Maternal Mental Health

Pregnancy and Postpartum

Having a baby can be an amazing time in a woman’s life. Watching a growing bump, being doted on by passersby who all want to hear about your new plans, daydreaming about the imminent addition to the family can contribute to feelings of excitement and anticipation. But, sometimes this time can be eclipsed by feelings of loss, worry or grief. It is a time many women experience anxiety and/or sadness as they consider what the future may hold and reflect on previous periods of their life that are now coming to a close. Whether a mom-to-be feels prepared or not, it is a significant emotional and psychological life adjustment for the mother, the partner and the entire family.

It is not surprising that many women feel ashamed to express feelings that may run countercurrent to anything but a state of joy in the months leading up to and after their birthing experience. What is surprising, however, is the high number of women who suffer in silence because they believe themselves to be the only ones. Many people are aware of the “baby blues,” a term meant to explain the hormonal and physiological changes occurring in the two weeks following a mother’s birth, but even this term can be misleading. The baby blues are still a significant moment of vulnerability for a new mother, and require a supportive social network to nurture not just the baby, but the healing mother as well. As high as 80% of women experience the baby blues, which can include mild mood fluctuations, tearfulness, irritability and anxiety after giving birth. This is quite common and resolves in about two weeks. If symptoms last longer than two weeks or become more intense, this could be a sign of a more serious condition.

Regardless of age, ethnicity, social status, or educational level, 10%  to 20% of women who are still feeling distress after this two week period will be experiencing symptoms serious enough to interfere with their everyday functioning. Their perinatal distress will require treatment to improve. With the right help, they will get better.

Prenatal Counseling

Though there is so much emphasis on creating baby registries and building a nursery, it is equally important to make a plan for what will happen once baby arrives. The best time to connect with a therapist is during your pregnancy. Establishing a relationship with a licensed therapist can help you to get the best treatment available should you need support postpartum. Meeting with a therapist during your pregnancy helps to establish a baseline of how you are functioning before baby’s arrival, discuss possible risk factors such as history of depression, anxiety, or childhood trauma, and make a plan to prepare for the postpartum period that will best support a new mother, her newborn and her family members. 

Perinatal and Postpartum Depression and Anxiety Disorders

Maternal depression is the number one complication of pregnancy and childbirth. 

Affecting approximately one million women in the United States, postpartum depression is often used as an umbrella term for a wide range of mood disorders that are also known as Perinatal Mood and Anxiety Disorders (PMADs).  

Perinatal refers to the the preconception period, pregnancy itself, and the child’s first year of life. PMADs can occur at any time during pregnancy, following miscarriage or stillbirth, and up to one year after delivery. They include a spectrum of disorders: depression during pregnancy, postpartum depression, perinatal anxiety (generalized anxiety, panic disorder, obsessive-compulsive disorder, PTSD), and postpartum psychosis.* This category of mental health disorders has serious consequences for mothers, infants and families regardless of ethnicity, race, age or income level. 

Perinatal mood and anxiety disorders are highly treatable.  However, when left untreated, the effects on the fetus, newborn, developing child and family can be profound.  Research suggests that clinical, therapeutic interventions may prevent or lessen the intensity and duration of perinatal mood and anxiety disorders.

Fathers and Partners are also affected

Whereas 1 in 7 women will experience a postpartum depressive or anxious episode, it is little discussed that fathers and partners are also at risk. It is estimated that 1 in 10 fathers will experience a postpartum mood and anxiety episode, which can look like increased irritability, anger, a sense of 'checking out' of the relationship, increase in substance use/abuse such as gambling, alcohol or drug use, as well as the other symptoms listed below. If you are concerned that your partner or spouse might be in need of support, reassure them that these thoughts do not make them a bad parent and that with help, they will get better. 

What you or someone you love might be experiencing

Symptoms of depression and/or anxiety, prenatal and postpartum, can be mild to severe and vary for each individual. They can include: 

 •  Sadness, crying

•  Feeling overwhelmed and unable to cope

•  Excessive and constant worry, nervousness (this is often a prominent feature in perinatal depression)

•  Difficulty concentrating or making decisions

•  Intrusive or scary thoughts (especially about the baby) that are inconsistent with who you know yourself to be

•  Feelings of guilt

•  Irritability, anger, short temper

•  Changes in appetite

•  Feeling hopeless, worthless

•  Withdrawal from family and friends

•  Lack of interest in your baby, or not feeling connected to your baby

•  Lack of interest or pleasure in general

•  Insomnia: difficulty falling asleep, staying asleep, not being able to sleep when the baby sleeps

•  Sleeping too much

•  Rapid heartbeat, nausea, feeling hot or cold

•  Thoughts of harming yourself or your baby*

What causes Perinatal Mood and Anxiety Disorders?

Unfortunately, we don’t know the exact cause. And while anyone may develop PMADs, even without known risk factors, there are factors that can increase the risk of developing PMADs. These factors include:

 •  Personal or family history of depression, anxiety, bipolar disorder

•  Personal or family history of postpartum depression or anxiety

•  Depression or anxiety during pregnancy

•  Sensitivity to hormonal changes, history of PMS or mood problems with oral contraceptives

•  Lack of social, emotional, or practical support

•  Relationship stress

•  History of trauma

•  Previous miscarriage or stillbirth

•  Medical complications or traumatic birth

•  Unplanned (even if not necessarily unwanted) pregnancy 

Treatment can be very effective

Though the exact cause of PMADs is not known, we do know that treatment can be very effective.  Treatment varies depending on individual symptoms and needs, and can include psychotherapy, increased self-care, social support, and in some instances, medication.

As a psychotherapist, I work collaboratively with psychiatrists who specialize in maternal mental health and can make referrals as needed. There are also a variety of community resources available, ranging from postpartum groups to parenting support.  If you are feeling depressed and anxious, you need not suffer alone.  Seeking help is not a sign of weakness.  It is a sign of courage and strength.

You are not alone – You are not to blame

If you are having any of these thoughts and feelings, please know that they are symptoms. They are not a definition of who you are as a person, a woman, or a mother.  You are not alone—this is not your fault.  With treatment, you can feel better.

Do you need immediate support?

When in doubt, call to consult. You have nothing to lose. 

Suicide Prevention Hotline: 1-800-SUICIDE (1-800-784-2433)

National Postpartum Depression Hotline: 1-800-PPD-MOMS (1-800-773-6667)

Postpartum Support International Warmline: 1-800-944-4773; dial extension 1 for Spanish and 2 for English. Calls are returned by a volunteer within 24 hours, 7 days a week. 

Contact me for a phone consultation and/or to schedule an appointment. 

*Postpartum psychosis is a medical emergency and requires immediate treatment.  Symptoms of postpartum psychosis can include but are not limited to: seeing or hearing things that are not there, suspiciousness, decreased need for sleep, rapid mood changes, bizarre delusions/commands (sometimes to harm the baby). If you are experiencing these symptoms, or feel that you are in immediate danger of hurting yourself or your baby, please call 911 or go to your local emergency room.

Information on these pages is not meant to be advice and is not a substitute for consultation with a qualified professional.