New mothers are more likely to experience postpartum anxiety than they are postpartum depression, according to Penn State College of Medicine researchers, yet screening for anxiety does not routinely occur during maternity hospital stays or during the postpartum period.

"Many clinicians would anecdotally tell you that they have seen anxious women after childbirth, but the important thing is that few people really talk about it," said Ian Paul, M.D., professor of pediatrics and public health sciences. "Our study really highlights that it is a significant issue, both in terms of the number of women it affects -- more than 1 in 6 after childbirth and 1 in 5 first-time mothers -- and the effect it has on maternal outcomes, such as increased health-care use. Importantly, there is reduced success with breastfeeding and reduced breastfeeding overall."

Childbirth can be scary, as can the realization of parental responsibilities, so it is not surprising that a mother can find the process anxiety inducing. Paul and his colleagues found that women who screened positive for anxiety were more likely to stop breastfeeding during the first six months after childbirth than women who did not screen positive.

The researchers analyzed data collected for the Nurses for Infants Through Teaching and Assessment after the NurserY (NITTANY) study. The women participating in the study had given birth at Penn State Milton S. Hershey Medical Center between September 2006 and August 2009. Women who had given birth to twins were excluded from this analysis.

For this study, published in the current issue of Pediatrics, the researchers focused on 1,123 mothers. Nearly half of them were first-time mothers. Each woman participated in an initial interview during their postpartum maternity stay followed by three telephone surveys -- two weeks, two months and six months after giving birth.

The women were asked the same questions each time they were surveyed. Some questions focused on determining levels of anxiety, and some focused on depression. The surveys consisted of short statements to which the new moms responded with one of four answers -- "not at all," "somewhat," "moderately so" and "very much so." The exact wording of each multiple choice varied depending on the statement in question. The researchers scored each survey based on the participants' answers. Women who scored above a certain number on the anxiety survey were considered anxious, and above a certain number on the depression survey, depressed.

At each time point Paul found that it was more common for mothers to have anxiety than depression. While guidelines are in place for recommending postpartum depression screening, these guidelines do not exist for postpartum anxiety.

"There is less stigma associated with postpartum depression now because it has been so well discussed and recognized," said Paul. "A lot of women aren't sad, but they are anxious. Medical professionals and the lay public don't talk about postpartum anxiety."

The researchers found that during the first six months after childbirth women who had anxiety were more likely to use hospital-based services and have unplanned outpatient visits, and were also more likely to stop breastfeeding.

"I think the pediatric community needs to consider whether we should be screening women for anxiety or talking with them about anxiety," said Paul. "Mothers need to know that they're not alone, that this is common. They should feel comfortable discussing anxiety with their pediatrician, their obstetrician, and with the nurses that are taking care of them in the hospital so that whatever the cause of their anxiety -- if there is a cause -- it can be discussed and addressed and they can get help for it."

Working with Paul were Danielle S. Downs, associate professor of kinesiology and obstetrics and gynecology; Eric W. Schaefer, biostatistician; Jessica S. Beiler, research project coordinator; and Carol S. Weisman, Distinguished Professor of Public Health Sciences and Obstetrics and Gynecology.

The Health Resources and Services Administration -- Maternal and Child Health Bureau, Department of Health and Human Services and the Children's Miracle Network supported this research.

Health Canal