Katrina, a postpartum mother, called me to her room. She fearfully cried, “I think I’m having a heart attack.” She had chest pain and heart palpitations and felt short of breath. Her age and general health made a heart attack highly improbable but not impossible, and there are a few rare but severe issues that might present this way.
I took her vital signs. Her heart rate was 120—high, but not scary high. Her breathing was fast at 20, but her blood pressure was normal. Her lung sounds were clear. Her bleeding was okay.
My gut feeling was that she was having a panic attack, not a heart attack. In her chart, her midwife had noted that Katrina had anxiety. We talked for a while about what was stressing her. It turned out she was worried about her baby’s feeding issues, and there were financial issues at home.
We talked about how we could improve her baby’s feeding. Breastfeeding was a brand-new skill for both her and the baby, and they would both master it in time. I reassured her that she would be a great mom and that the financial issues would eventually be resolved. We discussed relaxation techniques. Within a few minutes, her heart rate and breathing slowed, her chest pain faded, and her fear disappeared.
Of course, if her vital signs and chest pain had not improved when she relaxed, I would have called the midwife to get an EKG and a full workup. But they were unneeded. She was having a panic attack, which occurs when anxiety rises quickly and hits a person like a rogue wave. It is usually intense but short-lived. The symptoms can be the same as a heart attack, but the treatment is very different.
We have all our usual stressors, such as bills and family issues. Now, the huge stressor of parenthood has been added to the list. How do we cope?
“Worry does not empty tomorrow of its sorrow. It empties today of its strength.” – Corrie Ten Boom
Some Science
As a nurse, I am fascinated by the science of the body. If this reminds you of school and your eyes start glazing over, skip over this section and go straight to the stress busters in the next section.
First, we will discuss some physiology, which means looking at what’s going on inside your body. Your body has two sets of nerves with opposite functions: the sympathetic and the parasympathetic nervous systems.
The sympathetic nervous system is also called the “fight-or-flight response” and the “stress pathway.” It turns on when stressful events happen. Extra blood is sent to your muscles, and your heart beats more quickly in case you have to run fast. In the past, when people were running away from bears or fighting invaders, this was beneficial. Now, it’s activated when we worry, which is not useful.
The good: This system saves your life when a car is bearing down on you and you need to jump out of the way. It is the reason you can run fast or fight hard if a bad guy is after you. It also helps you strive hard to meet deadlines so you can pay the bills. It gets the job done.
The bad: Nowadays, the “threats” that trigger our stress pathway are on social media, at our jobs, or in our homes. Many times, they exist only in our minds. We think about our unmet goals or relationship problems, and our body and brain respond as if they are something we need to run from.
In chronic stress situations, the flight-or-flight response is always turned on. Your liver puts extra sugar into your blood in case you need to run or fight. This is especially bad for people with diabetes. Your heart beats faster for no reason. Blood flows to your muscles and away from your stomach and intestines, so you have more digestion issues, such as constipation and irritable bowel syndrome.
The parasympathetic nervous system is the other set of nerves in the body. It is also called the “rest-and-digest” response or the “relaxation pathway” and has all the opposite functions and effects to the stress pathway. Stimulation of this pathway helps you combat stress and anxiety.
Our stress pathway is overloaded these days, and we need to move our bodies into the relaxation pathway. How do we do this? First, we’ll discuss ways to calm down on the inside, like deep breathing. Afterward, we’ll discuss ways to relax on the outside, such as listening to relaxing music (Clark, 2023).
Whenever you don’t get results with one tool, try another. The right tool is the one that works.
Internal Anxiety and Stress Busters
Relax your brain: For a few minutes, turn off your brain. You have a body and a mind. Worry is located in the mind. Right now, stop thinking and bring your attention to physical sensations. Shut your eyes. Focus on your breathing. What do you feel when the air goes in and out? What do you hear? What do you smell? What does the chair feel like underneath you? What do your feet feel? This is even more effective if you can do this outside in nature—listen to the birds and the creek, smell the flowers, and feel the damp earth under your bare feet.
Distract yourself from stressful things and think about relaxing or fun things. When a worrisome thought invades your mind, gently push it away and replace it with a relaxing thought.
Relax your eyes: With your eyes shut, gently move your eyes up, down, and to both sides. Then, let them flit around, moving quickly wherever they want to go. Staring is what your eyes do on the stress pathway. Bouncing around is what they do during the REM or dreaming stage of sleep. Consciously think about relaxing your eyes.
Breathe deeply: Breathe in slowly through your nose, using your abdominal muscles instead of your chest muscles. Hold it for a few seconds, then breathe slowly out of your mouth. Purse your lips so you have to push a bit to get the air out. This stimulates the vagus nerve, one of the most important parasympathetic nerves. Push as much air out as you can to empty your lungs of all the stale air. Repeat this several times.
Relax your body: Move down your body, from your head to your feet. Relax one part for two slow, deep breaths. Then, move down to the next part for two slow, deep breaths. Keep going until every part of your body is relaxed.
Whenever you feel like crying, find a private place and let it out. It helps a lot.
External Anxiety and Stress Busters
Enjoy nature. Watch the sunset. Walk in the park or woods. Get out of the house. Take a walk or a jog in your neighborhood. Sit under a tree. Plant seeds in your garden or bring in a bouquet of flowers. Seeing and experiencing the beauty of nature will elevate your mood.
Get some sunlight. This increases the hormone serotonin in your brain, boosting your mood and decreasing stress. Sunlight also increases vitamin D intake, which benefits your mood and immune system. You’ll get sick less, and therefore avoid the stress of being ill. Most of us are deficient in vitamin D.
Eat well and drink plenty of fluids. Never underestimate the power of food. Hippocrates, the father of medicine, wisely said, “Let food be thy medicine.” For a whole section on this subject, see Chapter 8: Nurturing the New Mother.
Limit visitors or give them a task. If they want to hang out, they can fold laundry or fix a meal. Ask for help, even if it’s just so you can take a shower.
Talk with someone about your feelings.
Make time for yourself. Whether it’s a hot shower, a short walk, or just a moment to enjoy a cup of tea, these small breaks can rejuvenate you. I love reading, so I kept an enjoyable book beside my rocking chair to read while feeding my babies.
Be creative. Do an art project or a craft.
Do something relaxing. Play music. Watch a movie. Try to take a long bath, although that’s not easy with young ones underfoot.
Seek out humor. Laughter is an inexpensive but effective wonder drug. Watch a comedy or a silly clip on the internet. Listen to a humorous podcast while cleaning the house or driving to work.
Call a friend and tell them today’s conversation will be about fun and positive topics only.
Learn to set boundaries to protect your time and energy. You cannot shirk certain responsibilities, so continue with them. You must feed your baby and change his diapers. However, you don’t need to bring cupcakes to that party someone’s planned. If you have some close relationships that are dysfunctional or toxic, you may need help from a counselor to determine whether others’ demands on you are excessive and how to kindly but firmly change them. See Chapter 9: Therapy and Medicine Can Help.
Accomplish something each day, even if it’s just making the bed. Set small goals and complete them (big goals may make you more anxious). Make a point of enjoying what you’ve accomplished. Anxious people tend to belittle themselves and the things they do.
Get some exercise. Exercise is a free, underutilized, but effective antidepressant. You can put your baby in his stroller and take a long walk. As an added bonus, your baby will get fresh air, so he will sleep better at night. If it’s rainy, you can walk in the mall. There is more on this in Chapter 8: Nurturing the New Mother.
Learn to prioritize. You can’t do everything. What’s most important to you? Look at the big picture, make sure your energy is spent on the essential things, and choose not to be bothered by the small stuff that didn’t get done. It’s okay to say “no” to the things that are not your high priorities.
“Most things which are urgent are not important, and most things which are important are not urgent.” – Dwight D. Eisenhower
Panic Attack Busters
Panic attacks are caused by extreme anxiety. During an attack, a rush of adrenaline throughout your body causes the symptoms. The “fight-or-flight” response has gone into overdrive. This is a type of anxiety.
Symptoms of a panic attack:
- Racing heart
- Chest pain
- Difficulty breathing, such as hyperventilation
- Trembling or shaking
- Chills
- Nausea
- Sweating
- Tingling or numbness in your fingers or toes
- Feelings of terror
- A choking or smothering sensation
- Fear of losing control
- Feeling you might die
- Feelings of unreality or depersonalization (feeling detached from yourself)
Panic attacks can be scary. Some people say it feels like they are dying. But rest assured, it is NOT dangerous. You will NOT die.
Don’t try to fight it or tell yourself to “just relax.” It doesn’t work. There is a fun online quote: “Never in the history of calming down has anyone calmed down by being told to calm down.” Don’t focus on the symptoms, as that tends to make it worse.
Panic busters.
Pick one. If it’s not effective, try a different one:
- Slow your breathing. Close your mouth and breathe through your nose. When you breathe through your nose, a chemical called nitric oxide is released. This helps to widen the blood vessels, which increases the oxygen in your body and helps you relax. During a panic attack, your vessels constrict.
- Use ice. Put an ice pack on the back of your neck or across your face. The cold shocks your nervous system and helps you recenter your feelings.
- Close your eyes. Shut out the rest of the world. Ignore your racing thoughts and fast heart rate. Turn off your brain for a time. Relax each part of your body.
- If you can, take a walk. Some light exercise will distract your mind and redirect energy away from your thoughts and into your muscles.
- Sniff some lavender. This has been shown to help, and it also interrupts your thoughts.
- Acknowledge it and do nothing. Just accept it. Say to yourself, “Oh, my heart is fast. Whatever. It will go away when it’s ready. It’s not hurting me.”
- Or do the opposite: Tell your emotions, “Go ahead, give me your worst. I will accept and feel this panic attack for one full minute. Go ahead. Is that the worst you can make me feel?” Set the timer on your phone. When it beeps, tell your emotions, “Okay, you’re done now. You need to fade away so I can go do whatever I was planning to do.” The reasoning behind this is that if you run away from the panic attack, you become more afraid that it will progress and overcome you. But when you allow yourself to feel it at its worst, you know it won’t hurt you. It can only get better from there.
