Is anxiety during and after pregnancy normal?

With a 1-and-half-year-old son at home and another baby on the way, Amy Ruggiero, 42, recalled the time of her second pregnancy as “torture.”

“I wanted so desperately to have babies and I couldn’t have been more miserable to be pregnant and then have a new baby,” said Ruggiero, of Drexel Hill, Pennsylvania.

Although she had experienced a bout of anxiety—including constant crying— after having her first child in 2001, the pregnancy in 2004 made her symptoms worse.

As her older son slept, she was terrified that something would happen to him if she didn’t check his breathing.

“His breaths needed to be a certain space apart, and I needed to check them for a certain amount of time. And if I lost track of one, I had to start all over again,” she recalled.  “Sometimes I couldn’t leave his room for 45 minutes at a time.”

Ruggiero also found herself flipping the light switches on and off, and checking the electrical outlets.

“I was afraid the house was going to burst into fire all the time,” she said.

Ruggiero was constantly crying and sleeping during the day, which caused her husband to miss work. Other times, she would rely on her parents for help.

Despite feeling she would never get better, she decided to seek help and was diagnosed with obsessive-compulsive disorder (OCD), an anxiety disorder.

Ruggiero started having OCD symptoms during her second pregnancy and as she learned more about the diagnosis through therapy, realized she had OCD her whole life.

Although it’s not clear whether psychiatric medications are safe during pregnancy, Ruggiero felt she had run out of options and, with her doctor's prescription, took them while she was still pregnant.

“It was to the point where it wasn’t healthy for me to be carrying a baby the way I was, so something had to be done,” she said.

The other postpartum condition

Experts estimate that perinatal anxiety disorders, which include generalized anxiety disorder (GAD), panic disorder and OCD, are about as common as postpartum depression.

There is some evidence, however, that anxiety disorders may be even more prevalent.

According to a study in the Journal of Affective Disorders, more than 17 percent of moms who had a baby within the last three months were diagnosed with anxiety disorders, while almost 5 percent were diagnosed with depression.

What’s more, according to a study in the Journal of Reproductive Medicine, 11 percent of moms had symptoms of OCD two weeks after giving birth. At six months, nearly 50 percent of those women continued to have symptoms.

Anxiety: What’s normal?

During pregnancy and after having a baby, it’s normal for moms to experience anxiety, which is in part due to hormonal fluctuations. Feeling anxious is also thought to be a natural response to becoming a mother because it helps women be alert and protect their babies.

In fact, pregnancy changes the size and structure of parts of the brain that are responsible for social processing, and may help moms protect and nurture their babies, according to a study in the journal Nature Neusroscience.

“I wouldn’t be surprised if women were neurologically more anxious because you have to be adequately more attentive to meet the needs of a newborn,” said Dr. Alice Domar, the executive director of the Domar Center for Mind/Body Health in Boston, and author of “Finding Calm for the Expectant Mom: Tools for Reducing Stress, Anxiety, and Mood Swings During Your Pregnancy.”

Anxiety can also increase as moms realize the enormous responsibility they now have and how their lives have changed. Having a baby can be stressful, even for moms who looked forward to motherhood and for those who struggled with infertility.

“All new mothers are anxious,” said Karen Kleiman, MSW, LCSW, founder of the Postpartum Stress Center in Rosemont, Pennsylvania. “The question really becomes, 'When is it pathological?'”

Excessive worry and anxiety become problematic when those feelings interfere with a mom’s ability to get through the day, impair her ability to function, or cause her to feel extremely overwhelmed. Clinicians use the frequency, duration and intensity of a patient’s problems to determine the level of distress, said Kleiman, who is Ruggiero’s therapist.

Moms with anxiety may have scary thoughts, urges or intrusive images about harm coming to their babies, but their distress is a good sign “because that’s what tells us it’s anxiety-driven,” Kleiman said.

Although there is increased awareness about postpartum depression, many moms who suffer from anxiety do not seek treatment. What’s more, in the United States, there’s still shame around mental health conditions and many moms aren’t always quick to admit that they can’t cope.

Cost is another barrier, especially for young families for whom money is tight. Because many of the best providers don’t take insurance, many moms simply can’t afford to pay the high rates they charge.

Nevertheless, experts say there are steps to take for moms and moms-to-be who struggle with anxiety:

Acknowledge your feelings
Instead of trying to deny how you feel or try to push it aside, which will only make it worse, admit to your feelings and accept that it’s OK to have anxiety.

Talk to someone
Find a therapist that you trust or ask your OB-GYN or midwife for a referral. Although it might feel that it will never end, postpartum anxiety responds very well to treatment, Kleiman said.

If cost is an issue, search for support groups or find support online at sites like Postpartum Progress or Postpartum Support International.

Do something else
Focusing on your anxiety makes it worse, so when you’re experiencing it, have a list of things that will distract you from the ruminations. Take your baby for a walk, brew a cup of tea, or call a friend.

Exercise
Studies suggest that regular exercise can help alleviate symptoms of anxiety. Whether it’s your favorite class at the gym, a run in your neighborhood, or a yoga class, make time to move.

Seek friends
Spending time with friends or joining a new mother’s group, where moms are honest and genuine, can help you realize you’re not alone.

Get sleep
When you have a newborn, sleeping sounds like a luxury. But if you’re dealing with anxiety, it can make a huge difference in how you feel. Ask your partner or a family member to pitch in, or consider hiring a postpartum doula or a baby nurse so you can get some sleep.

Set limits
If photos of your friend’s seemingly perfect life on Facebook make you feel worse, select the unfollow option or rein in your social media habit. Also, set limits with people in your life who bring you down, and surround yourself with those who are positive and bring out the best in you.

Be kind to yourself
Instead of running yourself ragged trying to make sure you do everything perfectly, accept what you can’t do, find shortcuts, and understand that your best is enough.

Today, Ruggiero is still on medication and attends therapy sessions. She hopes her story inspires other moms dealing with anxiety to seek help.

“You need to know as a new mom that this happens to other people and there are safe places for you,” she said.