Maternal Mental Health Conditions: The Most Common Complication of Pregnancy and Parenting

Having a new baby…the happiest time in a family’s life.

Not always.

Welcoming a baby into the family can be joyful, but it can also be stressful and overwhelming. In fact, mental health conditions — primarily anxiety and depression — are the most common complication of pregnancy and childbirth. [1] This article will shed light on maternal mental health (MMH) conditions and offer resources for those impacted by these conditions.

Images provided with permission from Karen Kleiman from her book: *Good Moms Have Scary Thoughts*.

What are maternal mental health (MMH) conditions?

Maternal mental health (MMH) conditions impact childbearing individuals during pregnancy or the year following pregnancy; they include anxiety, depression, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness, psychosis, and substance use disorder.

Combined, MMH conditions impact one in five pregnant or postpartum people, or an estimated 800,000 families each year in the United States. [1-3] The vast majority — as many as 75% — of individuals who experience MMH conditions do not get the care they need, increasing the risk of long-term negative impacts on mother, baby, and family, and costing our economy $14 billion each year in addressing poor birth outcomes and accounting for lost wages and productivity. [4,5]

What causes maternal mental health (MMH) conditions?

Maternal mental health (MMH) conditions are caused by a wide range of bio-psycho-social factors. [6] Some childbearing people are particularly sensitive to the dramatic changes in hormones during and following pregnancy (biology). [7] Some individuals struggle with the changes in roles, responsibilities, and relationships that come with the transition to parenthood, and many new parents keenly feel the loss of freedom and the social isolation of being at home with a newborn (psychology). [8] Some new parents struggle financially and worry about the costs associated with another child (social/environmental). [9]

Having a new baby can turn a new parent’s world upside down, with round-the-clock feeding, burping, changing, holding, rocking, and soothing a tiny person who cannot articulate what is wanted or needed. Add in lack of sleep, recovery from the physical and emotional demands of pregnancy and childbirth, and challenges caring for others in the household; it’s understandable that many new parents find themselves struggling. External stressors such as moving households, changing jobs, returning to work, dealing with financial changes, and living with or caring for aging parents can exacerbate a new parent’s feelings of overwhelm.

Who is at risk?

The number one risk factor for experiencing a maternal mental health (MMH) condition is a previous personal or family experience with mental health conditions. [10] Like many issues of maternal and mental health, individuals from communities of color and individuals experiencing poverty are disproportionately impacted by MMH conditions, experiencing them at rates as high as one in three. [11-13] Other high-risk groups include: [10, 11, 14-19]

Individuals who have complex reproductive histories, which might include infertility, miscarriage, or stillbirth.
Individuals who lack social support, especially from their partner.
Military servicemembers and their spouses, who are usually away from their family of origin and who are often solo-parenting while their partner or spouse is deployed.
Women Veterans.
Parents with a baby in the neonatal intensive care unit.
Individuals who experienced a traumatic birth or previous sexual trauma in their lives.
Individuals with disabilities.
Immigrant parents.

Non-birthing parents, including fathers, partners, and adoptive parents, are also at risk for experiencing mental health conditions related to pregnancy and parenting. As many as one in ten fathers experience postpartum depression, with maternal depression as the number one predictor of paternal depression. [20] Parents involved in adoption — both the birthing parents and the adopting parents — can also experience challenging emotions, including grief and loss. [21, 22]

What do maternal mental health (MMH) conditions look, sound, and feel like?

The “baby blues” are a normal period of transition that are thought to be associated with the tremendous physical and hormonal changes associated with labor, delivery, and childbirth. The baby blues, which often include weepiness, emotional changes, and irritability, are short-lived (no more than two weeks) and resolve without medical assistance. [23]

Maternal mental health (MMH) conditions are more serious and last longer. Symptoms of MMH conditions include those commonly associated with depression (feeling sad, hopeless, lonely, or numb) and anxiety (feeling overwhelmed, worried, or fearful). [24]

Individuals experiencing MMH conditions say things like…

“I just don’t feel like myself. What is wrong with me?”
“Being a new parent is so much harder than I thought it would be.”
“I love my baby, but I hate my life.”
“I’m exhausted, but I can’t sleep, even when my baby sleeps.”
“I feel like I am drowning.”
“I am overwhelmed with irritability and / or rage” (often focused on the partner).
“Having a baby was a mistake.”
“I feel like the worst parent in the world.”
“My family would be better off without me.”

According to Karen Kleiman, MSW, LCSW, Founding Director of The Postpartum Stress Center, almost all new parents have scary, intrusive thoughts about harm coming to themselves or their baby.

Why should we care?

Three out of four individuals who experience maternal mental health (MMH) conditions remain untreated, potentially leading to significant long-term, two-generational negative impacts, with both mother and baby suffering. [25] Pregnant people experiencing MMH conditions are less likely to receive routine prenatal care and more likely to use substances such as alcohol, tobacco, or drugs, leading to increased risk of poor birth outcomes for their infants, such as small gestational size, preterm birth, and longer hospital stays. [26,27] Untreated MMH conditions can lead to behavioral, cognitive, or emotional delays in the child, and children of parents with untreated mental illness are themselves more likely to require psychiatric care over their lifetime. [28] Individuals experiencing MMH conditions are more likely to use the healthcare system for non-emergent reasons; and they are less likely to adhere to general guidelines for safe infant sleep or car seat usage. [29]

Where can parents find help for maternal mental health (MMH) conditions?

Fortunately, maternal mental health (MMH) conditions are often temporary and treatable. The well-documented path to recovery includes a combination of self-care, such as proper sleep and nutrition, light exercise, and time off from caring for the baby; social support, which could be a support group, an online community, and help with childcare, meals, and the household; as well as counseling and medication.

To support the mental health and wellbeing of our country’s mothers, the federal government launched the National Maternal Mental Health Hotline (1-833-TLC-MAMA) on Mother’s Day in 2022. The Hotline provides free, confidential 24/7 voice and text support in English and Spanish for mothers and others impacted by MMH conditions.

In addition, Postpartum Support International (www.postpartum.net), the world’s leading organization in supporting parents experiencing mental health conditions related to pregnancy and early parenting, offers many free online support groups, a helpline, a directory of specially-trained mental health providers, and volunteers in almost every state who can provide additional information about local resources.

How can I help a new mother?

This Mother’s Day, ask a new mother how she is doing. Bring a meal, watch the children, or take over some of the chores, like the laundry or the dishes. Tell her about the National Maternal Mental Health Hotline (1-833-TLC-MAMA). Let her know that help and support are just a call or text away.

Citations

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