The Baby Blues

Up to eighty percent (80%) of women will experience the “baby blues” after giving birth, tied to sudden shifts in hormones.⁴

• Women who experience the baby blues may feel sad, have mood swings and crying episodes.
• The Blues are not considered a disorder as the symptoms often resolve within a few days. If symptoms persist, beyond two weeks, it’s likely the mother is suffering from depression.

Pregnancy and Postpartum Depression

(Also referred to as maternal depression, peripartum depression or perinatal depression.) A Major Depressive Disorder with onset during pregnancy or within 4 weeks of birth though in practice it is applied to depression occurring within the first year from birth. Up to twenty percent (20%) of women experience clinical depression during and/or after pregnancy.^{1-3, 5}

• Maternal depression is treatable during pregnancy and postpartum.
• Symptoms can range from mild to severe and, mothers with pre-existing depression prior to or during pregnancy are more likely to experience postpartum depression.
• Maternal depression is treatable and risk can also be mitigated.
• Symptoms generally include sadness, trouble concentrating, difficulty finding joy in activities once enjoyed, and difficulty bonding with the baby.

Research shows that the onset of depression occurs before delivery for the majority of women. Depression onset occurred prior to pregnancy among 27% of women, during pregnancy for 33%, and in the postpartum period for the remaining 40%. Therefore, it is important to screen for depression throughout the pregnancy and during the postpartum period.^8,9

Maternal Dysthymia

Dysthymia is defined as a low mood occurring for at least two years, along with at least two other symptoms of depression.

• Women with pre-existing dysthymia may be at a higher risk for severe symptoms/depression during the perinatal period.

Pregnancy and Postpartum Anxiety

Up to fifteen percent (15%) of women will develop anxiety during pregnancy or after childbirth. ²

• Anxiety is treatable during pregnancy and postpartum.
• Symptoms often include restlessness, racing heartbeat, inability to sleep, extreme worry about the “what if’s” - like what if my baby experiences SIDS, what if my baby falls, what if my baby has autism, etc.; extreme worry about not being a good parent/being able to provide for her family.

Pregnancy and Postpartum OCD

Fairbrother et al.,⁶ found the prevalence rate for perinatal OCD to be 7.8% during the prenatal period and 16.9% during the postpartum period.

OCD includes obsessions (an unwanted thought or feeling) that a person has an urge to relieve through an action or a “compulsion.” OCD “obsessions” can include intrusive thoughts (see below for more information about intrusive thoughts). About 50% of women with OCD have intrusive/unwanted thoughts about intentionally harming their infant (e.g., throwing the baby).⁶ It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children.

Birth Related PTSD

The prevalence of postpartum PTSD is 3.1%.⁷ Most often, this illness is caused by a real or perceived trauma during delivery or the postpartum period.

• These women are plagued with intrusive memories and flashbacks of the event.

Birth Loss and Grief

• Expectant mothers who experience miscarriage or stillbirth are also at risk for postpartum mental health disorders including PTSD in addition to grief or complicated grief. In the U.S. 10-15 percent of known pregnancies, end in miscarriage and 1 percent of all pregnancies end in still birth (March of Dimes). According to the CDC Black mothers face double the stillbirth rate as White women in America. Native Americans face the second highest stillbirth rates.

Postpartum Mania

• Women may suffer from an extreme inability to sleep, where a mother simply isn’t tired. She generally feels elated, and enthusiastic about completing tasks and motherhood. This is considered a state of hypomania or mania which may or may not be tied to an underlying bipolar disorder.
• A state of mania is not in and of itself dangerous but because mania/severe lack of sleep may lead to impulsive and high risk behavior and can be a precursor to psychosis, it’s critically important that the mother receive clinical support from a psychiatric provider experienced in reproductive mental health.

Postpartum Psychosis

• Postpartum psychosis is a rare/disorder symptom and occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately 0.1-0.2% of births. ³
• The onset is usually sudden, most often within the first 2 weeks postpartum.
• The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.
• Postpartum Psychosis is considered a medical emergency due to the potential for a mom to harm herself or her baby.

Learn more.

Intrusive Thoughts

70-100% of women (and their partners) have “intrusive” thoughts surrounding childbirth/the postpartum period.⁶ These thoughts may include thoughts of infant harm (e.g., dropping the baby or a woman herself harming her baby). These thoughts are unwanted (ego-dystonic) and recognized by the woman as inappropriate and concerning, (which is why these thoughts alone are not cause for alarm). It is important to note that although obsessions often contain alarming content they do not represent a psychotic process, where mothers are at a higher risk of harming themselves or their infants/children. Intrusive thoughts are not considered a “disorder.” When symptoms become persistent and are disabling, they are generally thought to be tied to OCD.