Understanding Perinatal Mental Health: Identifying Risks, Recognizing the Need for Help, and Finding Support
Though cultural narratives will lead you to believe that you should “glow” and feel calm, blissful, and excited during pregnancy and postpartum, many people find that their actual experience is marked by fluctuating emotions, highs and lows, and worry about their mental health. For some, especially those with known increased risk for perinatal mood and anxiety disorders (PMADs: a term that encompasses perinatal and postpartum depression, anxiety, obsessive-compulsive disorder, bipolar disorders, psychosis, and posttraumatic stress), the perinatal period, which covers pregnancy and the first year after a baby is born, can lead to frequent worry and rumination.
Will I develop postpartum depression like my mother?
Since I experienced a major depressive episode during college, will I relapse and experience postpartum depression?
My anxiety has always been a bit “extra;” will I develop postpartum anxiety or obsessive-compulsive disorder?
Who is at risk for PMADs?
Anyone can experience PMADs, and up to 20% of pregnant and postpartum people experience depression or anxiety during pregnancy or the postpartum period. Those with a family history of mental illness, as well as those with a personal history of mental illness, including previous PMADs have an elevated risk of developing PMADs. It’s important to note that increased risk does not mean imminent risk or certainty of illness. Many people with family and/or personal history of mental illness are unaffected during the perinatal period.
What should I do if I am at risk of developing PMADs?
First, take a long, slow breath.
Don’t panic. Being “at increased risk” does not mean that you will experience PMADs. There are many things that you can do to support your mental health during this time. In this case, knowledge really can translate to power. If you know you have elevated risk, monitoring your mental health, increasing positive health behaviors, and securing partner and/or social support can be an important part of preventing or mitigating the effects of PMADs. Some of my favorite work with clients is helping them to manage their anxiety about PMADs and engage in preventative work prior to or during pregnancy and postpartum. Teaming up with a knowledgeable professional and making a plan can be very empowering. You don’t have to be in severe distress to benefit from seeing a perinatal mental health professional; you can work with someone in reaction to distress or with hopes of preventing or mitigating the impact of PMADs.
What are the signs of PMADs?
It’s important to be informed about PMADS, including knowing signs to look for and knowledge about what to do, in case you are worried you may be experiencing PMADS. It’s important to note that some may experience just a few symptoms, whereas others may experience several of the following:
Persistent sad, anxious, or “empty” mood
Increased tearfulness
Irritability and anger
Persistent anxiety or worry
Feelings of guilt, worthlessness, hopelessness, or helplessness
Emotional numbing, detachment, or disinterest
Persistent exhaustion
Feeling restless or having trouble sitting still
Confusion and/or difficulties with concentration decision making.
Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or oversleeping
Abnormal appetite
Aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause or do not ease even with treatment
Trouble bonding or forming an emotional attachment with the new baby
Persistent doubts about the ability to care for the new baby or lack of interest in doing so
Thoughts about death, suicide, or harming oneself or the baby
How do I know if I need help with PMAD?
Every pregnant and postpartum person is likely to experience some of these symptoms for hours or even days at a time. The influence of fluctuating hormones and additional stressors of planning for a baby to arrive/caring for an infant are REAL. If you find that you experience mild symptoms for a few hours or a few days at a time with periods of wellness and normal mood in between, then I would recommend mentioning these experiences to your OB or midwife for discussion, screening, and monitoring.
However, if you find that you are experiencing severe symptoms and/or prolonged symptoms (more than 1-2 weeks at a time), reaching out to a perinatal mental health provider is a good idea. If you ever find yourself thinking about death, suicide, or harming yourself or others, that is an emergency that needs immediate attention. If you need immediate help, you can call 988 or visit 988lifeline.org; this is a national service with reliable support 24/7. You can also present to your nearest emergency department.
What do I do, and where do I turn for help?
If you find yourself feeling down, angry, confused, or anxious, start talking about it with trusted, supportive people in your life. The sooner you start talking with others and reaching out for support, the sooner you will feel better. Even though 1 in 5 experience PMADs, people hesitate to talk about it – often due to shame and the perception of being alone in this experience. It might be hard at first, but learning to speak up and reach out is critically important to receiving the care that you need and deserve; learning to reach out and ask for help might end up being one of your greatest achievements.
If you are experiencing symptoms of PMADS, many people start by talking with their OB or midwife. These professionals should have a baseline understanding of maternal mental health and the ability to assist with screening for PMADS and/or suggest options for seeking treatment from a qualified mental health professional. If your OB or midwife minimizes or dismisses your concerns, trust your gut. You know yourself and your baseline mental health functioning better than anyone. You don’t need your OB or midwife’s permission to seek the care that you believe you may need. One option is using the provider directory offered by Postpartum Support International, which will give you a list of trained perinatal mental health professionals in your zip code and surrounding areas. So many mental health professional are offering online therapy, and many perinatal psychologists are able to provide online therapy across state lines through the psychology interjurisdictional compact (PSYPACT), so even if you live in a more remote area, you may have more options than you think!
What kind of treatment is available?
Many people benefit from the support and guidance that can be provided through individual and group therapy. Evidence-based therapies for PMADs are very effective, when delivered by an experienced perinatal therapist. Medication is also an option (and can be critical part of mental health stability for some people), and a prescriber who is knowledgable about the perinatal period can advise you on relative risks of taking medication during pregnancy or while breastfeeding. No medication is 100% free of risk; however, for many people, the risk associated with taking a medication approved for pregnancy and/or breastfeeding is relatively small, compared to the risk of untreated mental illness for the birthing person, baby, and family.
Final thoughts on Perinatal Mental Health
There is no single cause of PMADs; research informs us that risk is comprised of genetic and environmental factors. There is a lot that you can do to bolster your mental health and wellness, but even the best executed wellness plan is not a guarantee against illness. If you do find yourself struggling with PMADs, it is NOT YOUR FAULT. You did nothing to cause this and it was not preventable. Experiencing PMADs does not mean that you are failing or not cut out to be a parent; it doesn’t mean that you will always feel this way. There are very effective treatments for PMADs, and you will feel like yourself again.
Reach out. You aren’t alone, and you deserve access to the care that will restore your sense of self and your experience of wellness during this time in your life. You’ve got this.