Written by Harbor Council Member: Dr. Sunita Osborn
Consider what comes to mind when you consider mental health during pregnancy and after giving birth. While it looks different for everyone, some seem to breeze through while others struggle meaningfully. The image most often portrayed is a woman experiencing postpartum depression who has trouble connecting with her child, struggling to get out of bed, and crying copiously. For moms experiencing a perinatal mood and anxiety disorder (PMAD), this can be a very accurate and genuine portrayal of their experience.
A PMAD can also look like a pregnant woman who is very put together and appears cheerful, but is managing countless and significantly distressing intrusive thoughts most of the day. A PMAD can look like the non-birthing parent experiencing flashbacks and nightmares related to the traumatic birth of their child that is further amplified by their previous experiences.
It is essential that we, as parents, as partners, as supporters, and beyond, take the time to understand and educate ourselves on the reality of PMAD’s and all they can entail. Being informed could mean the difference between helping yourself or someone you love access care that is so deeply needed.
Fact #1: The perinatal time period is defined as the time from conception to one year after giving birth.
PMAD’s can, and commonly do, occur during pregnancy, not just in the postpartum period (i.e., after giving birth). This makes sense as we consider the myriad of physiological, emotional, and psychological changes that occur during pregnancy. In fact, rates of perinatal anxiety are higher during pregnancy than after giving birth (Twaio, et. al, 2024).
Fact #2: The mental health concerns you can experience during pregnancy and the postpartum period go beyond postpartum depression.
Perinatal mood and anxiety disorders can include depression, but it can also include anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder, bipolar disorders, or psychosis. Additionally, these conditions can be comorbid, meaning an individual may be experiencing more than one of these concerns at a time. For example, there is a high rate of co-morbid perinatal anxiety with perinatal depression and adequate assessment of both of these conditions can be essential to proper treatment (Shen, 2024).
Fact #3: PMAD’s are not just a women’s issue, they are universal and can impact anyone experiencing pregnancy or having a child regardless of income level, gender, nationality, ethnicity, geographic region, or age.
Thus, perinatal mood and anxiety disorders can impact non-birthing partners or parents who use a surrogate or adopt as well as the surrogate.
Fact #4: Baby Blues, which can occur two days to two weeks after giving birth and include mood swings and weepiness, are not considered a PMAD.
Fact #4: Baby Blues, which can occur two days to two weeks after giving birth and include mood swings and weepiness, are not considered a PMAD.
They are very common and can impact 60-80% of birthing parents (Chechko, 2024). Baby Blues typically resolve without clinical or medical intervention.
These points are all important because they help clarify the nuances and ways in which PMAD’s may manifest or express themselves and ensure that we don’t leave anyone behind in such a critical time period.
What can I do about it?
If you are concerned you or a loved one is experiencing a PMAD, there are a number of organizations that can get you connected to resources, groups, and/or trained therapists. Asking your pediatrician, your PCP, or OB is a great place to start as well as the resources listed below. Along with this, a helpful tool created by the Postpartum Stress Center is the FID formula to help better understand your experience or the experience of your loved ones. For example, if I found myself experiencing depressive feelings, I may ask myself the following questions.
Frequency: How often do I feel this way? (more often than not)
Intensity: How bad does it feel? (over 5 on 1-10 scale)
Duration: How long has it been going on? (over 2 weeks)
If the answers to each of these are all in the affirmative, more care may be necessary. It’s also important to remember that the perinatal time period, as exciting as it may be, can also be physically and emotionally overwhelming. It is expected and normal that you may experience feelings of anxiety, worry, sadness, confusion, or even a combination of all of these feelings. What’s most important is that you take the time to consider how you are feeling and to reach out for support when you need it, particularly if you have thoughts that feel scary or unmanageable.
If you are struggling to know how to share your experience with others, consider saying something like, “I feel overwhelmed and I’m concerned. Can you help me figure out what I need?”
How to help yourself now:
One of the most challenging aspects of the perinatal time period is that the elements or steps that would be most beneficial seem like the hardest to achieve, such as quality sleep, access to social connection, or time outside in the sun. Indeed, it is the very lack of these fundamental elements that are listed as risk factors for an increased chance of individuals developing a PMAD. While we cannot erase the reality that the perinatal time period does bring a new set of challenges and conditions that make reaching optimal health conditions harder, we also want to empower parents to take the steps to help themselves now.
Consider sleep, social connection, and time outside in the sun and challenge yourself to complete and follow through with the following prompts. Tip: Doing this with your partner or a friend may make it easier and more enjoyable.
- What is one thing I can do today that would support my health and overall wellness? (E.g., I will have my morning tea outside to get some sunshine).
- What external actions would I need to take to make this happen? (E.g., I’m going to set a reminder on my phone).
- What internal beliefs or feelings do I need to make space for to allow me to do this? (E.g., I will remind myself that each little step I take matters).
- Who do I need to ask for help to make this happen? (E.g., I will make sure my partner is around in case the baby gets fussy, so I can stay outside).
During pregnancy and beyond, the helpful may feel impossible. However, making a shift that improves your health or the health of someone you love by even one percent can and will make a difference in your life. By taking the time to read this article, you are putting yourself in a position to look out for yourself, your partner, your children and other parents.
Resources:
If you need immediate support, please consider reaching out to a crisis counselor by texting HOME to 741741 at any time. For perinatal support, if you're not in crisis but feeling overwhelmed, you can contact the PSI helpline at 800.944.4773 for assistance.
Note: The information provided on the site is for educational purposes only and does not substitute for professional medical advice.
Chechko, N., Losse, E., Frodl, T., & Nehls, S. (2024). Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences. BJPsych Open, 10(1), e3.
Shen, Q., Xiao, M., Wang, B., He, T., Zhao, J., & Lei, J. (2024). Comorbid Anxiety and Depression among Pregnant and Postpartum Women: A Longitudinal Population-Based Study. Depression and Anxiety, 2024.
Taiwo, T. K., Goode, K., Niles, P. M., Stoll, K., Malhotra, N., & Vedam, S. (2024). Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort. Health Equity, 8(1), 76-86.anxiety disorders and the treatment that needs to be sought to support those
