Postpartum anxiety: when worry stops being protective
Published
Some worry after a baby is normal and useful. It keeps you checking the car seat and noticing a fever. Postpartum anxiety is different: the worry runs most of the day, does not settle when the baby is safe, and starts to take over sleep, eating, and the time you have with your baby. It is common, it can happen without depression, and it responds to treatment.
How common is it?
A review that pooled 102 studies of anxiety during pregnancy and after birth found that, in the first six months after birth, about 15% of women reported anxiety symptoms, and about 10% met criteria for an anxiety disorder (Dennis et al., Br J Psychiatry 2017, PMID 28302701). A second analysis, which counted specific disorders such as panic disorder and OCD, put the share with at least one anxiety disorder during pregnancy or after birth at about one in five (Fawcett et al., J Clin Psychiatry 2019, PMID 31347796).
Ordinary new-parent worry, or anxiety?
Ordinary worry comes and goes and eases once you check. Anxiety keeps going after you check, and the checking itself starts to fill the day. Signs it is time to raise it with a clinician: you cannot rest when someone else has the baby, you lie awake when the baby sleeps, you avoid going out or letting others help because something might go wrong, or the worry is there most days for two weeks or more.
What it can feel like in the body
Anxiety is physical as well as mental: a racing heart, tight chest, shortness of breath, nausea, dizziness, and muscle tension. Some parents have panic attacks, sudden waves of intense fear that peak within minutes. The full list is on our warning signs page under Anxiety.
Anxiety without depression
Some parents with postpartum anxiety do not feel sad at all, so they assume a depression screen does not apply to them. The Edinburgh Postnatal Depression Scale, the questionnaire many practices use after birth, includes three questions that track anxiety (often called the EPDS-3A), and studies suggest it can help pick up anxiety disorders as well as depression (Matthey et al., J Affect Disord 2013, PMID 23116811). If worry is your main symptom, say so directly rather than waiting for the right question.
Intrusive thoughts and postpartum OCD
Sudden, unwanted images of the baby being hurt are common, and on their own they do not mean you will act on them: in a study of 388 new mothers, those who had these thoughts were no more likely than other mothers to act aggressively toward their baby (Fairbrother et al., J Clin Psychiatry 2022, PMID 35235718). Thoughts that come with confusion, hallucinations, or beliefs that do not match reality are different: call 911. When unwanted thoughts come with rituals such as repeated checking or avoiding the baby, the pattern may be postpartum OCD, which is treated a little differently. Our article on intrusive thoughts after having a baby covers it in detail.
What treatment looks like
Cognitive behavioral therapy (CBT) is the usual first talking therapy for anxiety. A preliminary review of 13 studies of CBT for anxiety during pregnancy or after birth found that symptoms improved more with CBT than with comparison conditions, although the studies varied widely and not all were randomized (Maguire et al., J Anxiety Disord 2018, PMID 30388545). ACOG recommends screening for anxiety as well as depression during pregnancy and after birth (Clinical Practice Guideline No. 4, PMID 37486660). Its companion guideline on treatment covers medication during pregnancy and while breastfeeding (Clinical Practice Guideline No. 5, PMID 37486661). A prescriber can talk through the options with you.
When to act on it
If anxiety is there most days for two weeks or more, or it keeps you from sleeping, eating, or caring for yourself, talk to your OB, midwife, or primary care clinician. If you or your baby are in immediate danger, or you have an urge or plan to harm yourself or the baby, call 911 or go to the nearest emergency room. If you are having thoughts of harming yourself, call or text 988 now.
For lines that can help today, including the National Maternal Mental Health Hotline at 1-833-852-6262 (free, 24/7, English and Spanish), see Get Help Now. For how anxiety compares with depression and other perinatal conditions, see our conditions guide.