Is It Just Normal Worry? How to Recognise Perinatal Anxiety in Your Clients
Is It Just Normal Worry? How to Recognise Perinatal Anxiety in Your Clients
Almost every new parent worries. They worry about whether baby is feeding well, sleeping enough, developing on track. They worry about whether they are doing any of this right. For those of us who work with families in pregnancy and postpartum, these worries are part of our everyday conversations. But somewhere in that sea of normal worry, some of our clients are quietly struggling with something more.
In this very first episode of Perinatal in Practice, I'm tackling one of the most common and most important questions we face as perinatal providers: how do we tell the difference between the normal uptick in worry that comes with the transition to parenthood, and a perinatal anxiety disorder?
We explore why anxiety naturally increases in pregnancy and postpartum, what normal worry actually looks like, and the three key questions that help us recognise when a client's anxiety has moved beyond what we would expect. I share practical, grounded ways to listen for proportionality, impact and response to reassurance, so you can walk into your next session with more clarity and confidence.
This episode is for every provider who has ever sat with a client and wondered, "Is this normal, or is this something more?" It's short enough to fit into a coffee break and grounded in what actually helps in the room.
In This Episode We Cover:
Why anxiety is the most common experience in the transition to parenthood
Why distinguishing normal worry from perinatal anxiety changes the care we offer
The evolutionary reasons parents become more vigilant in pregnancy and postpartum
What normal perinatal worry looks like, and why it tends to resolve
Three key questions: proportionality, impact and response to reassurance
The four areas where perinatal anxiety shows its impact: physical, thoughts, behaviour and emotions
Resources + Links to Delve Deeper
Is It Just Normal Worry? How to Recognise Perinatal Anxiety in Your Clients
As a perinatal professional you have certainly sat in the room with a new parent as they share their worries. They worry about their baby's health. Are they sleeping enough? Eating enough? Developing the right way? They worry about their own ability to be a good parent. Maybe they tell you it's keeping them up at night, that they feel incredibly guilty, that they are tired all the time.
And you find yourself wondering: is this that normal new parent worry, or is it something a little bit more?
When I was deciding what our very first article should be, anxiety was the obvious choice. It is, without question, the most common experience we see in that tender transition to parenthood. Which is exactly why being able to tell the difference matters so much. The answer shapes everything about how we support the families in front of us.
Why the Distinction Matters
If someone is experiencing the normal uptick in worry that comes with pregnancy and postpartum, our path as providers is really clear. We share information about why anxiety increases during this time, and we normalise their experience. You are not the only one who feels this way. Feeling more vigilant and more aware is incredibly common, and it doesn't mean something is bad, broken or wrong.
We might also gently explore their definition of being a "good" mother or parent. Is it reasonable? Realistic? Sustainable? Perfectionism and unrealistic expectations can absolutely increase anxiety, even when we're not looking at an anxiety disorder.
But if we are looking at perinatal anxiety, one of the several anxiety disorders that can show up as a complication of pregnancy and postpartum, then our care needs to become more targeted. We want to identify the thoughts that are keeping someone stuck, the behaviours that are feeding the anxiety, and what we can do to dial the temperature down on all of it. The goal is to help them come back to feeling like themselves, and to being the parent they want to be.
Why We Expect More Worry in the First Place
The shift actually begins during pregnancy. The amygdala, the brain's fear centre, changes during pregnancy and into postpartum, becoming more sensitive and more easily activated.
This is evolutionarily beneficial. Parents who were a little more anxious were more likely to take protective and preventative steps to keep their babies safe. Is that rustle in the bush a squirrel or a bear? I don't know, but out of an abundance of caution, I'm taking the baby and leaving.
Sometimes it really was just a squirrel. But sometimes it was a bear, and the babies of those who left were far more likely to survive. That protective vigilance has been passed down through generations of human development, and alongside the enormous hormonal shifts of this period, it makes a lot of sense.
What Normal Worry Actually Looks Like
When we see a normal increase in anxiety, it's exactly that: an uptick. It's not a full turn of the volume knob.
Normal worry tends to respond well to reassurance or to an action step. Say a parent worries the car seat is out of date. They check. If it is, they buy a new one. If it isn't, they feel relief. Either way, the worry resolves and they get back to everything else they were doing. It doesn't keep popping back up.
The same goes for those bigger questions. Am I a good mum? Is baby doing okay? A parent might do a bit of research, talk to other parents, get the lay of the land, and feel better.
We'll also often see worry rise when sleep is poor or when there's a particular stressor. But after a good night's sleep, or once that stressor has passed, the anxiety eases too. It may be more than the person felt before pregnancy or before baby arrived, but it generally feels manageable.
Question One: Is It Proportionate?
When we move beyond that normal uptick, there are three key questions that help us tell the difference.
The first is proportionality. Rather than looking at the overall amount of worry someone is feeling, we want to look at whether it makes sense in the situation they are in.
A parent with a baby in the NICU facing serious health complications may understandably feel a high level of anxiety, vigilance and worry. That response is in proportion to what they're living through, it makes sense.
But if baby is thriving, meeting their developmental milestones, with no indicators of concern, and the parent is intensely worried about whether their baby will develop correctly? That's an out of proportion response, and it's a great indicator that there may be something else going on.
Question Two: What Is the Impact?
Normal worry might spike and settle, or come as a period of anxiety that then resolves. With perinatal anxiety disorders, the impact is much bigger, and it tends to show up in four areas.
Physical. Sleep is disrupted because the brain simply won't switch off. There may be a pounding heart, tightness in the chest, a churning stomach, difficulty eating or comfort eating.
Thoughts. I often describe this as the brain running on a hamster wheel. Instead of problem solving or weighing up the pros and cons, the mind spins the same material over and over and over again.
Behaviour. We might see more irritability, snapping at a partner, or less patience with older children. Instead of making a cup of tea while baby naps, a parent may find themselves checking on baby again and again, unable to leave the room even for a moment. Leaving baby with others can feel very anxiety provoking.
Sometimes clients are aware of this change: "I know my partner can absolutely take care of the baby, but I worry so much it's easier to just do it myself." Other times there's a belief that the behaviour is necessary. This is what being a good mum is. I have to do these things to keep baby safe. They may be believing what the anxiety is telling them.
Emotional. Listen for words like overwhelmed, exhausted, nervous and worried. The person is more consistently and persistently in a state of fear. That fear might be general ("I just feel like something bad is going to happen"), specific ("Is baby getting enough to eat?"), seemingly logical ("It's my job to make sure they hit their milestones, so I have to research everything to get it perfect"), or seemingly illogical ("I'm so worried I'll scald the baby in the bath that maybe it's better if I don't bathe them at all").
Checking in across these four areas gives you a clear sense of whether that volume knob has been given a full turn.
Question Three: Does It Respond to Reassurance?
With normal worry, reassurance or an action step settles things. We look up the expected age range for a milestone, see baby is right on track, and feel better. Or baby is a little behind but still within the normal range, or we decide to follow up with the GP. Either way, it resolves.
With perinatal anxiety, reassurance is far less effective. Sometimes it's like a game of whack-a-mole: one worry is resolved and another pops straight up in its place. Other times the relief is only temporary. We breathe out, everything's going to be okay, and then the same worry comes right back.
Whether that reassurance is coming from a loved one, from you as a provider, or from the client themselves, the thoughts are simply stickier.
Bringing It Into the Room
You don't need a complicated framework to begin making this distinction. When you're sitting with a client and wondering what's going on, come back to three simple questions:
Is it proportionate to the situation?
What is the impact across their body, thoughts, behaviours and emotions?
How does it respond to reassurance?
Together, they offer a reliable guide to help you understand what your client is experiencing and what kind of support will help most. If you can carry just one of these questions into your next appointment, then this episode has done its job.
Want to Go Deeper?
If this topic has sparked something for you, we have several trainings at PMHI that build on exactly these distinctions:
Introduction to Perinatal Mental Health: a strong foundation for anyone supporting families through pregnancy and postpartum.
Beyond Normal Worry: Recognizing and Supporting Health Anxiety in the Perinatal Period: a closer look at one of the presentations that so often hides behind "normal" parental worry.
Aren't Mums Meant to Worry? Understanding Perinatal OCD: exploring those sticky, intrusive thoughts and how to support clients who are living with them.
Take our FREE PMADs Training: Symptoms and Screening for Perinatal Mood and Anxiety Disorders
Listen to the Full Episode
This article is based on the first episode of Perinatal in Practice: Supporting Providers Through the Entire Perinatal Arc. Each week we take one piece of the puzzle and work through it together.
Listen to "Perinatal Anxiety vs. Normal Worry: What to Look For" on your favourite podcast app
If you find it useful, please subscribe so you don't miss the next piece of the puzzle, and share it with a colleague who is also part of someone's village. You can't pour from an empty cup, and your clients and your village really need you well.
