Mental health issues are the MOST COMMON complications of pregnancy and childbirth,

affecting approximately 1 in 5 women during pregnancy or the first year after being pregnant.

It’s not just postpartum.  It’s not just depression.

  • Maternal mental health (MMH) conditions affect 1 in 5 women (800,000 women each year in the United States). 1-3
  • MMH conditions include depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness (which may include psychotic symptoms), and substance use disorders. 1-3
  • The Baby Blues are a normal period of transition affecting up to 85% of new mothers in the first 2-3 weeks after baby is born.  Baby Blues typically include emotional sensitivity, weepiness, and/or feeling overwhelmed.  Baby Blues resolve without treatment. 4
  • MMH conditions are caused by a combination of changes in biology, psychology, and environment.  4
  • Women at increased risk of MMH conditions are those who  1,4
    • have a personal or family history of mental illness
    • lack social support, especially from their partner
    • experienced a traumatic birth or previous trauma in their lives
    • have a baby in the neonatal intensive care unit (NICU)
  • Suicide and overdose are the leading causes of death in the first year postpartum, with 100% of these deaths deemed preventable. 5-7
  • All parents — including fathers, partners, and adoptive parents — can experience changes in mood when there is a new baby in the household.  8,9
  • 75% of women experiencing maternal mental health challenges do not get the care needed for recovery. 10
  • Maternal mental health challenges are temporary and treatable. Most women fully recover with proper care.
  • Recovery from MMH conditions includes a combination of self-care, social support, talk therapy, and medication. In rare cases, hospitalization might be necessary.  11

If you or someone you know might be experiencing an MMH condition and need assistance, contact Postpartum Support International.

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CITATIONS

  1. ACOG Committee Opinion 757 (2018). “Screening for perinatal depression.”
  2. Gavin et al. “Perinatal depression: A systematic review of prevalence and incidence.” Obstetrics & Gynecology. 2005; 106: 1071-83.
  3. Fawcett et al. “The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis.” Journal of Clinical Psychiatry. 2019; 80(4):1-14.
  4. National Institute of Mental Health (2013). Postpartum Depression Facts. NIH13-8000.
  5. Davis et al.  “Pregnancy-related deaths: Data from 14 U.S. Maternal Mortality Review Committees, 2008-2017.” Atlanta GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.
  6. Metz et al.  Maternal deaths from suicide and overdose in Colorado, 2004-2012.” Obstetrics & Gynecology. 2016; 128(6): 1233-1240.
  7. Goldman-Mellor and Margerison. “Maternal drug-related death and suicide are leading causes of postpartum death in California.” American Journal of Obstetrics & Gynecology. 2019; 221(489): e1-9.
  8. Da Costa et al.  “A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers.”  Journal of Women’s Health. 2019; 21(9): 830-836.
  9. Foli et al. “Post-adoption depression: parental classes of depressive symptoms across time.” Journal of Affective Disorders. 2016; 200: 293-302.
  10. Byatt et al.  “Enhancing participation in depressive care in outpatient perinatal care settings: A systematic review. Obstetrics & Gynecology. 2015; 126(5): 1048-1058.
  11. Fitelson et al. “Treatment of postpartum depression: Clinical, psychological, and pharmacological options.  International Journal of Women’s Health. 201; 3:1-14.

Maternal mental health (MMH) conditions include not only depression but also a range of anxiety disorders.  The full range of illnesses include:  1-3

  • Depression
  • Anxiety
  • Obsessive-Compulsive Disorder
  • Post-traumatic Stress Disorder
  • Bipolar Disorder (which may include psychotic symptoms)
  • Substance use disorder

Learn more about these illnesses at Postpartum Support International.

Baby Blues.  Most new mothers (up to 85%) will experience temporary mood swings, tearfulness, and irritability during the first days after being pregnant.  Known as the Baby Blues, these mild mood changes  should resolve by themselves within 2-3 weeks.  4

Postpartum Psychosis.  Postpartum psychosis is a rare but serious illness impacting 1-2 in 1,000 women.  Symptoms of postpartum psychosis may include confusion, delusions, and hallucinations.  Postpartum psychosis is a MEDICAL EMERGENCY and women should be taken to the nearest Emergency Department for assessment and assistance.  Learn more HERE5

TERMINOLOGY. 

  • Perinatal: ~2 year timeframe from conception to baby’s first birthday
  • Antenatal or Prenatal: during pregnancy
  • Postpartum or Postnatal: First year following pregnancy

The following terms are used interchangeably to describe the mental health conditions women experience during pregnancy and the first year following pregnancy:

  • Postpartum depression (PPD) has long been used as an umbrella term encompassing mood changes following pregnancy
  • Antenatal / prenatal / perinatal / postnatal depression and anxiety
  • Perinatal mood disorders (PMDs) or perinatal mood and anxiety disorders (PMADs)
  • Maternal mental health (MMH) challenges / complications / conditions / disorders / illnesses / issues

If you or someone you know might be experiencing an MMH condition and need assistance, contact Postpartum Support International.

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CITATIONS

  1. ACOG Committee Opinion 757 (2018). “Screening for perinatal depression.”
  2. Gavin et al. “Perinatal depression: A systematic review of prevalence and incidence.” Obstetrics & Gynecology. 2005; 106: 1071-83.
  3. Fawcett et al. “The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis.” Journal of Clinical Psychiatry. 2019; 80(4):1-14.
  4. National Institute of Mental Health (2013). Postpartum Depression Facts. NIH13-8000.
  5. Postpartum Support International website, http://www.postpartum.net/learn-more/postpartum-psychosis

Signs and symptoms of maternal mental health (MMH) conditions include:

  • Feeling sad or depressed
  • Feeling overly irritable or angry with those around you
  • Difficulty bonding with baby
  • Feeling anxious or panicky
  • Having problems with eating or sleeping
  • Having upsetting thoughts that you can’t get out of your mind
  • Feeling as if you are out of control or “going crazy”
  • Feeling like you never should have become a mother
  • Worrying that you might hurt your baby or yourself

Women experiencing MMH conditions may say things such as:

  • I worry all the time.
  • Why am I such a failure?
  • Having a baby was a mistake.
  • I’m not bonding with my baby.
  • I’m afraid to be alone with my baby.
  • I feel like the worst mother in the world.
  • I’m having thoughts that are scaring me.
  • I’m exhausted but can’t sleep, even when my baby sleeps.
  • Everything would be better if I just got a good night’s sleep.
  • I’m supposed to be happy…why do I feel sad (or overwhelmed or anxious)?
  • I’m such a bad mother, my baby (or family) would be better off without me.

If you or someone you know might be experiencing an MMH condition and need assistance, contact Postpartum Support International.

Maternal mental health (MMH) conditions are bio-psycho-social illnesses most often caused by a combination of stressors.  Some women are predisposed to anxiety, depression, or other mental health disorder, while others are sensitive to the hormonal fluctuations during pregnancy and immediate postpartum period.

Biological risk factors include:

  • Personal or family history of mood or anxiety disorders
  • Reproductive history that might include severe premenstrual symptoms, fertility treatments, miscarriage or stillbirth
  • Sensitivity to hormonal changes
  • Young age / teenage pregnancy
  • Medical issues such as thyroid dysfunction or anemia
  • Sleep disruption / lack of sleep

Psychological risk factors include:

  • Perfectionist tendencies
  • Difficulty with transitions
  • Unrealistic or rigid expectations
  • Negative attitude toward pregnancy / baby
  • Low self-esteem

Social risk factors include:

  • Lack of support, particularly from spouse or partner
  • Social isolation
  • Low income or immigrant status
  • Financial stress
  • Domestic violence
  • Sexual abuse

Women living in poverty and women of color are MORE like to experience MMH conditions and LESS likely to get help due to:

  • Lack of access to healthcare, including culturally appropriate mental health care
  • Cultural and racial biases in the healthcare system
  • More barriers to care, such as lack of transportation or childcare
  • Fear that child protective services or immigration agencies will become involved

If you or someone you know might be experiencing an MMH condition and need assistance, contact Postpartum Support International.

You are not alone.  You are not to blame.  With help, you will be well.

When left untreated, maternal mental health (MMH) conditions can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide.

Risks to mother.  Women with untreated MMH conditions are more likely to:  1-5

  • Not manage their own health
  • Have poor nutrition
  • Use substances such as alcohol, tobacco, or drugs
  • Experience physical, emotional, or sexual abuse
  • Be less responsive to baby’s cues
  • Have fewer positive interactions with baby
  • Experience breastfeeding challenges
  • Question their competence as mothers

Most concerning, SUICIDE is one of the leading causes of death for women in the first year after pregnancy.  6-8

Risks to child.  Children born to mothers who untreated MMH conditions are at higher risk for:  4, 10,11

  • Low birth weight or small head size
  • Pre-term birth
  • Longer stay in the neonatal intensive care unit (NICU)
  • Excessive crying
  • Impaired parent-child interactions
  • Behavioral, cognitive, or emotional delays

Untreated mental health issues in the home may result in an Adverse Childhood Experience, which can impact the long-term health of the child.  12

If you or someone you know might be experiencing an MMH condition and need assistance, contact Postpartum Support International.

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CITATIONS

  1. National Institute of Mental Health. “Postpartum Depression Facts.” 2013: NIH13-8000.
  2. Zhou et al. “Treatment of substance use disorders among women of reproductive age by depression and anxiety disorder status, 2008-2014.” Journal of Women’s Health, 2019: 28(8): 1068-1076.
  3. Field. “Postpartum depression effects on early interactions, parenting, and safety practices: A review.” Infant Behavioral Health, 2010; 33(1): 1-14.
  4. Sriraman et al. “Postpartum depression: What do pediatricians need to know?” Pediatrics in Review, 2017; 38(12): 541-551.
  5. Fitelson et al. “Treatment of postpartum depression: Clinical, psychological, and pharmacological options.” International Journal of Women’s Health, 2011; 3: 1-14.
  6. Davis et al. “Pregnancy-related deaths: Data from 14 U.S. maternal mortality review committees, 2008-2017.” Atlanta GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services,; 2019.
  7. Metz e tal.  “Maternal deaths from suicide and overdose in Colorado, 2014-2012.” Obstetrics & Gynecology, 2016; 128(6): 1233-1240.
  8. Goldman-Mellor and Margerison. “Maternal drug-related death and suicide are leading causes of postpartum death in California.” American Journal of Obstetrics & Gynecology, 2019; 221(489): e1-9.
  9. Cherry et al. “The contribution of maternal psychological functioning to infant length of stay in the neonatal intensive care unit.” International Journal of Women’s Health, 2016: 8: 233-242.
  10. Grote et al. “A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.” Archives of General Psychiatry, 2010; 67(10): 1012-1024.
  11. Stein et al. “Effects of perinatal mental disorders on the fetus and child.” The Lancet, 2014; 384: 1800-1819.
  12. Felitti et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study.” American Journal of Preventive Medicine, 1998; 14(4): 245-258.

If you or someone you know might be experiencing postpartum depression or a related maternal mental health (MMH) condition, please know that you are not alone, that you are not to blame, and that with help you will be well.

Talk to your spouse / partner / family / friend / healthcare provider.

IN AN EMERGENCY: 

  • LOCAL EMERGENCY ROOM
  • NATIONAL CRISIS TEXT LINE:
    • Text HOME to 741741 from anywhere in the USA, anytime, about any type of crisis.
  • NATIONAL SUICIDE PREVENTION HOTLINE AND WEBSITE
    • 1-800-273-8255
    • www.suicidepreventionlifeline.org Call for yourself or someone you care about; free and confidential; network of more than 140 crisis centers nationwide; available 24/7

FOR SUPPORT AND RESOURCES:

  • Postpartum Support International (PSI) is the world’s leading organization in providing hope and help to mothers, fathers, and families affected by maternal mental health challenges.
  • PSI staff and trained volunteers respond to calls, emails, and text messages, providing connections to local resources.
  • Call 800-944-4773 or text 503-894-9453
  • www.postpartum.net

ADDITIONAL INFORMATION