How Pregnant Women Can Support Postpartum Mental Health

Congratulations, mama-to-be! There’s so much to prepare for when you’re expecting. You’ve read the books, (ok, maybe skimmed a few…) downloaded the parenting apps, painted the nursery. Which stroller are you getting? Have you pre-washed all those adorable tiny onesies? Oh, and don’t forget taking a birth class!

Have you put yourself on your list? So much of preparing for parenthood is about the baby — but what about you? In addition to all the physical care that both you and the baby will need, there are emotional considerations, too. Did you know that up to 80% of new moms will experience the baby blues, and 10 to 15% of them will experience a perinatal mood and anxiety disorder (PMAD)? Mood disorders, like postpartum depression, are a common — but not-commonly-talked-about — side effect of giving birth. The good news is that there are steps you can take now to assess your risk factors and make a plan in case you need additional support.

About Perinatal Mood and Anxiety Disorders (PMADs)

First of all, what exactly is a PMAD? You’ve likely heard of postpartum depression (PPD), but PMADs encompass more than just PPD, and they can start as early as during the pregnancy. That’s why we use the inclusive term “perinatal” as opposed to the more narrow “postpartum”. PMADs include depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and postpartum psychosis. Although these disorders can be quite serious, they are all treatable.

Anxiety and depression are the most common, and easy to miss in a routine checkup with your OB, or even during screenings you may have with your pediatrician. Why? Because a lot of the symptoms for depression are hard to distinguish from the expected rigors of taking care of a newborn. Take some of the classic signs and symptoms of depression: changes to your eating and sleeping habits, loss of interest in sex, difficulty concentrating, increased anxiety. It’s very likely that a new mom will be experiencing these things as a natural result of her new responsibilities. 

Perinatal depression is different because it onsets during or after the pregnancy and is related to the massive hormonal shifts your body is going through. Fear, guilt, and struggling emotionally with the transition to motherhood are all normal — to a point. When these difficult feelings start interfering with your ability to take care of yourself and the baby, it may be time to ask for more help.

So is there anything you do in advance to prepare? Yes! There are three risk factors that put a perinatal woman at risk for a PMAD: a personal or family history of anxiety or depression, the rapid and intense hormonal changes of the perinatal period, and your individual psychological factors. Let’s break these down a bit.

Understand Your Personal and Family Health History

The enormous and unpredictable hormonal impacts of pregnancy and childbirth are unavoidable. What you can do is be aware of the upcoming changes and prepare as best as you can for the stress and strain that comes along with welcoming a new baby into the world. Acknowledge any prior or ongoing mental health challenges you may have, including generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder, and understand that they may put you at higher risk for postpartum mental health challenges.

Are you currently taking any medications to support your mental health? If so, you’ll want to talk with your healthcare provider about the risks to continuing your medication versus the risks to titrating down your medications, for both the baby’s health as well as your own.

Here is where it gets tough: do you have trauma in your background? Here are some questions to ask yourself:

• Do you have a history of emotional, physical, or sexual abuse?
• Did your parents separate or divorce at a young age?
• Was there mental illness or substance misuse in your home growing up?
• Was a member of your household incarcerated while you were growing up?

If you answered yes to any of these, know that factors like these may contribute to a risk of perinatal depression.

Your intersectional identities may also increase your risk, including those who are adolescent, unmarried, financially disadvantaged, or of color. 

When it comes to your family’s mental health history, you can’t change, nor perhaps even know, the full extent of it. But you can try to find out if you have family members who have been diagnosed with anxiety disorders or depression.

Assessing Your Combined Risk Factors for PMADs

If you are reading this while currently pregnant and you are already dealing with a significant amount of anxiety, you should know that prenatal anxiety is one of the strongest risk factors for developing postpartum depression. PMAD vulnerability is also directly related to life stress. Transitions are triggers. That means you should take extra care around situations like a stressful or traumatic birth, excessive sleep troubles or sleep training, and other transitions like you and/or your partner going back to work.

If you don’t have many risk factors, stay attuned to any significant life stress beyond pregnancy and childbirth. If you do recognize yourself in many of these risk factors, know that you will likely experience perinatal anxiety regardless of additional life stress.

Your Perinatal Mental Health Resource Kit

It’s not a bad idea to line up the medical providers you may need while you are still pregnant. This way, if you find that you need support down the road, you can easily ask a family member or friend to help you set up appointments, rather than starting a search from scratch.

At minimum, you should have a primary care doctor and an obstetrician. You may also need a therapist and/or a psychiatrist. If you’re not familiar with these terms, they might sound similar or confusing.

A therapist is a trained professional who listens and provides support. A psychiatrist is a medical doctor who specializes in mental health and can prescribe medication. You may need one or both of these types of providers, depending on your particular situation.

If you have insurance, you may want to start by asking them if your coverage includes mental health or behavioral benefits. You should also ask about your in-network and out-of-network benefits, and whether there is a limit to the number of sessions covered.

Searching for a new therapist can feel like a daunting task, especially if you have never worked with this type of professional before. Start by asking the doctors you know if they have any recommendations. You may want to ask for a therapist who specializes in perinatal mental health and has experience working with new moms. You can also ask your insurance company for a list of in-network providers. If you’re someone who wants to take the search into your own hands, you can search for therapists on the websites of Psychology Today and the American Psychological Association.

Plan On Success

Understanding your risk factors and making a plan does not mean you will inevitably suffer. But it does give you more options if you start feeling unwell at any point during your pregnancy or postpartum journey. Perinatal mental health struggles are common and treatable. You are not alone and you do not need to suffer in silence. Taking a few steps now means you’ll be able to access your support systems more easily if you need them. The sooner you feel better, the more you’ll be able to enjoy time with your new bundle of joy.