Maternal mental health

Women often experience a variety of emotions during and after pregnancy, and some of these feelings can be unpleasant. Feeling anxious, overwhelmed, or sad is not unusual, but sometimes these emotions are felt much more strongly, last longer, and can become a serious mental health condition.

In such cases, it could indicate conditions called perinatal depression or postpartum depression, depending on when they occur. “Perinatal” refers to the time during pregnancy or just after birth, and “postpartum” is the period within the first year after having a baby.

Research suggests that depression and anxiety are among the most common conditions that affect new or expecting moms. They can happen together or separately, and some women may experience just one or neither. If a person experiences these feelings, it’s important to know the symptoms and seek help from a professional.

The symptoms listed below can help determine if a woman may have depression and/or anxiety.

Perinatal depression

Perinatal depression can happen during pregnancy or after childbirth (postpartum), and it can affect women of any age, race, ethnicity, income, culture, or education. It is a medical condition – not a reflection of who you are or something you did or didn’t do.

Symptoms may include:

• Feeling sad, helpless, or overwhelmed
• Crying or becoming upset more often than usual
• Becoming angry or irritable easily
• A sense of being distant or detached from your baby
• Worrying about your ability to care for your baby
• Not feeling like yourself

There is no single cause of perinatal depression. Research suggests that a mix of genetic, hormonal, physical, and environmental factors may play a part. These may include:

• Life stress, including demands at work, relationship difficulties, or past trauma
• The physical and emotional demands of pregnancy, childbirth, and caring for a new baby
• Hormonal changes that happen during and after pregnancy
• A personal or family history of depression or bipolar disorder
• Depression during a previous pregnancy

If you have symptoms of perinatal depression, you are not alone. Help is available, and treatment can make a difference.

Postpartum psychosis

Postpartum psychosis is a rare but serious medical emergency that can occur after childbirth, usually within the first few days or weeks. A person experiencing postpartum psychosis may lose touch with reality and experience some of all of these symptoms:

• Confusion
• Extreme agitation
• Hallucinations
• Delusions
• Paranoia
• Strange beliefs about them or their baby
• Dramatic changes in mood or behavior
• Thoughts of harming themselves or their baby
• Periods where they “lose time” or become disoriented and disconnected from their surroundings.

These symptoms can develop quickly and may put the mother and/or baby at risk. Notify the provider immediately if the mother has an abnormally elevated or irritable mood, extreme energy, or a decreased need for sleep.

Postpartum psychosis requires immediate medical attention and an emergency evaluation.

Postpartum Obsessive Compulsive Disorder (OCD)

Postpartum Obsession Compulsive Disorder (OCD) is a common and treatable subset of postpartum anxiety disorders, and includes a range of intrusive thoughts and compulsions. Postpartum OCD specifically affects women during the postpartum period, the first 12 months following the birth of a child, which can involve new onset OCD symptoms, or worsening of underlying OCD. Unlike general postpartum anxiety, which can manifest as excessive worrying, postpartum OCD is characterized by obsessive and repetitive, unwanted, and often distressing thoughts and compulsions. Compulsions could be repetitive behaviors that one feels the urge to perform in response to an obsessive thought.

Examples may include unwanted intrusive thoughts or mental images of harm coming to their babies, whether accidentally or intentionally, obsessions about cleanliness and contamination of the baby, repeated compulsions or behaviors meant to reduce harm or distress such as excessive checking, counting, washing, and seeking reassurance from others. OCD often causes intense guilt, shame, and fear. These thoughts are very disturbing to moms and can even be violent or sexual in nature. Parents with postpartum OCD recognize that these thoughts are irrational and horrifying, which often distinguishes the condition from postpartum psychosis. 

However, if you are having these symptoms, it is recommended that you speak to a healthcare provider for a more thorough assessment.

Treatment

Early mother-child bonding is important for your baby’s development. Becoming close to your baby is a big part of that bonding, but depression or anxiety can make it difficult. Early treatment is important for you, your baby, and the rest of your family. The sooner you start, the more quickly you could start feeling better.

Many treatment options are available, and there is no single treatment that works for everyone. Your healthcare provider may ask you a set of screening questions to learn more about what you are feeling. He or she also may suggest additional tests to rule out any other health conditions that could be causing anxiety or depression. You probably won’t need to prepare for these tests, but it can be helpful beforehand to write down your symptoms and make notes about what you’d like to talk about.

The first step to seeking treatment is to talk to your healthcare provider and ask for a referral to a mental health professional. After your visit, follow up on all referrals and recommended treatments.

Prevention

Currently, there is no known way to prevent perinatal depression or anxiety. But knowing what signs and symptoms to watch for during and after pregnancy can help you prepare and get help.

Some simple steps you can take to prepare include:

• Finding out if you have factors that put you at greater risk for depression and anxiety
• Talking with your healthcare provider about depression and anxiety to learn what to watch for
• Talking to other moms about their experiences
• Doing things in addition to seeking treatment that may help you feel better, such as exercise, yoga, or meditation
• Planning ahead. Think about the people who can help support you when your baby comes, and talk to them in advance.

What to do in a crisis

If you are in crisis, you shouldn’t be alone, and you shouldn’t leave someone alone if he/or she is in crisis. If you can’t be with him/her personally, immediately tell someone who can help.

Other options include:

• Call 911 or go to the nearest hospital emergency room for treatment.
• Call or text 988 to reach the Suicide and Crisis Hotline, or visit 988lifeline.org to chat online.
• Call or text 1-833-TLC-MAMA (1-833-852-6262) to reach the National Maternal Mental Health Hotline. Help is available in 60 languages.
• For non-urgent support, call the Postpartum Support International help line 1-800-944-4773 or text HELP to 800-944-4773.

Resources

• Depression Among Women (Centers for Disease Control and Prevention)
• 24/7 National Maternal Mental Health Hotline (U.S. Health Resources & Services Administration)
• Postpartum Support International
• Women and Depression (U.S. Food and Drug Administration)