Postpartum Mental Health Is More Than Depression
Understanding Perinatal Mental Health: Anxiety, Depression, Birth Trauma & When to Seek Support
When people hear “postpartum mental health,” they often think of postpartum depression. Depression is an important part of the conversation and it isn't the whole conversation.
Mental health concerns can emerge during pregnancy as well as after birth, and they can involve anxiety, depression, trauma symptoms, intrusive thoughts, changes in mood, and other experiences. Understanding that broader picture can make it easier to recognize when you, or someone you love, may benefit from additional support.
What Does “Perinatal Mental Health” Mean?
The perinatal period includes pregnancy and the time following birth. Mental health conditions can begin during this period, but pregnancy and postpartum can also affect conditions or symptoms that existed beforehand.
The American College of Obstetricians and Gynecologists (ACOG) addresses depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis within its clinical guidance for mental health during pregnancy and postpartum. This matters because someone doesn't need to identify with the stereotypical picture of postpartum depression to be struggling.
What Can Perinatal Mental Health Struggles Look Like?
Experiences can vary considerably from person to person. Some people may notice persistent sadness or loss of interest. Others primarily experience anxiety, worry, irritability, difficulty sleeping, or feeling constantly on edge. Some struggle with guilt or feel as though they aren't doing parenthood “right.” Others may find that pregnancy, birth, medical interventions, fertility experiences, pregnancy loss, feeding difficulties, or previous traumatic experiences have affected them in ways they weren't expecting.
The National Institute of Mental Health describes symptoms of perinatal depression that can include persistent sadness or anxiety, hopelessness, irritability, guilt, fatigue, difficulty concentrating, sleep disturbance, difficulty bonding with a baby, and persistent doubts about one's ability to care for a baby. Having one difficult day, or even several, doesn't tell us whether someone has a mental health condition. Patterns, duration, severity, functioning, history, and individual circumstances all matter.
Aren't Mood Changes Normal After Having a Baby?
Some emotional changes shortly after birth are common. The “baby blues” generally involve relatively mild, short-lasting changes in mood during approximately the first two weeks after birth. Symptoms that are severe, persist beyond that period, interfere significantly with functioning, or cause concern deserve attention. You also don't have to determine on your own whether what you're experiencing is “normal or not normal.” Talking openly with an appropriate healthcare or mental health professional can help determine what kind of support may be useful.
What About Anxiety During Pregnancy or Postpartum?
Anxiety can be an important part of perinatal mental health. It may show up as persistent worry, difficulty settling, physical tension, feeling unable to stop anticipating what could go wrong, or becoming overwhelmed by uncertainty and responsibility.
ACOG recommends screening for both depression and anxiety during pregnancy and postpartum using standardized, validated screening instruments. For some people, anxiety existed long before pregnancy. For others, pregnancy, birth, postpartum changes, sleep disruption, medical experiences, or the responsibility of caring for a new baby can bring new concerns to the surface. Therapy can provide a safe space to explore those experiences without assuming every worry means something is wrong.
Can Birth Experiences Affect Mental Health?
Yes:
Pregnancy and birth can involve intense physical sensations, vulnerability, uncertainty, loss of control, unexpected medical procedures, changes in plans, and concerns about the health of the parent or baby.
Two people can experience similar events very differently.
A birth doesn't have to look traumatic from the outside for someone to experience it as overwhelming or distressing.
Trauma-informed therapy doesn’t determine whether an experience was “bad enough” and rather incorporates more on understanding how that experience affected the individual. For someone experiencing ongoing distress related to pregnancy or birth, therapy may include processing the experience, exploring beliefs and emotions connected with it, and noticing how the body responds when the experience is remembered. Depending on someone's needs, goals, and clinical appropriateness, approaches such as EMDR or somatic therapy may be incorporated into treatment.
When Should Someone Seek Additional Help?
You don't have to wait for symptoms to become severe before asking for support. Consider talking with a healthcare or mental health professional when emotional distress feels persistent, interferes with daily functioning, feels difficult to manage alone, or simply concerns you.
ACOG recommends mental health screening throughout pregnancy and postpartum and emphasizes that screening should be connected with appropriate assessment, treatment, monitoring, and follow-up. Some symptoms require more urgent attention. Postpartum psychosis is a rare but serious psychiatric emergency. The National Institute of Mental Health describes possible symptoms including hallucinations, delusions, mania, paranoia, and confusion and advises seeking immediate medical help when these symptoms occur.
If you or someone else is in immediate danger, experiencing a mental health emergency, or having thoughts of suicide or harming yourself or someone else, call 911, go to the nearest emergency department, or call or text 988 for crisis support.
Therapy for Pregnancy, Postpartum & Reproductive Transitions
You don't need a crisis to deserve support during the perinatal period. Pregnancy and postpartum can intersect with identity, relationships, previous trauma, family dynamics, expectations, grief, anxiety, and enormous changes in the body and daily life. Therapy can offer a place to make sense of those experiences while receiving individualized mental health support.
At Hidden Trails Therapy, we provide trauma-informed and integrative psychotherapy for adults navigating pregnancy, postpartum, reproductive experiences, and other significant life transitions. Depending on your needs and goals, therapy may incorporate approaches such as EMDR, somatic therapy, mindfulness-based practices, and other evidence-informed approaches within the therapist's scope of practice.
If you're looking for perinatal mental health therapy in Oregon, learn more about working with Hidden Trails Therapy or schedule a consultation to explore whether one of our clinicians may be a good fit.
Sources & Further Reading
American College of Obstetricians and Gynecologists (ACOG)
Screening and Diagnosis of Mental Health Conditions During Pregnancy and PostpartumAmerican College of Obstetricians and Gynecologists (ACOG)
Perinatal Mental Health: Patient ScreeningNational Institute of Mental Health (NIMH)
Perinatal Depression
