CHAPTER
18

Anxiety During and After Pregnancy

In This Chapter

• Finding out what’s normal worry during pregnancy and what’s not
• Shedding light on the predictors of postpartum anxiety
• Developing a plan to minimize anxiety during and after pregnancy
• Exploring the pros and cons of medication during pregnancy

“I had a few panic attacks back when I was in college, but I could still function. I got some therapy at the university counseling center, still hung out with my friends, and made it to my classes. In fact, I graduated with honors and got a great job in the Bay area.

“Nothing prepared me for the panic attacks that hit me six years later, after my daughter was born. I got them more often. They lasted longer. I had a hard time breathing; my heart pounded so I hard I thought it would burst. It was even worse when I nursed. I got tingling sensations and numbness in my hands. I’d pound my hands together or on my leg, but it was kind of out of control, like I couldn’t help it. It got to the point where I didn’t want to go out by myself. Even at home, I felt uncomfortable by myself. My husband tried to help, but he didn’t know what to do; I’d gone from this independent spirit to this terrified, clingy person, and he’d wind up getting impatient with me.

“Lucky for me, though, my mom was supportive because she’s suffered from panic attacks her whole life. She helped me get back in therapy and gave me some ‘time out’ from our new baby. It’s been two years now, and I feel like I’m pretty much back to normal. But I’ll never forget it. We want to add more children to our family, and it scares me. At least I now know what might happen, so I can prepare for it. My doctor says there are a lot of things we can do to keep it from being so bad.”

By publicly sharing their painful experiences with postpartum depression, celebrities such as Brooke Shields and Marie Osmond have helped the 12 percent of new mothers who suffer through it feel less alone and ashamed. Physicians, too, are making strides in telling the difference between “the baby blues” and clinical depression.

However, it is also important to shed light on postpartum anxiety, a condition that touches 4 to 6 percent of new mothers. How does an already-established anxiety disorder impact pregnancy? What do you do about medication? What can you expect after the baby’s born? We answer these questions in this chapter as we explore how to create a plan to minimize anxiety during and after pregnancy.

Anxiety During Pregnancy

Talk to any expectant mother and the conversation will likely include some concern, fear, or worry about her pregnancy. What about the drinks you had before you found out you were pregnant? How much morning sickness is normal, and what if you don’t have any? What if you decide on natural childbirth and then can’t stand the pain? How in the world are you going to juggle motherhood with your career—as stressful as your job already is? With natural concerns such as these buzzing around in your head, what mom-to-be doesn’t worry these days?

Even the information age has been both a blessing and a curse to pregnant women. On the plus side, you can make informed decisions about your medical care. You can carefully weigh the pros and cons of amniocentesis or an at-home delivery rather than automatically take your healthcare provider’s recommendation. From conception, you can “parent” your embryo, making sure your developing baby boy or girl is getting the best in-utero environment possible by taking care of your physical and mental health during pregnancy.

On the dark side, not all information is created equally. Pregnancy magazines, literature, and websites are rife with cautionary tales, sensational warnings, and information about seemingly innocent dangers that could lead to a negative pregnancy outcome. We hear terms such as ectopic pregnancy, blighted ovum, and gestational diabetes, often without understanding the true risks or likelihood. We read warnings about everything from changing kitty litter boxes to eating canned tuna to pumping gas to taking aspirin. Well-meaning friends and family members offer unsolicited advice on everything from traveling while pregnant to avoiding miscarriage.

STRESS RELIEF

Two of the most common pregnancy anxieties—miscarriage and irreversible weight gain—are largely unfounded. When a woman hears the fetal heartbeat, her chances of miscarrying drop to 2 percent. And the majority of women, without killing themselves with exercise or crash dieting, are back to their pre-pregnancy weight by their children’s first birthdays. (Breastfeeding is a great help with this.)

The result? Obstetricians report a dramatic increase in anxiety-related phone calls from expecting mothers. In fact, some physicians spend up to half their patient-contact time addressing unrealistic concerns and reassuring their patients. And an anxiety-riddled pregnancy can set the stage for a difficult postpartum experience, particularly among women who are already at risk.

Postpartum Anxiety

“I was driving to the grocery store with the baby for the first time. Six blocks from home, my heart started pounding. I was sweating. I thought I was going to faint. I went back home. I didn’t tell anyone because I didn’t want to worry them and I felt so ashamed; why couldn’t I do something as simple as go to the grocery store?

“I thought maybe I was still tired from the delivery or was anemic. But it kept happening when I drove, so I made up excuses not to drive. I refused to go out of the house for four months. Finally, my husband got impatient with me and made an appointment for me to go see a counselor. I found out I was having panic attacks. I never knew other people had the same thing; I mean, I’ve heard of postpartum depression, but panic attacks?”

As Angela’s story illustrates, new mothers often don’t recognize that symptoms such as the racing heart and sweating of panic; obsessions about cleanliness, safety, or germs; or an inability to get past the birth experience are surprisingly common postpartum emotional complications.

One reason is that postpartum depression is often used as an umbrella term for different conditions—simple baby blues, serious postpartum depression, postpartum anxiety, postpartum obsessive-compulsive symptoms, postpartum traumatic stress from childbirth, and postpartum psychosis. As a result, new moms expect postpartum depression to look just like any other clinical depression—pervasive sadness, frequent crying, lack of energy, and so on. When a new mom feels so anxious she can’t sleep or finds herself haunted by irrational fears of hurting her child, she is more likely to blame herself than to look for help.

ANXIETY ATTACK

An important rule of thumb for getting help is that if you are so anxious that you can’t sleep when your baby does, it may be time to see a professional.

Even if she does confide in her physician, she might not get much help. Most new mothers are somewhat anxious; it’s tough to be in a new role and responsible for another person. The sleep deprivation alone is enough to make new parents jumpy and irritable. Pediatricians, obstetricians, and nurses are used to worries, concerns, and fears and can easily chalk up clinical symptoms to normal new-mother worries. In addition, physicians are no different from regular folks in associating postpartum emotional problems with depression.

However, although it’s normal for new mothers to worry about their babies, women affected by a postpartum anxiety disorder experience excessive worries and fears regarding their child as well as their own actions. A new mother suffering from a postpartum anxiety disorder finds her daily life disrupted by her symptoms and her thoughts; she is as much consumed by fear as she would be if an anxiety disorder surfaced at any point during her life.

A postpartum anxiety disorder is triggered by and occurs during a time already rife with physical and psychological stress. The dramatic hormonal shifts that occur after birth can make postpartum anxiety symptoms especially intense and unpredictable. In addition, the typical stressors of new parenting—the disrupted sleep, social isolation, and ongoing role negotiations between spouses—can be so overwhelming that you can’t get enough distance to realize that your anxiety has gone way beyond worry.

Women who have experienced an anxiety disorder in the past may have an edge when it comes to recognizing their symptoms but can fall prey to another postpartum trap: the bad mother complex. Few roles carry as much psychological significance as that of “mother.” As a result, new moms can feel overwhelming guilt and shame if they find themselves feeling irritable and angry when their newborn cries, are afraid to be alone with their baby, or have obsessive thoughts about harm coming to their child. “Maybe I can’t handle being a mom” is the fear that surfaces with every anxiety symptom. Fortunately, it’s often this fear—coupled with the fierce protectiveness of motherhood—that can help you get the help you need.

Beyond Worry

Postpartum anxiety typically arises within a few days of delivery. Postpartum anxiety disorders can range in severity from adjustment disorder to panic disorder. (From a symptom perspective, panic disorder that develops after birth looks the same as panic disorder that develops during any other stressful period in a person’s life.)

Postpartum anxiety symptoms may include the following:

• Trouble concentrating and remembering things
• Difficulties finishing everyday tasks
• Trouble making decisions
• Irritability and difficulty relaxing
• Insomnia
• Exhaustion
• Feelings of extreme uneasiness for prolonged periods of time
• Loss of appetite
• Anxiety or panic attacks
• Intrusive memories of trauma from the birth experience
• Obsessive thoughts or concerns about one’s child’s health or about hurting one’s child

Once again, you can see how the boundary between normal new motherhood and clinical anxiety can easily be blurred. What new mother isn’t exhausted? Sleep deprivation can also reduce your ability to concentrate or make decisions.

When are worries about your baby’s health obsessive? Instead of focusing on “how much” or “how often,” perhaps the question to ask in terms of when to get help is “how painful.” In other words:

• Are you so anxious that you cannot adequately care for your baby?
• Are you afraid of hurting yourself or the baby to the extent you are not sure you can stop yourself?
• Are you so anxious you cannot eat or sleep?
• Is your anxiety wearing you down to the point that you’re starting to get depressed?

Answering yes to one or more of these questions suggests that you are putting too much of the burden on yourself. In particular, when talking your feelings out with friends and family doesn’t help, when your life is becoming increasingly restricted, or when your symptoms last longer than a few weeks, you’ve probably crossed the line from normal postpartum adjustment to postpartum anxiety. No matter what side of the line a new parent finds herself on, it’s not her fault. In fact, as you’re about to see, whether or not a new mother experiences postpartum anxiety is a complex puzzle with some pieces still missing.

Why Me?

Like postpartum depression, postpartum anxiety problems are real mental conditions that impact thousands of new mothers every year. What is not as clear, though, is what causes them.

One theory is that pregnancy stimulates activity in certain neurotransmitters. Another popular theory is that some women have a built-in sensitivity to hormonal changes that increases their vulnerability to psychological, environmental, and physiological stressors during their reproductive years. Others argue that the genetic vulnerability is simply a biological predisposition to anxiety and that the stress of the postpartum period is no different from the stress of any other major life transition; because full-blown anxiety is often predated by a period of life stress, a certain number of biologically prone new mothers will develop anxiety during their postpartum days. This is consistent with the diathesis-stress model we discussed in Chapter 3.

ANXIETY ATTACK

Women who become pregnant after suffering a miscarriage often find themselves in a constant state of worry and tension over the possibility of another loss. BellaOnline’s miscarriage section can be a great source of emotional support (bellaonline.com/subjects/6461.asp).

Research has identified a number of risk factors that contribute to postpartum anxiety. It’s likely that women who develop postpartum anxiety do have some degree of biological vulnerability, which is then exacerbated by pregnancy and after-birth stressors. The more risk factors you have, the more likely it is that you will develop postpartum anxiety. Here are the most commonly identified risk factors for postpartum anxiety.

Risk Factors for Postpartum Anxiety

For example, Joni’s family has a history of health anxiety and postpartum panic attacks. As the oldest of three children, she did quite a bit of caretaking as a child and had some ambivalence about what the role of motherhood had in store. On the other hand, she did not have a preexisting anxiety disorder and had never had much trouble with PMS.

During pregnancy, she had a number of pregnancy-related scares and a difficult labor followed by an unscheduled C-section. Before delivery, she also experienced mild anxiety symptoms, primarily when flying and when she was in confined spaces. Post-delivery, she was lucky to have a supportive spouse and a healthy baby. On the downside, her oldest child was colicky and didn’t sleep through the night until he was 9 months old.

Social support, or the lack of it, can play a major role in postpartum adjustment. Single mothers who never get a break, or whose family of origin is unsupportive and/or judgmental, can have a particularly tough time adjusting to the overwhelming demands of new motherhood. In fact, combine a lack of social support with a biological vulnerability, and a postpartum distress-free experience is likely to be the exception rather than the norm.

As you can see from Joni’s story, risk factors often have a cumulative effect. There are some risk factors, though, that seem to weigh more heavily in determining the odds of postpartum emotional problems. And one of the heaviest is your emotional state during pregnancy.

ANXIETY ATTACK

Thyroid problems and anemia in pregnant and postpartum women can cause psychiatric symptoms. Ask your doctor what specific tests have been given to rule out underlying physical causes for your emotional symptoms.

The Pregnancy Protection Myth

The joy of pregnancy. Few phrases get thrown around as much as that one. Granted, there’s a lot to be both thankful for and happy about during pregnancy. However, over the past few years, there has been increasing recognition that for some women, pregnancy can be plagued by mood problems. The common wisdom that pregnancy hormones inevitably create a sense of elation and calm is slowly going by the wayside. Many of the postpartum emotional complications women suffer, including anxiety, may start during pregnancy.

In fact, in many cases, a woman’s emotional state during pregnancy may be the best single predictor of what is to follow. Community studies consistently show that less than half of the 8 to 10 percent of new mothers experiencing either postpartum anxiety or depression were newly depressed or anxious; most of them had some symptoms prior to their child’s birth. Twenty percent of pregnant women suffer from some type of psychiatric disorder during pregnancy, and study after study shows that health-care providers are often unaware.

ON THE CUTTING EDGE

There may be a link between calcium and postpartum emotional symptoms. In one study, women given 2,000 mg of calcium carbonate for prevention of preeclampsia (hypertension) had significantly lower incidences of depressive symptoms 12 weeks after delivery. However, research on this topic is scant, and the jury is still out.

If pregnancy can precipitate the onset of an anxiety disorder, what effect does it have on those of us who already have one? It depends. Women with a history of panic disorder, for example, often report a lessening of symptoms during their pregnancy. This may be due to the hormone progesterone, which increases during pregnancy. When it drops again during the postpartum period, the woman’s symptoms may return.

On the other hand, about 25 percent of women with OCD will get worse during pregnancy, with some women even seeking treatment for OCD for the first time. In addition, symptoms may ebb and flow with various pregnancy stages; many women report the greatest number of symptoms during the first and third trimesters, sandwiched around a three-month period of relative calm.

For the anxiety sufferer anticipating pregnancy, this news can be quite disturbing. However, knowledge is power. An anxiety sufferer doesn’t have to choose between motherhood and mental health. By working with your physician and mental-health professional, you can create a pregnancy plan that takes into account your personal vulnerabilities and reduces your risks.

MYTH BUSTER

Mothers with obsessive thoughts involving hurting their babies are likely to act on them. Reality: it is extremely rare for a woman to hurt her infant. By definition, obsessions are intrusive, unwanted thoughts, images, or urges. Mothers who have obsessions do not want to hurt their babies.

Pregnancy Planning

At first glance, it might seem depressing to consider taking “pregnancy precautions” because of your struggle with anxiety. If so, let’s propose an alternative viewpoint. Many of the steps in a good pregnancy plan will not only reduce postpartum risk factors, they will help any transition to motherhood go more smoothly.

First of all, take ownership of your pregnancy. The greater the sense of control you have over your pregnancy-related choices and options, the less often uncertainty and anxiety will plague you. Select a medical team you trust; make sure you can ask questions of your medical practitioner and get them answered satisfactorily. Have a list of questions prepared before each OB visit. Get an early ultrasound and, subsequently, whatever testing will make you feel calmer. Research birth options and agree on the birth plan long before delivery.

ANXIETY ATTACK

Your pregnancy plan should take into account how much your anxiety is presently under control. If you are currently in treatment, strengthen your therapeutic relationship. If it’s been a while since you’ve had symptoms, consider boosting your relaxation and stress-management skills.

Because stress aggravates anxiety, one goal of a mentally healthy pregnancy should be to make it as low-stress as possible. Too many of us consider pregnancy a time to complete all of our household projects. We worry about getting the baby’s room finished when all we really need when we leave the hospital is diapers, a few outfits, and a car seat. By the time we head into the delivery room, we’re already exhausted. It’s normal to want everything to be just right for a new baby, but you may be able to reduce your stress by making a conscious decision to let go of the less crucial details.

Instead, consider pregnancy a time to mentally and physically prepare for motherhood. Mother yourself. Accept help from others. Rest whenever you can. Take into account the physical demands of growing a baby and adjust your expectations of yourself. If you can’t sleep for long periods at night, take naps during the day. Even sitting in a chair with your eyes closed can provide some respite from fatigue. Eat healthfully but don’t obsess about it. The average woman’s diet, although not nutritionally perfect, provides enough nutrients for a healthy baby, especially if you’re taking a prenatal vitamin. Eat a variety of foods, but don’t be too restrictive or obsessive about what you eat. Similarly, although you should generally stay away from caffeine, don’t worry too much if you have an occasional caffeinated soda or cup of coffee. If you’re having frequent morning sickness, it can be especially hard to eat a healthy diet. Do what you can and talk with your doctor about ensuring that you’re getting adequate nutrition.

ON THE CUTTING EDGE

Persistent fatigue immediately following birth may be a signal that a woman will develop postpartum mood complications. Women who said they still felt extremely fatigued two weeks after having a baby were more likely to suffer from postpartum depression.

Actively promote inner resilience and calm. Keep a daily journal to help you keep track of your emotions. Practice some form of relaxation, meditation, or yoga; not only do they make a meas-urable difference in anxiety and tension, the breath control they promote can be a powerful aid in the delivery room. In addition, while you’re developing your inner calm, don’t create external chaos. Avoid major life changes; it’s often too much to find a new job, move across the country, and find a house within a month before the baby is born.

Finally, surround yourself with allies. Develop a peer support system of new and seasoned parents; the former can provide the “we’re in this boat together” kind of camaraderie; the latter can help you know what to expect during your first year as a mother. If you’re in therapy, consider increasing the frequency of your sessions, especially during the third trimester. If you’re not, getting support from a professional before pregnancy—or prior to birth—is not a bad idea. A trusted mental-health team can help you minimize risk factors by developing a plan for how to handle breakthrough symptoms during and after pregnancy and by developing a post-hospital plan that will cut down on sleep deprivation.

But what should that plan be? Do you go off your psychotropic medication when you first realize you’re pregnant and white-knuckle it through an anxiety-riddled nine months, or stay on your meds and hope for the best? Pregnant women whose anxiety worsens during pregnancy often feel trapped; on the one hand, terrified their medication could harm the fetus; on the other, worried they won’t survive without it.

ANXIETY ATTACK

Never discontinue medication “cold turkey” without talking with your doctor. Studies show that women who stopped their antidepressant during pregnancy were five times more likely to have a return of symptoms than those who decided to continue them during pregnancy.

Medications During Pregnancy

Doctors used to be very hesitant to prescribe psychiatric medications to pregnant women. In fact, most pregnant women were discouraged from taking any type of medication during pregnancy. However, not only can untreated anxiety during pregnancy put the mother in jeopardy, increasing research has shown that the mood of the mother during pregnancy can have long-lasting effects on her child’s development. As a result, the decision to take psychotropic medication requires a careful weighing of the costs and benefits to both mother and child.

Potential Risks of Taking Medication

Let’s first look at the potential risks of taking meds. As discussed in the preceding chapter, many of the medications used to treat anxiety fall into the category of selective serotonin reuptake inhibitors (SSRIs). Preliminary studies suggest that some of these antidepressants may carry a greater risk than others during pregnancy.

For example, preliminary results from two 2005 studies found that women who took Paxil during the first three months of pregnancy were 1.5 to 2 times more likely to have a baby with a heart defect as women who took other antidepressants or women who took no medication. Another study found that 30 percent of newborns whose mothers took antidepressants during the last trimester showed symptoms of withdrawal (sleep disturbances, high-pitched cry, tremor, gastrointestinal problems) after birth. None required medical treatment, and symptoms subsided within 48 hours.

In general, all medications commonly used to treat anxiety should be regarded with caution during both pregnancy and lactation, and you should talk with your doctor about this. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) convey clear risks for benzodiazapines in general, and the kind of benzodiazapines prescribed for sleep are contra-indicated outright during pregnancy. ACOG also notes that “risk cannot be ruled out” for other common meds used to treat anxiety. For many of them, good long-term safety information is simply not available. See focus.psychiatryonline.org/data/Journals/FOCUS/1839/foc00309000385.pdf.

Potential Risks of Not Taking Medication

To an unborn child, the risks of a mother’s untreated anxiety during pregnancy can be worse. The idea that a woman’s emotional state during pregnancy affects her unborn child has existed for centuries. Called the fetal programming hypothesis, it theorizes that certain disturbing factors occurring during certain sensitive periods of development in utero can “program” a variety of biological systems in the unborn child. This, then, affects the ability of those biological systems to change later in life, predisposing a child to certain diseases and disorders.

In recent years, this theory has been supported by science. Stress or anxiety during pregnancy are risk factors for premature birth and growth restriction within the womb, both of which are risk factors for behavioral problems in the child. In addition, a 2010 neural imaging study of 6- to 9-year-old kids showed lower gray matter density in several brain structures when their moms had been more anxious during pregnancy. Interestingly, timing of moms’ anxiety mattered, as this effect was seen for anxiety at 19 weeks’ gestation but not for anxiety at 25 or 31 weeks’ gestation.

ON THE CUTTING EDGE

A longitudinal study followed a group of women and children from pregnancy until the children were 7. The children of mothers who rated in the top 15 percent for anxiety at 32 weeks into pregnancy (but not at 18 weeks) had double the risk for behavioral problems at ages 4 and 7. This was true for both boys and girls.

Making the Decision

Obviously, whether or not to take antidepressant medication during pregnancy is an important decision. Educating yourself is an important aspect of feeling comfortable with whatever decision you make. Weighing the possible impact of using medication against the impact of living with anxiety through pregnancy is important to assess.

Many physicians are promoting a happy medium. Because of the risk of symptom rebound, most women who become pregnant while taking antidepressants may do well to either discontinue them gradually or continue taking them. It may be prudent to reduce multiple medications down to a single agent and use the lowest effective dose possible.

Unfortunately, just as an optimal diet and exercise routine can’t guarantee that you’ll never get sick, no amount of prediction or preparation is 100 percent foolproof against postpartum anxiety. Should your anxiety symptoms resurface during or after pregnancy, you will hopefully take the attitude you would if you were to suddenly develop asthma or diabetes. Rather than view your symptoms as evidence that your pregnancy plan failed, you see the work you did as giving you a head start in your recovery, again, much the same as a healthful lifestyle makes recovery from physical illness easier. And rather than search for causes or assign blame, you can focus on getting the best treatment available.

ON THE CUTTING EDGE

Doctors look for three things when testing a psychiatric medication’s effects on pregnancy: the occurrence of birth defects, unusual symptoms at birth, and later behavioral problems.

Treatment for Postpartum Anxiety

Not surprisingly, the most effective therapy for postpartum anxiety is often a combination of the cognitive behavioral techniques we’ve discussed throughout this book in combination with specific strategies to tackle the tough transition to parenthood (or having another child).

Cognitive behavioral psychotherapy for postpartum anxiety focuses on identifying and correcting inaccurate thoughts associated with anxious feelings, particularly those that center on one’s sense of (in)competence as a mother and her concerns over the health and well-being of her infant. In addition, depending on her diagnosis, treatment strategies might center on halting compulsive behaviors, coping with panic attacks, or gradually approaching avoided situations.

In addition, although postpartum anxiety is not caused by relationship problems, it affects relationships. Interpersonal therapy is a form of therapy that focuses on interpersonal issues that can either aggravate or arise from depression or anxiety. It can help the new mother deal with her changing role and other stressors by learning how to communicate more effectively with others. Relationship issues that often surface during the postpartum period include interpersonal disputes/conflicts over the parenting role as well as grief/anger over the sudden lack of intimacy as emotional energy is consumed by the new baby. Left unaddressed, these issues can complicate a new mother’s recovery from postpartum anxiety; successfully resolved, the couple’s bond strengthens and serves as a vital source of emotional support.

ANXIETY ATTACK

Check out Postpartum Support International (postpartum.net) for a wealth of information on postpartum mood disorders and a national list of postpartum support groups.

For the woman who is breastfeeding, concerns about the impact of medication on the baby can resurface. If untreated anxiety is impacting the parent-child bond, talk to your physician about possibly resuming your medication.

What About Fathers?

Throughout this book, we’ve discussed how helpful supportive family and friends can be in encouraging and supporting your progress. This is especially true when anxiety intrudes during the postpartum period. Husbands and partners are often the first to recognize that a new mother is exhibiting signs of postpartum anxiety and can be a lifeline to treatment and support. A partner’s leadership in providing reassurance and emotional support, not to mention picking up the slack, can make the difference between a woman’s quick recovery and months filled with unnecessary shame, self-blame, and turmoil.

Of course, the postpartum period can be tough on dads, too. More than half of new fathers feel depressed sometime during the first four months following the birth of their baby. Many factors can contribute to these feelings: worries over new responsibilities and potential loss of freedom, financial concerns, and uncertainties of being a good dad. Active involvement in a spouse’s postpartum anxiety treatment can not only assure new fathers that their partners are being cared for, it can also provide a safe forum to sort through their own feelings and concerns.

As you’ve seen, postpartum anxiety can add to an already stressful time. Identifying and minimizing risk factors during pregnancy can reduce the odds of postpartum emotional problems, but it doesn’t completely remove them. As such, for women with a history of anxiety, the best defense may be a good offense: making sure pregnancy is as low-stress as possible and lining up a team of professionals ready to treat postpartum symptoms.

On the bright side, postpartum anxiety is as treatable as anxiety during any other period of a woman’s life. Early symptom recognition and good professional help can minimize the impact of postpartum anxiety on the mother, the child, and the couple. In fact, some couples say that dealing with postpartum anxiety forced them to deal sooner, and more effectively, with interpersonal issues that surface among most new parents.

ANXIETY ATTACK

New fathers can find information and support about postpartum emotional complications (and lots of other stuff) at Brand New Dad (brandnewdad.com/askarmin/postpartumblues.asp). We also suggest checking out The Complete Idiot’s Guide to Being a New Dad.

This chapter has been about the relationship between pregnancy and anxiety and how new mothers can get off to the right start with their babies whether or not they experience anxiety symptoms during or after pregnancy. In the next chapter, we take a look at what you can do to continue this “right start” throughout the parenting years—how you can raise resilient children and prevent anxiety from being passed from this generation onto the next.

The Least You Need to Know

• Feelings of anxiety and worry are common among expectant mothers, but panic attacks, obsessive thoughts, and an inability to complete daily tasks can be symptoms of an anxiety disorder.
• Postpartum anxiety is often missed by both patients and physicians. Physicians either dismiss the anxiety as part of normal new-mother worries or think postpartum mood problems are limited to depression.
• All of the clinical anxiety disorders can show up during pregnancy or after birth. The distressing symptoms are often magnified by dramatic hormonal shifts and the stress of changing roles.
• Understanding and minimizing risk factors during pregnancy can reduce the likelihood of postpartum anxiety. In particular, managing anxiety symptoms during pregnancy can benefit both mother and fetus.
• The pros and cons of antidepressant medication during pregnancy must be carefully weighed; there are infant risks associated with untreated anxiety as well as certain antidepressant medications.