Despite the recent growth in research on maternal mental health, many people are still unclear about what the concept of maternal mental health actually means for them, and how they might manage their mental health during this challenging season of life. This is especially true for individuals identifying with BIPOC and LGBTQ2+ communities. 

Perinatal mental health relates to your mental health from pre-conception (including fertility challenges and loss), through pregnancy, and 12 months postpartum. Mental health disorders experienced during this period of life are referred to as perinatal mood and anxiety disorders (PMADs). Several studies have shown that the rates of PMADs are relatively common amongst women who have recently given birth, as well as for their partners and for families who adopt. Fortunately, there are ways to support pregnant women and new parents with their mental health throughout the perinatal period.

Depression & Anxiety in Pregnancy

During pregnancy, it is not uncommon for a woman to experience symptoms of depression and anxiety. Whether it is mild or severe, prenatal depression and anxiety can disrupt a woman’s ability to take care of herself and her baby and engage in valued areas of life.

Several factors contribute to prenatal depression and anxiety, including a personal or family history of depression, anxiety, or other mental illness; stressful life events; and a lack of social support. Some women may experience shame around their mental health, or they may not have access to effective treatment. However, working with specialized professionals who are trained to assist new parents can help you on a quicker road to recovery.

Prenatal depression is treated with similar methods to other types of depression. In many cases, treatment consists of a combination of medication and talk therapy. One of the gold standard treatments for prenatal depression and anxiety is a therapy called cognitive behavioural therapy (CBT). 

It is important to identify any mental health concerns early to help birthing families make the most of this vulnerable yet rewarding time of life. 

Postpartum Mood & Anxiety Disorders 

In the postpartum period, women are at a higher risk of experiencing a wide range of mental health concerns due to significant life changes, sleep deprivation, relationship and identity shifts, and hormonal fluctuations. The most common postpartum mental health concerns are postpartum depression (PPD) and postpartum anxiety (PPA). These concerns may be seriously debilitating for the new mother and her family. Approximately 15% of women experience significant depression symptoms following childbirth, and 10% experience significant anxiety symptoms. This number is even higher for women who are experiencing abuse or trauma, who lack a supportive home environment, or who are also dealing with poverty.

Women who have a personal or family history of major depression, past or current abuse and trauma, or other mental health concerns are at an increased risk of experiencing PPD and/or PPA. 

Postpartum Depression

The symptoms of postpartum depression can show up any time in the first year postpartum, and are different from the “baby blues” (which always resolve by 3 weeks postpartum. If you’re feeling unwell after 3 weeks postpartum, it is not the “baby blues”). 

Symptoms of PPD may include the following:

  • feelings of anger, rage, or irritability 
  • lack of interest in or difficulty bonding with the baby
  • appetite and sleep disruptions
  • persistent feelings of sadness and crying
  • feelings of guilt, shame, failure as a mom, and hopelessness
  • a loss of interest in previously enjoyed activities and relationships
  • possible thoughts of harming yourself or your baby

Postpartum Anxiety

The symptoms of postpartum anxiety can also show up any time in the first year postpartum. Anxiety may be more generalized, and have symptoms like:

  • unpleasant physical sensations, like a pounding or racing heart, muscle tension, hot flashes, nausea, and trembling
  • feeling restless, or like you are unable to sit still
  • appetite and sleep disruptions
  • worrying constantly
  • a feeling of doom or like something bad will happen
  • being unable to sleep when the baby sleeps due to worry and constant monitoring of the baby

Another type of anxiety is postpartum panic disorder, where a person may struggle with recurrent panic attacks. With postpartum panic disorder, a mother may experience a number of unpleasant symptoms:

  • periods of intense feelings of dread and fear
  • worry that she is “going crazy”, “losing control”, or dying
  • intense physical sensations, like shortness of breath, chest pain or tightness, heart rhythm changes, dizziness, and numbness or tinging in her extremities
  • behavioural changes due to fear of having another panic attack

It is important to remember that, while uncomfortable and scary, these sensations will not hurt you, and they will always pass.

Postpartum OCD

Postpartum OCD is one of the lesser talked about mental health concerns, but for the 3-5% of new mothers (and some fathers) who experience it, it can be debilitating and terrifying. Risk factors for developing postpartum OCD include a personal or family history of anxiety or OCD. Symptoms of postpartum OCD include:

  • terrifying thoughts and images that may seem to come out of the blue (called obsessions)
  • these thoughts are repetitive, unwanted, and negative, and may be related to accidental or intention harm coming to you or your baby
  • a sense of distress, disgust, or horror about these thoughts
  • fears of acting upon on these thoughts, that may result in being afraid to be alone or look after the baby alone
  • compulsions, or behaviours aimed at reducing the anxiety (e.g. needing to clean bottles repeatedly, needing to check things many times)
  • a feeling of hyper-vigilance to reduce the chances of the thoughts happening (being very protective of your baby)
  • a sense that these thoughts are unlike you and that you would never want to act on them

These thoughts are typically very frightening for the new parent. Research has shown that these intrusive thoughts and images are typically based in anxiety (and not delusional), and there is a very low risk of the mother acting on them. In fact, most parents are so distressed by these thoughts that take measures to avoid their triggers and protect their baby from what they fear will cause harm.

Postpartum Post-Traumatic Stress Disorder (PTSD)

For many people, the road to growing their family is a difficult one. It is estimated that approximately 1 in 3 people who give birth describe their experience as traumatic. Birth trauma may be related to experiences such as unplanned C-sections, injury or illness during pregnancy and/or childbirth, infant loss, the use of forceps or vacuum extractors during delivery, NICU stays, and prolapsed cord. In addition, people with a history of infertility and reproductive treatment, pregnancy complications, perinatal loss, and previous sexual abuse and trauma are at risk for developing symptoms of post-traumatic stress disorder (PTSD) in the perinatal period. About 9% of women will go on to develop PTSD after one of these devastating experiences. 

Symptoms of postpartum PTSD may include:

  • intrusive and upsetting re-experiencing of the traumatic event (such as flashbacks and nightmares)
  • avoidance of reminders of the trauma, including places, people, thoughts, feelings, and details of the event
  • persistent heightened arousal (irritability, restlessness, difficulty sleeping, being startled more easily, and feeling hypervigilant)
  • feeling detached from the people around you and from reality itself
  • changes in mood and cognition (e.g. symptoms of depression and anxiety)

Bipolar Mood Disorders

Bipolar mood disorders can look like severe depression or anxiety, and so can  sometimes be hard to identify. For many women, pregnancy or postpartum may be the first time she becomes aware that she has bipolar mood cycles, and it may be a confusing and frightening time for her and her loved ones.

Bipolar mood disorders are different from depression and anxiety. There are typically two phases: a low phase, called depression, and a high phase, called mania or hypomania. With Bipolar 1, there is a full manic episode. With Bipolar 2, there is a hypomanic (less severe) manic episode. Bipolar 2 mood shifts may be less extreme, and they may not be as readily noticeable to the person themselves. Sometimes the highs and lows may co-occur, which is called a mixed episode. It’s important to remember that the mood shifts with bipolar mood disorder are more extreme than the typical moodiness experienced in pregnancy and postpartum.

For some people, manic episodes may also include psychotic symptoms, like hallucinations and delusions. This is considered a medical emergency and the individual must be treated immediately. 

It is essential that you connect with a medical provider with experience and training in mental health assessment during pregnancy and postpartum if you have been diagnosed with or suspect you may have a bipolar mood disorder. Monitoring during pregnancy and postpartum can help to ensure you and your baby are cared for during this vulnerable time.

The risk factors for bipolar mood disorder are a personal or family history of bipolar mood disorder. 

The symptoms for bipolar mood disorder 1 include:

  • episodes of severely depressed mood when in the low phase (irritability, crying, hopelessness, etc.)
  • episodes of heightened mood, high energy, rapid speech, a little need for sleep when in the high (manic) phase
  • racing thoughts and difficulty focusing
  • delusions 
  • impulsiveness and poor judgment
  • grandiose thoughts and inflated confidence
  • for severe episodes, delusions, hallucinations, and bizarre beliefs

The symptoms for bipolar mood disorder 2 include:

  • episodes of severe depression
  • periods where mood is improved, better than normal
  • rapid speech, little need for sleep, and high energy
  • racing thoughts and difficulty focusing
  • anxiety symptoms (including irritability)
  • inflated confidence

Postpartum Psychosis

Postpartum psychosis is a relatively rare but frightening experience for the new mother and her family. Postpartum psychosis occurs in approximately 1-2 out of every 1,000 deliveries. The onset of symptoms typically is very sudden, and usually happens in the first 2 weeks following delivery, but symptoms may appear at any time in the first 12 months postpartum

The biggest risk factors for postpartum psychosis are a personal or family history of bipolar mood disorder, and a history of a previous psychotic episode.

Postpartum psychosis is considered a medical emergency and immediate medical treatment is indicated. Research has suggested that there is approximately a 5% suicide rate and a 4% infanticide rate associated with postpartum psychosis, because the mother experiences a break from reality and her delusions and hallucinations make sense to her in the moment. Though not all people who experience postpartum psychosis experience violent urges or destructive beliefs, immediate medical evaluation is necessary to ensure her and her baby’s safety and to get her on the road to recovery. Symptoms of postpartum psychosis are temporary and treatable if a woman receives treatment right away.

Symptoms of postpartum psychosis may include:

  • bizarre beliefs or delusions that make sense to the person
  • hallucinations (seeing or hearing things that aren’t there)
  • severe irritability
  • feeling hyperactive and seeing a decreased need for sleep (or an inability to sleep)
  • paranoia 
  • rapid mood swings
  • difficulty with clear communication

If you or a loved one is experiencing a perinatal mood or anxiety disorder, remember that this is not your fault, and that effective treatment is available. The first step is to contact your doctor and/or a reputable maternal mental health clinic near you. Besides medications and therapy, there are also support groups and counselling options that can help you recover from perinatal mood and anxiety disorders.

As someone who has both personal and professional experience with maternal mental health concerns, Jennifer knows how difficult this road can be to travel alone. If you’ve been worried about how you’re feeling and are looking for perinatal mental health support, consider calling Jennifer at (604)-991-7127 or emailing [email protected] to book an appointment to discuss your concerns.