Why aren't Canadians talking about postpartum anxiety?
After having her baby, one Canadian woman found herself unable to stop having intrusive thoughts of harming her child. She sought help from a physician but was too afraid to admit to having these dark, obsessive thoughts. Thankfully, she never acted on these recurring thoughts, but she did wind up suffering in silence and enduring unsuccessful treatment for two years. Why was her treatment unsuccessful for so long? Her physician didn't ask the right questions. The mother didn't have postpartum depression — she had OCD, an anxiety disorder. And sadly, her experience isn't as uncommon for new mothers as you might hope.
"We've been concerned that pregnant women and postpartum women who are suffering from an anxiety disorder may not be getting the screening or assessment or treatment that they need because we aren't thinking to ask about these kinds of concerns because we're so focused on depression," says psychologist and UBC professor Nicole Fairbrother in a radio interview with CBC's The Coast. Fairbrother is the lead researcher in a Canadian study in the Journal of Affective Disorders that found that postpartum anxiety is actually much more common than previously assumed — in fact, it's around three times more prevalent than postpartum depression, yet nobody talks about it.
Fairbrother actually worked with the woman who had thoughts of harming her infant and figured out she'd been misdiagnosed with depression, so that woman's story has a happy ending: "Her treatment with me was successful within 8 weeks."
To ensure other women with postpartum anxiety don't fall through the cracks, Fairbrother and her team gave questionnaires to pregnant women before and after they'd given birth, providing additional screening to those they deemed to be at risk of anxiety and depression. The researchers found that nearly 16 per cent of mothers they interviewed experienced anxiety and anxiety-related disorders while they were pregnant, with 17 per cent experiencing significant postpartum anxiety. By contrast, only 4 per cent of pregnant women and close to 5 per cent of mothers post-pregnancy reported experiencing depression.
While medical practitioners may focus on screening women for postpartum depression, these findings show that it's essential they screen for postpartum anxiety as well. This is especially important given that women with postpartum anxiety often hide their symptoms from the world, putting on a brave, happy public face.
"You can’t tell when a mother has postpartum depression, anxiety, OCD or PTSD just by looking at her," shares Katherine Stone, a survivor of postpartum OCD on the support website Postpartum Progress. "People assume it should be fairly obvious, except it isn’t. We can get pretty good at hiding how we are feeling and what we are thinking."
So how do you know if you or someone you care about is suffering from a pregnancy-related anxiety disorder? "It is really normal to be nervous during pregnancy, to be a little worried about how the pregnancy is going to go," says Fairbrother. "You don't see that as a problem unless the anxiety becomes really distressing to the woman who's experiencing it or it begins to interfere with her life."
But she says a lot needs to change if Canadians want to properly screen for postpartum anxiety. For one, she says there's a lack of assessment tools to properly diagnose pregnant and postpartum Canadian women with anxiety disorders, which is why she and a colleague are working on developing a tool to do so. Fairbrother says it's also difficult for women to affordably access psycho-social treatment (which can include everything from support groups to vocational support) for women with anxiety during and after pregnancy.
"We need to really increase funding for evidence-based psycho-social treatment, particularly for pregnant women where there are safety concerns when administering medication for these kinds of problems to a pregnant woman because of the developing fetus," Fairbrother says.
She points out that expanding screening and treatment for women suffering from anxiety before and after childbirth can be life-changing, because left untreated, anxiety disorders can cause women to develop depression.