Perinatal Mental Health

According to researchers, perinatal mental health is the emotional well-being of a person before, during and after pregnancy. This time includes trying to become pregnant, pregnancy, around the birth, and up to two years after having a baby (K. Womersly & H. Alderson, 2024). Steen adds that it also includes people who have lost a pregnancy or are having fertility treatments. People may have changes in their mood and emotions during this time. For some, these changes will be more intense, qualifying for a mental health diagnosis. If we are experiencing intense symptoms, it can be helpful to know we are not alone and to get support.

Perinatal mental problems can happen for different reasons. Here a few common causes Steen noted:

· Changes in hormones during and after pregnancy or fertility treatments

· Not getting enough sleep while taking care of a new baby

· New responsibilities of becoming a parent

· Changes in daily life

· A difficult or traumatic birth

· Past experience with trauma

· Preexisting mental health diagnoses before pregnancy/treatment

Knowing about symptoms for ourselves and our loved ones is very important to get the care we deserve. It is normal to have shifts in mood, to feel overwhelmed and to have difficulty sleeping. These things are not always a big problem, but if we have multiple of the following symptoms (Postartumdepression.org) for a long period of time, seeking support can help.

Symptoms of Perinatal depression

• Eating too much or too little
• Trouble sleeping (not due to baby’s sleep)
• Oversleeping
• Extreme fatigue and loss of energy
• Muscle aches and pains
• Headaches
• Stomach pains
• Excessive and uncontrollable crying
• Persistent feelings of sadness and hopelessness
• Feeling numb or empty
• Extremes in mood swings
• Irritability and restlessness
• Feeling anger and rage
• Anxiety and fear
• Feeling guilt and shame
• Inability to concentrate
• Trouble remembering details
• Difficulty making decisions
• Doubting ability to care for baby
• Thinking things are too overwhelming to handle
• Thinking you have failed or are inadequate, feelings of worthlessness
• Distance or withdrawal from loved ones
• Difficulty feeling attached to your baby
• Unwilling to care for baby out of fear of harming them
• Not being able to enjoy things you used to enjoy
• Not wanting to be alone with the baby
• Exhibiting angry behaviors toward others
• Thoughts of harming the baby
• Recurring thoughts of suicide

Symptoms of Perinatal Anxiety

• Increased heart rate
• Chest pain
• Shortness of breath
• Inability to sleep (not due to baby’s sleep)
• Muscle tension in the back, neck and shoulders
• Stomach aches
• Loss of appetite
• Weight loss
• Dizziness
• Nausea
• Nervous thoughts that control your brain
• Recurring negative thoughts of worry and worst-case scenarios involving baby’s health
• Thoughts that you aren’t good enough
• Avoiding situations and interactions out of fear that something bad will happen
• Feeling constant “nervous energy”
• Feeling on edge
• Guilt and shame that you are not doing things right
• Restlessness and tension

Symptoms of Perinatal Psychosis

• Visual or auditory hallucinations (seeing or hearing things that are not there)
• Delusions or having uncharacteristic beliefs and thoughts
• Manic mood with a tendency to be overwhelmed by thoughts and speaking very quickly
• Feeling “high,” as if on top of the world
• Extremely low mood
• Extreme fatigue
• Severe anxiety
• Sleep disturbances
• Appetite changes
• Difficulty concentrating
• Feeling fearful and suspicious
• Restlessness and confusion
• Recurring thoughts of suicide or homicide
• Making attempts to harm yourself or your baby
• Behaviors that are different from usual nature or habits

At higher risk if:

• History of bipolar disorder
• History of schizophrenia and schizoaffective disorder
• History of traumatic pregnancy
• Depression during pregnancy
• Family history of bipolar disorder or postpartum psychosis

Taking care of your mental health during the perinatal period is important. Here are a few our expert, Steen suggests:

Ask yourself:

• Do I often feel worried or anxious or feel emotions deeply?
  • We can use this information to start practicing strategies to help with prevention.
• Have I been given a mental health diagnosis in the past?
  • Preexisting mental health diagnoses increase our risk for perinatal mental health diagnoses.

Create a plan:

• Build in self-care practices now.
  • Practicing things like mindfulness, self-check-ins and breathing strategies now can make them more helpful when we need them most. Use what has worked for you in the past as a starting point.
• Plan for when things get hard.
  • It will be hard at times. If we acknowledge that, we can give ourselves a bit of grace when we’re struggling. Then gift yourself with a plan. For example, Megan suggests we create a strategy for getting at least 3-4 hours of sleep per day. If that’s not possible on our own, it’s okay to ask for help.

Talk to your doctor:

• Ask questions about medications
  • If we are taking mental health medications, ask questions about treatment options. Steen encourages us to ask for solutions that consider the physical and mental health of the pregnant person and the baby. A common myth is that we have to stop taking medications when we are pregnant.

If we are not pregnant ourselves, but supporting someone who is in the perinatal period, we can be a huge help. Steen suggests asking things like, “are you sleeping, are you eating, are you getting five minutes to yourself?” Then help them find ways to make these things happen.

Steen emphasizes the best advice she received from a provider during her pregnancy journey, “When it gets hard, because it will get hard, you get to acknowledge the hard of it.” We also don’t have to do it alone. Asking for support and using the resources below are a couple of places to start.

• 988 Lifeline
  • Call, chat or text 988 24/7 for confidential support
• PSI (Postpartum Support International)
  • Support groups, peer mentorship and connection with an expert
  • PSI HelpLine
  • Call: 1-800-944-4773 (English & Spanish)
  • Text in English: 800-944-4773
  • Text en Espanol: 971-203-7773
  • Call, Chat or Text 988 24/7 in an emergency
• National Maternal Mental Health Hotline
  • Call or Text 1-833-852-6262
  • 24/7, Free, Confidential Hotline for Pregnant and New parents. Interpreter Services are available in 60 languages.
• Postpartumdepression.org
  • Information about perinatal mental health, resources and treatment.
• Mental Health America
  • Free mental health screeners