Maternal mental health disorders

Moms of every culture, age, and income level, can develop perinatal mental health disorders, which are mental health conditions that occur during pregnancy or after giving birth.

Perinatal mental health disorders include depression, anxiety, and psychosis. These disorders can be caused by a combination of biological, psychological, and social stressors, such as the lack of support. Maternal anxiety and depression are the most common complications of childbirth, affecting about 1 in 5 women.

Types of maternal mental health disorders
Symptoms of maternal mental health disorders (MMH) can appear any time during pregnancy and the first 12 months after childbirth. They can take any of these forms:

Baby blues: This happens to about 2 in 3 mothers after giving birth, and it is likely caused by a sudden shift in hormone levels after childbirth. Moms who experience baby blues may have mood swings, feel sad, and may start crying for no obvious reason.

These symptoms often resolve within a few days, which is why baby blues are not considered a disorder. However, if symptoms persist beyond two weeks, the mother may be suffering from postpartum depression and would need expert evaluation and treatment.

Depression during pregnancy and postpartum: Depression during pregnancy and depression after pregnancy, collectively known as perinatal depression, is the most common mental health complication of childbearing. About 15% of moms experience significant depression following childbirth, and the percentages are even higher for women who are also dealing with poverty.

Women who have perinatal depression may experience:

• Lack of interest in the baby
• Loss of interest, joy, or pleasure in things you used to enjoy
• Feelings of anger or irritability
• Possible thoughts of harming the baby or yourself
• Appetite and sleep disturbance
• Crying and sadness
• Feelings of guilt, shame, or hopelessness

These factors can increase the risk of perinatal depression:

• A personal or family history of depression, anxiety, or postpartum depression
• Premenstrual dysphoric disorder (PMDD or PMS)
• Inadequate support in caring for the baby
• Financial stress
• Marital stress
• Complications in pregnancy, labor, or breastfeeding
• A major recent life event: loss, house move, job loss
• Multiple pregnancies
• Having a sick baby in the Neonatal Intensive Care (NICU)
• Requiring infertility treatments
• Thyroid imbalance
• Any form of diabetes (type 1, type 2, or gestational)

Anxiety during pregnancy and postpartum
About 6% of pregnant women and 10% of postpartum women develop anxiety. They may experience anxiety alone or together with depression.

Here are the symptoms of prenatal and postpartum anxiety:

• Persistent worry
• Racing thoughts
• Disturbances of sleep and appetite
• Nervousness
• Inability to sit still
• Feeling that something bad is going to happen
• Physical symptoms, such as dizziness, hot flashes, palpitations, numbness, and nausea

Some of the risk factors for perinatal anxiety and panic include:

• A personal or family history of anxiety
• Previous perinatal depression or anxiety
• Thyroid imbalance

Maternal obsessive-compulsive disorder
Studies estimate that as many as 3-5% of new moms and some new fathers experience perinatal obsessive-compulsive disorder (OCD). The condition manifests as follows:

• Obsessions often manifest as persistent, repetitive thoughts related to the baby. These thoughts can be upsetting and not something the mother has ever experienced before
• Compulsions are the felt need to do certain things over and over again to reduce her fears and obsessions. They may include things like needing to clean constantly, checking things many times, and recounting or reordering things
• A sense of horror about the obsessions
• Fear of being left alone with the infant
• Hypervigilance in protecting the infant

Postpartum post-traumatic stress disorder
Postpartum post-traumatic stress disorder (PTSD) is experienced by up to 9% of women following childbirth. The condition is often caused by a real or perceived trauma in the past, such as:

• Traumas experienced during delivery or postpartum period
• Traumas from a severe physical complication or injury related to pregnancy or childbirth
• Feelings of powerlessness, poor communication, or lack of support and reassurance during the delivery
• Traumas from rape or sexual abuse

The condition manifests as follows:

• Flashbacks or nightmares
• Involuntary thoughts about a past traumatic event
• Avoidance of anything that reminds you of a past traumatic experience
• Persistent stress which can lead to difficulties sleeping
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

Bipolar mood disorders
Also called manic-depression, Bipolar is a mood disorder in which the individual’s mood swings between two phases: the lows (depression) and the highs (mania). The risk factors are family or personal history of bipolar mood disorder.

Features of bipolar include:

• Periods of severe depression
• Periods when the mood is much better than normal
• Rapid speech
• Little need for sleep
• Racing thoughts, trouble concentrating
• Anxiety 
• Continuous high energy
• Overconfidence
• Delusions (often grandiose, sometimes paranoid)
• Impulsiveness, poor judgment, distractibility
• Grandiose thoughts, inflated sense of self-importance
• In the most severe cases, delusions and hallucinations

Postpartum psychosis
About 1 in a thousand women experience psychosis following childbirth. The illness usually starts suddenly, most often within the first 2 weeks postpartum.

The condition often manifests with these symptoms:

• Delusions or strange beliefs
• Hallucinations (seeing or hearing things that aren’t there)
• Feeling very irritated
• Hyperactivity
• Decreased need for or inability to sleep
• Paranoia and suspiciousness
• Rapid mood swings
• Difficulty communicating at times

The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. Of the women who experience postpartum psychosis, studies have suggested that there is approximately a 5% suicide rate and a 4% infanticide rate associated with the illness.

If you feel you may be suffering from one of these illnesses, know that it is not your fault, and you are not to blame. Inform your partner, try to find support groups of mothers who go through the same, and seek professional help before it affects your and your child’s health. With help, you can prevent a worsening of these symptoms and can recover.

Thank you note
This article about maternal mental health was made in collaboration and with the support of the Pranaiya & Arthur Magoffin Foundation — Better Well-Being for Parent & Baby.