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Ask a new mom about her actions after giving birth, and you’ll hear a range of behaviors that would probably sound odd to most non-moms. Watching the baby’s breathing, checking the baby monitor dozens of times, keeping an eye on the front door for potential intruders. To new moms these actions are likely all too familiar. The anxiety that comes with motherhood is something many new moms feel but rarely discuss. And perinatal anxiety – that is, anxiety during pregnancy and the postpartum period – has received limited attention from researchers and health professionals, according to a 2017 review article in The British Journal of Psychiatry, despite the fact that it is highly prevalent. We are, after all, suddenly responsible for tiny, helpless, precious humans. Who wouldn’t be anxious? This can all lead a mom to wonder, how much anxiety is too much?


Protecting our babies: some physiological explanations

Entering pregnancy, mothers experience a ramping up of their stress systems in order to help them care for and protect their new little beings, explains Mary Kimmel, M.D., Assistant Professor and Medical Director of the Perinatal Psychiatry Inpatient Unit at the University of North Carolina, Chapel Hill, and mother of two. “The main hormone from the stress system is cortisol, and that actually increases across pregnancy to support the development of the baby, but it also functions in this role of trying to help mom find the right amount of stress or anxiety once the baby comes,” says Kimmel.

Researchers are working to understand how hormones and neurological reactions foster feelings of protectiveness. By using functional magnetic resonance imaging (fMRI) to observe brain activity in new parents, for instance, researchers at Yale University observed that when new parents heard their babies cry, the parents often experienced an anxious neural response in brain areas associated with obsessive-compulsive disorder (OCD) and with emotions such as empathy. As Anna Abramson and Dawn Rouse report in “The Postpartum Brain,” the researchers believe this neural response is evolutionary and primal: after childbirth, a period of high alert, or vigilant watch, was necessary in order for parents to protect their babies from all sorts of environmental dangers.

At the University of Denver’s Family and Child Neuroscience Lab, under Director Pilyoung Kim, Ph.D., researchers are studying the brain activity of first-time mothers for patterns that are linked to their anxiety or depressive symptoms. Researchers found greater connectivity between the amygdala (the brain’s almond-shaped masses of gray matter associated with emotional awareness) and frontal regions in the brain in mothers with higher levels of postpartum anxiety. “Heightened amygdala activity has been linked to greater fear responses or threat detection and anxiety symptoms,” explains Amy L. Anderson, doctoral candidate at the University of Denver. “Our finding of increased connectivity between the frontal regions (PFC) and amygdala potentially indicates that even in the absence of threat stimuli, mothers with higher levels of anxiety may still be activating regions of their brain that react to heightened emotions or anxious states.”

Defining postpartum anxiety

Defining postpartum anxiety can be difficult, explains Kimmel, since each woman is unique and some women worry more than others. “We all fall on a spectrum, in terms of our personality. It’s not good or bad where you fall, but wherever you fall, if you have no anxiety, that can be problem for you at certain times, and having too much anxiety can be a problem. That makes it harder to define postpartum anxiety. When is it a separate thing from how you are just working within the world?”

Sarah,* who has a 22-month-old daughter, believes she suffered from anxiety after her daughter was born although she never sought treatment. “I was really worried about keeping my daughter alive and her breathing. I kept the lights on in the house at night. I must have checked her breathing 20 times a night.” Sarah did not feel depressed, but she felt exhausted since checking her daughter’s breathing so often interrupted her own sleep. And she had no way of knowing whether checking her daughter’s breathing that often at night was normal. Only after her daughter grew older and less fragile did her worries dissipate and did Sarah come to believe she’d been suffering from anxiety. “When I compare myself to my peers who had newborns at the time, many women seem much calmer and less neurotic about their babies and their breathing,” she says.

Similarly, Katherine, who has a four-and-a-half-year-old daughter and 6-month-old son, worried about keeping her daughter alive. “I was constantly worried she was going to die,” adding that as a new mother, her lack of mastery over caring for babies left her feeling on edge all the time. “I couldn’t calm myself down when she cried. I had a visceral reaction to it.” Katherine’s anxiety about her baby caused her to become anxious about her own health. A psychologist by training, she recognized her anxiety was interrupting her life and causing her to not enjoy spending time with her daughter, which prompted her to seek treatment and medication.

The many forms of anxiety

About 85 percent of women experience some type of mood disturbances after having their babies, according to the Massachusetts General Hospital (MGH) Center for Women’s Mental Health. For the majority of these women, the disturbances are short-lived and mild. However, for about 10 to 15 percent, the disturbances develop into more severe symptoms of anxiety or depression.

Anxiety can be generalized or specific and affect a mom in a number of ways. A mom may suffer from constant worry, racing thoughts, sleep disturbances, or a feeling something bad will happen. The anxiety may get to a level where she never feels comfortable letting someone else take over, or it could be the other extreme: she is so anxious about doing something wrong she becomes paralyzed and unable to be left alone with her child. Specific anxieties include agoraphobia, literally “fear of the marketplace,” Postpartum Panic Disorder, or Postpartum Obsessive-Compulsive Disorder (OCD), a form of anxiety where moms experience obsessions, or intrusive, upsetting, often very frightening thoughts, and ritualistic behaviors or compulsions.

For Jennifer, mom of a two-and-a-half-year-old daughter, her obsession centered on harming her daughter while feeding her. “I was afraid to feed her because I was afraid to stab her,” says Jennifer. “I was afraid to hold a fork anywhere near her.”

Worries about harming their children are very common obsessions for new mothers, particularly in the postpartum period, says Kimmel. According to the non profit organization Postpartum Support International (PSI), these frightening obsessions are anxious in nature and have a very low risk of being acted on. “One mom’s example was the mom thought, ‘oh, my child can fit in the microwave, what a weird thought, oh my gosh, that’s horrible I was thinking about that,’ and she got stuck on that thought,” says Kimmel. “If you were worried about the microwave then you stop going into the kitchen, you can see how that can be negatively impactful.” Similar are obsessive thoughts about knives in the kitchen. “If you’re having that worry about knives in the kitchen, and that’s keeping you from cooking, and cooking is a thing you love, clearly, that’s gotten to a place that needs to be addressed,” she explains, adding that when a mom’s stress system over-responds – when the anxiety makes her feel uncomfortable, when it keeps her from being able to enjoy things, or when it keeps her from doing things she wants to do – that the woman should seek treatment.

But even Jennifer, who had a history of OCD, had difficulty talking about her thoughts. “I was so worried that if I told people what I was thinking that it would happen or that I wanted it to happen. I was afraid to talk about it because I was afraid they would call Child Protective Services on me.” Jennifer says she feels fortunate her longtime psychiatrist “picked” it out of her and can only imagine how many women, who do not have longstanding care and treatment, are suffering. “Even though I had a history of OCD, I did feel ashamed. How could I be a decent person and have these thoughts about my child?”

Anxiety with or without depression

Thanks to the media and to ongoing education, it may be fair to say many women know about postpartum depression (PPD), but many do not know they can suffer from postpartum anxiety alone, without depression. Anxiety is often subsumed under the umbrella term “postpartum depression,” which means recognizing you may be suffering from anxiety may be difficult if you are not feeling depressed. Plus, “little attention” has been given to postpartum anxiety by clinicians and researchers possibly because of the overlap between depression and anxiety symptoms, according to The MGH Center for Women’s Mental Health.

“Part of where it can be hard for some moms is they don’t recognize as being depressed be-cause they don’t feel depressed,” says Kimmel. “They don’t feel sad. They don’t feel like they’re not enjoying things, they just feel overwhelmed with worry.” She added that when moms are feeling really anxious and overwhelmed, they may begin to feel depressed, too. “That’s why it can be hard to piece the two apart because you can begin to feel a lot of the symptoms of depression, such as guilt and feeling hopeless, when you feel so anxious and worried.”

For Lisa,* who has a three-month-old daughter and was diagnosed with PPD, a lot of her PPD was anxiety-driven: she was on high alert, she would wake up in the middle of the night to stare at her daughter to ensure she was alive, and she had sudden fears she’d drop her daughter while carrying her. Then there were the socks. “When I put socks on my daughter, every time, I was scared I was going to pull one of her toes off,” she says, explaining she had such irrational fears, and she knew they were irrational, but she couldn’t stop them. Eventually, Lisa’s husband found her crying in the bathroom. “I couldn’t even explain why,” she says. “I was so overwhelmingly sad.”

But Jennifer, who had braced herself for PPD, was caught off-guard when she was met with anxiety. “I was bracing myself for possible PPD but never about panic attacks about my daughter and obtrusive thoughts about my daughter,” she says. “I’d read a lot about PPD, but the hospital never asked me the right questions. They didn’t notice I was panicking every time I was alone with my daughter.”

Getting treatment

Unlike PPD, a classic screening tool does not exist for postpartum anxiety. Instead, a combination of screening tools are used, such as the Edinburgh Postnatal Depression Scale (EPDS), used for PPD, and the Patient Health Questionnaire (PHQ-9), but these may not detect all symptoms, such as OCD symptoms, which are predominant. Accordingly, these tools may not identify all women with clinically relevant anxiety. “We’re still trying to figure out how to get at some of these diverse groups of symptoms that may be going on,” says Kimmel. Only recently, in 2014, did researchers in Western Australia develop the Perinatal Anxiety Screening Scale (PASS), a 31-item questionnaire – the first survey to date – to detect perinatal anxiety.

But even if women, themselves, recognize they are suffering, finding the right treatment can be difficult. Lisa, who suffered from PPD, was told by her daughter’s pediatrician that she needed to get help. But when Lisa contacted her prenatal care provider, she had to wait over two weeks to talk with a therapist, at which time she was told she had PPD. Lisa’s provider told her that she would be prescribed medication on the condition Lisa find a different provider for postpartum care and that the medication could take six to eight weeks to kick in. “I felt like no one was helping me from a medical perspective,” says Lisa. “So I got angry and channeled that anger to figure out how to help myself.” For Lisa, helping herself meant being honest about her feelings and talking about them: she decided to stop lying that having a baby was all wonderful. “The more I talked about it, people said, ‘oh, I felt that way, too.’ So why don’t more people talk about it?” she asks. “We don’t, as women and mothers, talk about it enough. We’re left feeling like something’s wrong with us.”

Moms need time to talk about their experiences so they can find and receive the support they need. “We’re moving towards this system of these really short [medical] appointments,” says Kimmel, “and we need to have time. These are hard things to talk about.” Kimmel suggests that a multidisciplinary approach – a team of people who can address the mom’s unique needs and background and offer the most effective support, whether that’s medication or therapy such as cognitive behavioral therapy or mindfulness – is important.

One resource is Postpartum Support International, which provides a network of volunteers in each of the 50 states to contact for support. Anyone may call its toll-free Warmline (1-800-944-4773) for basic information and resources. It hosts “Wednesday Chats for Moms” and “First Monday Chats for Dads,” free live phone sessions where parents can connect with other parents and talk to experts.

Thankfully, more steps are being taken to increase awareness and to address the many facets of maternal health. In 2015 the American College of Obstetricians and Gynecologists began recommending clinicians screen women at least once during the perinatal period for depression and anxiety symptoms. And in 2016, Congress passed groundbreaking legislation, enacted as part of the bipartisan 21st Century Cures Act in December 2016, to fund screening and treatment programs for maternal depression. Some states, like New Jersey, Illinois, and West Virginia, already require screening of new mothers for postpartum depression.

Steps are being taken. Still, many more need to be.

For information on additional perinatal mood disorders, visit Postpartum Support International.

*Names have been changed per requests not to be identified.

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We spend a lot of time prepping for the arrival of a baby. But when it comes to the arrival of our breast milk (and all the massive adjustments that come with it), it's easy to be caught off guard. Stocking up on a few breastfeeding essentials can make the transition to breastfeeding a lot less stressful, which means more time and energy focusing on what's most important: Your recovery and your brand new baby.

Here are the essential breastfeeding tools you'll need, mama:

1. For covering up: A cute nursing cover

First and foremost, please know that all 50 states in the United States have laws that allow women to breastfeed in public. You do not have to cover yourself if you don't want to—and many mamas choose not to—and we are all for it.

That said, if you do anticipate wanting to take a more modest approach to breastfeeding, a nursing cover is a must. You will find an array of styles to choose from, but we love an infinity scarf, like the LK Baby Infinity Nursing Scarf Nursing Cover. You'll be able to wear the nursing cover instead of stuffing it in your already brimming diaper bag—and it's nice to have it right there when the baby is ready to eat.

Also, in the inevitable event that your baby spits-up on you or you leak some milk through your shirt, having a quick and stylish way to cover up is a total #momwin.

2. For getting comfortable: A cozy glider

Having a comfy spot to nurse can make a huge difference. Bonus points if that comfy place totally brings a room together, like the Delta Children Paris Upholstered Glider!

Get your cozy space ready to go, and when your baby is here, you can retreat from the world and just nurse, bond, and love.

3. For unmatched support: A wire-free nursing bra

It may take trying on several brands to find the perfect match, but finding a nursing bra that you love is 100% worth the effort. Your breasts will be changing and working in ways that are hard to imagine. An excellent supportive bra will make this so much more comfortable.

It is crucial to choose a wireless bra for the first weeks of nursing since underwire can increase the risk of clogged ducts (ouch).The Playtex Maternity Shaping Foam Wirefree Nursing Bra is an awesome pick for this reason, and because it is designed to flex and fit your breasts as they go through all those changes.

4. For maximum hydration: A large reusable water bottle

Nothing can prepare you for the intense thirst that hits when breastfeeding. Quench that thirst (and help keep your milk supply up in the process) by always having a water bottle with a straw nearby, like this Exquis Large Outdoor Water Bottle.

5. For feeding convenience: A supportive nursing tank

Experts recommend that during the first weeks of your baby's life, you breastfeed on-demand, meaning that any time your tiny boss demands milk, you feed them. This will help establish your milk supply and get everything off to a good start.

What does this mean for your life? You will be breastfeeding A LOT. Nursing tanks, like the Loving Moments by Leading Lady, make this so much easier. They have built-in support to keep you comfy, and you can totally wear them around the house, or even out and about. When your baby wants to eat, you'll be able to quickly "pop out" a breast and feed them.

6. For pain prevention: A quality nipple ointment

Breastfeeding shouldn't hurt, but the truth is those first days can be uncomfortable. Your nipples will likely feel raw as they adjust to their new job. This will get better! But until it does, nipple ointment is amazing.

My favorite is the Earth Mama Organic Nipple Butter. We love that it's organic, and it is oh-so-soothing on your hard-at-work nipples.

Psst: If it actually hurts when your baby latches on, something may be up, so call your provider or a lactation consultant for help.

7. For uncomfortable moments: A dual breast therapy pack

As your breasts adjust to their new role, you may experience a few discomforts—applying warmth or cold can help make them feel so much better. The Lansinoh TheraPearl 3-in-1 Breast Therapy Pack is awesome because you can microwave the pads or put them in the freezer, giving you a lot of options when your breasts need some TLC.

Again, if you have any concerns about something being wrong (pain, a bump that may be red or hot, fever, or anything else), call a professional right away.

8. For inevitable leaks: An absorbing breast pad

In today's episode of, "Oh come on, really?" you are going to leak breastmilk. Now, this is entirely natural and you are certainly not required to do anything about this. Still, many moms choose to wear breast pads in their bras to avoid leaking through to their shirts.

You can go the convenient and disposable route with Lansinoh Disposable Stay Dry Nursing Pads, or for a more environmentally friendly option, you can choose washable pads, like these Organic Bamboo Nursing Breast Pads.

9. For flexibility: A breast pump

Many women find that a breast pump becomes one of their most essential mom-tools. The ability to provide breast milk when you are away from your baby (and relieve uncomfortable engorged breasts) will add so much flexibility into your new-mom life.

For quick trips out and super-easy in-your-bag transport, opt for a manual pump like the Lansinoh Manual Breast Pump .

If you will be away from your baby for longer periods of time (traveling or working outside the home, for example) an electric pump is your most efficient bet. The Medela Pump In Style Advanced Double Electric Breast Pump is a classic go-to that will absolutely get the job done, and then some.

10. For quality storage: Breast milk bags

Once you pump your liquid gold, aka breast milk, you'll need a place to store it. The Kiinde Twist Pouches allow you to pump directly into the bags which means one less step (and way less to clean).

11. For keeping cool: A freezer bag

Transport your pumped milk back home to your baby safely in a cooler like the Mommy Knows Best Breast Milk Baby Bottle Cooler Bag. Remember to put the milk in a fridge or freezer as soon as you can to optimize how long it stays usable for.

12. For continued nourishment: Bottles

Nothing beats the peace of mind you get when you know that your baby is being well-taken of care—and well fed—until you can be together again. The Philips Avent Natural Baby Bottle Newborn Starter Gift Set is a fan favorite (mama and baby fans alike).

This article is sponsored by Walmart. Thank you for supporting the brands that support Motherly and mamas.

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Motherly is committed to covering all relevant presidential candidate plans as we approach the 2020 election. We are making efforts to get information from all candidates. Motherly does not endorse any political party or candidate. We stand with and for mothers and advocate for solutions that will reduce maternal stress and benefit women, families and the country.

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A viral video about car seat safety has parents everywhere cracking up and humming Sir-Mix-A-Lot.

"I like safe kids and I cannot lie," raps Norman Regional Health System pediatric hospitalist Dr. Kate Cook (after prefacing her music video with an apology to her children."I'm a doctor tryin' warn you that recs have changed," she continues.

Dr. Cook's rap video is all about the importance of keeping babies facing backward. It's aptly called "Babies Face Back," and uses humor and parody to drive home car seat recommendations from the American Academy of Pediatrics (AAP).

"Switching from rear-facing to forward-facing is a milestone many parents can't wait to reach," Dr. Cook said in a news release about her hilarious video. "But this is one area where you want to delay the transition as long as possible because each one actually reduces the protection to the child."

Last summer the AAP updated its official stance on car seat safety to be more in line with what so many parents were already doing and recommended that kids stay rear-facing for as long as possible. But with so many things to keep track of in life, it is understandable that some parents still don't know about the change. Dr. Cook wants to change that with some cringe-worthy rapping.

The AAP recommends:

  • Babies and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat.
  • Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible. Many seats are good up to 65 pounds.
  • When children outgrow their car seat they should use a belt-positioning booster seat until the vehicle's lap and shoulder seat belt fits properly, between 8 and 12 years old.

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[Editor's note: Motherly is committed to covering all relevant presidential candidate plans as we approach the 2020 election. We are making efforts to get information from all candidates. Motherly does not endorse any political party or candidate. We stand with and for mothers and advocate for solutions that will reduce maternal stress and benefit women, families and the country.]

Suicide rates for girls and women in the United States have increased 50% since 2000, according to the CDC and new research indicates a growing number of pregnant and postpartum women are dying by suicide and overdose. Suicide rates for boys and men are up, too.

It's clear there is a mental health crisis in America and it is robbing children of their mothers and mothers of their children.

Medical professionals urge people to get help early, but sometimes getting help is not so simple. For many Americans, the life preserver that is mental health care is out of reach when they are drowning.

Democratic presidential candidate Pete Buttigieg just released a plan he hopes could change that and says the neglect of mental health in the United States must end. "Our plan breaks down the barriers around mental health and builds up a sense of belonging that will help millions of suffering Americans heal," says Buttigieg.

He thinks he can "prevent 1 million deaths of despair by 2028" by giving Americans more access to mental health and addictions services.

In a country where giving birth can put a mother in debt, it's not surprising that while as many as 1 in 5 new moms suffers from perinatal mood and anxiety disorders, more than half of new moms who need mental health treatment don't get it. Stigma, childcare and of course costs are factors in why women aren't seeking help when they are struggling.

Buttigieg's plan is interesting because it could remove some of these barriers. He wants to make mental health care more affordable by ensuring everyone has comprehensive coverage for mental health care and by ensuring that everyone can access a free yearly mental health check-up.

That could make getting help more affordable for some moms, and by increasing reimbursement rates for mental health care delivered through telehealth, this plan could help moms get face time with a medical professional without having to deal with finding childcare first.

Estimates from new research suggest that in some parts of America as many as 14% or 30% of maternal deaths are caused by addiction or suicide. Buttigieg's plan aims to reduce those estimates by fighting the addiction and opioid crisis and increasing access to mental health services in underserved communities and for people of color. He also wants to reduce the stigma and increase support for the next generation by requiring "every school across the country to teach Mental Health First Aid courses."

These are lofty goals with a lofty price tag. It would cost about $300 billion to do what Buttigieg sets out in his plan and the specifics of how the plan would be funded aren't yet known. Neither is how voters will react to this 18-page plan and whether it will help Buttigieg stand out in a crowded field of Democratic candidates.

What we do know is that right now, America is talking about mental health and whether or not that benefits Buttigieg's campaign it will certainly benefit America.

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[Editor's Note: Welcome to It's Science, a Motherly column focusing on evidence-based explanations for the important moments, milestones, and phenomena of motherhood. Because it's not just you—#itsscience.]

If you breastfeed, you know just how magical (and trying) it is, but it has numerous benefits for mama and baby. It is known to reduce the likelihood of developing cardiovascular disease, type 2 diabetes, and rheumatoid arthritis, and cuts the risk of sudden infant death syndrome (SIDS) by half.

If this wasn't powerful enough, scientists have discovered that babies who are fed breast milk have a stomach pH that promotes the formation of HAMLET (Human Alpha-lactalbumin Made Lethal to Tumor cells). HAMLET was discovered by chance when researchers were studying the antibacterial properties of breast milk. This is a combination of proteins and lipids found in breast milk that can work together to kill cancer cells, causing them to pull away from healthy cells, shrink and die, leaving the healthy cells unaffected.

According to researchers at Lund University in Sweden, this mechanism may contribute to the protective effect breast milk has against pediatric tumors and leukemia, which accounts for about 30% of all childhood cancer. Other researchers analyzed 18 different studies, finding that "14% to 19% of all childhood leukemia cases may be prevented by breastfeeding for six months or more."

And recently, doctors in Sweden collaborated with scientists in Prague to find yet another amazing benefit to breast milk. Their research demonstrated that a certain milk sugar called Alpha1H, found only in breast milk, helps in the production of lactose and can transform into a different form that helps break up tumors into microscopic fragments in the body.

Patients who were given a drug based on this milk sugar, rather than a placebo, passed whole tumor fragments in their urine. And there is more laboratory evidence to support that the drug can kill more than 40 different types of cancer cells in animal trials, including brain tumors and colon cancer. These results are inspiring scientists to continue to explore HAMLET as a novel approach to tumor therapy and make Alpha1H available to cancer patients.

Bottom line: If you choose to breastfeed, the breast milk your baby gets from your hard work can be worth every drop of effort.

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