common but less recognized. One reason is that it isn’t screened for as much as postpartum depression. One study that appeared in the journal Pediatrics in March 2013 looked at more than 1,100 women who delivered healthy full-term newborns. These women answered standardized questionnaires for both depression and anxiety. They completed personal interviews after delivery while in the hospital, and then answered follow-up phone calls at 2 weeks, 2 months, and 6 months postpartum. At baseline, 17% of the mothers had symptoms consistent with anxiety based on the standardized questionnaire. Women who underwent cesarean section had even higher rates of postpartum anxiety. Women who had positive scores for anxiety on the standardized screen were more likely to breastfeed for a shorter period of time. Of note, at every time point scores were positive more for anxiety than depression.
Risk factors for postpartum anxiety include:
- Family history of panic, anxiety, or depression.
- Personal history of having depression or anxiety after a prior pregnancy.
- Thyroid problems (which affects metabolism).
Symptoms of postpartum anxiety include:
- Constant worry, or feeling that something bad is going to happen.
- Racing thoughts.
- Physical symptoms like nausea.
- Trouble sleeping.
- Change in appetite.
Pediatricians need to better identify mothers who are struggling with the symptoms associated with postpartum anxiety and provide resources to help them overcome a problem which affects 1 in 6 postpartum women (and 1 in 5 first-time mothers). Mothers should feel comfortable bringing this issue up with their pediatrician and vice versa. Pediatricians need to ask if mothers are feeling nervous and worried, and how that may be affecting them. I often hear (almost on a daily basis): “… I know you are going to think I am that crazy mom, or the worried mom…” My response is: “You are not that ‘crazy’ mom or the ‘worried’ mom, you are a mom, and this is normal.” This can be at times a difficult subject for mothers to bring up, especially first-time moms that don’t know their pediatrician very well yet. This is why open lines of communication are so important, and why it is so important for pediatricians to listen.
- Your pediatrician and/or obstetrician.
- Postpartum Support International (PSI) – www.postpartum.net (Has an excellent resource page).
- Parents Magazine – www.parents.com (Has a 15 question quiz on postpartum depression).