Maternal mental health (MMH) refers to a range of conditions or illnesses that can occur anytime during pregnancy or the first year following pregnancy and include:

• Depression

• Anxiety

• Obsessive-compulsive disorder

• Post-traumatic stress disorder

• Bipolar disorder (which may include psychotic symptoms)

• Substance use disorder

• Postpartum psychosis

The Baby Blues are a normal period of transition as the new parent recovers from the physical and emotional experiences of pregnancy, labor, and delivery. The Baby Blues affect up to 85% of new mothers and typically include emotional sensitivity, weepiness, and/or feeling overwhelmed. Baby Blues resolve without treatment within 2-3 weeks following pregnancy.

Warning Signs (temporary):

• Feeling sad and happy, alternately

• Feeling anxious

• Crying more easily than usual

• Feeling emotional

• Feeling overwhelmed

• Irritability

• Exhaustion

Perinatal Anxiety is the presence of excessive worry during pregnancy and the postpartum period. While anxiety is normal during this time too much worry can cause tension, nervousness, and irritabilitymore often than usual.

Warning signs:

• Feelings of heart racing, palpitating, skipping beats

• Sense of pending doom

• Pressure or pain in your chest

• Preoccupation with uncontrollable worry

• Ruminating about physical wellbeing or the health of the baby

• Feeling consumed by the “what ifs” and feel anxious about future events

• Lose of appetite, nothing tastes good

• Feeling exhausted all the time

• Difficulty sleeping

• Challenges quieting the mind

• Relaxing feels impossible

• Constantly questioning your decisions

• Overthinking, overanalyzing, over processing everything

• Increase in physical symptoms, such as nausea, dizziness, blurry vision

Postpartum OCD is an anxiety disorder characterized by obsessive, intrusive thoughts, images or urges which may or may not be accompanied by compulsive behaviors. These unwanted thoughts appear “out of nowhere” and are extremely distressing. Those experiencing these thoughts may be worried that if they tell anyone, something terrible will happen, like someone will take their baby away. While it is understandable that to worry about these thoughts, these thoughts are a common manifestation of acute anxiety and are not associated with any negative outcomes. Most new parents experience unwanted negative thoughts about their infants, even women who do not have OCD. The anxiety felt about these thoughts are anxiety-driven and is very treatable.

Warning signs:

• Scary thoughts of hurting the baby (stabbing, suffocating, sexual abuse, dropping)

• Obsessions that the baby could die while sleeping in the crib

• Thoughts or images of dropping the baby from a high place

• Thoughts of the baby drowning baby during a bath

• Fear of inadvertently harming the baby through inattentiveness

• Being preoccupied with thoughts of harm to the baby from exposure to medications, environmental toxins, germs, crowds, chemicals, foods

• Worry of being responsible for something horrible happening to your child

• You are afraid you are making bad decision which may lead to a catastrophic outcome

• Checking, counting, cleaning repeatedly to reassure that things are in control

• Asking the same questions repetitively and not reassured by the answers

• Difficulty sleeping due to uncontrollable thoughts

Postpartum psychosis is the least common, but most serious, postpartum mood disorder. It affects one to two per thousand deliveries and typically appears within the first month after delivery. The presence of psychotic symptoms necessitates aggressive medical treatment and most likely, hospitalization. Psychosis is strongly associated with bipolar disorder; therefore, if you have a personal or family history of bipolar disorder you should be carefully assessed.

Warning signs:

• Seeing things that others do not see

• Belief that what others say are not true

• Hearing voices other than your own directing you to do things such as harm the baby

• Contantly racing thoughts

• Rapid speech

• Paranoia and questioning the loyalty or intentions of those closest to you

• Feeling extraordinarily agitated

• Difficulty expressing yourself and having trouble making sense to others

• Inability to sleep or not feeling the need to sleep

• Suicidal thoughts

• Directly harming your infant

Read more about postpartum psychosis assessment tips for loved ones and medical providers here.

Maternal mental health (MMH) conditions are bio-psycho-social illnesses most often caused by a combination of changes in biology, psychology, and environment.

Some people are physically predisposed to anxiety, depression, or other mental health disorders, while others are sensitive to the hormonal fluctuations during pregnancy and the immediate postpartum period. Some new parents have trouble adjusting to the changes associated with having a new baby in the home, such as lack of sleep or isolation from family, friends, or co-workers. Sometimes having a new baby overlaps with existing stressors, such as relationship challenges, financial concerns, or changes in living or working situations.

Whatever the cause, individuals experiencing MMH conditions need to know that they are not alone, they are not to blame, and with help they will be well.

All parents — including fathers, partners, and adoptive parents — can experience changes in mood when there is a new baby in the household. As many as 1 in 10 fathers experience postpartum depression or anxiety. In fact, the leading risk factor for paternal depression is maternal depression. Fathers experiencing anxiety or depression often cite stress as a major contributing factor, including having a new baby in the home, adjusting to changes in sleep and household routines, adapting to new and demanding tasks and roles, struggling with financial and economic concerns, and balancing work-life concerns. Stress can increase the level of cortisol in the body, which can contribute to or exacerbate symptoms of irritability and/or depression.

Resources for fathers:

PSI Help for Dads

Postpartum Men

The Dovetail Project