Not Just ‘Baby Blues’: Addressing Issues in Maternal Mental Health

Why are babies called “bundles of joy” when, in reality, parents experience a full range of emotions? More like “bundles of everything.” 

Pregnancy and becoming a parent are a big deal. Mothers’ bodies are going through major hormonal and physical changes, and bringing a new human into this world can trigger a range of emotions in parents and siblings.

Many new mothers experience sadness, tiredness, or more serious types of mental illnesses called perinatal mood and anxiety disorders.

These disorders appear during pregnancy and can develop at any time during the first year after childbirth. What should behavioral health professionals know about working with expectant and new mothers? 

Understanding PMADs

It is not unusual to feel down, tired, or confused during pregnancy or after having a baby. But 15 to 20% of women experience depression or anxiety, which requires serious attention. 

In the Consortium training Addressing Perinatal Mood & Anxiety Disorders: Integration and Intentionality, Elaine Flynn-York, LCSW, PHM‑C, and Jennifer Vendetti, LMSW, CEIM, address diagnoses, approaches, and maternal mental health resources that can help expectant and new mothers.

Most of us have heard the term “postpartum depression (PPD),” but not all mood disorders are depression. According to the online resource postpartum.net, there are several different forms of mental illness that fall under the category of perinatal mood and anxiety disorders (PMADs).

• Depression During Pregnancy and Postpartum. This is when someone feels a mix of complicated feelings: sadness, anger, irritability, guilt. They might have trouble taking care of the baby, have difficulty eating, sleeping, or concentrating. They might feel hopeless and have thoughts of hurting themselves or the baby.
• Anxiety During Pregnancy and Postpartum (PPA). This is a form of anxiety that can cause someone to worry or fear about the baby’s health or safety. They can experience panic attacks, shortness of breath, chest pain, dizziness, a loss or control, or numbness and tingling.
• Pregnancy or Postpartum Obsessive‑Compulsive Disorder (PPOCD). Like OCD, this illness causes people to struggle with unwanted thoughts or mental images. They sometimes feel they have to do things again and again (compulsions) to try to reduce their anxiety.

To the list above, Flynn and Vendetti add adjustment disorder, postpartum post‑traumatic stress disorder, brief psychotic disorder, and postpartum psychosis.

How Common Are PMADs? 

Unfortunately, they are all too common. And the prevalence of postpartum depression is higher among low‑income moms. Flynn and Vendetti’s course cites the following statistics:

• 15‑20% of all women who give birth experience postpartum depression or anxiety.
• 40‑60% of low‑income moms experience these disorders.
• 33.4% of episodes began during pregnancy.
• 19% of the women reported having thoughts of harming themselves.

Recognizing the Signs 

How do you know if someone is experiencing a “normal” amount of “baby blues” or is at risk for a more serious mental illness?

Postpartum.net lists the following warning signs:

• The person feels sad or depressed.
• The person is irritable or angry with the people around them.
• They have difficulty bonding with their baby.
• They feel anxious or panicky.
• They are having problems sleeping or eating.
• They are having upsetting thoughts running through their mind.
• They feel “out of control” or that they are “going crazy.”
• They worry that they shouldn’t have become a parent.
• They are worried they will hurt the baby or themselves.

What Do Moms Say?

Flynn and Vendetti recommend getting familiar with the language of postpartum depression and anxiety. For example, pay attention when a pregnant or expectant mom says things like

• “This is harder than I thought.”
• “I’m on an emotional roller coaster.”
• “I made a mistake having this baby.” 

Some new moms have scary thoughts about their ability to care for the baby. These thoughts can include excessive worry, rumination, obsessive thoughts, intrusive thoughts, and memories that usually connect with the baby being harmed. 

Scary thoughts are not the same as postpartum psychosis. Four percent of mothers suffering from postpartum psychosis will kill their children, and 5% will die by suicide. 

That’s why diagnosis and treatment of postpartum depression and other mood disorders is so important.

Clinical Interventions

There are three main areas of intervention for treating PMADs: psychotherapy, medication therapy, and group psychotherapy. Within these, many approaches have shown promise: Interpersonal Therapy (IPT), Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Supportive Psychotherapy, and Eye Movement Desensitization and Reprocessing (EMDR). 

In addition to the behavioral health interventions, many new moms need practical support with tasks like laundry and cooking. They require emotional support from relationships with doulas, partners, friends, lactation consultants, and other parents. 

And they require psychosocial support in the form of moms’ groups, information, networks, programs—people who understand what they are going through.

The Body Image Connection

We live in a culture with some pretty messed‑up ideas about what bodies should look like. The issue of body image is especially difficult for new mothers, whose bodies have grown and changed in drastic ways. 

The Consortium workshop The Impact and Importance of Cultivating Positive Body Image in the Perinatal Period examines the ways negative body image can impact women. The training focuses on the risk factors for PMADs, including negative body image and weight difficulties. 

When we work together to challenge myths around weight and health, new moms learn new and better ways of taking care of themselves and their babies.