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Abstract illustration of a mother with her breastfeeding childAbstract illustration of a mother with her breastfeeding child

Medical Corner

5 Things To Know About Maternal Mental Health

As many as one in five (or even more!) new moms struggle during pregnancy or in the year afterwards. Learning more about them can help prevent issues, or resolve them more quickly should they arise.

Written By
Marnie Schwartz
Illustration
Diana Ejaita

There’s a wide spectrum of possible challenges

As many as 4 out of 5 new moms experience the so-called “baby blues” in the week or two after delivery. This might include feeling really overwhelmed and exhausted, irritable, and low, and might alternate with feeling really happy. But as hormones start to stabilize, people tend to return to their baseline, explains Paige Bellenbaum, LMSW, the founding director of The Motherhood Center in New York City. When those feelings extend into the third or fourth week, there might be something else going on. And while you may be most familiar with postpartum depression, and it is definitely among the most common issues, postpartum anxiety and post-traumatic stress disorder also frequently occur postpartum, explains Dr. Christine Sterling, an OB/GYN and founder of Sterling Parents. There’s also postpartum OCD (obsessive compulsive disorder), which is less common, and postpartum psychosis, a rare but very serious condition that may be considered a medical emergency, Dr. Sterling explains.

Mental health issues can come up during pregnancy—and for a while after birth

While we tend to think of these problems as happening postpartum, PMADs, or perinatal mood and anxiety disorders, can happen anytime in the perinatal period, which starts at conception and ends at a year postpartum, says Bellenbaum. Stressors in that first year, like returning to work, can trigger a PMAD, as can weaning from breastfeeding, she says. “A lot of people are surprised by the profound emotional changes that can occur during weaning,” says Dr. Sterling. “It is not something that we understand fully… but it is likely multifactorial.” Your hormones go through a major shift, you may be weaning because you are going back to work or earlier than you’d hoped, or it could even relate to feelings of sadness about your child getting older.

PMADs are extremely common—and extremely treatable

It might not seem that way, since many women keep this experience to themselves due to feelings of shame and fear of judgement, but up to 20 percent of postpartum women experience significant depression or anxiety—and experts believe that the true number is actually higher. The numbers have also increased during the pandemic, says Bellenbaum. “We are experiencing a maternal mental health crisis.”

While a previous experience with a PMAD or with depression or anxiety do put you at higher risk for experiencing it again with a subsequent pregnancy, you can develop one in a second or third pregnancy even if you never had one before. The good news is that whether it’s through therapy, medication, support groups, other changes, or a combination of these things, PMADs are very treatable.

Myths about “ideal motherhood” are really damaging

When society constantly spoon-feeds us images of pregnancy and motherhood as glowing and blissful perfection, with an immediate and unconditional bond, it’s not surprising that women whose experience don’t match the unrealistic ideal feel stigma and shame. Whether it’s celebrity culture or social media influencers or even the images in commercials and on baby products, this romanticized image is really harmful. Because while motherhood can be fulfilling and gratifying and satisfying, it can also be a lot of other things. “Until we start to portray that very real narrative to the general population, then we're going to continue to see these [high] rates of expecting moms not getting treated or diagnosed because they feel like they're the only ones that are doing this wrong and everybody else has it figured out,” says Bellenbaum.

Planning ahead may help prevent some of these issues

We spend so much time preparing for the physical and environmental aspects of the perinatal period, but it’s just as important to plan for the emotional ones, too, says Bellenbaum. Educating yourself and your partner (if you have one) ahead of time about what mental health challenges may lie ahead, as well as some red flags, can help you recognize them if they pop up, so that you can get help sooner. Locating resources, including your healthcare provider or organizations like Postpartum Support International and The Motherhood Center (if you’re in New York City), is also helpful.

And there are things you can do to help prevent postpartum depression, says Dr. Sterling (she even created a free workbook on the topic.) One important aspect is prioritizing sleep at the end of pregnancy, and making a plan to get some restorative sleep postpartum, whether that means relying on outside support, pumping milk, or supplementing so a partner can take over a feed. “Sometimes, if you are experiencing postpartum depression or anxiety you may just need a few nights of sleep,” she says. “When you're really struggling, sleep is critical for your brain.”

If you or someone you care about is struggling, contact Postpartum Support International for more information; their helpline can connect you with the resources you need. If you or someone else are in crisis, contact your physician, local emergency number, the National Crisis Text Line (text HOME to 741741), or the National Suicide Prevention Hotline (1-800-273-8255).