Enf.ª Ana Isabel F. Rocha

Gynecology Obstetrics Service

Postpartum anxiety

HPA Magazine 21 // 2024

Pregnancy involves significant physiological, emotional, psychological, and cognitive changes that impact the perception of femininity and the conceptualization of a woman's identity and personality. 
It can become a potential stressor since it is an extremely emotional and specific state where the woman's experience and various factors, such as stress, have the ability to influence her well-being and, consequently, affect normal fetal development.
The experience of pregnancy strongly influences the postpartum period, and high levels of stress and anxiety appear to be related to the development of psychiatric disorders. 

The postpartum period is a sensitive time, conditioned by the drastic changes inherent to it, where the woman returns to the pre-pregnancy state, undergoing intense physiological mechanisms that contribute to the recovery of various bodily systems and organs. It is then expected that such mental disorders may arise in such a sensitive period in a woman's life cycle.
Anxiety disorders constitute a group of mental illnesses characterized by exaggerated fear responses and are related to behavioral disturbances. 
They are the type of pathology that most affects the Portuguese population, with an estimated 30% of women experiencing some type of these disorders throughout their lives. However, despite presenting as a condition with increased prevalence, it is often undervalued and untreated in the postpartum period. 
It is challenging to perceive whether the woman's symptoms are conditioned by the postpartum period itself and/or affect her autonomy and functioning. 
There are various types of anxiety disorders, each with inherent specificities. Therefore, it would be interesting to understand how excessive anxiety, manifested in one of these disorders, affects the postnatal period.
It is important to understand the factors that predispose women to the development of postpartum anxiety disorders, the impact these disorders have, and how healthcare professionals can support women when these disorders manifest. 
It is known that excessive anxiety is associated with poorer relational outcomes between the mother/newborn dyad, impairs maternal functioning, conditions distress, and can, in extreme cases, lead to infanticide. 
Some authors also speculate that exposure to maternal anxiety, from the moment of conception, can have negative effects on normal fetal development and, subsequently, on infant development. 
Postpartum anxiety is associated with disruption between the mother/baby dyad, an increased risk of child abuse, a decreased likelihood of breastfeeding, an increased likelihood of the child developing anxiety, and has a detrimental effect on the health of both the woman and the child.

Predisposing Factors for Postpartum Anxiety
The conditioning factors for postpartum anxiety include high maternal education, a previous history of depression, preterm birth, negative experiences during childbirth and the first week postpartum, low maternal efficacy, inadequate partner support, perception of the baby's crying as excessive, and deteriorating maternal health. Additionally, a woman's expectations regarding pregnancy, childbirth, and postpartum can predispose her to an anxiety disorder if her expectations do not align with reality, leading to feelings of fear and a sense of losing control. 
A woman who fears childbirth and experiences it as a negative event exhibits higher levels of anxiety than someone with a positive experience. It is not necessarily the occurrence of complications during childbirth that leads a woman to experience anxious feelings, but rather the fear of the possibility of these events happening.
Another important aspect relates to maternal self-efficacy, which translates into the woman's ability to organize and execute maternal tasks and actions. 
Her perception of her role and confidence in caring for the newborn affect her actions and can cause anxious feelings if she sees herself as incapable.
What to do as a healthcare professional?
The healthcare professional, as a promoter of maternal well-being, plays a crucial role in the relationship established with the woman. The way they act and communicate has a significant impact on such a sensitive and vulnerable phase, as their actions can positively or negatively influence the woman's mental health. 
Even if the professional has good intentions and feels that they are providing support, if their actions are not careful and appropriate, they may predispose the woman to postpartum anxiety. They should respect the woman and validate her feelings so that she feels welcomed during this important stage of her life.
So, how should they do this?
By basing their actions on active listening and empathy, and by attempting to build a therapeutic relationship based on trust. Communication is fundamental, not only verbal communication but also how the healthcare professional presents themselves to the woman: tone of voice, chosen words, how they convey them, expressions used, body language, etc. When the healthcare professional has a haughty, arrogant, cold, and emotionless posture, the woman feels helpless, unable to trust, and consequently does not express what troubles her. 
Therefore, she lives secluded within her mind, without someone who understands and values her feelings and anxieties. 
A woman is more likely to seek help if she feels that she has been listened to empathetically, and it is easier to establish a therapeutic plan for a woman who shares her experience and anxious feelings. Therefore, communication is established as an essential tool for the healthcare professional's actions and for the establishment of an action plan with the woman when this type of disorder is present.