When I work with women who are pregnant or in the postpartum period, I often am asked “Do you think I need to take medication for my anxiety?” While I am not a prescriber, it is such an important question to ask. I am honored to have Dr. Sipra Laddah write this guest blog post about the role that a psychiatrist can play with your mental health during and after your pregnancy.

What is Perinatal Psychiatry?

When I see patients in my office or through telepsychiatry, I typically hear that they are confused and upset by their symptoms. Often, it can be very isolating. Most women just want to enjoy what is supposed to feel like “the happiest time in my life.” While postpartum depression has started to get more press, peripartum anxiety is not often talked about, suspected, or diagnosed. The good news is that peripartum disorders are often VERY treatable. The important thing is to be working with someone who has experience in this area, as symptoms can show up a little differently.

Perinatal psychiatry is a subfield of psychiatry dedicated to taking care of women who are attempting to conceive, pregnant or postpartum. A perinatal psychiatrist is a physician who has attended 4 years of medical school, followed by 4-6 years of residency, and is specialized in understanding and treating mood disorders with a combination of therapy, medication, and other modalities. There are often special considerations that need to be taken into account when thinking about treatment during this time, and there are specialized psychiatrists who do just this. 

Perinatal anxiety refers to disruptive, excess anxiety in women during pregnancy and up to two years after birth (this can be even longer if it goes untreated). This can include antepartum anxiety, which occurs during pregnancy, and postpartum anxiety, which begins after childbirth. Some level of anxiousness and anticipation during these major life events is normal. However, perinatal anxiety becomes an issue when anxiety symptoms start to interfere with your quality of life. 

Perinatal Anxiety

Anxiety disorders are very common during the perinatal period. One study by the Journal of Clinical Psychiatry found that one in five pregnant women has an anxiety disorder. While postpartum anxiety is less researched than its counterpart postpartum depression, one study found that 17 percent of women reported having symptoms of postpartum anxiety. Additionally, the rate of comorbidity of postpartum anxiety and depression was 75 percent.

In some ways, it can be helpful to conceptualize peripartum anxiety as an evolutionarily selected trait that has gone off the rails a bit. It is natural for a woman’s self-protective instincts to be heightened during gestation and shortly afterward as biology’s response to preparing for an important and vulnerable time. However, sometimes our brains do this a little too well. The result is that for women with general antepartum or postpartum anxiety disorders, it can feel like every day is filled with stress and fear. Anxiety can feel like a constant stream of intrusive, worrying thoughts that are difficult to drown out. You may constantly feel like something bad is going to happen or picture the worst-case scenario outcome. For many soon-to-be and new moms, your anxiety may revolve around the health and safety of your baby. While every parent feels some level of stress about their baby’s wellness, perinatal anxiety can take this to the extreme, causing you to obsessively worry your baby’s life is being threatened or preoccupied with bad things to come.

Physical Symptoms of Anxiety

Anxiety’s effects often go beyond just feelings of stress and fear. Sometimes women experience physical symptoms that can be hard to manage. You may experience frequent dizziness, nausea, and hot flashes. You may feel restless and struggle to stay still. You may also notice major changes in appetite and have difficulties sleeping at night.

Miscarriage, Birth Trauma, and Perinatal PTSD

Another common source of perinatal anxiety is postpartum post-traumatic stress disorder. PTSD is intense anxiety caused by experiencing a traumatic experience. It causes symptoms such as:

• Intrusive thoughts and flashbacks

• Nightmares and difficulties sleeping

• Loss of pleasure in activities

• Emotional detachment and social isolation

• Hypervigilance and increased startle response

• Irritability and hostility

• Avoiding events, people, or places that trigger intrusive thoughts

While PTSD symptoms can be caused by any activity that someone perceives as traumatic, perinatal PTSD is often caused by a previous miscarriage, ectopic pregnancy, stillbirth, pregnancy complications, or birth trauma.

Postpartum Anxiety and Birth Trauma

One of the most common causes of perinatal PTSD is birth trauma. About 50% of new mothers described the childbirth of their baby as traumatic. Factors like having an unplanned C-section, experiencing major blood loss, fetal distress or complications, and using forceps can all make birth an incredibly distressing event.

If you’ve experienced a traumatic birth, you may develop symptoms of PTSD. This can involve reliving the birth through flashbacks and nightmares. You may avoid the hospital where you gave the birth or the doctor who did the delivery, and you may have difficulties bonding with your baby.

Perinatal Panic Disorder

Panic disorder is a type of anxiety disorder that causes frequent panic attacks. In pregnancy and after birth, perinatal panic disorder can lead to intense episodes of panic that make you like you are having a heart attack or being smothered. Your heart rate will go up and you may sweat, get hot flashes, have shaking hands, and feel numbness in the hands and feet. You may also feel as if you might faint and get intense nausea. Panic disorder can cause you to avoid certain activities or places because you fear they can trigger a panic attack.

Getting Treatment for Antepartum and Postpartum Anxiety

Living with persistent anxiety can make it difficult to complete everyday tasks and may interfere with your ability to take care of yourself and your baby. Increased stress during pregnancy can also lead to certain complications, such as increasing your chance of infection, causing sudden weight changes, contributing to gestational diabetes and preeclampsia, or leading to premature birth. Treatment for perinatal anxiety often includes a combination of therapy, medication, mind-body interventions such as mindfulness and breathing techniques.

Medication

Seeing a perinatal psychiatrist does NOT automatically mean that you will end up with medication. Many people worry about the meaning of needing to see a psychiatrist, but mental health just like physical health should be addressed proactively and preventatively (just as you might see any other specialists such as an OBGYN, reproductive endocrinologist, cardiologist, etc. during your pregnancy). A perinatal psychiatrist can help assess your symptoms and put them into the context of a biopsychosocial formulation, looking at the bigger picture including family history, previous episodes, risk factors, and help develop a comprehensive treatment plan. If symptoms of anxiety, depression, panic, or other disorders are moderate to severe, then medication is often incorporated.

There are some special considerations that should be taken into account.

When pregnant or postpartum and breastfeeding, there are many safe options. Most women worry about the safety of these medications, and that is where having an in-depth discussion with a perinatal psychiatrist can be helpful in understanding both the risks and benefits of certain medications. While it used to be common to stop everything during pregnancy, current guidelines actually support treating mom’s symptoms aggressively. The most important thing is that mom’s maternal mental health is optimized and “white-knuckling” it or choosing not to treat has been proven to adversely affect both mom and baby.

Therapy and Online Therapy

Cognitive-behavioral therapy is one of the most common treatments used to address anxiety. It is a type of talk therapy that allows you to identify negative, anxiety-producing thought behaviors and better regulate your emotions. In addition to CBT, there is psychodynamic psychotherapy that takes an interpersonal approach and supportive therapy. Also, making healthy lifestyle changes can be very helpful as well as looking at food choices and increasing foods that will boost mood. Finally, finding time in your day to unwind and practice mindfulness can help sustain long-term wellness. Practices like yoga, meditation, and breathing techniques all teach your mind and body to relax and release stress

About the Author:

Dr. Sipra Laddha is a board-certified psychiatrist and co-founder of Thriving Lane. Thriving Lane is a teletherapy private practice dedicated to helping women thrive in every stage of life, including major life transitions like pregnancy, birth, marriage, loss, and infertility. The practice’s team of psychiatrists, physicians associates, and therapists take an integrative approach to treating anxiety, blending conventional practice with holistic approaches. They offer women’s online therapy and psychiatry for clients located in Florida, Georgia, Alaska, Nebraska, Minnesota, and Illinois.

Begin Online Therapy for Moms in Colorado, Hawaii, or Louisiana with Ashley Comegys

Pregnancy is hard enough, don’t let your mental health suffer. If you’re looking for support, please reach out. I offer services to women in Colorado, Louisiana, and Hawaii. To start your therapy journey, please follow these simple steps:

1. Schedule a free 15-minute consult via phone or video

2. Learn more about me

3. Enjoy the bond with your newborn!

Other Services Offered with Ashley Comegys, LCSW

Counseling for Moms in Colorado isn’t the only service I offer to women in Colorado, Louisiana, or Hawaii. I offer a variety of online therapy services for women including therapy for anxiety, online postpartum depression treatment, online postpartum support, and online depression treatment. I also offer online grief counseling for women, online therapy for military spouses, and online trauma treatment for women. You can learn more from my about page, or my blog!