Perinatal Mental Health: What Every Family Should Know

The Irish Pastoral Centre
Aug 21
5 min read

Many people have been following the trial involving the tragic events that occurred in Duxbury in 2023. There are understandably strong feelings about what may or may not have happened, the people involved, and whether mistakes were made. There has also been considerable discussion in the media about possible mental health conditions and diagnoses. While the trial is ongoing, we do not have a complete picture of what happened, and it is important to be cautious about drawing conclusions based on information reported publicly or in hindsight. Regardless of the circumstances, this was a terrible tragedy.

It is important for all of us to be aware of mental health conditions that can occur during the perinatal period—the time during pregnancy and following the birth of a baby. Symptoms can develop at any point during pregnancy and in the months following birth. The first year is often used as a general guideline, but mental health concerns can emerge or continue beyond this period. Recognizing the signs and seeking help can make an important difference for individuals, their partners, babies, and families.

While most people are aware of postpartum depression, there are actually several forms of mental illness that can occur during the perinatal period, including perinatal depression, perinatal anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, and postpartum psychosis.

Perinatal mood and anxiety disorders (PMADs) are among the most common complications of pregnancy and the postpartum period. Approximately one in seven women experience depression during pregnancy or after giving birth. Estimates vary depending on the condition and population studied.

There is a difference between “baby blues” and postpartum depression. Up to 85% of women who have given birth will experience symptoms of the baby blues, which can include moodiness, crying, irritability, and sleeplessness. These symptoms usually appear within the first week after giving birth, peak around days 3–5, and typically resolve within about two weeks. Postpartum depression symptoms are more serious and can significantly interfere with daily functioning. They can include feelings of hopelessness, guilt or worthlessness, changes in appetite or sleep, loss of interest or pleasure, difficulty functioning, or feeling disconnected from oneself or others.

At least one in five women will experience an anxiety disorder during the perinatal period. A certain amount of worry and concern is a normal reaction to the major upheaval that comes with bringing a baby home. However, when anxiety or fears are persistent, overwhelming, or interfere with daily life, treatment can help. Intrusive, unwanted thoughts about something bad happening to the baby can also occur with perinatal anxiety or OCD. Having an intrusive thought does not mean a person wants it to happen or will act on it; however, when these thoughts are persistent or distressing, it is important to seek help.

In some cases, depression symptoms are part of a condition such as bipolar disorder, which can have severe symptoms and requires different treatment. Anyone with a history of bipolar disorder or symptoms suggestive of bipolar disorder should be carefully evaluated by a qualified mental health professional.

Psychosis is defined by a profound alteration in thinking or a break with reality and can include hallucinations (auditory or visual), delusions (fixed false beliefs), paranoia, and severely disordered thought processes. Postpartum psychosis is a rare perinatal psychiatric condition, occurring in approximately 1–2 out of every 1,000 births, and is often associated with bipolar disorder.

Postpartum psychosis is a psychiatric emergency. If someone who has recently given birth is experiencing hallucinations, delusions, severe paranoia, extreme confusion, or appears disconnected from reality, immediate emergency evaluation is needed. Partners and family members may be the first to notice these changes and can play an important role in getting help.

When mental health symptoms are not identified or adequately treated, they can worsen and may increase the risk of significant impairment, suicidal thoughts, self-harm, or, in some cases, psychosis.

The good news is that perinatal mental health conditions, including postpartum psychosis, are treatable. With timely screening and appropriate treatment, we can reduce suffering, save lives, and protect children and families from the impact of untreated perinatal mental health conditions.

Treatment depends on the severity and type of symptoms and may include psychotherapy, support groups, medication, or a combination of these. A clinician with expertise in perinatal mental health can help determine what treatment is most appropriate. For moderate to severe symptoms that interfere with daily functioning, medication may be an important part of treatment, and a referral to a perinatal psychiatric provider may be recommended. These providers have expertise in assessing the safety of psychiatric medications during pregnancy and breastfeeding.

When we think about it, it is not surprising that mental health concerns can occur during the perinatal period.

Bringing a baby into the world involves major physical, hormonal, and emotional changes. Add to that the birth process, caring for a newborn, sleep deprivation, the psychological transition to becoming a parent, and changes in relationships and family dynamics.

In some cases, people may also have had to contend with years of infertility and interventions to become pregnant, a traumatic birth, or a child born with medical needs requiring time in the NICU (neonatal intensive care unit). Many new parents are also isolated, with families of origin living in different parts of the country or world. That is why support is so important and ideally should be planned for before the baby arrives.

Support for new parents can include dropping off meals, running errands, helping with older children, or simply providing a few hours of practical help. Taking part in a new parent group can also be valuable, providing an opportunity to connect with others and normalize and address the stressors of having a new baby. Partners and family members can also play an important role by noticing changes, offering support, and helping a new parent connect with professional care when needed.

Perinatal mental health conditions are common, treatable, and not a sign that someone is a bad parent. Asking for help is a sign of strength, not failure.

If you or a loved one is pregnant, has recently given birth, or has questions or concerns about perinatal mental health, please see the resources below.

You can also reach out for free and confidential support to Gina Gallagher at the IPC, a certified perinatal mental health professional, at 857-303-9879 or ggallagher@ipcboston.org.