Becoming a parent is often depicted as a joyous and life-affirming event - images of love at first sight, instant bonding, practically a state of euphoria, and purpose. The reality, though, can be far more complex. For many, the perinatal period — the time during pregnancy and the first year postpartum (including infertility and fertility treatments) — can be a challenging emotional and mental landscape to navigate, often made even more challenging when it is not talked about. Even if and when love, bonding, and a sense of purpose are present, mental health during pregnancy and postpartum is too often silenced.

When pregnant moms, new moms, and grieving moms are unsupported, shame grows and self-compassion dissipates. Perinatal mental health is essential to the well-being of not only the pregnant, grieving or postpartum person, but also to the well-being of the baby, siblings, the other parent, and the family unit. Prioritizing perinatal mental health prioritizes the family system and all with which that system intersects.

What Is Perinatal Mental Health?

Perinatal mental health refers to the emotional and psychological well-being of individuals during pregnancy and the first year after childbirth. It encompasses a wide range of experiences, from the so-called "baby blues" to more severe conditions like perinatal mood and anxiety disorders (PMADs), as well as the mental health of individuals dealing with infertility or perinatal loss.

Perinatal mental health disorders are common, affecting up to 1 in 5 people during the perinatal period. Despite the prevalence, these conditions are often under-recognized or dismissed, leading many to suffer in silence. The stigma surrounding mental health, particularly in the context of pregnancy and childbirth, further compounds the issue.

The Common Struggles: Understanding the Spectrum of Perinatal Mental Health

The emotional challenges faced during the perinatal period can vary in intensity. Recognizing signs and symptoms is an important step to understanding support, both what is needed and why it is imperative to seek help. Though experiences vary, here are some of the most common mental health concerns during the perinatal period:

Baby Blues

The "baby blues" refer to mood swings, sadness, and emotional overwhelm that many people experience following childbirth, typically lasting up to two weeks. This condition is usually short-lived and is thought to be linked to the hormonal changes that accompany childbirth. Although the baby blues are typically mild, they can still be difficult to manage in the early days of parenting.

Perinatal Depression (PPD)

Perinatal depression is more intense and longer-lasting than the baby blues, impacting upwards of 1 in 5 women and 1 in 10 men. Symptoms can include irritability, limited interest in/limited bonding with the baby, sadness, feelings of shame or hopelessness, and possible thoughts of harming yourself or the baby (*this last one may be considered a medical emergency).

Certain risk factors can increase the likelihood of experiencing perinatal depression, including: history of depression, marital stress, complications or trauma, pregnancy or infant loss, infertility, and history of abuse.

Perinatal Anxiety (PPA)

Anxiety is another common issue during the perinatal period. Anxiety and depression often co-occur, though perinatal anxiety symptoms can also present independent of depressive symptoms. Symptoms can include constant worry and fear that something bad will happen, racing thoughts, difficulty relaxing, irritability, and changes in sleep patterns and/or appetite.

Understanding risk factors can serve as a protective factor and allow for treatment and intervention sooner. Risk factors include lack of partner or social support, unplanned pregnancy, financial stress, complications during pregnancy and birth, infertility, low self-esteem, and history of anxiety.

Perinatal OCD

Perinatal OCD often presents as intrusive thoughts (unwanted, obsessions) and excessive urges or behaviors (compulsions) that an individual engages in, in an attempt to minimize or avoid distress. OCD during the perinatal period typically, though not exclusively, revolves around health and safety during pregnancy and for the baby.

Intrusive thoughts often appear “out of the blue” and are significantly distressing. Intrusive thoughts - or severely anxious thoughts - are ego dystonic, meaning they are at odds with the individual’s values and are not something that the person is considering or wants.

Symptoms of perinatal OCD include intrusive thoughts, attempts to reduce fear related to intrusive thought, feeling horrified by the thought, and hypervigilance (i.e., constantly checking, reading about health issues).

Individuals with OCD prior to pregnancy or giving birth, and/or those with a family history of OCD, are more likely to develop postpartum OCD. Risk factors rooted in stress or distress - i.e., history of abuse, loss, parenting multiples, fertility challenges, NICU stay, and relationship challenges - can contribute to patterns of obsessions and compulsions.

Perinatal PTSD

Post-traumatic stress disorder (PTSD) can occur during the perinatal period and is caused by trauma experienced during the pregnancy, delivery or postpartum. Medical trauma, loss, feelings of powerlessness, severe complications, infant in the NICU, and mistreatment during the perinatal period are examples of situations or events that can trigger perinatal PTSD. Symptoms can include flashbacks, avoiding reminders, persistent increased arousal, panic attacks, feeling a sense of detachment, and avoiding aftercare following birth trauma.

Risk factors can be specific to a pregnancy or birth-related trauma (i.e., pregnancy or infant loss, traumatic birthing experience) and/or connected to previous trauma (i.e., previous sexual trauma, experiencing a traumatic event and/or feelings of helplessness, and a prior mental health disorder).

Perinatal Bi-Polar Mood Disorders

Bi-polar mood disorders (bi-polar I and bi-polar II) are characterized by highs (mania or hypomania) and lows (depression). According to Postpartum Support International, 50% of women with bipolar disorder are first diagnosed in the postpartum period. Symptoms can present similar to those of severe depression and/or anxiety, and may include periods of severely depressed mood, periods of significantly elevated mood, rapid speech or racing thoughts, little need for sleep, impulsiveness or poor judgment, and overconfidence. In the most severe cases, delusions or hallucinations can be present; this is considered a medical emergency.

Risk factors include family history of bi-polar disorder and/or history of depression, anxiety or PTSD. According to Postpartum Support International, substance use has been found to increase risk.

Postpartum Psychosis

Though rare, postpartum psychosis is the most severe mental health disorder that can occur following childbirth. It involves extreme mood swings, delusions, hallucinations, and impaired thinking. Within the psychotic state, these thoughts feel ego-syntonic (rather than being horrified by the thoughts, those with postpartum psychosis believe these thoughts - which can be harmful - to be true). Postpartum psychosis requires immediate medical attention, as it can pose serious risks to both the individual and their baby. It is essential that those experiencing symptoms seek help immediately.

Personal and/or family history of bi-polar disorder, or a previous psychotic episode, are the most significant risk factors, along with severe lack of sleep (i.e., days without sleeping).

The Impact of Perinatal Mental Health on Parents and Children

Mental health during the perinatal period is crucial not only for the well-being of the parent but also for the developing child. Untreated mental health conditions can affect attachment, parenting abilities, and the overall parent-child relationship. Research shows that parents with untreated perinatal depression or anxiety may struggle to provide the responsive and nurturing care that babies need, and can prolong mental health distress beyond the postpartum period.

Why Perinatal Mental Health Matters for Everyone

While much of the focus around perinatal health is often on the physical aspects of pregnancy and childbirth, mental health plays an equally important role. When mental health is neither prioritized nor normalized, new parents - and the family unit - can struggle or suffer. Creating a culture where it is okay to talk about mental health during pregnancy and postpartum is essential to reduce stigma and encourage those who need help to seek it out.

Seeking Help and Support

If you’re experiencing mental health challenges during pregnancy or after childbirth, you are not alone. Perinatal anxiety and mood disorders (PMADs) are treatable. Know your options and steps for seeking support:

Talk to Your Healthcare Provider: Your OBGYN, midwife, or primary care doctor can provide guidance and refer you to a mental health professional. You can also search for a certified perinatal mental health provider (PMH-C) through Postpartum Support International’s provider directory.

Therapy and Group Support: Therapy with a provider who specializes in perinatal mental health often means that the therapist has received specific training, and even certification, in perinatal mental health. Additionally, support groups—both in-person and online—can also offer valuable connection and shared experiences.
Reach Out for Support: Connecting with friends, family, or a support group can help reduce feelings of isolation. Having a strong support network is essential for managing the challenges of the perinatal period.
Self-Care Practices: While therapy and professional support are vital, self-care practices such as regular physical activity, proper sleep hygiene, and maintaining a balanced diet can also support mental well-being.

Breaking the Silence on Perinatal Mental Health

Addressing perinatal mental health is not just about helping the person who is struggling, it’s about supporting the entire family. By normalizing these challenges and seeking help and support, we can create an environment where everyone—parents, children, and families—can thrive. Acknowledging the need for help is the first step toward healing and building a healthier, happier future for both parent and child.

Gray Therapy Group specializes in psychotherapy for women’s mental health, perinatal mental health, and maternal mental health. For more information about starting therapy with Gray Therapy Group or to request a free 15-minute consultation with Marissa Gray, LCSW, PMH-C email marissa@graytherapygroup.com. You can also visit our website at www.graytherapygroup.com or our Instagram page at @graytherapygroup.

Removing Stigma, Embracing Support: A Guide to Perinatal Mental Health