Thanks to our guest blogger, the OCD and Anxiety Center of Minnesota (OCDMN), for this post. OCDMN is a clinic located in the Twin Cities area that provides services for individuals with OCD and related disorders. The clinic is owned and operated by Jayme Kolbo, Erin Venker and Emily Risinger. These therapists are highly trained in Exposure Response Prevention (ERP) and aim to provide more knowledge on the benefits of ERP through education, advocacy and therapeutic practices. Sign up for their newsletter or check out their website for more information.
NOTE: If you are experiencing anxiety or feel something is not right with your mental health, please consult your physician.
Tips for Handling Prenatal Anxiety and Postpartum Stress
Pregnancy and parenting are wonderful and challenging at the same time. There are great moments and not-so-great moments, and all parents struggle from time to time. Below are some ways to cope effectively with prenatal anxiety and postpartum stress.
Learn to ask for and accept help
Whether it be during pregnancy or after the baby is born, learning to ask for and accept help from others is an important skill. Asking for help is hard. It means relinquishing some level of control, accepting that you cannot do everything alone (and aren’t meant to), and requires a certain level of vulnerability with others. Remember that others cannot read your mind and even if they try to, they will probably get it wrong. We tend to think we’re better mind-readers than we really are. The solution is to be clear in expressing what you need from others. Focus on what you want, not what you don’t want. For example, if your friend’s car seat recommendations are triggering your prenatal anxiety, telling them you don’t need their recommendations is fine, but it doesn’t tell them what would be more helpful. Similarly, if someone offers help but you can’t think of how they could help in the moment, tuck the offer away for when you do need it. When someone becomes overbearing in offering help or advice, it’s okay to set boundaries and say no. Be kind and fair to yourself and others. Accept help that is offered to you. It takes a village (Linehan, 2014).
Alter expectations for yourself
What you used to be able to get done before becoming pregnant may not be the same as what is realistic to get done while you are pregnant or after the baby is born. This is normal. You are growing a human being inside of you or recovering from delivery and making a big life transition. It might take some time and practice before you find a new routine that works for you. Let the house be a mess, let others prepare food, and respond to texts/emails later if it means you can slip in a little extra sleep, food, or just some quiet time to yourself. Focus on self-care of basic needs: sleep when you can, eat when you can, stay hydrated, go to the bathroom, shower when you can, brush your teeth, step outside, move your body (as permitted by your doctor before and after birth), connect with support people when you can, and treat yourself like you would a good friend. Be kind! Small self-care actions can help alleviate postpartum stress. Remember: you do not have to do it all (Neff, 2013).
New parents have a lot to do to get ready for their baby to come. With COVID-19, there are additional things to think about, and these may trigger prenatal anxiety (Yassa et al, 2020). The emotional burden of living during a pandemic makes day-to-day life a little more exhausting, which makes asking for and accepting help even more important. Many new parents are being asked to quarantine themselves before and after the delivery, meaning parents can’t physically be with others, and others can’t meet the baby right away. Make a plan for how to tell family and friends about COVID-19 precautions and, more importantly, make a plan for how you can still accept help from others while quarantining. This is an essential step in managing postpartum stress. Family and friends can still drop off food and/or basic necessities/groceries and can still call/video chat to check in and offer emotional support (with the understanding that new parents may not answer, and that’s okay too). Reserve the right to change this plan as COVID-19 information progresses. Check in with your healthcare provider for the facts and allow yourself to set boundaries even if friends and family don’t agree or like it. When it is safe to be around others, your healthcare team will give the green light. Let others know any boundaries you have even after the quarantine period is over.
The pandemic has also led to increased financial hardship for many. There are resources that can help:
Learn how to cope with uncertainty
Becoming a parent comes with many changes, and the months leading up to meeting your child for the first time can certainly trigger prenatal anxiety. With change comes the loss of what we once knew to be our normal, loss of the comfort of generally knowing what to expect in our life, and uncertainty about the future. Uncertainty can feel daunting and scary, and it’s a normal part of life, especially during pregnancy. Our brains are wired for survival, so we are likely to look at an uncertain future through our worst-case-scenario lens as a way of trying to prevent or prepare for the worst – which in turn triggers prenatal anxiety (Grupe & Nitschke, 2013). What if I’m a bad parent? What if my baby never stops crying? What if I do something terrible because I’m sleep deprived or frustrated? What if I permanently mess up my kid? All of these thoughts are normal and we don’t have to have all the answers. When the uncertainty of the future feels overwhelming, remember that the opposite of our worries could also be true. Maybe I will be a bad parent, but also maybe I won’t be. Maybe I’ll do great. Even more realistically, maybe a perfect parent doesn’t exist and that’s okay. Maybe I can show up in my imperfection and still be capable of parenting a child. This helps our brains realize the worst-case scenario is not the only scenario, we cannot predict the future, we do not need to plan for every possibility of what could go wrong, and we have the amazing ability to adapt to new situations and cope with difficulties that come our way when they happen. Solving problems that haven’t actually happened yet feeds our anxious mind. Staying present and focusing on the answers you do have and the problems you can solve helps mitigate prenatal anxiety.
Postpartum stress is insidious, and if you don’t take time to check in with yourself it can run rampant. Take it one moment at a time. It could be just one day at a time, one hour at a time, or one step at a time. Break it down. You don’t have to get through the next year right now, just this present moment. Notice worry about the future and rumination about the past and return your attention to right here, right now. This can be challenging during the painful or difficult moments of parenting, and is still useful long-term. We must allow ourselves to experience anger, sadness, fear, guilt, shame, and whatever emotions come up because not allowing these “negative” emotions doesn’t work (Linehan, 2014). Emotions are part of what makes us human. They are there to give us information. Approach emotions with curiosity. What does it feel like to be mad right now? Am I shaming myself for not enjoying every second with my newborn? Maybe it’s okay to feel this way. Where do I feel it in my body? Breathe deeply into that feeling. Remember that actions are separate from emotions. I can feel anger and still act kindly to my friends and family. Being mindful of emotions is important for the positive moments with your baby as well. Experience these moments more fully by taking in information from all of your senses: how does your baby smell? Look? Sound? How does your baby feel in your hands? Throw yourself into this moment to build a stronger connection with your baby.
Parenting is difficult and messy. Nobody is perfect at it and nobody can do it alone. Consider finding a therapist or a support group if your postpartum stress or anxiety feels overwhelming, if you are experiencing excessive distress that impairs your ability to function or be present, or if you think you could benefit from having a safe place to be heard and learn coping skills. You don’t have to wait until you are in crisis to get support. The use of telehealth has become the new norm for therapy. This has made it more accessible to expecting and new parents. When searching for a therapist ask if they are ok with your baby being present should you not have someone to watch them and be sure they specialize in Cognitive Behavior Therapy (CBT) and Exposure and Response Prevention (ERP). (Hudepohl & Howard, 2017)
Below are some additional resources for prenatal and postpartum care:
You are not alone. Stay Brave!
Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: An integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14(7), 488-501. doi:10.1038/nrn3524
Hudepohl, N., MD, & Howard, M., PhD. (2017, December 28). Perinatal ocd: What research says about diagnosis and treatment. Retrieved February 16, 2021, from https://iocdf.org/expert-opinions/perinatal-ocd-what-research-says-about-diagnosis-and-treatment/
Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.
Neff, K. (2013). Self compassion. London: Hodder & Stoughton.
Yassa, M., Yassa, A., Yirmibeş, C., Birol, P., Ünlü, U. G., Tekin, A. B., Sandal, K., Mutlu, M. A., Çavuşoğlu, G., & Tug, N. (2020). Anxiety levels and obsessive compulsion symptoms of pregnant women during the COVID-19 pandemic. Turkish journal of obstetrics and gynecology, 17(3), 155–160. https://doi.org/10.4274/tjod.galenos.2020.91455
Additional Related Sources:
Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. Behaviour research and therapy, 59, 40–51. https://doi.org/10.1016/j.brat.2014.05.005
Sharma, V., & Sommerdyk, C. (2015). Obsessive–Compulsive Disorder in the Postpartum Period: Diagnosis, Differential Diagnosis and Management. Women’s Health, 543–552. https://doi.org/10.2217/WHE.15.20