UNC Health Talk

Understanding Postpartum Anxiety and PTSD

Childbirth is life-changing: Not only is a new baby born, but also a new mom. Many women experience a flood of emotions, some happy and some not, and the postpartum period can be a difficult time for mental health.

Most people have heard of postpartum depression, but there are other postpartum mood disorders, too. We talked to Mary Kimmel, MD, co-director of UNC Health’s Perinatal Psychiatry Program, to learn more about postpartum anxiety, including postpartum obsessive-compulsive disorder, and postpartum post-traumatic stress disorder.

Postpartum Anxiety

One of the hallmark emotions you feel upon becoming a new parent is worry—and it’s a feeling that may stay with you even when your children are grown and have children of their own. However, 1 in 5 new moms experience at least one type of anxiety disorder, which includes panic disorder (having panic attacks), social anxiety disorder and obsessive-compulsive disorder, which we’ll cover in more detail below.

“Perinatal anxiety is really common in pregnancy and in new moms,” Dr. Kimmel says.

Postpartum anxiety can be hard to spot because worrying is a normal response to having a child. But postpartum anxiety disorder is marked by more intense, unrelenting anxiety that interferes with daily functioning.

“Many pregnant women and postpartum women have worry, understandably, but if it’s getting in the way of them being present with their family, their baby or healthy behaviors, that is when it may be more than generalized worry,” Dr. Kimmel says.

For example: It’s fairly typical to bring your new baby home and feel anxious about his or her safety while sleeping; lots of new parents get up to check on their baby in the crib several times a night, at least at first. But if you’re so anxious that you watch the baby sleep all night and don’t allow yourself to go to sleep, that could indicate more problematic anxiety.

That’s just one example; behavior doesn’t have to be that extreme to warrant seeking help. If you’re struggling to enjoy time with your new baby or give yourself a break from baby care, talk to your primary care physician, your OB-GYN or your baby’s pediatrician.

There are many options for feeling better, Dr. Kimmel says. Treatment for anxiety disorders can include talk therapy and medication.

Therapy—alone or in combination with medication—can help you uncover the cause of your worries and fears, learn how to relax your body and give you the tools to manage your anxiety. Cognitive behavioral therapy, in which a therapist helps you learn to change your thinking patterns, is very effective in treating anxiety. Your doctor can advise you on medication; there are safe options for pregnant and breastfeeding women.

“Cognitive behavioral therapy teaches you to acknowledge the thoughts but not let the thoughts overrun you,” Dr. Kimmel says.

Postpartum Obsessive-Compulsive Disorder

Postpartum obsessive-compulsive disorder (OCD) is the most misunderstood and misdiagnosed of the postpartum mood disorders. OCD causes recurring, unwanted thoughts, ideas or sensations (obsessions) that can make you feel driven to do something repetitively (compulsions) or avoid something because of your obsessions.

Obsessive thoughts, though intrusive, are really common for new parents, and they may even include disturbing images that pop into your head, Dr. Kimmel says. For example, you’re about to walk down the stairs with your baby and you suddenly think, “What if I drop the baby?” or you even imagine it happening, perhaps vividly.

If you don’t have OCD, you may acknowledge the disturbing thought, pull your baby in tighter and proceed down the stairs.

“But with OCD, that thought really takes on this really large space, and even though you may even know that the thought doesn’t make sense, you can’t proceed down the stairs,” Dr. Kimmel says. “You logically know you’re going to be careful, but it feels so emotional and intense that it’s hard to not have that thought.”

If you are experiencing obsessive thoughts or compulsions, it’s important to talk to your provider. Therapy can help, as can medication.

“We will help build up your confidence in a way that helps you recognize the anxiety and understand that you can handle it,” Dr. Kimmel says. “So the next time you experience an anxious thought, you can say, ‘That’s my mom brain reminding me to be careful’ and acknowledge the thought and allow yourself to move through it.”

It’s also good to know that having an intrusive thought, even repeatedly, does not make you more likely to act on it. Therapy can help you realize that thoughts are not reality and that you are in control.

If you experienced OCD at another time in your life, you are more likely to have an episode during the postpartum period, Dr. Kimmel says.

Postpartum Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) can occur after you experience or witness an actual or threatened traumatic event, such as a serious car accident, near-death experience, serious injury, or physical or sexual violence.

After a traumatic event, it’s normal to experience upsetting memories or nightmares, have trouble sleeping, or just feel irritable, sad or anxious. Most people tend to feel better over time and get back to their normal lives after a few weeks or months. If you experience PTSD, however, you feel those reactions for a prolonged time.

Having a traumatic childbirth or experiencing trauma earlier in your life can cause postpartum PTSD, Dr. Kimmel says.

Even if you and the baby are fine, if you once felt fearful that you or your baby were in danger, it might have caused traumatic stress.

Childbirth is already a stressful experience, Dr. Kimmel says. “Our biological systems are working really hard in that moment, so if you have preeclampsia or an emergency C-section, which occurs very quickly—often before you have time to fully process what is happening—the feeling that you and the baby are in danger becomes overwhelming and sustained even when mother and baby have gotten through the delivery,” Dr. Kimmel says. “So it’s not uncommon to see PTSD in someone who has gone through a traumatic delivery.”

Postpartum PTSD is also common in women who have experienced trauma in the past, either during childhood or another time.

“Childbirth and pregnancy are a huge change, and our bodies may be remembering (that trauma) to prepare us for this moment of change,” Dr. Kimmel says. “So the women who’ve had trauma in the past are more likely also to have anxiety and depression during the perinatal period.”

Talk therapy can be very helpful in treating postpartum PTSD.

“Having these conversations is key for patients to be empowered, that it is their story, that it is important,” Dr. Kimmel says, “and they need to be able to process the trauma they experienced.”


If you think you are experiencing symptoms of a postpartum mood disorder, talk with your doctor. If you don’t have one, find one near you. here