Table 5.

N*U*R*S*E* plan for postpartum anxiety (adapted from the ACNM, 2002).

Nutrition	Women who are anxious after birth are often overwhelmed by the demands of motherhood and lack of sleep and have no energy to prepare meals. The body needs good food to heal so every effort should be made to eat well. Family and friends can help with food preparation. A multivitamin every day will provide some of the basic requirements for vitamins. Fluids are important for both health and breastfeeding. Drinking 8–10 glasses of water every day will help both mother and baby. Stay away from alcohol because it can add depressive symptoms to PPA. Omega-3 fatty acid is associated with improved outcomes in women with anxiety. Dietary intake is generally low in postpartum women. A daily fish oil supplement of 1–3 gs is encouraged.
Understanding	A woman with PPA feels a constant sense of dread and worry, and might feel unable to care her for baby (Postpartum International, 2016). This is NOT her fault. Understanding and acceptance by family and friends is essential for her to begin to believe in herself again. It is important to get professional help to cope with the anxiety and to begin to recover. Support groups are an excellent idea. The best understanding comes from those who have experienced postpartum mental health disturbances.
Rest and relaxation	Sleep is critical for health and healing. Most women with postpartum anxiety have difficulty sleeping. Try different strategies, such as a warm bath before bedtime, massage, relaxation techniques, or meditation. When women are breastfeeding, they may need assistance with one night-feeding to get some uninterrupted sleep. Call for help if she goes without sleep for more than two days.
Spirituality	It is helpful to draw on what has made her feel uplifted and joyful in the past. Many things, from formal religion to listening to music that helps her find a sense of well-being, will in turn, give her strength to cope and begin to recover. Mindfulness therapy has proven to be helpful at alleviating anxiety symptoms and may be practiced at home, utilizing resources found on the internet like podcasts and videos.
Exercise	Physical exercise improves brain function and a sense of well-being. Set up a program that is realistic, taking small steps to increase her activity. Family and friends can help with short walks, or with offers of childcare while she exercises. Some gyms and yoga studios may offer classes where she can bring her baby. Yoga has been shown to be effective at reducing anxiety symptoms (Li & Goldsmith, 2012).
Psychological and pharmaceutical strategies	Both interpersonal psychotherapy and cognitive behavioral therapy can both have positive effects on anxious behaviors and coping mechanisms (Beck, 2014).
	The SSRI class of antidepressants is the most commonly prescribed medication for women with postpartum anxiety and is safe for breastfeeding. All patients who screen positive for postpartum anxiety should be offered SSRI therapy such as Prozac, Zoloft or Lexapro.