The perinatal period starts around the time you become pregnant and continues through the first year postpartum. A person’s mental health can definitely experience some ups and downs during this time. Some of that is caused by hormone fluctuations and the physical stress that conception, pregnancy, and birth can put on the body. But it’s also affected by the special circumstances in a person’s life during this time.

Before Pregnancy

Just deciding that it’s time to start a family is a big deal. It might be a huge decision that you don’t come to lightly. It might also be something that is unplanned. Either way, it can definitely cause some stress and emotional upheaval.

If you’re making the decision to start a family, conception is another big hurdle for some people. It might be easy to become pregnant, but it can also be a long and very difficult process.

Pregnancy Changes & Stressful Decisions

Once you are pregnant, the hormones and physical changes can cause a lot of emotional ups and downs. Sometimes people become forgetful, irritable, or easily overwhelmed. It’s very normal to experience mental and emotional changes. This isn’t necessarily healthy or unhealthy, it’s just part of the process.

In addition to all of that, there are the logistics of being pregnant, giving birth, and starting a family. You might have a job or career that will need to change or adjust. It can be intimidating to think about actually having a baby in your home. Will you know how to take care of a tiny baby? What about child care? What about toddlers and teenagers?! Those kinds of thoughts and planning can feel very overwhelming. You might have concerns about your other relationships. How will becoming parents affect you and your partner? Will you still find time for each other? Will you agree on parenting issues and be able to figure out a work/life balance that works for you both? You might have other family members or friends to think about too.

Having a child can definitely bring out the best or the worst in our loved ones. You might be getting a lot of unwanted advice or judgment. You might be having to choose who to ask to be at your birth or who you will visit first when the baby comes. You might worry about finances. You’ve probably heard that diapers and daycare are expensive! What about your home? Will it work with a new baby? A lot of people move or remodel when they’re expecting a baby. That alone is a big deal. There is just a lot to think about when starting a family.

It’s very normal to feel overwhelmed or a lot of stress during the perinatal period. Most of the time, this is just a normal part of this big life transition. This can be managed well with some awareness that you are normal, with some good talking and planning, good health care, and with some support. It’s also possible to have some more concerning issues during this period, so it’s important to recognize that you can get help if things start to feel like too much during this time.

Postpartum Mental Health

The postpartum period is what most people recognize as a time of high sensitivity and vulnerability to mental health issues. Postpartum means after birth. It’s true that postpartum depression is common, and a lot of people worry about this. The postpartum time is really just a part of the whole perinatal picture, although it does deserve some special attention.

What is normal?

First of all, it’s important to recognize that it’s normal to have some emotional changes, especially during the first couple of weeks after having a baby. Some people call this “The Baby Blues”.

You can expect to have some tearfulness, sadness, feel overwhelmed and exhausted. BUT you should still be able to do things you need to do. This time period should not be all bad. You might also have some moments of bliss and feel very positive and excited too.

The Baby Blues are a result of all of the things that are going on that were mentioned above. Your hormones, your physical state, and all of the new circumstances caused by having a new baby in your life. You’ll probably start noticing these ups and downs by day three postpartum, and it typically gets better after a couple of weeks.

Some people will describe feeling out of control or confused. “I just start crying all of a sudden for no good reason!” I always respond by saying, “You have PLENTY of good reasons!” It’s just hard to pinpoint only one right at that moment. I call all of the reasons for the emotional upheaval The Perfect Storm. There is a lot of change and physical healing going on, and when you add sleep deprivation to that, no one could be expected to feel perfectly stable and normal. After a couple of weeks of that though, you should gradually start to feel more normal and have fewer of the mood fluctuations.

Transition and Transformation

I like to think of this as a time of transition and transformation. You are not just growing and birthing a baby. You are becoming a parent. That is the butterfly that will emerge from the cocoon. You were a beautiful caterpillar, then you got really hungry and started to change. You formed a chrysalis. I love using this analogy. Scientists have discovered that what happens inside a chrysalis is a complete dismantling of the caterpillar. It stops being a caterpillar and becomes some kind of goo. The DNA is the same, but the form completely changes. From that goo, a new form is created. It’s completely unrecognizable, but is also the same at the most fundamental and cellular level. And it may be even more beautiful when it emerges. When a butterfly emerges, it needs some time to figure out its new form. Their wings are wet, so they can’t fly quite yet. They are a little weak and wobbly and need some time to rest, recover, and heal before they can safely fly.
So remember the butterfly, and give yourself the time to let your wings dry. It’s normal to need this, and healthy to take it. It’s also normal to feel like you’re not quite sure who you are. Are you the caterpillar anymore? Are you really ready to be a butterfly? I like to think that we get to be neither and both. The caterpillar is still there, but now it’s even bigger and has wings.

Some things you can do to support your recovery and help you ease through more gracefully:

• Recognize that you need this time and rest. Don’t push yourself.
• Accept or ask for help from others. You might ask family and friends, or hire help whenever you can.
• Get more sleep. Especially when you can let others help you, you might find more time for naps and better sleep. This can make a HUGE difference in how you feel.
• Breastfeeding and skin-to-skin time with your baby can also help. These are oxytocin making activities. Oxytocin is a feel-good hormone that also supports good bonding and breastfeeding.
• Take care of your physical needs. Get good nutrition, hydrate well, sleep, do some deep breathing, take your vitamins and supplements. Your body needs all the resources it can get for best healing.
• Practice mindfulness. When you’re holding your baby, just hold your baby and look carefully. Try not to think about anything else. To-do lists and planning can wait. Dwelling on the past is unnecessary. Try to be fully present and aware of what is happening RIGHT NOW.

Postpartum Mood Disorders

Mood disorders are different. In general, the feelings are more intense. The ups and downs are more dramatic, and the really good moments are harder to come by. You feel bad emotionally, and you may also feel physically worse. Postpartum mood disorders are not just a response to the normal circumstances following birth and pregnancy. There is definitely more going on, and it’s important to get specialized help.

Postpartum mood disorders are hard to predict, although there are some things that can put you into a higher risk category including a previous history of depression, anxiety, bipolar disorder or other mental illness. The good news is that even if you are at higher risk, nothing guarantees that you will experience a postpartum mood disorder. And if you do, you’ll likely have the resources ready to help you sooner.

The more common mood disorders are postpartum depression and postpartum anxiety. A lot of times, the symptoms of mood disorders can look similar to The Baby Blues. Something that can help you recognize that you might be experiencing a mood disorder and not just The Baby Blues is the timeline. Mood disorders don’t usually start until later, even months later. They also do not tend to get better on their own after just a couple of weeks. Also, mood disorders are a lot more intense, and it’s harder to find the good moments.

Depression

Although postpartum depression is the one we hear most about, it might actually be less common than postpartum anxiety. It looks very different though, and it’s easier to recognize, so it’s more likely that people will be diagnosed and get help with postpartum depression. This condition can cause a lot of the same symptoms of The Baby Blues, only more intense. It may also make it hard to bond with your baby and others. You might feel like just basic functioning is all you can handle, and even that feels very difficult. You might feel like you’re constantly in survival mode.

Anxiety

Postpartum anxiety looks very different because people tend to get a lot done. You might be putting a lot of energy into other people and tasks. This might look good on the outside, but true anxiety doesn’t feel good on the inside. It might feel like you HAVE to do these things or something terrible will happen. It’s stressful. People usually feel very restless, have trouble sleeping for very long, have a lot of distracting and even disturbing thoughts.

One of the more common disturbing thoughts postpartum is a recurring thought and fear that the baby will fall down the stairs. People worry that they will be the cause. This kind of disturbing thought might be normal if it just happens a few times and doesn’t change your behavior. All parents have worrying thoughts sometimes. But if your disturbing thoughts become obsessive, and you decide you can’t be trusted to hold your baby on the stairs and make someone else do that for you, that could be caused by anxiety.

How to Know the Difference Between Normal and Not Normal

The severity of the symptoms can be a clue if it’s a normal mood swing or not. Also, if the symptoms are negatively impacting you for more than two weeks, it’s probably more than The Baby Blues. And if the symptoms start later than just a few days postpartum, it’s probably more serious.

In some cases, you should absolutely trust your instincts. If you’re sure that you’re not feeling normal, and suspect a mood disorder, please seek help. You are probably right!

In other cases, the person who is depressed or experiencing anxiety does not recognize that something is wrong. Instead, it might be other people who bring it to their attention. If this is happening, it’s a very good idea to accept what your loved ones are seeing and telling you. At least get a second opinion with a professional. If they assess that you do not have a mood disorder, they may still be able to help you feel a little better, so there’s no loss in seeking the help. Doulas can be particularly helpful in noticing some of the signs of mood disorders and tend to be very good at giving gentle recommendations.

Friends and family members can be helpful by helping point out things that don’t seem normal, but this can be done in a better or worse way. It probably won’t go well if someone says, “What’s wrong with you?” or “You’re not acting right, you need therapy.” Here are some suggestions that might be helpful if you suspect a mood disorder in someone else:

Start from a place of love. “I care about you so much and want this to be a special time for you, but it seems like you’re really struggling.”
Let them lead the conversation. “Are you feeling ok? Is there anything I can do to help?”
Have a conversation before the baby comes. This is a great idea offered by Cheryl Reeley MS, LCSW-S, PMH-C. Talk about postpartum mood disorders with loved ones and discuss ways that they can help if something comes up. Maybe you could even set up a code word they can use playfully if they suspect you’re struggling too much.

When to Get Help

It’s best to get help right away. I recommend consenting to any assessments offered to screen for mood disorders. As soon as you suspect a mood disorder, you can reach out for help. Therapists don’t see people usually until 3-6 months postpartum, and often those people were feeling bad for a long time before seeking help.

I’ve known many people who have experienced a postpartum mood disorder. No one regrets getting help, but many people regret not getting help sooner. Some people just honestly don’t recognize that it’s happening until it’s gone on long enough. Other times, people think they’ll get through it without help and want to muscle through. It’s not shameful to have a mood disorder or to ask for help. It’s just something that happens sometimes, and the good news is that there are interventions that can make a big difference in how you feel and how you’re able to thrive and enjoy your time as a new parent.

How to Get Help

It’s very important to talk to your care provider if you suspect you have a mood disorder, or if you’re just not feeling quite right. If you’re under OB care, you may not have an appointment scheduled until six weeks postpartum. I would recommend calling to see about referrals before your scheduled appointment. If you see other providers such as a pediatrician or lactation consultant, they may also be able to give you an assessment and make a referral for you.

Our outpatient clinics provide a postpartum depression assessment when people come in for a lactation consultation, because we understand that many people need it before their next doctor visit and that early intervention is important. Many pediatricians will do the same. If you have a therapist or other care provider like a physical therapist, chiropractor, or acupuncturist, it’s also a great idea to contact them for help. Any of these practitioners should be able to offer you good referrals so you can get help.

What kind of help is available?

There are a couple of different ways to tackle this problem.

1. Behavioral/Talk Therapy: This can be individual or group therapy, or even support groups. The goal is that you are thinking about and talking about how the mood disorder is affecting you the most, how it affects your daily life. You can learn about strategies to take care of yourself while you’re dealing with the issue. You might get help coping with intrusive and disturbing thoughts, or trauma related to infertility, pregnancy, or birth.
2. Medication: Not everyone wants or needs medication, but many people benefit from it. It’s important to recognize that there are many medications that are very safe to use, even when you’re pregnant or breastfeeding. It’s also important to remember that the benefits of using a particular medication can sometimes outweigh the risks. You need to get all the information so you can make an informed choice. A therapist will usually refer to a perinatal psychiatrist for medication options. They are specialists working with people who are pregnant or postpartum, and have the knowledge and expertise to keep you safe.

For most people, a combination of the behavioral and medical help have the most impact and quickest results.

Postpartum Support International is an excellent online resource. They have a helpline, local resources, online groups to join, and more.

The Postpartum Health Alliance (PPHA) is an organization local to my area of Central Texas and is an excellent resource. Kristi’s List is their directory of local providers related to postpartum mental health.

The National Maternal Health Hotline is another great resource for getting phone support and help finding resources in your area. You can text or call 24/7 to 1-833-TLC-MAMA.

Prevention

Although there aren’t any guaranteed ways to prevent postpartum mood disorders, there are some things you can do to minimize your risk. Most of these things are basic self-care strategies and probably things you already know about. Prioritizing this kind of self-care is the hard part for a lot of people, but also the best way to keep you healthy and happy.

1. Good nutrition: A pregnancy diet high in protein, healthy fats, and lots of good fruits and veggies is associated with lower rates of postpartum depression. Doing the same after birth can help too. You’ll also probably sleep better and feel better if you keep things like caffeine and sugar to a minimum.
2. Exercise: Pregnancy exercise is also associated with lowered risk.
3. Sleep: Good sleep may lower your risk.
4. Breastfeeding and skin-to-skin contact: Breastfeeding can be associated with lower rates of postpartum depression. When things are going well, and especially when a person is exclusively breastfeeding, there are some protective hormonal changes that can improve moods. It’s important to remember though, that if breastfeeding is very complicated and difficult, please seek help. If you are experiencing a lot of distress caused by breastfeeding, you need to assess how it is affecting your mental health and what you can do about it. A lactation consultant may be able to help you find a solution that works for you and your family, even if that means you don’t breastfeed at all or provide breast milk in a different way.
5. Support: Having a supportive network of helpers is associated with better mental health. It’s so important to accept help or ask for it. If you can set this up while you’re still pregnant, that’s best! You’ll probably feel better knowing you have some help after your baby comes, and then you get to benefit from it when the time comes.

Your good mental health is critical. It should not be ignored or set aside for later. You deserve to feel better, and your family will benefit from having you healthy and more present.