What is Perinatal Mental Health?

We’re going to break this down by defining some key terms, identifying the diagnoses that are included & quick facts, how perinatal mental health impacts you and your family, how to recognize if you are struggling, and what you can do to get better.

Let’s start with a general understanding of perinatal mental health.

So, what does perinatal mean? Perinatal means the time in pregnancy and postpartum. I believe it also includes the experience of trying to conceive (TTC) and loss (miscarriage, TFMR), as those challenges can come with anxiety and depression for some women. Postpartum needs to be understood as longer than the socially defined 6 weeks. Postpartum is technically the first year after birth. I think it can be longer because you can’t take away the physicality of birth. Your body, mind, and emotions change after birth. Your values and goals in life often change after birth. What was incredibly important before birth takes a back seat. Pregnancy and postpartum can leave a significant mark on your life.

Other names for perinatal mental health that are used interchangeably:

• PMAD: perinatal mood & anxiety disorder

• PMD: perinatal mood disorder

• MMH: maternal mental health

• Postpartum mental health

How do I know if it is baby blues or postpartum depression?

There are some key differences between baby blues and perinatal mood disorders. Perinatal (postpartum) depression is often confused with baby blues, so I’ll focus on that comparison. Many women who have perinatal depression brush it off as the baby blues. This dismissal of a true mental health concern ends up hurting you and your family because you are not giving yourself the help and attention you need to heal. Baby blues is caused by a multitude of things, but the biggest two are the insane drop in hormones after birth and being sleep deprived. Baby blues often starts around 3 days after birth and can last up to 2 weeks postpartum.

What does baby blues feel like?

You are probably crying (a lot or randomly, and you don’t know why). Your mood goes up and down like the snap of a finger (happy, sad, and angry - all of ‘em). You haven’t slept in days, or at least long stretches of deep sleep. You still feel overall confident in your new role as a mom, even though you may have tiny moments of not knowing what you’re doing. This can sound like:

• “I’m doing the best I can and that’s enough.”

• “I’m prioritizing taking care of myself so I can better take care of my baby”

• “It’s okay to ask for help. I’m not a failure of a mother for asking.”

And lastly, the baby blues ends by 14 days postpartum! Your body is becoming more regulated hormonally and learning how to function on less sleep. But hopefully, you’re sleeping a tad more than the first few days!

IMPORTANT: If you think you have baby blues and your baby is older than 14 days, it’s not baby blues. It’s most likely perinatal depression or another perinatal mental health concern. Let’s talk.

Isn’t perinatal mental health just postpartum depression?

Nope! Perinatal mental health includes these diagnoses:

• Depression (commonly known as Postpartum Depression or PPD)

• Anxiety (Postpartum Anxiety or PPA)

  • Panic Disorder

• Obsessive-Compulsive Disorder (POCD, OCD)

• Post Traumatic Stress Disorder (PTSD)

• Bipolar Disorder

• Psychosis

They all have different symptoms that you feel and different ways to treat them. This is why it’s important to have a therapist who is trained & certified in perinatal mental health! Here’s a brief breakdown of the diagnoses and what they look like.

How do I know if I have a perinatal mood disorder?

Many symptoms come with each diagnosis we listed above. So what I’m about to list is NOT the end-all-be-all exhaustive list of things you might experience. The laundry list of symptoms you could have is why it’s vital to talk with a therapist, psychiatrist, or another medical professional who is knowledgeable in mental health, specifically perinatal mental health. It is not your job to figure out what you are struggling with. It is your job to ask for help and for those people to help you.

Here are common signs of a perinatal mental health disorder like PPD:

• Sadness

• Anxiety & worry

• Change in appetite that seems unrelated to pregnancy or postpartum

• Difficulty bonding with your baby

Like I said above, there are so many ways perinatal mood disorders can show up in your life. If you are having symptoms that aren’t one of these four, please talk to a professional about what’s going on. We’re here to help you.

How often does postpartum mental health affect women?

Let’s lay out the numbers of how many women meet the criteria for a PMH diagnosis. Now, when I say that they meet the criteria for a diagnosis, this means that their symptoms (sadness, worry, scary thoughts) are making it so hard to do daily life things like shower or brush her teeth, and there’s a certain amount of symptoms that check the boxes to diagnose. You can have symptoms of a PMH like postpartum depression or postpartum anxiety and not meet the criteria for the diagnosis. If you don’t check a certain number of boxes on the symptom list, that DOES NOT mean that your suffering isn’t worth treating. You deserve help and support just as much as the mom who’s got it harder! Starting therapy when you have a few of the symptoms rather than when it has taken over your life is the BEST thing you can do as a new mom.

These numbers are probably higher because many women don’t share their struggles with anyone that can report numbers (like a doctor or other professional).

• Baby Blues impacts 3 out of every 5 women.

• Intrusive (scary) thoughts impacts 85% of moms.

• Depression impacts 1 out of 7 women.

• Anxiety impacts 1 in 5 women.

• OCD impacts 32% or 8 in 25 women.

• PTSD impacts 1 in 25 women.

• Bipolar Disorder with no history/first episode impacts 1 in 5 women. For those with diagnosed BD, 54.9% experienced a bipolar-spectrum episode like depression or mania. (https://pubmed.ncbi.nlm.nih.gov/35830616/)

• Perinatal Psychosis affects 1-2 out of every 1,000 postpartum women

When do perinatal mental health struggles like postpartum depression start?

Wondering when women start feeling depressed or anxious after birth? Any of the PMH symptoms can start at any point in pregnancy or postpartum. Like we said in the beginning, the postpartum period lasts much longer than the societal norm of 6 weeks, and the perinatal period includes pregnancy and postpartum.

Here’s what you need to know: We know that baby blues ends at 14 days postpartum. If you feel depressed, anxious, or just “off” and not how you wanted to feel emotionally within those two weeks, seek help! And especially if you feel off after the 14-day window for baby blues, I want you to seek help because you can feel better.

Perinatal mental health concerns like postpartum anxiety or depression often start or get louder (intensify) around 3 months postpartum. My theory for this peak is that many women are returning to work outside the home and/or friends and family have stopped checking in because their baby is not considered a newborn anymore. Going back to work and less contact with community leaves many new moms feeling alone and thinking that no one cares. Our society does a terrible job of supporting new parents and mothers, in particular.

I do think, though, that many women who have a perinatal mental health concern brush it off as baby blues for so long. By the 3-month postpartum mark, they start to think about how long they have been feeling sad or keyed up and anxious. It’s only then that they start to accept that the crappy emotions they have been pushing through since giving birth are much more than baby blues.

What causes a perinatal mood disorder like postpartum anxiety?

There’s not one scientifically identified cause for postpartum mental health issues, but we do know that there are some things like personality traits and medical diagnoses that can create a perfect storm for PPD/PPA. These are called risk factors. A risk factor is essentially a vulnerability that opens you up to the possibility of developing symptoms of postpartum depression or postpartum anxiety.

What caught me by surprise when I was learning about perinatal mental health is that perfectionism and being someone who is more controlling or needs control are personality risk factors. This risk factor is likely because you may have a pretty strict or harsh inner voice that is telling you “You’ve failed” or “You’re a terrible mom. You can’t even breastfeed or give birth the right way.” We know these statements are not true, but when you struggle with these traits, it’s difficult to let it go. (I love helping moms realize the rules they have for themselves as perfectionists and learning how to distance themselves from those rules. If this sounds like you, learn more here!)

Another risk factor is if you have ever experienced trauma or struggled with depression, anxiety, or another mental health concern. This means that if at any time in your life, you have struggled with mental health, there’s a possibility of it coming back in postpartum. Even for you ladies who have been in therapy before, you managed your anxiety or sadness through pregnancy, and you felt like everything was under control. Unfortunately, despite the work you have done to heal, there’s a risk that it could come back postpartum.

If life is wild during pregnancy or postpartum, this also puts you at risk. That was a little vague, sorry. If you are having relationship (marriage, family, friends, etc.) problems, that puts you at risk because of the stress. And it removes an important piece of healing: community & support. Another stressor that can bring postpartum mental health struggles your way is financial stress.

If your birth did not go the way you hoped, this can put you at risk for perinatal mood disorders. I know. You may be saying, “But Olivia, I had a loose idea of what I wanted birth to be, not a plan that HAD to be followed. I was at peace with ‘whatever happens, happens’.” I get it. Even though your birth idea/loosey-goosey plan wasn’t set in stone, if something different happened than your ideal scenario, this leaves room for a bunch of feelings and thoughts to bring the mood down.

On that note, if your baby had/has any medical complications or NICU stay of any length, this is an incredibly stressful time. It’s likely also a traumatic experience. You may be making major medical decisions for your child. You may not know anyone else who has experienced what you are going through, leaving you feeling alone. This postpartum experience hasn’t been what you dreamt of, at home with everyone healthy. You knew having a baby would be hard. You just wish it wasn’t this hard.

Lastly, a risk factor that shocked me was having a difficult breastfeeding experience. Breastfeeding and mental health have a bi-directional relationship. What does that mean? Breastfeeding can impact your mental health (positive or negative). Your mental health can impact your breastfeeding experience.

This can look a few different ways:

• If breastfeeding is going well, it can help your mental health stay positive.

• If breastfeeding is a struggle, you are likely experiencing symptoms of anxiety or depression.

• If your mental health is suffering, breastfeeding is probably not going well or is going to be an issue.

And this is my push for you to find an IBCLC (the gold standard for breastfeeding (pumping & nursing)). I also want to bring attention to D-MER, although it is not classified as a Perinatal Mood Disorder. Dysphoric Milk Ejection Reflex is experienced when the letdown reflex is triggered by a nursing child or pumping, and the mother immediately experiences symptoms of anxiety or depression. These symptoms typically decrease or disappear over the time of the nursing or pumping session, or after the feeding session is complete. There are ways you can cope with this.

Does perinatal mental health like PPD hurt my baby?

An important factor in a mom’s mental health is how it unfortunately impacts the family. It’s been found that if a postpartum woman experiences perinatal depression (postpartum depression), the father also has a chance of experiencing depression. Actually, 1 in 10 new dads will have postpartum depression. Going through a massive identity shift and having more responsibility can be difficult. Then you add mom having depression or anxiety on top of these changes, it puts a lot more pressure on dad to step up. Sometimes that pressure is too much. And it’s just as vital for Dad to seek help to feel better as it is for Mom.

Another way that postpartum depression and anxiety can wreak havoc on a family is through the family dynamics. I’ve seen that when a mom is battling postpartum anxiety, her thoughts can take over and agitate her husband or other family members. These thoughts are often controlling toward Mom and can get pushed on others. For example, if the baby has to be put down for a nap or bedtime a “certain way,” this may cause tension because only Mom can put the baby to sleep because no one else will do it the “right way.” This often leaves Mom resenting Dad because she’s the one who has to put the baby to sleep and no one else. So she has that weight on herself, unnecessarily. Dad may feel resentful toward Mom because she’s not allowing him to take care of his child. When mom is suffering from postpartum depression, she often feels disconnected or “checked out” from her relationships. This can leave a lot of responsibility on Dad, which can lead to different feelings like depression or anger, exhaustion, or fear.

The last way that perinatal mental health impacts the family is the bond between mom and baby. This symptom of perinatal depression is likely the one that most family members will see and be alarmed, for good reason. If a mom has postpartum depression, she may feel neutral toward the baby. Not overwhelming joy and love, which is common for moms without postpartum depression. She may not take care of and tend to the baby when they are crying. She may even feel resentful towards the baby. This emotional distance can be heartbreaking for the family to watch, and for the mom to experience. The good thing is that there are some great therapy treatments to strengthen the bond a mother has with her baby, like Child-Parent Psychotherapy (CPP) and Circle of Security.

These are all examples of why it is incredibly important for moms to get help in the form of therapy, medication, or a combination of both!

What can I do if I have a perinatal mood disorder?

If you are struggling mentally in pregnancy or postpartum, let’s list out some things you can do to start feeling better because you can feel better after postpartum depression or postpartum anxiety.

Therapy: I’m not saying this because I’m a therapist. I truly believe that everyone can benefit from therapy at some point in their life. That may be now for you. Therapy can directly focus on the symptoms of depression or anxiety you’re feeling now. Or, if you want to set yourself and your family up for major success, I recommend treating the symptoms you have now AND working through any trauma or younger ‘you’ struggles (like childhood hurts). This deep work can help you have a stronger and healthier relationship with your kids, help communication with your husband so your marriage gets back on track, and figure out what’s important in your life so you can set work and family boundaries. Something to note: if you want to start therapy, I highly recommend finding a Perinatal Mental Health Certified (PMH-C) therapist through the directory. And, if you live in Oklahoma and want to start therapy with me, learn more and schedule an intro call here.

Medication: There is absolutely a time and place for medication to help take the edge off symptoms. Sometimes, it can be a band-aid over a big ole’ wound when you are ignoring trauma, know that you have control issues, or have stressful relationships with those you love. But, for some people, medication helps them through each day, and that’s wonderful! Medication can also help you feel and be more like your true self so you can do the deep work I mentioned earlier. Something to note: if you want to start medication during pregnancy or postpartum, it’s recommended to look for a reproductive psychiatrist. They are specifically trained and educated in the medications that you can & cannot take during this time. The next option would be your OB/GYN who is trained in this area.

Support groups: Support groups are a great option if you’re not ready to start therapy but need help in things like accountability and community. A great benefit to support groups is the validation that comes from other people to show that you aren’t alone. There are great support groups by Postpartum Support International. And if you are local to Tulsa, Peyton at Flourish Wellness runs a Perinatal Support Group.

Community: Having a strong community of family & friends is vital to a mother’s mental health. You need to know that you’re not alone in the difficult moments. You need to know that people care about you. You need people you feel safe to talk with when times get tough. If you’re local to Tulsa, Tulsa Moms Club hosts Mom Walk Tulsa on the 2nd and 4th Tuesday of each month. It’s a great way to meet other moms, have community, and get a little exercise outside! Her Outlet has Connection Circles that help moms find community and support in each other.

Looking for a postpartum therapist in Tulsa, OK?

If you are looking for a Perinatal Mental Health Certified therapist in Tulsa, Oklahoma, click here to learn more about how I can support you in postpartum through therapy. If you’re no longer in that year of postpartum and would like to start therapy, learn more about therapy in motherhood with me. If you need help and don’t know where to start, check out Postpartum Support International. They have loads of information on their website, a HelpLine that will listen and provide support, and even help you find a therapist and other resources in your area.