If you are a pregnant woman who already has a generalized anxiety disorder, you may be at higher risk for postpartum anxiety. Here's how to prepare.

By Irina Gonzalez
February 20, 2020
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Credit: Ioannis Tsotras/Getty Images

For the third night in a row, I am tossing and turning in the middle of the night. It's almost three in the morning and I have been wide awake for the past hour. At 2 a.m., I woke up to pee—something that wasn't unusual for the past eight months of my pregnancy—but now I just couldn't fall back asleep. But this was now a typical night; my pregnancy anxiety (and subsequent insomnia) was in full swing ever since I hit 20 weeks or so.

Unfortunately, anxiety wasn't unfamiliar to me. Five years ago, I was diagnosed with a generalized anxiety disorder (GAD) while struggling with substance abuse (I have been sober ever since). When I first became pregnant a year ago, I was excited—but then a miscarriage meant that my subsequent pregnancy has been filled with even more anxiety than I was used to. And coping with my newfound pregnancy anxiety, along with my GAD, was no easy feat.

I'm not the only one, though. According to Postpartum Support International, 15-21 percent of women experience anxiety or depression during pregnancy. Even worse, for someone like me who already has anxiety, there is a real fear of experiencing further anxiety after the baby is born. One of the questions keeping me up at night, besides worrying about anything and everything baby-related, was: Would my GAD mean that I am at a higher risk for postpartum anxiety?

"Yes," says Krysta Dancy, M.A., MFT, a licensed therapist specializing in perinatal trauma and mental health, and founder of The Birth and Trauma Support Center. "GAD during pregnancy is a risk factor for postpartum anxiety. Other risk factors include previous depression or anxiety, your stress level during and after pregnancy, sociological stress such as lack of support or resources or relationship strain, and previous fertility concerns such as miscarriage or complicated pregnancy."

As for my insomnia? It could also be adding more fuel to the fire. "The sleep disturbance of caring for a newborn can be a trigger for postpartum anxiety, too," says Dancy.

While worrying about whether or not I'll have postpartum anxiety is not going to help my current pregnancy anxiety or insomnia issues, there is thankfully something that I and other women dealing with perinatal mood disorders can do to prepare ourselves.

Ask for help

For me, therapy was a great place to start. "Understand your anxiety through therapy," says Sarah Gundle, Psy.D., noting that it's important to talk to someone about recognizing your own anxiety symptoms, whether they're thoughts, emotions, body responses, or behaviors.

In fact, I started seeing my therapist more frequently during the third trimester—something which prenatal psychiatrist Amanda Tinkelman, M.D., PMH-C, says is a great idea. "Don't stop treatment!", she advises women who have GAD before getting pregnant. In fact, she says one of the best things that I can do to prepare for postpartum anxiety is to discuss the symptoms to watch out for during the perinatal period, talk about various treatment options in case I need them, and tell my therapist about my personal concerns and preferences.

And while medication may be an option as part of a woman's overall treatment approach, there are many treatment options and interventions "that have been shown to be helpful for perinatal mood and anxiety disorders (PMADs)," says Dr. Tinkelman, "including psychotherapy, yoga, mindfulness-based meditation, peer support groups, and relaxation exercises."

Get better sleep

The only bad thing about my once-a-week appointments with my therapist is that she wasn't around during those sleepless nights when I couldn't turn my brain off. The constant ruminating about all the things I needed to get done around the house or at work to prepare for my maternity leave or still buy for the baby before he came was keeping me up almost every night, leading to many nights when I only got four or five hours of sleep. But setting yourself up for better sleep after the baby comes could be the answer, according to Dr. Gundle.

"Ask for help with getting adequate rest and sleep," she advises. "This may involve asking a friend or partner to watch the baby or take over some chores so that you can get to bed earlier or take a nap. Many women have reported the difference that five hours of uninterrupted sleep can make to their anxiety, mood, and ability to cope."

As for how to get more sleep right now? "Create a bedtime ritual or routine," says Dr. Gundle. "Most of us settle down for sleep best when we have some routine that helps us unwind and relax, such as taking a warm bath, light pleasure reading, listening to soft music, or doing breathing or relaxation exercises. It is important to have a wind-down period before going to bed."

With her encouragement, I started a new pre-bed routine: An hour before bed, I go to lay in my hammock and relax while reading the American Academy of Pediatrics' Caring for Your Baby and Young Child. Doing this is helping me feel a bit more prepared for my new role as a mother. Then, when I inevitably still wake up in the middle of the night with pregnancy insomnia, I have started to meditate with Expectful—an app made especially for soon-to-be and new parents.

Exercise

After the baby comes, there's more I can do to help prevent—or at least lessen—the possibility of postpartum anxiety. "When a new mother has been cleared to return to exercise, encourage this," says Christiane Manzella, Ph.D., a senior psychologist at Seleni Institute. "Start with little steps, such as a short walk. Exercise can improve mood as well as having a sense of mastery and control—something which is in short supply during pregnancy and with a newborn!"

Do you your homework

She also encouraged me to continue to educate myself about perinatal mood disorders and find social and support networks. In order to get more support for dealing with my pregnancy anxiety and possible postpartum anxiety, I reached out to my local Postpartum Support International group and plan to attend the next La Leche League meeting in my area. I've also started to open up more to my husband and my friends (especially those who are already moms) about the anxiety I'm feeling.

At the end of the day, the best thing I can do to prepare for postpartum anxiety as an already anxious person is to be ready for the possibility and not let myself suffer in silence the way so many women do. "Up to half of women with PMADs never seek treatment," says Dr. Tinkelman. "Many women feel it is selfish of them to prioritize their mental health needs, but it is incorrect of them to think they need to choose between their wellbeing and the child's wellbeing. That is to say, the mother doing well is better for the mother, the pregnancy, and the offspring. These conditions are treatable. With help, people can and do feel better."

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