Understanding Perinatal Mental Health

Welcoming a new life into the world is an incredible experience, but it also comes with numerous challenges that can affect a mother's mental health.

What Is Perinatal Mental Health?

Perinatal mental health refers to emotional and psychological well-being during and after pregnancy. It includes a range of emotional responses that can occur before and after childbirth, including anxiety, depression and stress. It's important to acknowledge these feelings, as they can affect both the mother and the baby's health.

Perinatal or Maternal Mental Health

The terms "perinatal" and "maternal" are often used interchangeably. Maternal mental health and perinatal mental health refer to the period while you are pregnant and up to a year after childbirth.

"Postpartum” is the period following childbirth up to one year after delivery. 

Common Perinatal Mental Health Disorders

Perinatal mood and anxiety disorders (PMADs) include a range of conditions that can affect expectant and new mothers.

• Perinatal depression: A form of depression that occurs during pregnancy and after giving birth, characterized by symptoms such as extreme sadness, changes in energy and loss of interest in activities you once enjoyed
• Perinatal anxiety: Excessive worry or fear that can affect daily functioning during pregnancy and postpartum periods
• Postpartum psychosis: A severe mental illness, often associated with bipolar disorder, that can occur after childbirth — characterized by hallucinations, delusions and disorganized thinking
• Perinatal obsessive-compulsive disorder (OCD): Recurring, distressing thoughts (obsessions) and repetitive behaviors (compulsions) often related to the baby's safety and wellbeing

PMADs are among the most common complications of pregnancy and childbirth, affecting approximately one in five women. These disorders not only affect mothers but can also impact the entire family, affecting bonding, relationships and overall household well-being.

Recognizing Symptoms and Red Flags

It's vital to spot the signs of perinatal mental health disorders early. Symptoms can start in pregnancy or after delivery and may include:

• Persistent sadness or low mood
• Severe anxiety or panic attacks
• Excessive crying or irritability
• Changes in sleep or appetite
• Lack of interest in the baby or overwhelming fears about harming the baby
• Desire to escape or thoughts others would be better off without you
• Thoughts of self-harm or suicide

Comparing Baby Blues and Postpartum Depression

Understanding the difference between the "baby blues" and postpartum depression — as well as other PMADs — is crucial for proper diagnosis and treatment.

What Are Baby Blues?

The "baby blues" is a common, short-lived emotional state experienced by new mothers. It usually occurs within the first two weeks after delivery and can include mood swings, irritability and feelings of sadness or anxiety. Symptoms typically resolve on their own without medical intervention.

What Is Postpartum Depression?

In contrast, postpartum depression is a more severe and persistent condition that requires medical attention. It can emerge any time within the first year after birth and significantly impacts the mother's ability to care for herself and her baby.

Both are real conditions. People may dismiss more serious symptoms as mild. If you think you need help, talk to your OB/GYN or care team.

Causes and Risk Factors of PMADs

Several factors contribute to the development of perinatal mental health disorders. Understanding these can help in early identification and prevention.

• Hormonal changes: Fluctuations in hormones during and after pregnancy can affect mood and emotions. Hormones significantly increase in pregnancy and quickly drop in the early postpartum period. Lactation can continue to influence hormonal states for women.
• Lifestyle adjustments: New responsibilities and changes in lifestyle can increase stress and anxiety.
• History of mental health issues: A personal or family history of mental health disorders may increase the risk.
• Social support: Lack of support from family or friends can exacerbate feelings of isolation and depression.
• Traumatic birth experiences: Difficult or traumatic deliveries can contribute to the onset of mental health issues.

Any physical condition, especially a chronic medical condition, can further heighten the risk of mental health symptoms in the perinatal period.

Why Mental Health Is Challenging During Pregnancy

Pregnancy brings about a whirlwind of physical and emotional changes. Hormonal fluctuations, combined with societal and personal expectations, can create a breeding ground for anxiety and mood disorders. It's important to normalize these feelings and provide support and information to expectant mothers.

Diagnosing PMADs

Symptoms of PMADs can vary. It's crucial for doctors and clinicians to conduct thorough screenings to diagnose these conditions accurately. Tools like the PHQ-9 and GAD-7 — questionnaires used to assess the severity of depression and anxiety — can aid in this process.

Treatment Options for Perinatal Mental Health Issues

PMAD symptoms respond well to treatment, and early intervention is key to managing PMADs. Treatment options include:

• Cognitive Behavioral Therapy (CBT): This common psychotherapy approach helps change negative thought patterns.
• Medication: Antidepressants may be prescribed to help manage symptoms, but it's crucial to discuss risks and benefits with your care team.
• Support groups: Joining groups like Postpartum Support International can provide valuable social support and shared experiences.
• Self-care: Engaging in activities that promote overall health (adequate sleep, hydration, nutrition and activity) and those that help with stress management (yoga or meditation) can aid recovery and improve mood.

When to Seek Support and How

If you or someone you know is experiencing symptoms of a perinatal mental health disorder, it is important to seek support. Indicators that professional help is needed include:

• Symptoms persisting beyond two weeks without improvement
• Inability to function in day-to-day activities
• Thoughts of self-harm or harming the baby
• Lack of interest in the baby or overwhelming fear of not being a good mother

Remember, asking for help is a sign of strength, not weakness. Reach out to your OB/GYN or care team if you have any concerns about your mental health during the perinatal period.