New parenthood and anxiety seem almost synonymous. Every parent worries about their newborn. But there is a distinction between the universal worry of early parenthood and a clinical anxiety disorder – and that distinction matters because clinical anxiety does not tend to resolve on its own without support, and it can significantly affect the parent's wellbeing and their experience of this period.
Postnatal anxiety is frequently overlooked because: it looks, from the outside, like devoted parenting; the parent may feel ashamed of their intrusive thoughts; and much professional attention during the postnatal period focuses on depression as the primary mental health concern.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers parental mental health and wellbeing in the perinatal period.
What Postnatal Anxiety Is
Postnatal anxiety (also called perinatal anxiety or postpartum anxiety in international literature) refers to anxiety disorders that develop or are exacerbated in the context of pregnancy and new parenthood. These include:
Generalised anxiety disorder (GAD) – persistent, uncontrollable worry across multiple domains, difficulty relaxing, and physical symptoms of anxiety.
Panic disorder – recurrent panic attacks with physical symptoms (racing heart, difficulty breathing, chest tightness, feeling of impending doom) and persistent worry about having another one.
Health anxiety (illness anxiety) – persistent worry about the baby's health, frequent checking behaviour, difficulty being reassured by normal clinical findings.
OCD with perinatal content – intrusive, unwanted, ego-dystonic thoughts about harm coming to the baby (including, distressingly, thoughts about harming the baby oneself). These thoughts are highly distressing precisely because they are ego-dystonic – the parent is horrified by them, not acting on them. They are a feature of OCD in the perinatal period and should be disclosed to a GP or midwife so that appropriate support can be offered.
Research by Nicola Wiles at the University of Bristol, and by Jeannette Milgrom at the University of Melbourne, documents that perinatal anxiety is common (around 10-15% of new mothers) and frequently co-occurs with postnatal depression, but that it is underidentified because routine screening (the Edinburgh Postnatal Depression Scale) was designed primarily to detect depression, and anxiety symptoms are not fully captured by it.
How It Differs from Normal New Parent Worry
Normal new parent worry: you worry about the baby, and then you can be reassured, distracted, or calmed. The worry does not take over your day.
Postnatal anxiety: worry that is difficult to turn off, that escalates despite reassurance, that is accompanied by physical symptoms, that disturbs sleep beyond what the baby's waking causes, or that involves intrusive thoughts that feel frightening. If checking the baby breathing is done once before you sleep, that is normal; if it is done 20 times per night and you still cannot settle, that is anxiety.
Getting Help
The first step is raising concerns with the GP, health visitor, or midwife. Honest disclosure of anxiety symptoms, including intrusive thoughts, is important; the professional response to disclosed perinatal OCD and anxiety is supportive, not punitive. Anxiety is not a sign that you are a bad parent.
Perinatal mental health services in England are available through NHS Talking Therapies (IAPT) and specialist Perinatal Mental Health teams. CBT (cognitive behavioural therapy) is the most evidence-based psychological treatment for anxiety disorders, including in the perinatal period. For moderate to severe anxiety, or where therapy is not sufficient, medication (including SSRIs, which are considered relatively safe in the perinatal period under medical guidance) may be indicated.
Peer support organisations including PANDAS Foundation and the charity PNI Connect (previously Birth Trauma Association and Maternal Mental Health Alliance resources) offer support alongside professional services.
Key Takeaways
Postnatal anxiety is at least as common as postnatal depression (PND) but is less recognised and less routinely screened for. It is experienced by around 10-15% of new mothers, and also occurs in new fathers and partners. Symptoms include persistent excessive worry about the baby's health or safety, intrusive thoughts, physical symptoms of anxiety (racing heart, difficulty breathing, insomnia beyond normal new parent sleep deprivation), and in some cases panic attacks. Perinatal anxiety responds well to treatment, including psychological therapy (CBT) and, where indicated, medication. Seeking help is the most important step.
