Next Steps

How You Can Start to Overcome Postpartum Anxiety

Treatment recommendations authored by professional and scientific organizations from around the world recommend that mothers with PPA (Postpartum Anxiety) attempt lifestyle changes or low-intensity (e.g. online) therapies prior to attempting more intensive treatments like formal psychotherapy or medications.

Below you will find a range of lifestyle approaches based on cutting-edge scientific research that can help improve your postpartum anxiety and reduce symptoms.

The Lifestyle steps that you can take to begin to overcome PPA are easier to remember if you use the NEST-S approach to self-care.

  • Nutrition
  • Exercise
  • Sleep
  • Time for yourself
  • Support

Step 1: Lifestyle Changes

How Is Nutrition Linked to Postpartum Anxiety?

  • During pregnancy and after birth, women are sometimes so busy that they may not notice that they are hungry and/or struggle to consume a healthy, balanced diet
  • Food and adequate fluid intake are essential for your brain to operate properly
  • Without these, low mood, anxiety, and irritability can develop and worsen

What You Can Do?

  • Keep a full container of water nearby and sip from it when you can
  • Have easy, healthy snacks that available/accessible (e.g., baby carrots, cherry tomatoes, fruits, nuts, and bagged salad)
  • Sit down to eat three times per day
  • Have others prepare meals/snacks for you and drop them off
  • Attempt to follow the Canada food guide
  • Carefully monitor caffeine intake – if overused it can make anxiety/irritability worse. Visit this Caffeine Calculator to see how much caffeine you should have per day
  • If you smoke or vape, gradually reduce tobacco intake with an eye toward quitting over time – visit this Government of Canada article to see your quitting options
  • Avoid recreational substances such as alcohol and cannabis if you feel depressed and/or anxious as they interfere with your diet, memory, and mood
  • Take a multivitamin or macronutrient supplement if you know you’re struggling with adequate food intake
  • If you’re struggling with very high levels of fatigue, consider asking your doctor to measure your iron levels and start a supplement if they’re low

Resources

How Is Physical Activity Linked to Postpartum Anxiety?

  • Following birth, it can be really challenging to exercise! However, even just a little regular physical activity can help improve your mood, sleep, and anxiety

What You Can Do?

  • Choose exercises that are easy (and even enjoyable if possible)
  • Try exercising from home (i.e. using work out videos on YouTube)
    • Start small! For example, try to walk for 10-15 minutes, three times per week (and then increase by 2 minutes each week)
  • If you used to do exercises before, try shorter or less intense (modified) versions of what you used to do
  • Involve someone you like (e.g., another new mom, a friend, or a family member) to help you to meet your goals
  • Try to prioritize yourself and your health and be consistent if you can (e.g., 3 times a week)
  • Take your baby with you to exercise or find childcare
  • For examples of exercises you can do with baby, look here.
  • Seek supervision and support from a professional like a trainer, nurse, or physician
  • Some other potential exercises that you can do can be found here.

Resources

How Is Sleep Linked to Postpartum Anxiety?
  • Adequate rest and sleep are vital to your mental and physical health, especially after baby
  • Research suggests that getting more than 3 continuous hours of sleep per day can reduce your risk of PPA substantially
  • In the perinatal period, it can be difficult to get the quality and quantity of sleep that you need
  • Practicing good sleep routines and using relaxation techniques can help
  • Sleep problems during pregnancy can increase risk of Postpartum Depression (PPD)
What Can You Do?
  • Have your partner take the first feed after you go to bed (or the last one of the night if they are an early riser) so that you can get 3 or more hours of sleep in a row
  • Nap or rest when your baby naps if you can (if you have trouble napping, just try lying down for 15 minutes to rest your body)
  • Create a bedtime routine or ritual for yourself (e.g., a shower or bath, moisturize, read/listen to a podcast, etc.)
  • Make sure that your bedroom is only for sleeping
  • Try to ensure that your bedroom is dark and cool (16-20 degrees Celsius is ideal for most people)
  • Go to bed at the same hour every night if you can (consistency is key)
  • Ask for help to complete your household/children’s tasks before bed
  • Avoid caffeine after 4 pm.
  • Avoid eating too much after 7 pm
  • Avoid alcohol, smoking, and screen time (including phones) in the last hour before bed
  • Relaxation techniques like box breathing or progressive muscle relaxation or guided imagery may help you fall asleep faster
Resources

How is taking time for self-care linked to Postpartum Anxiety?

  • Pregnancy and the postpartum period are very busy times when it can be easy to neglect one’s own self-care and well-being
  • It is well-known that people who are struggling with their mental health engage in fewer pleasurable activities, as well as fewer things that give them a sense of accomplishment
  • When people are sleep-deprived, anxious, and/or depressed, they also often avoid things that make them feel more uncomfortable or stressed. While this can help in the short-term, over time, this avoidance can make us feel worse

7 Tips for What You Can Do

  1. Take at least one or two periods of personal downtime each day
  2. Do at least one thing each day that you enjoy that makes you happy!
  3. Use relaxation techniques like Progressive Muscle Relaxation and Box Breathing
  4. “Behavioural Activation” is a great structured way to track daily activities and moods to identify what makes you feel better (or worse). You can use this worksheet on page 8-5.10
  5. Next, expand your list of pleasurable activities using this link to help give you ideas. Another list of enjoyable activities can be found at this link on pages 20-5.21
  6. Consider writing out activities that give you a sense of mastery or accomplishment (e.g., paying a bill, donating old clothes etc.) using this link of a list of potential pleasurable and mastery activities, on the second page. Make sure it is feasible in your life right now.
  7. Next, schedule and engage in at least one mastery or pleasure activity per day
    • Start with small, simple activities (watch one episode of a show, go for a 15-minute walk, etc.)
    • Schedule these activities at times you are likely to succeed.
    • Rate your moods (on a 0-100 point scale) before and after activities to see what works and what doesn’t. You can use page 5.25 from this link
    • Create a weekly schedule and set reminders/alarms on your phone.
    • Have an ‘accountability partner’, who you can share your goals with and can help stick to your plan.

Engaging in more healthy routines again, can improve your mood and anxiety and even help you regain your identity after pregnancy and delivery

Resources

How Can a Lack of Help and Support Contribute to Postpartum Anxiety?

  • Raising an infant without help can be difficult
  • Engaging your supports can help you adapt to life with a baby more easily
  • Good relationships play an important role in protecting new moms against mental health problems and help them in their recovery
What Types of Support Can Be Helpful?
  • Emotional supports, such as a close friend who you can talk to about your feelings and who can provide you with a sense of how valuable you are as an individual can be really valuable.
    • Some possible sources of emotional support may include a close friend (new or old!), your partner, and/or family members. Remember to pick someone who makes you feel good about yourself!
  • Social supports, this includes groups and people that help you feel like you belong/are a part of something
    • Possible sources of social support may include an online postpartum support groups found on Postpartum Support International or even a networking app like Peanut (whose free tier has lots of functionality)
  • Practical supports, such as a family member or friend can help you complete everyday chores and errands
    • Some possible sources of practical support may also include friends, family members, neighbours, other relatives, grocery or food ordering & pickup services, cleaning services, etc.
  • Informational supports are important to receiving reliable and accurate information (e.g., healthcare providers)
    • For example: a public health nurse, midwife, teacher, family doctor or other general practitioner, or a psychiatrist or psychologist, or mental health organization (e.g., Postpartum Support International).
Resources

Step 2: Formal Psychotherapy

What is Low Intensity Psychotherapy?

Psychotherapy (i.e., talk therapy) refers to interventions whereby speaking with another person can help alleviate symptoms of anxiety. Psychotherapy can help mothers shift their thinking and feelings and recover from PPA.

Low Intensity Psychotherapy refers to talk therapies that do not involve a therapist nor supported directly by a mental health professional. These are often delivered online or via apps. Popular online resources include the website MoodGym, and self-help books like Mind Over Mood. There are also websites and resources such as PositivePsychology and Therapist Aid, which contains tips and worksheets to work through when trying low intensity psychotherapy by yourself.

How Can it Help? 

In the postpartum period, low intensity psychotherapy can be a great option for mothers who have difficulties accessing formal psychotherapy with a mental health professional (due to time, financial or geographical constraints).

Some studies suggest that Internet-based Cognitive Behavioural Therapy (ICBT) can be effective like therapist-led CBT. You can also try out CBT on your own – there are many resources online (such as the ones listed below) that outline what CBT looks like, with tips and specific steps to follow. Remember to be patient with yourself as you work through therapy, and applaud yourself for taking the first step to seek help. Your mental health is important, and taking care of yourself is the essential first step in being able to take care of your baby the way that you want.

Low Intensity Psychotherapy Sources

Some of the best resources are listed below:

What is Formal Psychotherapy?

Formal psychotherapy involves talking with a professional trained in one or more evidence-based forms of treatment (e.g., cognitive behavioural therapy, interpersonal psychotherapy, etc.). These professionals can include psychologists, psychiatrists, social workers, nurses, registered psychotherapists, or others.

If your symptoms of PPA interfere with your functioning (i.e., taking care of baby, taking care of yourself, maintaining your household), it may also be worth exploring formal psychotherapy with a trained professional. This should also be considered if one’s problems don’t seem to get better despite lifestyle changes including the support of one’s family of friends.

How Can Formal Psychotherapy Help? 

This type of therapy can help you talk through your concerns and develop better ways to cope with negative feelings, set tangible goals, and respond to situations in a more adaptive manner.

Research suggests that over half of women who receive a full-course of Cognitive Behavioural Therapy (CBT) will have their symptoms completely resolve (i.e., remit). Another 25% will notice a big improvement.

Resources

  • Cognitive Behavioural Therapy (CBT): A structured form of talk therapy where you become aware of negative thinking to respond more effectively to overwhelming situations CBT has shown to have both short-term and long-term effects on postnatal depression. These are available in-home based, internet-based, and telephone-based.
  • If you would like to get in touch with a Therapist, please visit the Psychology Today website relevant to your area.
  • If you live in Ontario, a provider like Elle Psychotherapy can help.

Step 3: Medications and Complementary/Alternative Medicines

What Are Antidepressants and Anti-Anxiety Medications?

The first line of medication treatment for anxiety is a group of antidepressants with anxiolytic properties called the SSRIs (selective serotonin reuptake inhibitors). These medicines work by reversibly optimizing the balance of chemicals in your brain. Medicines called SNRIs (serotonin-norepinephrine reuptake inhibitors) can also help.

Anti-anxiety medications like benzodiazepines may be prescribed as well. They can quickly induce a calming effect, but are prescribed as a second-line of treatment (and for a short period) because your body can get used to them and the effect can wear off over time.

If the response to first and second-line treatment is insufficient, atypical antipsychotic medications can sometimes be given. However, given their short- and long-term side effects, they are reserved for more severe cases of anxiety that are difficult to control with first and second-line medications.

The decision of whether or not to take a medication is a challenging one. There are some risks associated with taking antidepressants during lactation (breastfeeding). While some medications are less harmful than others, almost all types of antidepressants and anti-anxiety medications make their way into the breastmilk in varying quantities. Notably, the majority of data indicate that only low amounts of medications are found in breastmilk and the infant, and only a few isolated instances have shown adverse signs. The potential risks from medication should be weighed against the risks of untreated PPA.

If you wish to explore the possible consequences of taking medication during lactation, please visit the links below and consult a healthcare professional.

Resources

What is it?
  • Yoga is a combination of physical and mental exercises that are used to calm and strengthen the body and mind.
What You Can Do
  • While any amount of yoga can help, in one study, taking two one-hour classes per week for eight weeks delivered by a certified yoga instructor helped to alleviate postpartum anxiety
  • Consistency is key – there are many accessible resources (ex: Simple Yoga Poses),
Resources
What is it?
  • Mindfulness training, which is based on commonly used meditation techniques, is the practice of awareness and attention exercises focused on accepting one’s present state of emotions, thoughts, and physical sensations
What You Can Do
  • Try and schedule time in your daily routine for mindfulness training, perhaps after waking up or right before bed when the house can be more quiet. Start with a shorter training session (~10 minutes) and extend it over time. Mindfulness training can help improve your mood and decrease
Resources
What is it?
  • Relaxation techniques include activities such as slow muscle relaxation and deep breathing
  • These techniques are often key components of cognitive behavioural therapy (CBT)
What You Can Do
  • Relaxation techniques have shown to reduce anxiety and stress among new moms
  • Schedule time to practice relaxation techniques! There are lots of opportunities throughout the day to spend a few minutes practicing. Whether it’s a few minutes before bed, after breakfast, while breastfeeding or soothing the baby etc. Consistency is important – teaching your body how to relax is a skill, so expect it to take some practice!
  • Examples of relaxation techniques include
Resources
What is it?
  • Massage therapy is a traditional therapy technique in which a therapist manipulates your muscles and other soft tissues to promote relaxation
What You Can Do
  • Consider scheduling weekly massage therapy sessions. In one study, 8 weeks of weekly 20 minute sessions helped with postpartum anxiety (with little evidence of adverse effects)
Resources

Understandably, postpartum anxiety can be a distressing and frustrating experience for new moms who already have a large number of tasks and responsibilities to handle. Luckily, there are many options, such as lifestyle interventions, low-intensity psychotherapy, medication, and virtual resources, which can work to support you during this time. With the right resources, you can overcome postpartum anxiety!

 

*Disclaimer: The results of this questionnaire are for informational purposes only and do not represent a formal diagnosis. Only a trained healthcare professional can make psychiatric diagnoses. This is because the symptoms of anxiety can be due to a range of problems ranging from postpartum anxiety to physical health problems. If you are concerned, please consult your healthcare professional.

 

**Note: majority of the resources shared may be restricted to Ontario or Canada.

en English
en Englishfr Françaisar العربيةzh-CN 简体中文nl Nederlandstl Filipinode Deutschit Italianofa فارسیpl Polskipt Portuguêspa ਪੰਜਾਬੀru Русскийes Españolur اردو