Mental health is a part of whole health, even during pregnancy. While parts of a pregnancy may spark joy and immense gratitude, some triggers can surface or exacerbate mental health conditions.
Everything from family history to past personal history with mental health conditions could make an individual more likely to experience perinatal mental conditions, explains Dr. Meggie Smith, Attending Physician at Nashville Fertility Center.
According to studies, it’s 1 in 5 birthing individuals who will be diagnosed with perinatal mental health conditions during pregnancy.
Dr. Sarah Oreck, MS, Reproductive psychiatrist and the CEO and co-founder of maternal mental health platform Mavida Health, adds:
“Women of color face an increased risk of perinatal mood and anxiety disorders (PMADs) due to racial biases in the healthcare system. Additionally, while research on queer and trans birthing individuals is limited, available evidence suggests that these groups experience higher rates of PMADs.”
What are perinatal mental health conditions, and when can they show up?
The American College of Obstetricians and Gynecologists defines perinatal mental health as conditions or disorders that present in an individual’s life during pregnancy and up to two years after childbirth.
“Patients can be affected by anxiety, depression, and other mental health issues at any part of their journey into parenthood,” explains Dr. Smith. “We can see it when patients are trying to conceive and unable to, are in the first trimester and have experienced miscarriage, have health/medical anxiety, and pregnancy comes with a lot of healthcare encounters, etcetera.”
For Brianne R, a new mom of one, it was her early pregnancy that triggered some of her mental health conditions the most.
“I had probably middle-of-the-range symptoms,” explains Brianne, who has a history of mental health conditions before pregnancy. “They were somewhat manageable but definitely incredibly unpleasant and left me very quickly feeling like I couldn't do much of what I used to do to manage my mental health. I felt that I had very little control over my own body.”
Ali P. also felt sensitive to her changing body and how those changes impacted her mental health.
“I've been struggling with OCD and anxiety since the moment I got a positive pregnancy test,” explains Ali P. “I was diagnosed with OCD about five years ago and had been doing really well with a combination of medication and talk therapy, but pregnancy has really heightened my symptoms. I became obsessive over every sensation in my body (which is very many during early pregnancy!), would spend hours googling to try and know for 100% certain if I was ok or having a miscarriage, and was an anxious mess before any testing or ultrasounds. Even when the doctor would reassure me that things were normal, I was struggling to believe that something wasn't seriously wrong and they were just missing it.”
Because early pregnancy can be especially triggering, Dr. Oreck recommends that both women and their friends and family take an active approach to identifying any red flags that may surface.
According to Dr. Oreck, some of these potential symptoms include “persistent sadness or mood swings, loss of interest in usual activities or the newborn, excessive worry or anxiety about parenting, severe irritability or anger, sleep disturbances, cognitive impairments like trouble focusing or making decisions, feelings of worthlessness or guilt about parenting, social withdrawal, and unexplained physical symptoms such as aches or extreme fatigue.”
How to manage the isolation and triggers of early pregnancy
Both women in this piece turned to their support systems once they identified their mental health struggles, but most importantly, they created a support system that made sense for them.
“Early pregnancy felt very isolating,” explains Brianne. “There's the whole dynamic of whether to reveal your pregnancy early on, to how large of a circle of people you want to reveal it, how to hide it from those you don't want to tell. You're experiencing one of the most jarring physical and mental experiences, and yet you often are doing so in secrecy.”
So, in addition to turning to “Sour Patch Kids and Shake Shack,” Brianne explains she curated a group of friends she knew had walked similar paths before her.
“I decided early on that I would be very open with a small circle of friends, specifically those who had recently experienced or were currently experiencing pregnancy and postpartum. While I wasn't interested in having the entire world know I was pregnant early on, I pushed back on the notion that no one should. Especially having experienced a previous miscarriage and a long process to conceive, I knew I'd need others to rely on if anything happened with the pregnancy.”
Hannah Hewes-Clark, LCSW and therapist at Mavida Health, adds:
“Treating yourself with a lot of kindness and compassion is big,” encourages Hewes-Clark. “Dealing with mental health struggles during this time can be scary, but remembering that they are not a reflection of who you are as a person or parent, is a great starting point for finding the supports that will help you along the way.”
How a therapist and psychiatrist can support perinatal mental health
Women who are pregnant and struggling with their mental health can seek support from therapists, but also from psychiatrists and certain medications.
“I recommend that they consult with someone specialized in prescribing during the perinatal period (like all of the providers at Mavida Health),” explains Dr. Oreck. “The choice of medication involves careful evaluation of the benefits against potential risks to both mother and fetus. It's crucial for women to consult with a healthcare provider who specializes in reproductive psychiatry to ensure safe and effective treatment.”
Both Ali and Brianne sought out a care team who were versed in a mix of talk therapy and prescribing to pregnant individuals.
“My therapist recommended I reach out to my psychiatrist to ask about increasing my dose of SSRIs,” explains Ali P. “At first, I was hesitant because I was worried increasing my dose would impact the fetus, but ultimately, I knew I needed something additional to be able to cope. My psychiatrist was able to increase my dose and refer me to a peri/postnatal psychiatrist to make sure I wasn't doing anything that could harm the fetus (which I found very reassuring!). I also told my OB that my OCD had gotten really bad, and she booked me for a visit with a high-risk OB in her practice to make sure I was on the best meds for both myself and the fetus.”
As much as possible, open communication with yourself and your care team can help you find personalized coping techniques for you, your health, and your pregnancy journey.
“It's real and normal to both love your baby and truly want a successful and healthy pregnancy while at the same time not enjoying the process and the day-to-day experience,” explains Brianne. “Especially after a long conception journey and very much wanting to become a parent, I felt a lot of guilt that I wasn't enjoying every moment. Did I really want this like I thought I did? The answer is yes, absolutely. But those two feelings can exist at the same time. Hearing this from others who had experienced the same dichotomy helped me a lot.”
Vivian Nunez is a writer, content creator, and host of Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.