Postnatal anxiety: symptoms, support and treatment after birth

The NHS says you may feel a bit down, tearful or anxious in the first week after giving birth and that this is normal. If these feelings start later or last for more than 2 weeks after giving birth, it could be a sign of postnatal depression, and postnatal depression and anxiety are both common and treatable. The NHS asks you to speak to your midwife, GP or health visitor as soon as possible if you think you may be depressed or anxious.

The NHS describes the main symptom of perinatal anxiety as feelings of stress or worry that affect your daily life and are difficult to control. PANDAS Foundation, a UK perinatal mental health charity, explains that anxiety is a normal response to a situation that feels difficult or threatening, but with an anxiety disorder the feeling of dread and imminent danger does not go away, and that not knowing what triggers it can intensify it.

The NHS description of perinatal anxiety lists feeling tense and unable to relax, worrying all the time, finding it hard to concentrate, difficulty sleeping because you cannot stop worrying, feeling others are judging you, a noticeable heartbeat (palpitations), feeling faint or dizzy, and teeth grinding, and says it can also cause panic attacks with sudden intense anxiety and fear. PANDAS separates psychological symptoms from physical ones.

The Maternal Mental Health Alliance lists signs that your mental health may be under pressure: sudden, big or constant changes in mood; thoughts or images of harming yourself or of harm coming to your baby (intrusive thoughts); feeling overwhelmed by guilt, shame or hopelessness; struggling to bond with your baby; being unable to sleep or relax even when the baby sleeps; thinking you are not a good parent; seeing, hearing or believing things others do not; and frequent worry about food or body image. It says to speak to your GP, midwife or health visitor without delay, not to dismiss it as baby blues, and that you know what is normal for you.

The NHS says to contact a GP immediately if someone hears or sees things that are not real (hallucinations) or develops strong beliefs not shared by others (delusions), and to call 999 if you think there is a danger you might harm yourself or others. PANDAS gives Samaritans on 116 123 for urgent help. If you feel unsafe, do not wait for an appointment.

The NHS says a GP or midwife will ask about your symptoms and how they affect daily life, and about any earlier anxiety problems, and that these questions are only to make sure you get the help you need; it says clinicians are used to treating anxiety in the perinatal period and will not judge you. PANDAS says early recognition, support and treatment can be a huge benefit to the whole family and that withdrawing from social contact is a common effect of anxiety. NICE says you should be offered a chance to talk about your birth experience at postnatal contacts, which is another opening to raise worries.

If you are already under a mental health team or take medicine for anxiety, tell your doctor as soon as possible. The NHS says you should not stop a prescribed medicine until you have spoken to them.

NICE says that if you have an anxiety disorder you should be offered psychological therapy, with the type depending on your symptoms and the kind of anxiety disorder, with regular check-ups, and more intensive therapy if symptoms have not improved after 2 weeks. The NHS says the usual treatment for perinatal anxiety is cognitive behavioural therapy (CBT), delivered in person, online or by telephone, and that if symptoms cause a great deal of distress you may be referred to a specialist to discuss other options including medicines and their risks.

If you were already taking medicine for anxiety, NICE and the NHS describe discussing options: gradually stopping the medicine and changing to therapy such as CBT, continuing it if you understand the risks, or switching to one with lower risks, and sometimes combining with therapy. These are individual decisions made with your doctor; do not start, stop or change medicines without advice, including when breastfeeding. For tokophobia (a phobia of giving birth), NICE says you should be offered a chance to talk about your fears with an experienced professional.

The NHS suggests breathing exercises and meditation, regular exercise (walking, swimming and yoga are named for pregnancy, and it says gentle exercise after birth helps recovery), talking about feelings with a friend or family member, and local groups. After birth, the NHS recommends waiting for the 6 to 8 week check before more high-impact exercise. PANDAS offers support calls, message-based support and groups, and the Maternal Mental Health Alliance publishes a symptom checker and guidance on treatment and support. Local perinatal mental health services and waiting times vary between UK nations.