Birth & Parenting News: Anxiety Disorders in Pregnancy and the Postpartum Period

Are you worrying excessively? Do you have horrible thoughts of harm coming to your child? Are you suffering with panic attacks? Do you have flashbacks or nightmares of traumatic events? Are your loved ones concerned about you? If so, you are not alone. Anxiety during pregnancy and in the postpartum period is very common, but is considered a “disorder” when it causes great distress and interferes with one’s ability to function well. Studies have shown that 5-16% of women suffer with anxiety disorders in the perinatal (around the time of childbirth) period (1 p. 8). In addition, many moms and moms-to-be suffer with symptoms of anxiety but do not quite meet the diagnostic criteria for a “disorder” (1, pg. 8). These women, however, would still benefit greatly from treatment. Some of the anxiety disorders that may emerge or worsen during this time in a woman’s life are: Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Panic Disorder, and Posttraumatic Stress Disorder. Anxiety can occur by itself or can coexist with other conditions such as depression. Women of every race, income level, culture and age, as well as fathers and adoptive parents, can suffer from perinatal anxiety disorders. If you are suffering, please tell your doctor. You deserve to get the help you need.

Generalized Anxiety Disorder (GAD)
People with GAD worry excessively about everyday things, including the health and safety of their children, even though the chance of something bad happening is very low. Other symptoms include: difficulties with sleep and concentrating, being easily fatigued, irritability, restlessness, and muscle tension.

Obsessive Compulsive Disorder (OCD)
Obsessions are unwanted, disturbing images, thoughts, or impulses that occur over and over and cause feelings of disgust, fear and doubt. In the perinatal period, obsessions usually revolve around harm befalling the baby either accidentally (i.e. being in a car accident while the baby is in the car) or intentionally (i.e. the mother may fear losing control and harming the baby herself).* The crucial feature of these thoughts is that they are very distressing to the mother and contrary to her personality and character (called “ego-dystonic”); she does not want to act on them and tries desperately to avoid them. Although the chance of a parent with OCD acting on a violent obsession is extremely rare, the anxiety and fear caused by morbid obsessive thoughts like these can be paralyzing and dramatically effect a mother’s ability to care for herself and her child. A parent suffering from OCD may fear being left alone with their baby and, in some cases, completely avoid the child. Ninety percent of people with OCD perform compulsions, or behaviors, to neutralize these thoughts; in reality, these compulsions make the OCD worse.

Panic Disorder
Symptoms of a panic attack may include a racing heart, shortness of breath, dizziness, tightness of the chest, chills, hot flashes, claustrophobia, and the fear of going crazy or losing control. These symptoms appear out of the blue—there is no apparent trigger – and are very distressing. Panic Disorder is characterized by two or more panic attacks where at least one of these attacks is “followed by one month (or more) of persistent concern about having another panic attack or worry about the possible implications of having another panic attack” (2, p. 5).

Posttraumatic Stress Disorder (PTSD)
Some of the symptoms of PTSD include intense anxiety, fear, flashbacks of a traumatic event, recurring nightmares, emotional numbness, feelings of detachment from others and avoidance of external situations associated with the trauma (2, p. 17). The symptoms of PTSD can arise after a traumatic childbirth experience. In addition, pelvic exams, delivery, breastfeeding and other events in the perinatal period can trigger memories of past abuse and lead to PTSD.

What should you do if you are suffering from an anxiety disorder?

  • Tell your doctor and get a referral to a Health Care Provider who is trained in perinatal mood and anxiety issues.
  • Share your feelings with your partner or a trusted family member or friend.
  • Learn as much as you can about your condition. See the “Resources” section below.
  • Ask your partner, family members, friends or a postpartum doula for help with the baby.
  • Take care of yourself. It is not easy with a new baby, but eating well, exercising, and trying to get at least 4-5 hours of uninterrupted sleep every day can help reduce your symptoms.

What puts you at risk for a perinatal anxiety disorder?

  • A personal or family history of an anxiety or mood disorder (for example, depression).
  • High levels of stress. In addition to the baby, other stressors my include marital problems, a new house, positive or negative changes to one’s finances or job, loss of a loved one, and personal injury or illness.
  • Difficult personal life experiences such as: past miscarriages (1 pg. 9), a high-risk pregnancy (1, pg. 9), a traumatic childbirth experience, or a history of abuse (especially sexual abuse).
  • Sensitivity to hormonal fluctuations.
  • Lack of support.

Are anxiety disorders treatable?

Yes. According to Pamela Wiegart and Kevin Gyoerkoe, authors of The Pregnancy and Postpartum Anxiety Workbook, the two most effective forms of treatment for anxiety are: (1) Cognitive Behavioral Therapy, a form of psychotherapy that focuses on how your thoughts and behavior affect your mood and (2) medication.

What if I don’t have insurance?

Many therapist and psychiatrists offer their services on a sliding scale for those without insurance. The local coordinators through Postpartum Support International (www.postpartum.net) can help you find services within your means.

Local affordable services include:

  • University of Michigan Psychological Clinic, www.psychclinic.org, 734-764-3471
  • Eastern Michigan University Psychology Clinic, www.emich.edu/psychology/dept-psychologyclinic.html, 734-487-4987
  • Women’s Center of Southeastern Michigan, http://www.womenscentersemi.org, 734-973-6779

Is medication safe for the baby during pregnancy and while nursing?

The two main classes of medications used to treat anxiety are anti-depressants and anti-anxiety medication. In some cases, the benefits of medication may outweigh the risks. Talk to your doctor about the pros and cons.

My loved one is suffering with an anxiety disorder. What can I do to help?

  • Listen and do not trivialize her feelings.
  • Be patient, supportive, and non-judgmental.
  • Encourage her to get help.
  • Learn about the illness via the resources below.
  • Help her with the child, around the house, etc.

Resources

Books

  • The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions by Pamela Wiegartz and Kevin Gyoerkoe.
  • Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel.
  • Postpartum Depression for Dummies by Shoshana Bennett.
  • The Anxiety and Phobia Workbook by Edmund Bourne.
  • Overcoming Postpartum Depression and Anxiety by Linda Sebastian.

Organizations

  • Postpartum Support International (PSI), www.postpartum.net, 800-944-4773. PSI is a nonprofit group dedicated to helping those suffering with perinatal mood and anxiety disorders. In addition to a wealth of information on their website, they offer expert advice via the telephone and online support groups.
  • The Postpartum Stress Center, www.postpartumstress.com
  • Fathers Support, www.postpartumDADS.org
  • Postpartum Depression Blog, www.postpartumprogress.typepad.com
  • International OCD Foundation, www.ocfoundation.org
  • DONA International, www.dona.org
  • Association for Behavioral and Cognitive Therapies, www.abct.org. This website allows you to search for Cognitive Behavioral Therapists in the area.

Suicide Prevention
National Suicide Prevention Hotline at 800-273-8255

Local Support Group

  • Postpartum Depression Support Group of the Greater Ann Arbor Area, www.ppd-annarbor.org, 734-418-2683
  • See also, Center for the Childbearing Year, online Directory, www.center4cby.com.

Therapy/Support Services in Ann Arbor
The University of Michigan Depression Center, www.depressioncenter.org, 734-764-9190. In addition to helping pregnant women and parents who are suffering with anxiety and depression, the Depression Center also counsels women, before they are pregnant, who are at risk for emotional difficulties in the perinatal period.

References

1. Wiegartz, Pamela and Gyoerke, Kevin. The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions. Oakland, California: New Harbinger Publications, Inc., 2009.
2. Bourne, Edmund. The Anxiety and Phobia Workbook, Third Edition. Oakland, California: New Harbinger Publications, Inc., 2000.

 

Article written by guest blogger, Kristin Burgard, kristinb@talkamerica.net

Posted by Patty Brennan on June 29, 2011 • Filed under Birth & Parenting News
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