What are Perinatal Mental Health Conditions?

Some people have heard of Postpartum Depression but did you know there are other mental health conditions that are experienced in this period? We call these conditions Perinatal Mental Health Conditions (PMHC) and all of these conditions together are the number one complication of childbearing. Below you will find a list of Perinatal Mental Health Conditions that can occur during the perinatal period which includes pregnancy, post-loss and postpartum. These conditions affect not only the pregnant person but also other family members, including dads and partners.

Perinatal Depression

Perinatal depression, including postpartum depression, occurs more often than most people realize. Studies show that 1 in 5 women and 1 in 10 men may experience depression and anxiety during the perinatal period. However, the numbers are likely higher and increase for high-stress parenting groups.

It is important to know the signs and symptoms of Perinatal Depression. Perinatal Depression is treatable, and help is available.  You do not need a diagnosis to reach out for help.

  • Symptoms can start anytime during the perinatal period and they may differ for each person. They might include the following:

    • Feelings of anger, irritability and/or rage

    • Lack of interest in the baby

    • Disturbances of sleep and appetite

    • Crying and sadness

    • Feelings of guilt, shame or hopelessness

    • Loss of interest, joy or pleasure in things you used to enjoy

    • Possible thoughts of harming the baby or yourself

  • Research shows that the items listed below may put you at a higher risk for perinatal depression. It is important to discuss your risk factors with your medical provider so that you can plan ahead for the care you may need.

    • A personal or family history of mental health conditions, like depression, anxiety, perinatal depression, bipolar, or OCD.

    • Premenstrual dysphoric disorder (PMDD or PMS)

    • Inadequate support in caring for the baby

    • Financial stress

    • History of Abuse

    • Marital stress

    • Unplanned Pregnancy

    • Unwanted Pregnancy

    • Complications in pregnancy, birth or lactation.

    • A major recent life event including: loss, moving or relocation, and job loss

    • Pregnancy and/or infant loss

    • Parents of  multiples

    • Having an infant(s) in the Neonatal Intensive Care (NICU)

    • Fertility Challenges

    • Thyroid imbalance

    • Any form of diabetes (type 1, type 2 or gestational)

    In addition, belonging to a high-stress parenting group may also be a risk factor.  These groups might include:

    • Queer and Trans Families

    • Military Families

    • Teen Parents

    • Parent(s) of Multiples

    • Single Parents

    • Parents of Color

    • Near Miss Survivor

    • Those who experience a pregnancy and/or infant loss

  • Perinatal depression is treatable, and there are many options to consider when looking for the correct treatment option.  You should consult your doctor or therapist, to find the right plan for you.  Some may include:

    • Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, meditation, asking for help & support groups.

    • Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & IPT (​Interpersonal Psychotherapy), but others may be an option. You can find Utah providers trained in Perinatal Mental health at maternalmentalhealth.utah.gov

    • Medical Evaluation and Treatment: Medication may be an option, and you must consult a doctor to see what will work for you. Antidepressants are the most commonly used to treat depression.  You can find more information about breastfeeding and medication here.

    • Intensive Treatment Facilities are another option as needed.

  • The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item self-report questionnaire used to screen for perinatal depression. It takes about five minutes to complete, assessing feelings over the past seven days. A score of 10 or higher, or 13 or higher depending on the guidelines used, suggests potential depression requiring further evaluation by a healthcare professional, rather than a definitive diagnosis. You can view the screening tool here in both English and Spanish.

Perinatal Anxiety

Research shows that 1 in 5 women and 1 in 10 men may experience depression or anxiety during the perinatal period. You may experience perinatal anxiety independently, but it is often combined with perinatal depression. High-stress parenting groups experience perinatal anxiety at a higher rate.  

Perinatal anxiety is treatable, and help is available.  You do not need a diagnosis to reach out for help.

  • The symptoms of anxiety during the perinatal period might include:

    • Constant worry

    • Feeling that something bad might happen

    • Racing thoughts

    • Disturbances of sleep and appetite

    • Inability to sit still

    • Physical symptoms could include dizziness, hot flashes diarrhea and nausea

    • Feelings of anger, irritability and/or rage

    • Nervousness/on edge/anxious, trouble relaxing

  • Many people with anxiety, may also experience panic or anxiety attacks.

    This is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks. During a panic attack, they may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you. It may be helpful to know that panic attacks subside after 5-7 minutes.

  • Risk factors for perinatal anxiety and panic include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance.

    • Lack of partner support

    • Lack of social support

    • History of abuse

    • Teen Parents

    • Unplanned pregnancy

    • Unwanted pregnancy

    • Adverse life events

    • High-levels of stress

    • Pregnancy complications currently or in the past

    • Pregnancy and/or infant loss

    • Financial Challenges

    • Thyroid imbalance

    • Single parent

    • Negative or low self-esteem and self-efficacy

    • Relationship challenges

    In addition, belonging to a high-stress parenting group may also be a risk factor.  High-stress parenting groups include:

    • Queer and Trans Families

    • Military Families

    • Teen Parents

    • Parent(s) of Multiples

    • Single Parents

    • Parents of Color

    • Near Miss Survivor

    • Those who experience a pregnancy and/or infant loss

  • Perinatal anxiety is treatable, and there are many options to consider when looking for the correct treatment option.  You should consult your doctor or therapist, to find the right plan for you.  Some may include:

    • Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.

    • Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & IPT, but others may be an option. Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP  (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). You can find Utah providers trained in Perinatal Mental Health at maternalmentalhealth.utah.gov

    • Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Antidepressants, and possibly anti-anxiety medications,  are the most commonly used to treat anxiety. You can find more information about breastfeeding and medications here.

    • Intensive Treatment Facilities are another option as needed.

  • The PASS is a valid and reliable 31-item self-report instrument designed to screen for problematic anxiety in antenatal and postpartum women. It differentiates between high and low risk for presenting with an anxiety disorder by measuring four domains that address specific symptoms of anxiety as they present in perinatal women. You can view this screening tool here.

Perinatal Obsessive Compulsive Disorder (OCD)

Perinatal OCD  is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). These obsessions and compulsions often center around the health and safety of the pregnancy and/or baby.

Some people find these Obsessions and Compulsions worries can get in the way of your everyday functioning (brushing your teeth, driving a car, leaving your house). 

Repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.”  Research has shown that these images are anxious in nature, not a break from reality. It is likely that the parent experiencing symptoms may take steps to avoid triggers and what they fear could harm the baby.

Perinatal OCD is treatable, and help is available.  You do not need a diagnosis to reach out for help.

  • Symptoms of Perinatal Obsessive-Compulsive symptoms can include:

    • Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images that are often related to the baby. These thoughts are very upsetting.

    • Compulsions, where you may do certain things over and over again to reduce your fears and obsessions. This may include things like needing to clean constantly, checking things many times, counting, or reordering things and/or avoiding triggers.

    • A sense of horror about these thoughts

    • Fear of being left alone with the infant

    • Hypervigilance in protecting the infant

  • Risk factors for perinatal OCD include a personal or family history of anxiety or OCD. Rates of perinatal OCD are higher among people who had OCD prior to giving birth.

    • History of mental health disorders and/or family history of mental health disorders

    • Thyroid imbalance

    • Premenstrual dysphoric disorder (PMDD or PMS)

    • History of Abuse

    • Inadequate support in caring for the baby

    • Financial stress

    • Marital stress

    • Complications in pregnancy, birth, or lactation.

    • Unplanned Pregnancy

    • Unwanted Pregnancy

    • A major recent life event including: loss, moving or relocation, and job loss

    • Pregnancy and/or infant loss

    • Parents of multiples

    • Having an infant(s) in the Neonatal Intensive Care (NICU)

    • Fertility Challenges

    • Thyroid imbalance

  • Perinatal OCD is treatable, and there are many options to consider when looking for the correct treatment option.  You should consult your doctor or therapist, to find the right plan for you.  Some treatment options may include:

    • Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.

    • Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP  (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). You can find Utah providers trained in Perinatal Mental Health at maternalmentalhealth.utah.gov

    • Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Anti-depressant medications are the most commonly used to treat OCD.  You can find more information about breastfeeding and medications here.

    • Intensive Treatment Facilities are also an option as needed.

Perinatal Post-Traumatic Stress Disorder (PTSD)

Perinatal PTSD is caused by a traumatic or disappointing experience during pregnancy, delivery or postpartum. These traumas could include pregnancy complications, prolapsed cord, unplanned C-sections, use of vacuum extractor or forceps to deliver the baby, baby going to NICU, feelings of powerlessness and/or lack of support and reassurance during the delivery, severe physical complication or injury related to pregnancy or childbirth.

Perinatal PTSD is treatable, and help is available. You do not need a diagnosis to reach out for help.

  • Symptoms of perinatal PTSD might include:

    • Flashback of a past traumatic event (which in this case may have been the childbirth itself)

    • Nightmares

    • Avoidance of reminders associated with the event, including thoughts, feelings, people, places and details of the event

    • Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)

    • Anxiety and panic attacks

    • Feeling a sense of unreality and detachment

    • Avoidance of aftercare following a birth trauma

    • Childhood sexual abuse or any previous sexual trauma

    • Living through or experiencing a traumatic event

    • Prior mental health disorder

    • Feelings of powerlessness and/or lack of support and reassurance during the delivery

    • Having an infant(s) in the Neonatal Intensive Care (NICU)

    • Pregnancy and/or infant loss

    • Traumatic or disappointing birth experience

  • Perinatal PTSD is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you.  Some treatment options, or combination of options, may include:

    • Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.

    • Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & EMDR (Eye Movement Desensitization and Reprocessing), IPT (​Interpersonal Psychotherapy).  A possible emerging therapy may include Brainspotting. Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP  (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy). You can find Utah providers trained in Perinatal Mental Health at maternalmentalhealth.utah.gov

    • Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Antidepressants, and possibly anti-anxiety and sleeping medications are the most commonly used to treat PTSD. You can find more information about breastfeeding and medication here.

    • Intensive Treatment Facilities are also an option as needed.

Bipolar Mood Disorders (including Bipolar 1 and Bipolar 2)

Mood episodes are the hallmark of both types of bipolar disorder. The highs are known as manic episodes. The lows are known as depressive episodes. Not all types of bipolar disorder have episodes of depression.

The main difference between bipolar I and bipolar 2 disorders is in the severity of the manic episodes. A person with bipolar I will experience an episode of mania, while a person with bipolar 2 will experience a hypomanic episode (a period less severe than a full manic episode). A person with bipolar I may or may not experience a depressive episode, while someone with bipolar 2 will experience a major depressive episode.

Research shows that 50% of women with bipolar disorder are first diagnosed in the postpartum period.

Perinatal Bipolar Disorder is treatable, and help is available. You do not need a diagnosis to reach out for help.

  • Bipolar disorder can look like a severe depression or anxietyand can include symptoms such as:

    • Periods of severely depressed mood and irritability

    • Elevated mood, higher energy than normal.

    • Rapid speech

    • Little need for sleep

    • Racing thoughts

    • Trouble concentrating

    • Overconfidence

    • Impulsiveness

    • Poor judgment

    • Distractability

    • Grandiose thoughts

    • Inflated sense of self-importance

    • In the most severe cases, delusions and/or hallucinations

    • Childbirth may be a specific trigger for a manic episode, which could then be followed up by the onset of depression.

    Doctors sometimes misdiagnose bipolar 2 disorder as depression since depressive symptoms may be the primary symptom when the person seeks medical attention.

  • Risk Factors for Bipolar Mood Disorder are family or personal history of bipolar mood disorder (also called manic-depression).

    • History of depression, anxiety, and/or PTSD

    • Substance use has been found to increase risk for bipolar depression 

  • Postpartum Bipolar is treatable, and there are many options to consider when looking for the correct treatment option.  You should consult your doctor or therapist, to find the right plan for you.  Some treatment options, or combination of options, may include:

    • Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.

    • Mental Health Counseling: Evidence-based therapy types may include DBT (Dialectical Behavioral Therapy) & CBT (Cognitive Behavioral Therapy). You can find Utah providers trained in Perinatal Mental Health at maternalmentalhealth.utah.gov

    • Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. You can find more information about breastfeeding and medications here.

    • Intensive Treatment Facilities are also an option as needed.

Perinatal/Postpartum Psychosis (PPP)

Postpartum Psychosis (PPP), also known as Perinatal Psychosis, is a serious PMH disorder that usually has an onset in the first 2 weeks (but up to a year). Postpartum Psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries.

Postpartum Psychosis is temporary and treatable with professional help, but it is an emergency, and it is essential that the perinatal individual receive immediate help. It is important to stay with the perinatal individual and the child to ensure everyone’s safety.

If you feel you or someone you know may be suffering from this illness, know that no one is at fault or to blame, and a diagnosis is not needed to reach out for help.

In an Emergency/If you suspect Postpartum Psychosis

  • Symptoms of Postpartum Psychosis can include:

    • Delusions or strange beliefs

    • Hallucinations (seeing or hearing things that aren’t there)

    • Feeling very agitated

    • Hyperactivity or having more energy than usual

    • Severe depression or lack of emotion

    • Decreased need for or inability to sleep

    • Paranoia and suspiciousness

    • Rapid mood swings

    • Difficulty communicating at times

    For more information about symptoms of postpartum psychosis, you can download the PPP Discussion Tool. Immediate treatment for someone going through psychosis is imperative.

    Call your doctor or an emergency crisis hotline right away to get the help you need.

  • The most significant risk factor for Postpartum Psychosis is a personal or family history of bipolar disorder, or a previous psychotic episode. It may also include prolonged lack of sleep (for instance, going days without any sleep).

  • The majority of individuals who experience Postpartum Psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment. It is important to stay with the perinatal individual and the child to ensure everyone’s safety. Call your doctor or an emergency crisis hotline right away to get the help you need.

    • Call or text the National Maternal Mental Health Hotline at 833-852-6262. Hotline Counselors are available to discuss and explore next steps for you and your loved one. Available 24/7, in the United States only.

    • Intensive Treatment Facilities are available and are listed here.

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    After inpatient psychiatric treatment:

    After emergency treatment, those individuals who have experienced Postpartum Psychosis should be followed by a doctor and therapist to continue treatment, including medication and ongoing therapy. PSI hosts peer support groups for Postpartum Psychosis survivors and those affected. Additional resources are available here.

SUNSHINE

Tools for mental wellness during pregnancy and after Birth

This tool was created in partnership with the Utah Department of Health and Postpartum Support International-Utah

S

Sleep

Aim for four to six hours of sleep at least three nights a week. Ask a family member or friend to give the first feeding of the night so you can get enough rest.

U

Understand

Counseling with a trained perinatal mental health professional prevents and treats mental health issues.

N

Nutrition

Take a prenatal vitamin through one year postpartum. Avoid caffeine and sugar when possible. Include protein and unsaturated fats at every snack and meal. Drink two large pitchers of water daily.

S

Support

Share your feelings with a trusted friend or family member, or find a support group online or in-person. Ask for help with baby care - getting an hour each day to yourself is essential.

H

Humor

Make time for silliness and joy each day. A funny movie, time with friends, or tickling your children can all improve your mood. If laughing seems impossible, it is time to seek more support.

I

Information

Take the Edinburgh Postnatal Depression Scale monthly for a year postpartum to track your mental health. Call your provider if your score is 10 or above, or if you marked anything other than “never” on question 10 about self-harm.

N

Nurture

Care for yourself through: nature, spiritual practices, music and art, meditation, dates with friends, etc. Schedule weekly time in your calendar to do things you enjoy outside of motherhood.

E

Exercise

Walking 10-20 minutes a day can help your body, mind and spirit heal and stay emotionally healthy. You can also try yoga or stretching if your provider gives the go-ahead