Postpartum Mental Health P2

Series: Beyond the Baby Blues: A Postpartum Mental Health Series

Intro to series:

At BESST Transitions, we explore the turning points that shape health and wellbeing. Few transitions are as profound as the shift into parenthood.  This post is part of Beyond the Baby Blues: A Postpartum Mental Health Series, which explores the emotional realities of the “fourth trimester.” This is a time of immense physical, emotional, and social change. In this series on postpartum mental health, we’ll follow this journey through its many layers: from the early adjustment beyond the baby blues, to the realities of anxiety and depression, to strategies for support and advocacy. Each post is an invitation to recognize the challenges of this transition, and to imagine more supportive pathways forward. Two other series will follow.  These will explore postpartum mental health across the lifespan and postpartum mental health in marginalized communities.

Posts in this Series:

1. Postpartum Mental Health: Beyond the Baby Blues

2. Postpartum Anxiety: The Silent Partner of New Motherhood

3. Postpartum Depression: Understanding the Shadows Beyond the Smile

4. Partners & Family: The Ripple Effects of Postpartum Mental Health

5. Self-Care and Coping Strategies for New Parents

6. Navigating Professional Support: From Pregnancy to Postpartum as a First-Time Parent

7. From Advocacy to Action: Canada Joins the Global Push for Perinatal Mental Health

Postpartum Anxiety: The Silent Partner of New Motherhood

Lived Experience

When my son was a newborn, I wasn’t only caring for him, I was also responsible for my ten-year-old neurodivergent stepdaughter, who still needed an adult present at all times. My husband was present and supportive for all of us, but because the baby arrived a month early (as I shared in an earlier post), he couldn’t take time off work we had planned for those first weeks. Since I was home on maternity leave, I took on my stepdaughter’s daily routines, something I had already been involved with before giving birth. Each morning, I brought her to the bus stop and every afternoon, I made sure to be home when the bus returned. The logistics, however, were daunting: my baby hated the car and often became carsick, so even a short, ten-minute trip to my parents’ house required careful planning around naps, feedings, and motion sickness. I often found myself isolating at home just to avoid the trouble.

Bigger trips, like the forty-minute drive to my in-laws, felt almost impossible. I was hyper-attuned to the clock, constantly checking whether I could get home in time to meet the school bus. Meanwhile, the baby’s difficulty sleeping meant I was perpetually calculating and recalculating how to fit everyone’s needs into the day.

I often wondered: Was this postpartum depression? I monitored myself carefully, sometimes too carefully, because I “knew too much” from my professional background. What I did know is that I felt very much alone, even with a very strong support network. To complicate things further, I was simultaneously navigating the tenure process at work, a high-stakes stressor in its own right. And, because of my age, I knew that this would likely be my only biological child, and I felt a deep desire to savour every possible moment with my baby.

When my son was nine months old, an ad appeared in my Facebook feed: a dance class where you wore your baby in a carrier. I love ballroom dancing, and my son already loved being in the carrier, so I signed up. There, I found joy and relief in dancing merengue, bachata, salsa, rumba, cha-cha-cha, and even African dance by the end of the semester. The travel stress never fully disappeared, but the baby loved the dancing, often falling asleep against me. The movement, music, and camaraderie lightened the weight I had been carrying. I even made a friend in that class, a younger mother with whom I am still in touch ten years later.

Was this postpartum anxiety? I don’t know.  What I do know is that I found ways to ease my mental load, while also keeping my baby close.  Dancing together gave me the best of both worlds, relief and joy in music and movement, and the comfort of knowing we were sharing the experience. But not every woman is able to find, or access, such outlets. For many the pressures of new motherhood build quietly, invisibly, until they become overwhelming.

This is where we turn to postpartum anxiety itself: what it looks like, how common it is, and why it so often hides in plain sight.

What is postpartum anxiety?

Postpartum anxiety (PPA), sometimes called perinatal anxiety when it begins during pregnancy, refers to excessive worry, intrusive thoughts, hypervigilance, or panic that develops during pregnancy or in the first year after birth and causes significant impairment (American Psychiatric Association, 2022); note that the DSM-5-TR does not have PPA as a category; criteria for General Anxiety Disorder are used for its diagnosis. Unlike depression, which is more widely recognized, anxiety can hide in plain sight: under the mask of “just being cautious,” “over-tired,” or “trying to keep everything together”. There is difficulty in diagnosing what is normal versus pathological (Misri et al., 2015).

How common is it?

Globally, a recent study found the prevalence for postpartum anxiety to be 12.3% (Feldman et al, 2025) whereas it had previously been estimated to affect at least 1 in 5 mothers, and in some populations the prevalence is even higher when measured by symptom scales (Fawcett et al., 2019). Yet it remains under-detected and under-treated.

Why it’s missed

The overlap between normal postpartum exhaustion and clinical anxiety makes detection difficult. Mothers may also hesitate to disclose anxiety, fearing judgment or intervention. Historically, routine screening focused almost entirely on depression; only recently have guidelines emphasized anxiety assessment as well.

Why Mothers Stay Silent

Beyond stigma or lack of awareness, many mothers carry a quieter, deeper fear: what will happen if I admit I’m not coping?

In my own research examining how postpartum mental health is represented on social media, my team noticed a striking pattern. While much of the online discourse focused on postpartum depression, one theme emerged consistently: mothers were reluctant to disclose their struggles not only because of shame or lack of knowledge, but because they feared repercussions. The most prominent fear voiced was the possibility of having their baby taken away (Erak et al., submitted).

This fear, whether grounded in personal experience, community stories, or systemic mistrust, silences conversations before they begin. It means mothers may sit alone with their symptoms rather than seeking the support they deserve. And it highlights that screening and intervention must go hand-in-hand with reassurance: that seeking help is about keeping both mother and baby safe and supported, not about punishment.

Symptoms to watch for

• Excessive worry about the baby’s safety, health, or one’s ability to parent.

• Repetitive checking or reassurance-seeking.

• Panic attacks or persistent physical tension.

• Intrusive, distressing thoughts — often about accidental harm — that the parent finds abhorrent.

• Difficulty relaxing, even when others assure that everything is fine.

  
  

(Texas Children’s Hospital, 2025)

Risk factors — the biosocial stress model in action

(Centre for Addiction and Mental Health, n.d.)

My own story illustrates how biological, psychological, and social layers combine to shape vulnerability:

• Biological: sleep deprivation, hormonal shifts, and genetic vulnerability can heighten anxiety.

• Psychological: perfectionism, fear of “failing,” or high achievement stress (like going through tenure review) increase cognitive load.

• Social/contextual: the daily caregiving responsibility for both a newborn and an autistic stepchild, time pressures, and travel logistics compounded stress despite strong family support.

  
  

This is exactly what the biosocial (biopsychosocial) stress model explains: postpartum anxiety rarely arises from a single cause. Instead, it emerges from the interplay of multiple vulnerabilities and environmental demands.

What helps

• Screening and validation: Asking directly about anxiety symptoms, not just depression, and normalizing the experience.

  
  

• Therapies: Cognitive-behavioral therapy (CBT) (Simhi et al., 2021) and mindfulness (March of Dimes, 2023) interventions have strong evidence of benefit.

  
  

• Medication: For moderate–severe cases, SSRIs and other medications may be recommended under specialist guidance (Centre for Addiction and Mental Health, n.d.). Other pharmacotherapy may be recommended, and many new medications are being explored to help reduce symptoms.

  
  

• Social connection: As I found in my dance class, activities that combine movement, community, and joy can provide powerful relief. Sometimes the most healing steps are those that get us out of isolation and back into rhythm with others, though taking those first steps was not easy.

  
  

A perfect storm: Postpartum anxiety during COVID-19

Of course, postpartum anxiety does not unfold in isolation, it is deeply shaped by the world around us. The COVID-19 pandemic created a unique and often traumatic context for new mothers. For many new mothers, what is already a vulnerable period became one of prolonged isolation, fear, and uncertainty.  Hospital policies often restricted birth partners and visitors.  Family members who might have stepped in to help were suddenly absent for long stretches.  The constant worry about viral exposure, whether via doctor’s appointments, grocery trips, or simply holding the baby, created a baseline of fear that fed into anxiety; the ordinary stressors of the postpartum period became magnified into something overwhelming.

Research bears this out, rates of perinatal mood and anxiety disorders rose sharply during the pandemic (Mamrath et al., 2024). My research group analyzed real-time Twitter posts from pregnant women and new mothers during the pandemic and found recurring themes of isolation, sleep disturbance, and lack of support (Talbot, Charron, and Konkle, 2021). These digital voices revealed what many were experiencing behind closed doors: increased anxiety, fears of being alone, and a longing for reassurance that help was available. The data showed that social connection and support, already known protective factors for maternal mental health, were profoundly disrupted, leaving many women to navigate both pandemic stress and postpartum anxiety simultaneously.  For many women, the postpartum experience during COVID was not just exhausting, it was traumatic.

Moving forward: Paths to healing

Postpartum anxiety is common, often hidden, and highly treatable. It can touch anyone, even mothers with strong support, professional knowledge, and “everything in place”. Recognizing that postpartum wellbeing is shaped by biological vulnerability, personal psychology, and social context helps us see why it so often goes unnoticed. Treatment may look different for each mother: for some, therapy or mindfulness-based strategies may be enough.  For others, medication is the first and most essential step. Many women need a combination of approaches over time. What matters most is that postpartum anxiety is not a life sentence. With the right care, whether pharmacological, psychological, or social, relief is possible.  No one needs to struggle in silence, and reaching out for help is an act of strength, not weakness.

-- Anne TM Konkle, PhD

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.

Centre for Addiction and Mental Health. (n.d.). Risk factors: Perinatal mood & anxiety disorders. CAMH. Retrieved September 20, 2025, from https://www.camh.ca/en/professionals/treating-conditions-and-disorders/perinatal-mood-and-anxiety-disorders/perinatal-mood---risk-factors

Centre for Addiction and Mental Health. (n.d.). Perinatal mood and anxiety disorders: Pharmacotherapy. CAMH. Retrieved September 20, 2025, from https://www.camh.ca/en/professionals/treating-conditions-and-disorders/perinatal-mood-and-anxiety-disorders/perinatal-mood---treatment/perinatal-mood---pharmacotherapy

Erak, A, Fenton, A, Konkle, ATM.  Pinterest: A Place for Women and Women's Issues An Analysis of Postpartum Depression Self-Disclosure Stories on Pinterest. Submitted to Information.

Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. Journal of Clinical Psychiatry. 2019 Jul 23;80(4):18r12527. doi: 10.4088/JCP.18r12527.

Feldman N, Hibara A, Ye J, Macaranas A, Larkin P, Hendrix E, Aydinian T, Mittal L, Wiegartz P, Silbersweig D, Liu CH. Postpartum anxiety: a state-of-the-art review. Lancet Psychiatry. 2025 Sep 1:S2215-0366(25)00197-X. doi: 10.1016/S2215-0366(25)00197-X. Epub ahead of print.

Mamrath S, Greenfield M, Fernandez Turienzo C, Fallon V, Silverio SA. Experiences of postpartum anxiety during the COVID-19 pandemic: A mixed methods study and demographic analysis. PLoS One. 2024 Mar 7;19(3):e0297454. doi: 10.1371/journal.pone.0297454.

March of Dimes. (2023, April). Postpartum anxiety mindfulness exercises: Short-form [PDF]. https://www.marchofdimes.org/sites/default/files/2023-04/CS_MOD_ISWM_ShortForm_Mindfulness.pdf

Misri S, Abizadeh J, Sanders S, Swift E. Perinatal Generalized Anxiety Disorder: Assessment and Treatment. Journal of Womens Health (Larchmt). 2015 Sep;24(9):762-70. doi: 10.1089/jwh.2014.5150. Epub 2015 Jun 30.

Simhi M, Sarid O, Rowe H, Fisher J, Cwikel J. A Cognitive-Behavioral Intervention for Postpartum Anxiety and Depression: Individual Phone vs. Group Format. Journal of Clinical Medicine. 2021 Dec 18;10(24):5952. doi: 10.3390/jcm10245952.

Talbot J, Charron V, Konkle AT. Feeling the Void: Lack of Support for Isolation and Sleep Difficulties in Pregnant Women during the COVID-19 Pandemic Revealed by Twitter Data Analysis. International Journal of Environmental Research and Public Health. 2021 Jan 6;18(2):393. doi: 10.3390/ijerph18020393.

Texas Children’s Hospital. (2025, March 28). Recognizing & treating postpartum anxiety. Texas Children’s. https://www.texaschildrens.org/content/wellness/recognizing-signs-postpartum-anxiety#:~:text=Women%20with%20postpartum%20anxiety%20disorder,bad%20happening%20to%20the%20baby