Every new parent worries. Worry is part of how we keep babies safe. Postpartum anxiety is when the worry stops being useful and starts running the show: it is there most of the time, it is hard to switch off, and it keeps you from resting even when the baby is fine and someone else is on duty.

It affects roughly one in ten new mothers, about as many as postpartum depression, and it often gets missed because it can look like being a careful, attentive parent. Dads and partners can have it too.

What it can feel like

• Racing thoughts you cannot slow down, often about the baby's health, breathing, feeding or safety.
• Not being able to sleep when the baby sleeps, even when you are exhausted.
• Checking, searching, counting and re-checking: the monitor, the feeding log, the locks.
• A sense of dread, or a feeling that something bad is about to happen.
• Physical symptoms: a pounding heart, a tight chest, shaky hands, nausea, dizziness, tense muscles.
• Irritability, and feeling unable to hand the baby to anyone else.
• Panic attacks: sudden waves of intense fear with shortness of breath, chest tightness or a feeling of losing control.

Scary thoughts

Many people with postpartum anxiety also have sudden, unwanted thoughts or images of something terrible happening to the baby. These are intrusive thoughts. They are frightening because they are the opposite of what you want, and having them does not mean you will act on them. When they are frequent and come with checking or avoiding, it can be postpartum OCD, which is also treatable. The guide to intrusive thoughts after a baby goes further.

Why it happens

• Big hormonal shifts after birth, on top of weeks of broken sleep.
• A history of anxiety, depression or OCD, including before pregnancy.
• A difficult pregnancy, birth or NICU stay, or a previous loss.
• Feeding struggles, a baby with reflux or colic, or little help at home.
• It is not caused by being a bad or weak parent.

What helps

• Say it out loud to your OB, midwife, doctor or the pediatrician. The words "I think I have postpartum anxiety" and a description of a normal day are enough to start.
• Therapy works well, especially cognitive behavioral therapy (CBT). Find Care can search for a perinatal therapist near you.
• Medication can help, and many options are considered compatible with breastfeeding. That is a conversation with a prescriber, not something to decide alone.
• Protect sleep. Someone else takes a full stretch of the night so you get four or five hours in a row, with the door closed and earplugs if that helps.
• Limit late-night symptom searching. Pick one trusted source, or write the question down for the pediatrician.
• In a spike of panic, slow breathing with long exhales, stepping outside, or naming five things you can see can take the edge off.

• Find a postpartum therapist near you
• Can't sleep even when the baby sleeps

For dads, partners and family

Reassurance alone rarely helps anxiety; it can turn into a loop of asking and answering. What helps more is taking something real off her plate, covering a full stretch of the night, and making the first call to a provider with her. The dads & partners guides have more on how to bring it up.