LEARN · PREGNANCY AND POSTPARTUM

Pregnancy and postpartum mental health

Mental health struggles during pregnancy and after birth are among the most common complications of this time. They can start during pregnancy or anytime in the first year. They are not a personal failing, and they are treatable.

1 in 5

mothers and fathers report symptoms of depression or anxiety in the first year after birth.

Before birth too

Symptoms often begin during pregnancy, not only after the baby arrives.

Treatable

With the right support, most people feel better. You don't need a diagnosis to ask for help.

FIRST, THE BABY BLUES

Baby blues or something more?

Most new parents have some tearfulness, mood swings and overwhelm in the first couple of weeks after birth. These "baby blues" are common and usually fade on their own within about two weeks.

It may be more than the baby blues if symptoms:

Last longer than two weeks
Start during pregnancy or later in the first year
Feel intense or frightening
Make it hard to function, sleep or enjoy anything

THE CONDITIONS

Six perinatal conditions to know

Symptoms vary, and many people have more than one at the same time.

01 — DEPRESSION

Perinatal depression

More than sadness. Many women describe feeling irritable, numb or disconnected, and guilty that they aren't enjoying this time the way they expected to.

What helps: therapy such as CBT or interpersonal therapy, practical support and sleep protection, and medication when appropriate.

Irritability, anger or rage
Persistent sadness, emptiness or crying
Loss of interest or joy
Sleep and appetite changes beyond what a newborn explains
Guilt, shame or hopelessness
Trouble bonding with the baby
Thoughts of harming yourself (get help right away)

02 — ANXIETY AND PANIC

Perinatal anxiety

Some worry is normal with a new baby. Perinatal anxiety is worry that doesn't switch off, often with physical symptoms. For some women it comes as sudden panic attacks.

What helps: CBT, skills to calm the body and mind, support, and medication when appropriate.

Constant worry, often about the baby's health
Racing thoughts and trouble relaxing
Can't sleep even when the baby sleeps
Dizziness, nausea or a racing heart
Panic attacks: shortness of breath, chest tightness, a sense of doom

03 — OCD

Perinatal OCD

Unwanted, upsetting thoughts or images, often about something terrible happening to the baby, sometimes by your own hand. These thoughts are distressing precisely because they go against everything you want. Having them does not mean you will act on them.

What helps: CBT with exposure and response prevention (ERP), the gold-standard treatment for OCD. PSI's guide to postpartum harm thoughts is a helpful read.

Intrusive thoughts or images you can't shake
Checking, cleaning or counting to feel safe
Seeking reassurance again and again
Avoiding bathing the baby, knives or being alone with the baby
Feeling horrified by your own thoughts

04 — PERINATAL TRAUMA

Perinatal trauma

Can follow a frightening birth, an emergency, a NICU stay or a loss. Pregnancy and birth can also bring earlier trauma back to the surface.

What helps: trauma-focused therapy, such as cognitive processing therapy or EMDR, and space to make sense of what happened.

Flashbacks or nightmares about the birth
Avoiding reminders, including medical appointments
Feeling on edge or easily startled
Feeling detached or numb
Fear about a future pregnancy or birth

05 — BIPOLAR DISORDER

Perinatal bipolar disorder

Bipolar disorder is sometimes first recognized during pregnancy or after birth, and childbirth can trigger an episode. A personal or family history of bipolar disorder raises the risk.

What helps: psychiatric care alongside therapy, a plan that protects sleep, and close follow-up after birth.

Periods of depression
Periods of unusually high energy or irritability
Little need for sleep
Racing thoughts or very fast speech
Impulsive or risky decisions

06 — PSYCHOSIS · A MEDICAL EMERGENCY

Postpartum psychosis

Affects about 1 to 2 of every 1,000 births, according to PSI (about as common as appendicitis). It usually begins in the first weeks after delivery. A history of bipolar disorder or a past psychotic episode is the strongest risk factor, but it can affect anyone. With prompt treatment, full recovery is possible.

Unlike the unwanted thoughts of OCD, thoughts of harm in psychosis may not feel upsetting or strange to the person having them.

If you see these signs, call 911 or go to the nearest emergency room. Stay with the person and don't leave them alone with the baby.

Seeing or hearing things others don't
Strange beliefs or paranoia
Confusion or severe agitation
Little or no need for sleep
Rapid mood swings
Talking about harming the baby or herself

WHO IS AT RISK

Anyone can be affected

Mental health struggles during pregnancy and postpartum don't discriminate. They affect people of every race, culture, income, age and education level. Some factors raise the risk:

A personal or family history of depression, anxiety or bipolar disorder
Pregnancy or birth complications, loss, or a NICU stay
Thyroid problems or diabetes
Limited support, or relationship or financial stress
A history of trauma or abuse
Ongoing sleep deprivation

PARTNERS TOO

It's not only birthing parents

Fathers, partners and adoptive parents can develop perinatal depression and anxiety too. If you're worried about your partner, encourage them to reach out, and take care of yourself as well.

HOW THERAPY HELPS

You don't have to wait until it gets worse

Name what's happening

Understanding your symptoms often brings relief and less shame.

Build skills that work

Evidence-based tools for anxiety, intrusive thoughts, low mood and sleep.

Coordinate your care

With your permission, I work with your OB, midwife or psychiatrist, including on medication questions during pregnancy and breastfeeding.

RESOURCES

Let's talk about what you're feeling

A free 15-minute consult is a low-pressure first step.

Let's talk