By Dr. Alyssa Morris, clinical psychologist who provides mental health support for families with critically ill premature and full-term infants at Rady Children’s Health in Orange County
Welcoming a baby is a big life change. While pregnancy and parenthood can bring joy, love, and excitement, they can also be emotionally challenging. Many parents are surprised by how hard this season of life can feel. Mental health struggles during pregnancy and after birth are much more common than most people think. Parents often feel confused and alone because of how strong their emotions are during this time.
Emotional struggles during pregnancy and after birth can be treated and do not mean you are doing something wrong. Learning about perinatal mental health can help parents know when they need support and feel more comfortable asking for help.
What Is Perinatal Mental Health?
Perinatal mental health refers to how a person feels emotionally during pregnancy and in the first year after a baby is born. Some parents experience Perinatal Mood and Anxiety Disorders (PMADs), which are a group of common mental health conditions during this time. PMADs affect about 1 in 5 birthing parents and 1 in 10 non-birthing parents.
PMADs do not have just one cause. They can be linked to hormonal changes, lack of sleep, feeding challenges, stress, past mental health concerns, limited support, and medical complications. Families who experience high-risk pregnancies or have a baby in the NICU may have a higher risk. It is important to remember that any parent, regardless of their background or situation, can experience PMADs.
Despite how common these conditions are, many parents may feel ashamed or afraid to talk about how they are really feeling. Parents experiencing PMADs may often say or think things like, “I don’t feel connected to my baby,” and “I feel like the worst parent in the world.” These thoughts can feel isolating and frightening, but they are signs that support is needed, not signs of failure or of being a bad parent.
Baby Blues: A Common Experience
Many birthing parents experience emotional changes in the days and weeks after giving birth. These feelings are often called the “baby blues.” The baby blues are very common and can affect up to 85% of birthing parents. They are often linked to the hormone changes that happen after delivery. During this time, many parents describe feeling like they are on an “emotional rollercoaster.” These feelings can be intense, but it is important to remember that they are temporary.
Symptoms may include:
- Frequent tearfulness
- Emotional overwhelm
- Mood swings
- Anxiety or nervousness
- Difficulty concentrating
- Feelings of loneliness
Baby blues should not last more than about two weeks after birth. If symptoms last longer than two weeks after birth or feel intense or hard to manage, it is important to seek professional support.
Perinatal Depression: More common than you think
Perinatal depression is the most common concern during pregnancy and after a baby is born. It is often called postpartum depression, but it can start during pregnancy or anytime in the first year after birth. About 1 in 5 birthing parents experience it.
Symptoms may include:
- Feeling sad or hopeless most of the time
- Feeling more irritable or angry than usual
- Losing interest in things you usually enjoy
- Feeling numb or not connected, including trouble bonding with your baby
- Trouble focusing or making decisions
- Feeling guilty a lot
- Trouble sleeping, even when you have the chance to rest
- Changes in appetite
- Thoughts about hurting yourself
Perinatal depression can make everyday tasks feel very hard. With support and treatment, parents can get better. If you have thoughts about hurting yourself or your baby, it is important to get help right away.
Perinatal Anxiety: When the worries won’t stop
Anxiety is another common perinatal mental health concern. Perinatal anxiety affects 10–20% of birthing people and can occur during pregnancy or postpartum. Unlike everyday stress, perinatal anxiety often feels excessive, uncontrollable, and exhausting. Symptoms may include:
- Constant or racing worries
- Feeling overwhelmed
- Difficulty relaxing
- Feeling “on edge” or irritable
- Trouble concentrating or making decisions
- Feeling exhausted but unable to sleep, even when your baby is asleep or being cared for by someone else
Some parents also experience physical symptoms such as:
- A racing heart
- Stomach aches
- Jitteriness
- Muscle tension
Living with this much worry can be very tiring and make it hard to relax or feel calm. Even though these symptoms can feel overwhelming, they can be treated. Getting help from a professional can make a big difference.
Perinatal OCD: Intrusive thoughts and compulsions
Perinatal OCD is a condition that can happen during pregnancy or after a baby is born. It affects about 2 to 3 out of every 100 women. Parents may have unwanted and upsetting thoughts that are hard to control. They may also feel the need to repeat certain actions or thoughts to try to make the feelings go away.
Obsessions may include:
- Intrusive, unwanted thoughts or images
- Thoughts or images that are difficult to control
- Strong feelings of fear, disgust, or doubt
- Worries about accidentally or intentionally harming the baby
Compulsions may include:
- Behaviors or thoughts done repeatedly to get rid of the obsessions
- Excessive cleaning, sterilizing, sanitizing, checking
- Seeking excessive reassurance from medical providers about your baby’s health
Some parents have unwanted and upsetting thoughts about harming their baby. These are called “intrusive thoughts” and do not mean a parent wants or plans to act on them. Many parents feel scared to talk about this because they worry about being judged or misunderstood. However, trained providers can help. With the right care, these thoughts can get better.
If thoughts about harm do not feel upsetting, it may be a sign of a more serious condition, and it is important to get help right away.
Getting Support
It can be helpful for parents to think about small actions they can take to make the emotional ups and downs feel more manageable. This might include stepping outside for a few minutes of fresh air, resting wherever possible, or asking for help with chores. Some parents find it helpful to do one small activity each day that feels calming or familiar.
For parents who think they might be experiencing a PMAD, asking for help is the most powerful step forward. Seeking support may look like leaning on friends and family. It can also mean going to therapy, joining a support group, or talking to your doctor about medications that can help you feel better. There are many free and low-cost resources available to support perinatal mental health, including:
Warm lines:
- Postpartum Support International Warm Line (1-800-944-4773)
- National Maternal Mental Health Line (1-833-943-5746)
Support groups:
Ways to find therapists:
- Check your insurance provider directory
- Use Psychology Today’s “Find a Therapist” tool
- Ask your medical team for referrals
If you ever feel unsafe or have thoughts of harming yourself or others:
- Call 911 or 988
- Go to the nearest emergency room
Perinatal mood and anxiety disorders are common. Help is available. You are not alone. If you or someone you love is struggling during pregnancy or after the birth of a baby, support is within reach. Talking about perinatal mental health saves lives, strengthens families, and helps parents feel less alone during one of the most important transitions of their lives.
