Maternal Mental Health Concerns
Pregnancy mental health concerns include increased depressive or anxiety symptoms, ambivalence or reduced interest in becoming a mother, extreme anxiety or fears regarding the developing baby's health or possible miscarriage, lack of attachment to the pregnancy or feeling overwhelmed by this life change. Factors that may contribute to pregnancy concerns include infertility, pregnancy loss or birth trauma, COVID / pandemic pregnancy, prenatal testing results, structural racism and disparities in medical care, partner relationship difficulties and lack of social support. Pregnancy may be a challenging time for women with a history of depression, anxiety, PTSD, bipolar or OCD.
Baby blues are emotional or distressing feelings that naturally arise post-birth. Symptoms may include some feelings of anxiety or depression, a rise in moodiness and emotionality, tearfulness, feelings of frustration or disappointment and sleep concerns. Please know that the baby blues are experienced by the majority (80%) of new moms, appearing a few days after birth and resolving after a few weeks.
Postpartum depression is experienced by roughly 20% of new moms and ranges from mild to severe. Symptoms cause more distress than the baby blues, and include severe feelings of depression, increased mood swings, sadness, crying, strong feelings of shame and guilt, loss of interest in activities, feeling numb, difficulty concentrating, feeling overwhelmed, critical thoughts of being an inefficient mother and disconnection to the baby. Loss of sleep plays a role, along with isolation during maternity leave.
Postpartum anxiety doesn't get as much press but it's very real to many new moms. It happens when severe anxious thoughts become difficult to control, and can be confused with new mom worry. New moms are naturally in their heads a lot, but increased anxiety around infant care and safety can become problematic. Often moms report nonstop excessive worry about everything, not being able to turn off thoughts, an inability to relax, and irritability. Look for anxious thoughts, especially around infant health, sleep or feeding, catastrophic 'what if' scenarios, and a neverending to-do list. Life always felt ‘in control’ prior to birth. Racing thoughts may impact mom's already limited sleep, increasing anxiety. Learn more about postpartum anxiety here.
Postpartum obsessive-compulsive disorder occurs as recurrent and unwanted intrusive thoughts and images completely take over, causing significant distress and impairment. The thoughts are related to obsessive worry for the baby’s health, care or safety, or irrational fears around you or others causing harm to the baby. The imagery of some of these horrific safety scenarios may shock you. Many women respond by isolating or creating compulsive behaviors or rituals (counting, checking, ordering/arranging items, planning for worst case scenarios, specific behavior routines, hand washing, etc.) to temporarily increase control and alleviate anxiety related to the obsessive thoughts and imagery.
Postpartum panic disorder occurs when extreme fear and anxiety manifest somatically through panic attacks. Symptoms may include chest pain, heart palpitations, feeling faint, tingling, sweating, shaking and feeling out of control. Anxiety may increase as you begin to fear having more panic attacks.
Postpartum PTSD is often related to traumatic birth. Symptoms can include nightmares, flashbacks of birth or past trauma, feeling unsafe, avoidance, hypervigilance and a sense of unreality / out of one's body.
Postpartum bipolar disorder can manifest in women with a history of bipolar or major depressive disorder, and may also appear for the first time after childbirth. It typically presents initially with severe depressive symptoms. Manic symptoms include elevated mood, euphoria, decreased need for sleep, rapid speech and grandiose thought patterns.
Postpartum psychosis is the most severe postpartum concern and occurs rarely. Safety is an urgent concern. Symptoms include confusion, hallucinations, delusional thinking, odd speech patterns, paranoia, severe insomnia and extreme irritability. Psychotic symptoms have a rapid onset, feel real / true and require immediate medical attention.
Post-adoption depression affects up to 25% of adoptive parents. Symptoms may include depressed mood, increased anxiety, sleep or eating concerns, irritability, unrealistic expectations of motherhood, attachment concerns, self-doubt about parenting, lack of support, fear that the child will be taken away and feelings of disappointment, inadequacy or guilt. Mood concerns can be heightened by legal or societal stressors and previous infertility.
Resources
Postpartum Support International: https://www.postpartum.net/
PSI HelpLine: 1-800-944-4773
National Maternal Mental Health Hotline: 1-833-943-5746
Postpartum Depression and Fathers, Nonbiological Lesbian Mothers, and Adoptive Parents
The Other Postpartum Problem: Anxiety
The Lonely Terror of Postpartum Anxiety
Postpartum OCD and Intrusive thoughts: What new moms need to know
Prevention and Treatment of Traumatic Childbirth
Books:
Becoming a Calm Mom: How to Manage Stress & Enjoy the First Year of Motherhood, Deborah Roth Ledley
This Isn’t What I Expected: Overcoming Postpartum Depression, Karen Kleiman and Valerie Raskin
Buddhism for Mothers: A Calm Approach to Caring for Yourself and Your Children, Sarah Napthali
The Journey to Parenthood: Myths, Reality and What Really Matters, Diana Lynn Barnes, Leigh G. Balber
The Post-Adoption Blues: Overcoming the Unforeseen Challenges of Adoption, Karen Foli, John Thompson
Mindful Motherhood: Practical Tools for Staying Sane During Pregnancy and Your Child's First Year, Cassandra Vieten
The Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions, Kevin Gyoerkoe, Pamela Wiegartz, Laura Miller
Postpartum Support Groups:
Bay Area: UCSF and Marin General offer postpartum support groups
PSI Support Groups online
Various groups offered: General Postpartum Support, NICU Parents, Moms of Color, New Dads, Same Sex Parents