A comprehensive guide to maternal mental health
Updated May 17, 2024
Having a baby changes your life, your hormones — even your brain []! With a precious tiny human having entered your life, it’s common to experience a range of emotions. Between learning to care for your little one, sleep deprivation, and postpartum hormone changes, the early days can be filled with highs and lows.
But even once you’re beyond the fourth trimester, motherhood can be tough as new challenges arise with each new stage of growth and development. Along the way, you’re also navigating your own mental load, milestone anxiety, rage, burnout, etc. It can feel like a lot, even with a support system in place!
Experiencing some moderate levels of stress and anxiety, especially during the first weeks postpartum and throughout your child’s first year, is to be expected. However, it can be difficult to personally determine when your symptoms have gone beyond the expected range. Thresholds vary, triggers differ, and each person has a unique response to stress. Asking for help or admitting to yourself or loved ones that you’re struggling can be really tricky, too. Plus, it can be tough to track down resources and help.
Even though 1 in 4 people [] will experience a postpartum mental health issue, perinatal or postpartum mood and anxiety disorders (PMADs) are often overlooked and underreported. In this article, we hope to help parents better understand the many ways mental health can be impacted by this milestone and share resources for support.
What impacts maternal mental health?
There aren’t singular causes of maternal mental health conditions, though the following factors may contribute to them.
Editor’s Note:
If you are struggling with your mental health, know that you are not alone – and that it’s never too early to reach out for help. Trained maternal mental health professionals can offer the support you need. You can find additional resources at the end of this article.
IN THIS ARTICLE:
Baby blues
The first few weeks postpartum can feel like a roller coaster of emotions. Some moments are joyous and exhilarating while others come with a flood of tears and worries. It’s normal for this phase of motherhood to feel physically and emotionally overwhelming. Most new moms (approximately 50 - 80%) [] experience what’s called “baby blues” during the first two to three weeks after giving birth. These mood swings and bouts of sadness can take some adjusting but they are a normal response to hormones shifting and typically last [] only a few days or a week or two.
While there are some similar symptoms, note that baby blues are not the same as a perinatal or postpartum mood and anxiety disorder. Some of the key differences between baby blues and PPD include the onset, severity, and duration of symptoms. A helpful way to distinguish is that baby blues normally don’t prevent a mom from caring for herself or her baby, whereas with PPD, doing basic things to take care of yourself like sleeping and eating can seem overwhelming or even impossible.
Source []
Perinatal or postpartum depression (PPD)
While temporary baby blues are common in the first few weeks of motherhood, some moms will experience a more severe, long-lasting form of depression. This is called postpartum depression and is diagnosed when at least five depressive symptoms [] are present for two weeks or longer.
While we most often hear about depression in the postpartum period, PPD is part of a larger umbrella called perinatal depression, occurring any time from the beginning of pregnancy to 12 months after a baby is born.
The CDC estimates that 1 in 8 [] new mothers experience PPD. Globally, the World Health Organization estimates 1 in 5 will experience poor mental health conditions during pregnancy. Despite its common occurrence, a 2006 study suggests up to half of PPD [] in new moms goes undiagnosed from factors like not wanting to disclose it to family members. There are many stigmas around PPD that make it difficult to talk about. Additionally, many moms may already face a lack of support for their child that makes it hard to prioritize their well-being too.
If untreated, research shows that PPD symptoms can continue for at least three years. Seeking treatment early gives moms the resources they need to manage depression, both in the postpartum period and beyond. For half of those [] who are diagnosed with PPD, it’s their first experience with having depression.
Factors that can increase risk of PPD:
Stressful pregnancy or traumatic birth
Having a premature or special needs baby
Difficulty breastfeeding
Relationship, family, or financial troubles
Having twins, triplets, or other multiples
PPD in a previous pregnancy
Source []
Postpartum anxiety (PPA)
Worrying often comes with the territory when you become a mom. However, when anxious or intrusive thoughts (i.e. unwanted thoughts of accidental harm or intentionally harming your baby) are impacting your ability to enjoy motherhood or are causing sleep and other health issues, these may be signs that something else is at play beyond typical concern for your little one.
Studies have shown PPA affects between 11% and 21% [] of people, though an exact estimate is tricky because there’s no specific diagnostic test for postpartum anxiety. Sometimes a provider will diagnose PPA during an assessment for postpartum depression.
There’s a wide spectrum for when someone may start experiencing postpartum anxiety. It can begin as early as when trying to conceive, due to factors like hormone changes, recurrent losses, or negative tests. It can also develop during pregnancy, or right after birth. Or it may not develop until your baby is a few months old.
Symptoms can include:
| Physical symptoms | Emotional symptoms | Behavioral symptoms |
|---|---|---|
| Disrupted sleep | Inability to relax or keep calm | Avoiding certain activities, people, or places |
| Increased heart rate or heart palpitations | Intrusive thoughts and irrational fears, especially about worst-case scenarios | Being overly cautious about situations that aren't dangerous |
| Nausea or stomach aches, loss of appetite | Difficulty focusing or forgetfulness | Frequent worrying and checking things over and over again |
| Being unable to breathe or feeling short of breath | Difficulty bonding with your baby | Being controlling |
| Trouble sitting still |
Source []
Note:
If you’re experiencing PPA, these symptoms will likely become your undercurrent or baseline. The feelings tend to be ever-present in the background, instead of being situational and stemming from fear.
Postpartum rage (PPR)
Postpartum rage often involves pervasive anger, irritability, frustration, or losing your temper in ways that feel uncharacteristic or different from your normal baseline. Moms who struggle with PPR often wake up feeling at maximum capacity instead of experiencing bouts of anger due to a specific trigger. There’s often an underlying current of anger that permeates all facets of life, even happy moments. Postpartum rage is often a symptom of depression or anxiety and can coincide with other symptoms like hopelessness, excessive crying, and negative self-talk.
There aren’t many studies specific to postpartum rage, as it’s often folded into postpartum depression or overlooked on its own. PPR is most common within the first six weeks to one year postpartum. []
Source []
Postpartum obsessive-compulsive disorder (OCD)
Perinatal or postpartum obsessive-compulsive disorder is a type of severe anxiety disorder that involves intrusive thoughts that are followed by engaging in a compulsion or action/behavior in an attempt to alleviate the anxiety they are experiencing.
For example, an intrusive thought might be that your baby is going to stop breathing and the compulsion could be checking every few minutes to make sure they’re safe. There’s research that suggests the more you check, the less confident [] you become in your memories. Then your brain thinks checking is worthwhile, which erodes your own trust and confidence over time. When checking doesn’t soothe your anxiety, the cycle continues.
This type of OCD can occur [] during or right after childbirth or may develop 4 to 6 weeks later. It’s estimated that postpartum or perinatal OCD affects 3 - 5% of new mothers [].
Source []
Postpartum psychosis (PPP)
Postpartum psychosis is a rare and severe form of PMAD. It is considered a psychiatric emergency and should be treated immediately [] as it can lead to life-threatening thoughts or behaviors. While extreme cases are often reflected in the media, know that PPP is treatable and early intervention increases the odds of a positive outcome. Unlike many postpartum mental health conditions, PPP can be diagnosed through physical and neurological [] exams.
It’s estimated that it affects 1 in 1,000 people []. Note that diagnoses of other mental health [] conditions (bipolar disorder, schizophrenia, etc.) may increase the risk of developing postpartum psychosis. It also has a 30 - 50% recurrence risk [] for those who’ve already experienced PPP. It’s especially important to inform your healthcare provider of your mental health history in these instances.
Postpartum psychosis usually develops in the days following birth, though it can also appear up to six weeks later []. PPP symptoms can also occur within the first year of your child’s life around hormonal changes [], such as weaning from breastfeeding or your period returning.
Source []
Note:
If you’re experiencing these symptoms or believe you may have postpartum psychosis, immediately seek assistance from loved ones to care for your child and go to your local emergency department for help.
Partners and mental health
Postpartum mental health issues most commonly affect mothers, however, men and other partners/caregivers can be impacted too. Research suggests that men also experience hormone changes when a baby is born and 1 in 10 dads [] will experience postpartum depression. Men are 50% more vulnerable [] to PPD if their partner has PPD. It’s estimated that up to 18% [] of fathers will develop an anxiety disorder at some point during pregnancy or the first year postpartum.
After your child’s first year
Perinatal and postpartum depression and anxiety can occur any time from the beginning of pregnancy to 12 months after a baby is born. However, it can sometimes persist for years if not adequately treated. And because it often goes unnoticed, understanding these conditions and their symptoms is not just relevant to those in the child’s first year of life.
For someone with a toddler experiencing these symptoms, it may be that the depression and anxiety existed during the first year and weren’t as noticeable or that something has shifted to bring it about, like changing jobs, going through relationship struggles, etc. Hormonal levels changing, such as if you wean, can sometimes impact mental health and mood and that can be a trigger as well.
Depression doesn't always have an identifiable trigger, and it can sometimes arise when we least expect it. Whether it’s a postpartum-related mental health disorder or not, it’s important to speak with a trained medical professional to receive the support you deserve.
When and how to get help for postpartum mental health disorders
It can be overwhelming to know when to speak with someone and where to start — especially while trying to keep up with your family’s needs. Additionally, one of the reasons postpartum disorders can go overlooked is the societal pressure that leads new moms to believe they should feel nothing but joy and connection with their baby. Feelings that aren’t overwhelmingly positive can instead feel shameful, leading a mom to think they should conceal or dismiss them.
Know that struggling in the postpartum period is not a reflection of parenting or your relationship with your baby. You are a good mom with or without these conditions. In fact, if you’re reading this article, you’re taking an important first step in better understanding maternal mental health.
When to seek support
If you’re feeling depressed or anxious, or think you may be experiencing any of the other postpartum or perinatal mood disorders, it’s important to talk about it with a trained professional. You don’t have to wait for a diagnosis or extreme symptoms, as it can be beneficial to have resources and support earlier on.
A good first step is contacting your primary care provider or OBGYN to schedule an appointment if:
Your baby blues symptoms become very intense or don’t go away after a couple of weeks
Symptoms of depression last more than two weeks []
You’re not able to work or do normal activities at home
You’re having trouble caring for yourself and/or your baby
If left untreated, postpartum mood disorders and PPD can last for months [] or even longer. It often leads to harsher feelings about yourself as a parent, as you may not have the energy, focus, or emotional ability to address your baby’s needs or your own. This can become a vicious cycle that can lead to intensifying feelings of depression.
While taking steps to get help may feel overwhelming, treatment for postpartum mental health conditions is often successful. It’s estimated that 80% [] with postpartum depression will recover and feel like themselves again.
What help can look like
While you’ll want to consult your medical provider or mental health professional who can take your personal medical history and specific needs into account, there are some general ways that PPD and other PMADs can be addressed.
Mental health is a really personal experience but you’re not alone in facing it. It can be overwhelming to process and know where to start, especially because every person’s idea of support can look different. In addition to talking to your doctor, here are some other helpful avenues for support:
Social support: Asking for support can be uncomfortable, especially in the beginning. But chances are your family, friends, or other people you trust want to help.
Support groups: Postpartum support groups can provide help in a comfortable setting
Support lines: has a call/text line for 24/7 support
Self-care: This is often easier said than done with small children to care for. However, trying to get enough rest, eat a balanced diet, get outside, and ask for help when needed can be beneficial for your mental health
Mental health literacy: Continuing to learn more about these conditions and read about other parents’ experiences can be a really valuable tool. Articles, , and even social content help validate and support you.
Therapy and medication are two of the most common and effective resources for mental health treatment. It can feel like a big step and it’s normal to be a little hesitant about the idea. However, there are many different avenues within these forms of treatment, and with support from trained professionals, it is often successful.
When seeking a therapist, make sure you look for a trained perinatal/maternal mental health professional. offers virtual therapy and counseling sessions. You may also use a site like to find a local therapist.
Medicine (such as antidepressants) may be prescribed to help manage symptoms of depression. Some of them can be taken while breastfeeding. Note that it may take a period of several weeks to start working before you notice a difference. Some may continue to utilize medication past the postpartum period while others may choose to taper off.
Maternal mental health FAQ
Q: What should we expect from our partners on this difficult journey and how can we get them to better understand and support us? Or should we be looking outside our partnerships for that support?
A:
It is such a valid desire to want your partner to see and empathize with what you’re going through, and at the same time, it can be hard for partners to understand the postpartum mental health journey. One good place to start would be to share some educational resources with your partner, such as these Momwell podcast episodes on Postpartum Depression and Anxiety, The Difference Between PPD and Baby Blues, and How Partners Can Share the Mental Load. Your partner might be able to empathize more if they can understand what’s going on postpartum and why this is often such an emotionally heightened time. It’s also helpful to get very clear on our needs. Reflect on what it is you need to support your mental health journey. Is it more sleep? A more fair distribution of labor? Acknowledgment and appreciation? Time for yourself every day? It can be hard to know what we need – especially in the postpartum period. We can often fall into the trap of wanting our partners to just “know” what we need, when we can’t even clearly identify what we need. The more we practice identifying our needs, the more clearly we can communicate those needs to our partner. It is also valuable to have other people in our lives to turn to, such as friends or family, mom support groups, and maternal mental health therapists.Q: I'm ten months postpartum. Friends and family have told me that I can't still have “baby blues” that is just full-blown anxiety. I have always had anxiety, but it's different now. When does it change?
A:
Baby blues is an experience that most moms go through, particularly as hormonal changes occur – but it only lasts two weeks, typically at the very beginning of the postpartum period. If you are struggling beyond a couple of weeks, you very well might be dealing with postpartum anxiety – especially if you previously experienced mental health concerns (which increases the risk for PPA). It’s important to remember that although “postpartum” anxiety onsets during the first year after having a baby, it doesn’t always go away if you wait it out or after the postpartum period ends. While mild cases of anxiety might ease after time, more moderate anxiety often needs to be treated. Research is beginning to show that postpartum mental health struggles can persist for years if left untreated. That’s why it’s vital to develop coping skills and strategies to help with anxiety or depression. Treatment doesn’t always involve medication, although that is a great option for many people. Other treatment options might include lifestyle changes to manage symptoms, identifying and reframing negative thought patterns, or practicing mindfulness. A maternal mental health therapist can help you determine the right treatment plan and help you build these skills and techniques that will support you not just through PPA but for anxiety beyond the postpartum period.Q: My little girl will be starting nursery in 4 months (she will be 10 months then), how do I cope with the guilt that I am going back to work full time and the anxiety about leaving her with strangers?
A:
Returning to work and leaving your child at daycare for the first time can be a very hard experience, especially if you feel like you aren’t ready. Whether you’re returning to work for financial or economic reasons, or because you feel fulfilled and driven to work, you shouldn’t have to feel guilty. Reminding yourself of the research can help with the guilt. Research shows that there is no negative impact emotionally on our children from having working moms. The quality of time you spend with your child matters far more than the quantity (which doesn’t predict a secure attachment). So focus on the time you do have and create meaningful connections with your child. This is a big adjustment and it makes sense that you would feel nervous, but nervousness should improve as you move through the transition. If your fear and anxiety are persistent, it may be time to speak to someone about how you’re feeling. It is also helpful to challenge the societal message that mom must be the ones to care for their children, and remind ourselves that children benefit from multiple healthy attachments to caregivers. Reframing these societal messages and comforting ourselves with compassionate coping statements can help us ease the worry and reassure yourself that you are making the best decision for your family.Q: Why is the love of our child is not enough to gain physical resistance to be able to take care of the baby day and night? Why we feel guilty about that when the body is feeling drained of resources? What can we do about that when the rest isn’t an option?
A:
As moms, we have been conditioned to believe that we “should” love our child so much that we should never experience difficulty or have negative feelings about our role. This has become so ingrained that we think that there is something wrong with us when we can’t cope with things like sleep deprivation. But this is an unreasonable expectation. No amount of love for our child can change the fact that we have real emotional and physical needs, including sleep. Traditionally, moms had a village to rally around them, offering support during the day, helping with other children, cooking, and allowing them to rest when needed. Now, we’re mothering in isolation and expected to do it all alone. We need to break away from the idea that mom must be the one to do everything – to handle every feeding or night waking, to juggle the mental and emotional load, and to soothe and care for the baby while also running the household. It’s an impossible expectation. One of the best ways we can start to challenge these expectations is by protecting our sleep, separate from the baby’s. Research has shown that at least 4 - 6 hours of consecutive sleep is very protective for our brain function. We often can’t expect babies to sleep for that long – so we need to find other ways to ensure we can get consolidated sleep. This might look like “taking shifts” with a partner who handles night feeds during a set time. Mom might need to sleep in a different room during that consolidated sleep shift to ensure quality rest. For example, if the baby goes to sleep for the night at 8:00 PM, maybe Mom sleeps from 8:00 PM - 1:00 AM in a separate room while her partner sleeps in the room with the baby, handling night feeds that arise during that time. Then, they switch, with Mom sleeping in the room with the baby and handling night wakings from 1:00 AM - 6:00 AM while her partner gets protected sleep. It’s important to remember that our sleep matters as much as our partner’s – even if our partner is working outside of the home. Caregiving is real, valuable work and we need our brain function for that just as much as any other job. In some cases, partner support is not feasible. Perhaps there is no partner or perhaps the partner is away or works a job that doesn’t allow for this level of dividing the nighttime labor. In these instances, solutions might have to include creative options, such as calling in family or friend support to handle a shift at night or bringing in a night nurse if financially feasible.Q: I feel overwhelmed and judged when I share that feeling with my friends. How can I deal with people's expectations of what I should do without feeling I'm failing as a mother?
A:
We often feel like we need to meet other people’s expectations in motherhood. But the truth is that what it means to be a “good mother” is different for each of us depending on what we value, and if we are focused on trying to meet external ideals, we are setting ourselves up to feel like we’re failing. The best way to deal with outside expectations is to center ourselves on our values – the principles that matter most to us and can serve as a guide for our decision-making. Your values are likely different than those of your friends. Perhaps you value slowness, while a friend values novelty. That might mean that you are content to skip story times and outings and take your days one at a time without the pressure to pack up and leave the house each day, while your friend might need that connection or change from heading to meetups. Neither of you is wrong – and neither of your babies will suffer because of what you do. Spending time to discover our values can help us say no to things that are contributing to the pressure and overwhelm that often contribute to burnout and mom rage. We can choose where to put our focus, find some peace without feeling like we need to meet every expectation. In the process, we can learn to stand firmer in our decisions, to say no to guilt or shame, and to view our decisions in a different light. It’s also important to think about whether the judgment we are experiencing is coming from others or our own self-doubt. Sometimes we project our own insecurities into others, thinking that they are judging us when they aren’t. Other times, we do find ourselves coping with mom shame at the hands of others. While it can be very valuable to have friends to talk to, if you are receiving judgment or shame from them, then perhaps they don’t need to be in your circle of trust during this vulnerable time. Consider whether these friends are able to offer you the support you need. You might need to set boundaries or choose who to share your feelings with. Remember that struggling is nothing to be ashamed of. If you don’t have people you can turn to, consider reaching out to a maternal mental health therapist who is trained in the challenges you are facing.Q: How can I manage intrusive thoughts postpartum? I'm too afraid to tell family and friends or a clinician in fear of being judged.
A:
Intrusive thoughts are often very scary, but they are so much more common than we realize. Research shows that at least 90% of moms experience them, and half of those are intrusive, unwanted thoughts about intentionally harming the baby. Thoughts are just thoughts – they are not premonitions or an indication of some deep, dark, hidden desire. They are nothing to be ashamed of. When experiencing intrusive thoughts, the first step is to catch the thought in action and identify it for what it is. Then, bring yourself back into the moment with mindfulness or grounding, such as a deep belly breath or counting slowly to 10. Coping statements such as “Just because I think it doesn’t mean it will happen,” can help us move through these thoughts easier. It’s also important to remember that intrusive thoughts can be indicators of postpartum anxiety or postpartum OCD. If your thoughts are impacting your daily function, reach out to a maternal mental health therapist who understands what these thoughts are and can offer you a judgment-free, safe space.Share article:
Note: The content on this site is for informational purposes only and should not replace medical advice from your doctor, pediatrician, or medical professional. If you have questions or concerns, you should contact a medical professional.
