Adults
Postnatal Anxiety in New Mothers: When It Looks Like Perfectionism, Overthinking and Intrusive Thoughts
By Dr. Emma Smith, Director of Clinical Operations, Consultant Clinical Psychologist, The Chelsea Psychology Clinic
Most of the new mothers I see do not come in saying they are anxious.
They come in telling me about the spreadsheet, the colour-coded nap schedule or the feeding log updated every three hours. The two baby classes booked each week because they’ve read somewhere that babies need sufficient stimulation in the first six months, and they are not going to be the parent who got that wrong. And as I listen to them describe their week, I get a picture not just of an organised woman, but of a mind working very hard to feel safe in a situation that feels anything but.
That is what postnatal anxiety often looks like in practice. It isn’t always panic, or falling apart, as it can often be something that does not read as a mental health problem from the outside. Instead it can be q relentless, exhausting attempt to control enough variables that nothing can go wrong, and someone gaining an increasingly tight grip on the idea that if she just does enough, the fear underneath will go away.
But the fear is rarely relieved because of a schedule, in fact the schedule is the symptom; it’s what anxiety looks like when it gets dressed up as organisation.
Why high-achieving women are often more vulnerable after having a baby
Many of the women we work with have spent their adult lives in environments that reward precisely the qualities that motherhood discombobulates. They have built careers in studying, working, and getting clear, consistent feedback that they are doing well and achieving at a high standard. The cues are legible, for example, a good result, a promotion, a project completed to a high standard. It’s a tidy system that makes sense, and they have learnt to move through it with real competence.
However, motherhood removes almost all of that and it does so very suddenly, as many mothers will know, with very little warning. There is no objective measure of how well you are mothering a very young baby. The baby might settle easily today and not at all tomorrow and for absolutely no reason that any spreadsheet can capture. The absence of tangible feedback, or clear signal that you are doing a good job, can feel genuinely destabilising to someone who has spent years knowing, with reasonable confidence, that they are performing well.
So the mind reaches for what has always worked: more structure, higher standards, greater control over the variables that can be controlled – and hence the schedule emerges. It makes a certain kind of sense, because these strategies have been useful in other areas of life, and are probably part of the reason these women have done as well as they have. The problem is that the same qualities that serve a person so well professionally can make early motherhood much harder. Unrelenting standards, in an environment that is inherently chaotic and uncontrollable, become a source of suffering rather than a safeguard against it. Just to be clear though, I’m not anti-schedule completely, but there is a difference between creating a daily or weekly rhythm that feels like it is supporting the natural flex of baby and mother, and one that is to be lived by minute-by-minute no matter what. When it so packed and detailed that there is no space for anything spontaneous, this is an indication that the mother may be over-managing through anxiety.
The intrusive thoughts that new mothers are most afraid to mention
There is something else that comes up in the consulting room quite often and this is something that women find considerably harder to say out loud than anything about schedules or standards.
Intrusive thoughts. Unwanted images or thoughts that arrive without invitation and refuse to leave, often involving something frightening happening to the baby. Many mothers find it hard to talk about these thoughts as they wonder, with real what it says about her that her mind went there at all.
Research in this area demonstrates very clearly, that these experiences are nearly universal in the perinatal period. The vast majority of new mothers will have intrusive thoughts of this kind at some point in the first weeks and months, including mothers with no history of mental health difficulties or anxiety. And yet the shame around them is such that most women carry them alone for months.
What I try to offer every woman who brings this to me is a straightforward reframe. Having an intrusive thought is not a reflection of what you want and thinking them is not evidence of bad character. What the mind does under the pressure of new parenthood, when it is sleep-deprived and on high alert and responsible for keeping a very small and very vulnerable person alive, is scan relentlessly for threat. These thoughts are the by-product of a brain that is trying, in a primitive and not always helpful way, to prepare you for the worst case scenario so that you can protect the person it recognises as worth protecting. The distress they cause is proportional to how much you care.
That does not make them easy to live with. But it does make them workable.
How therapy helps with postnatal anxiety and perinatal anxiety
The clinical work with women experiencing perinatal anxiety in this form tends to begin not with challenging thoughts or building coping strategies, but with something more fundamental: helping a woman to see the pattern she is already in, and to understand where it came from.
For the high-achieving mother who has turned her professional standards on the chaos of early parenthood, that often means looking honestly at how useful those standards have been, where they developed, and why they feel so non-negotiable. There is something important to acknowledge here: these coping patterns are not flaws, but have served a real purpose, often for a very long time, and naming that matters before asking someone to put them down. What therapy can offer is a way of working towards something different, not lower standards, but a different relationship with standards altogether. The concept of ‘good enough’ parenting is not a consolation prize for people who could not manage better. It is, in developmental terms, genuinely what children need, and it is something that many high-achieving women find intellectually persuasive but emotionally very hard to accept. That gap between knowing something and being able to feel it is often what we work on in sessions and it’s really wonderful when we see, over time, these mothers relax into their role.
For women struggling with intrusive thoughts, the work involves developing the capacity to let a thought pass without treating it as evidence of something, to reduce the distress those thoughts cause, and often to understand the anxiety underneath them more fully. It is something that, in my experience, responds well to therapeutic work when a woman feels safe enough to be honest about what is actually happening. For more information on intrusive thoughts and anxiety in the postnatal period this link from Mind may offer more help.
It is also worth saying that postnatal anxiety does not exist in isolation. For many of the couples we see, the first year of parenthood is the period where the relationship comes under the most sustained pressure it has ever faced, often without either partner fully understanding why. If any of that is familiar alongside what is described here, it may be worth reading more about how stress and new parenthood can affect a couple’s relationship.
If any of this sounds familiar
You do not need to have reached a crisis point to find it useful to talk to someone. If you are in the early months of motherhood and something feels harder than you expected, whether that is the anxiety that keeps arriving dressed as organisation, or thoughts that really frighten you, or simply a persistent sense that you should be managing this better than you are, that is worth bringing to someone who understands what is going on and can help you work through it.
If you would like to talk through whether working with someone at the clinic might be right for you, you are welcome to call us on 020 3092 7353. The first conversation is a complimentary call with one of our clinical team, and there is no obligation to take things further from there.
