Helping Women Navigate Postpartum Mental Health

Insights to use in creating a mental health birth plan.

Reviewed by Abigail Fagan

Key points

• Moms-to-be should discuss strategies for postpartum support with their partners and mental health providers.
• The absence of sleep in the postpartum period is a risk factor for postpartum mental health disorders.
• Postpartum depression and childbirth-related PTSD are common conditions that may missed or misdiagnosed.
• New moms may not disclose that they are struggling due to fear of separation from their infant.

Becoming a mother, like so many of life’s exalted experiences, is a study in contrasts: It may be the high point of a woman’s life, but much can go wrong in the postpartum period as well. A zone, in other words, ripe for mental health challenges. Psychology Today recently took aim at this space, leading a panel on postpartum mental health disorders at Psych Congress 2024.

The discussion was wide-ranging; disorders in the spotlight were postpartum depression (PPD) and childbirth-related post-traumatic stress disorder (CB-PTSD). Both are common and both can be missed or misdiagnosed. Important themes emerged that are relevant not just to mental health clinicians/medical professionals (the panelists and audience) but to all new mothers and those who support them. I moderated the panel and pulled together several recommendations and trends:

Create a Mental Health Birth Plan

Mothers-to-be have hospital “go” bags packed and birth directives ready months in advance. Yet how many women incorporate, or focus on, mental health considerations? Given that one in seven women experience postpartum depression in the year following childbirth, PPD—and conditions discussed below—should be on everyone’s radar.

“Even if someone is doing well, knowing that the postpartum period is coming is important. What is that going to look like? What is helpful support?” asked psychiatrist Melanie Barrett, who serves as president of The International Society of Reproductive Psychiatry. Dr. Barrett suggests that whenever possible, women have these conversations with their partner or other key individuals in their life. She urges women to have these conversations in the presence of their mental health provider if they are in active treatment/therapy during pregnancy.

Don’t Normalize Poor Sleep

Sleep is vital for new moms, even if the world tells them to forego it and accept chronic sleeplessness. While inevitable that sleep is fractured and fleeting for parents of newborns, it needs to be monitored; ongoing sleeplessness is both a risk factor for many disorders and a symptom of some disorders. “Poor sleep is the expectation, but it can go too far,” stresses reproductive psychiatrist Maithri Ameresekere, director of Women’s Mental Health at Boston Medical Center.

Additionally, being aware of risk factors for PPD and perinatal mood and anxiety disorders (PMADs) is important for clinicians and for women. Relatively well-known risk factors include a prior history of mental health disorders and prior sensitivity to hormonal changes. Indeed, sensitivity to hormonal changes throughout the menstrual cycle is a risk factor, as Dr. Ameresekere pointed out. Dr. Ameresekere also sees a strong correlation between lack of social support and postpartum struggles. Women who are victims of domestic violence and who struggle economically are particularly vulnerable to postpartum mental health challenges.

Women are largely unaware of the fact that a high-risk pregnancy or complicated medical delivery can predispose them to experience disorders such as PPD and childbirth-related PTSD. Dr. Francine Hughes, a physician who is board-certified in both maternal-fetal medicine and in obstetrics and gynecology, and who specializes in high-risk pregnancies at Massachusetts General Hospital, tries to prepare women as best possible when medical problems loom. She might state that the medical team wants delivery to be a beautiful experience, but in cases where there is risk for mom or baby, “these goals can conflict.”

It is important to stress that disorders can arise at any point during matrescence (the transition to motherhood), including during pregnancy, and that women with no risk factors can develop PPD. If left untreated, the resulting episode of depression can persist for years. This reality underscores the need for early detection and early treatment of PPD and other postpartum mental health challenges.

A Range of Postpartum Disorders Should Be on the Radar

Postpartum depression is the most common mental health condition that afflicts new mothers. Bipolar disorder and OCD can also flare up in the postpartum period. Childbirth-related post-traumatic stress disorder has emerged as an important new clinical focus, driven in large part by Dr. Sharon Dekel, Founding Director of the Postpartum Traumatic Stress Disorders Research Program at Massachusetts General Hospital.

Dr. Dekel shared that 20 to 40 percent of women who experience complicated medical deliveries go on to develop PTSD, often beginning during the birth episode itself or within hours of delivery. (Childbirth is classified as complicated or traumatic based on a woman’s subjective experience or based on electronic medical records that reflect a threat to the mother’s life during delivery.)

Vexingly, childbirth-related PTSD and PPD are highly comorbid: 90 percent of women with childbirth-related PTSD present with depressive symptoms. The two conditions can be hard to tease apart: Intrusive thoughts are a hallmark of both, for example. Dr. Dekel clarified that in cases of childbirth-related PTSD, intrusive thoughts and flashbacks are often tied to the delivery itself and are accompanied by hypervigilance, a symptom of PTSD.

Treatment and Research Are Better Than Ever. Awareness Needs to Follow

New, fast-acting pharmacotherapies have emerged to target PPD specifically. On the research front, Dr. Dekel’s lab is conducting fMRI studies to identify neural signatures for both PPD and PTSD. Such findings could help clarify whether and how the conditions differ, as well as whether depression and postpartum depression differ.

In short, there’s never been more cutting-edge treatment and research for women with postpartum mental health disorders. The challenge is connecting women in need with available treatment and encouraging them to seek help.

As is the case in many mental health conditions, stigma remains and assumes unique contours for postpartum women. New mothers may fear being separated from their infant if in-patient psychiatric care is needed. They may also fear that disclosing symptoms such as intrusive thoughts about harming the baby will result in the infant being removed from their care.

High-profile cases of postpartum psychosis and infanticide raise awareness of postpartum mental health disorders but may inadvertently desensitize women to the subtler ways in which postpartum depression can manifest. This reality could skew women’s perceptions of their own distress. “Patients may think that because they are not having actively suicidal thoughts, they do not have PPD, when from a diagnostic point, they clearly do,” points out Dr. Barrett.

While no woman wants to struggle in the aftermath of giving birth, those who do can be assured that there is more help available—and more awareness amongst clinicians—than ever before.

To find a therapist near you, consult the Psychology Today Therapy Directory.