OPINION: When it’s more than just the ‘baby blues’

Perinatal mood and anxiety disorder is more than the baby blues. It affects 1 in 7 women.
Perinatal mood and anxiety disorder is more than the baby blues. It affects 1 in 7 women.

Perinatal mental health, the largest obstetric complication, affects 1 in 7 women

In this guest column, Laura Baldwin, a therapist with specialized training in perinatal mental health, writes about the need for more awareness on the complexities of that portion of pregnancy and the postpartum period, specifically why therapists and medical providers should seek training opportunities for treating perinatal mood and anxiety disorder, use screening tools in their practices and provide referrals to perinatal therapists.


When a woman becomes pregnant and has a baby, it is supposed to be a happy time. We have our baby shower, make plans for the nursery, expect a magical birth, and imagine an instant bond or connection when we meet our baby for the first time. Women are expected to be a “super mom” who can have their baby, run a household, and work full time. We look on social media and we see this perfect mother standard in the various posts. They make birth, breastfeeding, and taking care of an infant look easy.

So why is it that 1 in 7 women have a perinatal mood and anxiety disorder (PMAD)? Why is it that this is often the most underdiagnosed complication of birth? Research shows that this is the No. 1 obstetric complication for women.

Sadly, because it is underdiagnosed, women often go untreated. Even more difficult to comprehend, if a woman experiences a perinatal mood and anxiety disorder, her baby may experience adverse childhood outcomes related to emotional and behavioral issues in the future.

The difficulties of pregnancy and postpartum are not often talked about in society, so women feel ashamed to bring it up to their medical provider, or even their therapist.

When women become pregnant, there are many new causes for anxieties that appear, such as miscarriage, pregnancy complications, genetic testing, or unanticipated changes to the prenatal care or birth plan. Once she has the baby, there can be difficulties with breastfeeding, little support, mood changes, poor sleep, scary anxiety-based thoughts, and shame.

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During the first 2-3 weeks postpartum, 60-80% of women experience what we call the “baby blues.” This is normal and resolves easily without medical intervention. Usually women experience tearfulness, irritability, mood swings, and feel overwhelmed during this period.

Is this more than the ‘Baby Blues?’

When talking about red flag symptoms, women I’ve worked with often say things like:

“I am not a good mom.”

“I feel like I have no control over how I am feeling.”

“I will always feel this way.”

“I am powerless over how I feel.”

“I sometimes wonder why I had a baby.”

Some red flag symptoms to look for during postpartum are significant changes in appetite, rest that does not restore with sleep, inability to sleep, intense mood changes, intense irritability, scary intrusive thoughts, ruminating thoughts, obsessions, feelings of inadequacy, panic, hallucinations, delusions, or suicidal thoughts.

We often hear about women experiencing depression after having a baby. However, there is so much more that can happen during the perinatal period, ranging from perinatal generalized anxiety disorder to perinatal psychosis.

Unfortunately, there is a lack of awareness about perinatal mental health. Many mental health professionals do not even know what the word “perinatal” means. Perinatal mental health is not often part of graduate programs for therapists.

We intuitively understand that women can have mental health concerns during pregnancy or postpartum. However, there are many nightmare scenarios that women express going to a mental health professional who is not trained in perinatal mental health, which may lead the mom to feel dismissed and unheard.

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Further, this pattern of poor education about PMAD continues in the medical field. Some providers do a good job of screening for PMAD, but many medical providers also tell a woman, “this is normal,” or don’t understand the difference between baby blues and true PMAD due to lack of education and training.

Mental health programs and medical programs need to have a baseline education on screening, assessment and treatment options for PMAD versus baby blues. For example, institutions like the University of Texas at Austin – The School of Social Work MSSW program has implemented training for PMAD.

How can we improve screening?

Typically, a woman will have one or more postpartum visits with her medical provider in her postpartum journey. This makes it difficult to identify whether she is struggling. The visit(s) may be short, creating a barrier to opening up about her mental health. If the provider is not focused on asking the right questions and providing a safe space for a woman to open up, she may feel too ashamed to bring up how badly she feels.

There are many screening tools that can be used by a medical provider to initiate a conversation about perinatal mental health. These screening tools can be completed in the waiting room, prior to the appointment. The medical provider can then use the answers to create a discussion around symptoms she has noted on the screening tool. When red flag symptoms are disclosed, it’s important for the provider to refer to a local therapist.

It’s not just obstetricians and midwives that need to think about screening for perinatal mental health. Pediatricians, family doctors and primary care doctors, all need to begin to implement this into their practice and have referrals on hand for moms.

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Perinatal mood and anxiety disorders are highly treatable. Better screening and prompt diagnosis are vital first steps in feeling better.

Individual therapy, support groups, psychiatric treatment, and medication management are typical approaches that are highly effective for PMAD.

Therapy interventions such as cognitive behavioral therapy and interpersonal therapy are both effective and research-based interventions for PMAD. Support groups can be very effective ways of normalizing and validating experiences for women by providing a place to connect with other women feeling the same way. Knowing that other women feel the same helps a woman know that she is not alone.

Want to find out more? Try these resources.

The easiest way to find a therapist that is trained in this specialization is the Postpartum Support International directory. Therapists listed there have gone through a specialized training program and have a minimum level of competence to specialize in this type of work. To find out more information, go to: https://www.postpartum.net/get-help/provider-directory/.

Postpartum Support International also offers free online support groups. For local support groups or therapists trained in PMAD in your community, you can call or text PSI’s HelpLine at 1-800-944-4773.

Laura Baldwin , LCSW, PMH-C, provides therapy for pregnant and postpartum women at her practice in Atlanta and volunteers as the Georgia Lead Support Coordinator for Postpartum Support International’s Georgia Chapter. To learn more about Laura, visit her website at laurabaldwincounseling.com.

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