Salute to Mothers: Mental Health in Pregnancy and Postpartum

Source: Andrae Ricketts/Unsplash

May is Maternal Mental Health Awareness Month, and the first week of May is Maternal Mental Health Awareness Week.

What exactly is maternal mental health, and is it a real thing?

The proper name for what we are talking about here is perinatal mental illness, and I would bet you've never heard that term. Perinatal mental illness is a significant complication of pregnancy and the postpartum period. These disorders include depression, anxiety disorders, obsessive-compulsive disorder (OCD), and postpartum psychosis, which most commonly manifests as bipolar disorder. Perinatal mental illness is not considered part of the "normal" adjustment or normal response to pregnancy, but rather the above are psychiatric conditions that manifest in characteristic ways or have typical onset in women during the reproductive period of their lives and can result in a significant reduction in quality of life, impairment, and even disability (O’Hara 2014).

Postpartum depression has historically been underrecognized and underdiagnosed, though nowadays, because of increased awareness, it is getting somewhat more attention from the medical community, including being assessed by OB-GYNs, primary care doctors, pediatricians, and of course, psychiatrists. Perinatal depression and anxiety are common, with prevalence rates for major and minor depression up to almost 20 percent during pregnancy and the first 3 months postpartum (O’Hara 2014). Postpartum blues are a common but lesser manifestation of postpartum mood disorders. Estimates are that between 50-80 percent of women experience postpartum blues within the weeks following delivery (MGH Center for Women's Mental Health website, 2021).

Source: Jonathan Borba/Unsplash

So far, of the above conditions, we have come the farthest in recognizing postpartum depression—increasingly I am seeing colleagues screening and referring for treatment with antenatal and postpartum mood complaints. But maternal anxiety disorders and other perinatal mental health concerns, including bipolar disorder, also pose considerable risk to a woman’s well-being—and her child(ren)’s as well.

Unfortunately, we often normalize a woman’s struggles in pregnancy and postpartum. At first glance, we may not think there’s anything unusual about a woman having "difficulty" during this time of life. Often when these symptoms are written off, they are attributed to being caused by:

• “Being hormonal”
• “The stress of having a newborn”
• “Being a little cranky from being sleep deprived and/or breastfeeding all the time”
• A case of "Mommy brain"

While there is a grain of reality to there being legitimate hormonal fluctuations, that caring for a newborn is hard work, that pregnancy and childbirth constitute a major life change, and that sleep deprivation sure doesn’t help, sometimes there is more to the story. Some typical complaints that can indicate a perinatal mental health disorder can sound like:

• “No matter what I do, I can’t sleep. I’m up all night worried.”
• “I can’t stop thinking about the baby. I’m worried something could happen to the baby.”
• “I’m often angry for no reason. I can’t control my temper.”
• “There is nothing in this world more precious to me than my baby, so why am I feeling this way? Why am I having these thoughts?”
• “I’m afraid you’ll think I’m crazy.”
• “I cry for no reason at the drop of a hat over little things.”
• “I’ve lost interest in things. I can’t even enjoy my children.”
• “It’s like I’m crawling through mud.”
• "I can't bond with my baby."
• "My mind is racing all the time. I can't stop my thoughts."

Source: Dragos Gontariu/Unsplash

No two women’s experiences will be the same. If the postpartum adjustment seems extra hard, if it’s difficult to cope, if there’s a change in a woman’s functioning, if there are extremes of mood or she’s having thoughts or behavior that demonstrate extremes of fear or is preoccupied, it could be very worthwhile to seek a professional opinion. Perinatal mental illness is very treatable, and there's no shame in asking for a professional assessment of what one is going through. Treatment can improve both the mother’s quality of life as well as the health and the well-being of the family as a whole. For severe symptoms, including severe depressive, manic, and psychotic symptoms, treatment can be life-saving.

Ways to get help:

Organizations that are doing the important work of increasing awareness of maternal mental health and provide resources for treatment include the following:

• The International Marce Society for Perinatal Mental Health
• Postpartum Support International
• Maternal Mental Health Leadership Alliance

To find a therapist, please visit the Psychology Today Therapy Directory.