Postpartum and Breastfeeding

Perinatal Psychologist Dr Alyssa Berlin, Explains the Signs of the Most Common Maternal Mental Health Challenges

Dr. Alyssa Berlin

Perinatal Psychologist Dr Alyssa Berlin, Explains the Signs of the Most Common Maternal Mental Health Challenges

As a perinatal psychologist, I have had the pleasure of working with hundreds of women through one of the most transformative periods in life: motherhood. It’s a privilege to help them navigate fertility journeys and positive pregnancy tests as well as the ups and downs of pregnancy and the first few weeks after bringing home a baby. As a mother of four myself, I know firsthand that it’s not all rainbows and butterflies along the way. 

I remember when we were new parents, we sometimes wouldn’t eat dinner until after midnight to accommodate our oldest son’s sleep and feeding cycles! And I’d be remiss if I didn’t mention that this is the same son who we brought home from the hospital in a literal hand towel. My husband had been tasked with finding a swaddle, but when we started trying to wrap him unsuccessfully, the nurse had to let us know with a smile that we must’ve been mistakenly shopping in the bed and bath section. One of the most powerful approaches to the perinatal period (the time before, during, and after childbirth) is to identify that there will be challenges, and that these challenges can and should be conquered without feelings of shame or isolation.  

Did you know that for example, according to the CDC, 1 in 8 women experience postpartum depression, and 50% of them are untreated? You are not alone in the boundless joy you feel as a mother and you are certainly not alone in the dark emotional trenches in which we sometimes find ourselves. The best news? Maternal mental health disorders are very common and entirely treatable with early detection and a gentle, patient approach to healing.

Many times our maternal mental health challenges come fast and unexpectedly and they can be extremely overwhelming for mom and for those around her. Let’s talk about having multiples, or perhaps a newborn and 23 month old. It never crossed my mind until the situation was staring me down that I could be sent into a tailspin to have two kids who need two different things at the same time. One needed to be fed, the other needed to be put to bed, and it’s a stressful feeling that can’t be fully understood until you’re experiencing it yourself. It's then that we need to find ways to release the immense pressure we often create for ourselves and find solutions. But finding solutions amidst new mom chaos is nearly impossible when you’re struggling with your mental health. That’s why it’s important that we stay open to unexpected emotional challenges that may come up.

Mom might be completely surprised by the onset of unwanted symptoms she’s noticing in herself, even if she previously did her research and thought she might be immune. It’s crucial to recognize and address the signs of possible mood disorders early on to ensure the best possible outcome for both mom and baby. In a perfect world, we all would know what signs to look for and what behaviors may indicate a more serious condition. My offering here is to share with you the most common maternal mental health challenges that I have observed in my practice and to remind you that with early detection, significant improvement and positive outcomes can be achieved.

 Postpartum Depression (PPD)

 Postpartum depression is one of the most well known maternal mental health challenges. Affecting approximately 10-20% of new mothers, PPD goes beyond the "baby blues" which typically resolve within a couple of weeks after childbirth. PPD can last for months and significantly impair a mother's ability to care for herself and her baby.

What to look for:

  • Prolonged periods of sadness and crying episodes

  • Loss of interest in once enjoyed activities

  • Difficulty concentrating

  • Severe fatigue impacting daily function

  • Marked changes in eating and and sleeping habits

  • Difficulty bonding with baby

  • Guilt and shame surrounding the symptoms


Postpartum Anxiety (PPA)

While less frequently discussed and sometimes lumped into the PPD discussion, postpartum anxiety is just as prevalent as postpartum depression. New mothers may experience intense worry and fear that something bad will happen to their baby, leading to excessive checking, difficulty sleeping, and physical symptoms like heart palpitations.

What to look for:

  • Persistent worry

  • Racing thoughts

  • Inability to relax

  • Inability to allow anyone else to provide care for the child

  • Physical symptoms like nausea, dizziness or shortness of breath linked to the anxiety

    Postpartum Obsessive-Compulsive Disorder (OCD)

    Postpartum OCD involves intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that mothers feel driven to perform to reduce their anxiety. Common obsessions include fears of accidentally harming the baby, while compulsions might involve excessive cleaning or checking.

    What to look for:

    • Persistent unwanted thoughts, often linked to concerns about harm coming to the baby (obsessions)

    • Compulsive behaviors aimed at preventing said harm (compulsions)

    • Avoidance of certain activities due to fear about the child’s wellbeing


    Post-Traumatic Stress Disorder (PTSD)

     Traumatic pregnancy, labor, and delivery experiences can lead to PTSD in some mothers, and it can happen whether you give birth at home or in a hospital setting. This condition is characterized by flashbacks, nightmares, severe anxiety, and avoidance of anything related to the traumatic event.

    What to look for:

    • Re-living the traumatic event through nightmares or flashbacks

    • Avoiding any reminders of the trauma for fear of being triggered

    • Hypervigilance surrounding baby’s well being or their own

    • Emotional numbness

    • “Checked out” behavior

    • Physical symptoms of distress such as tremors and shaking, lack of appetite, hyperventilating, and increased heartbeat when thinking about the event(s)



    Perinatal Bipolar Disorder

    Perinatal bipolar disorder is characterized by extreme mood swings, from manic highs to depressive lows, occurring during pregnancy or postpartum. These mood swings can be unpredictable and may pose risks to both the mother and the baby.

    What to look for:

    • Periods of elevated mood followed by low mood

    • Increased energy and risky behavior (manic episodes)

    • Periods of feeling down and hopeless, having diminished energy, and self isolating (depressive episode) 

      Addressing the Challenges

      A good question to ask yourself when addressing all of these challenges is this: Does this behavior persist, worsen, and/or affect daily function and ability to care for myself and baby? If the answer is yes, it’s a great time to seek a referral from your primary care physician to a perinatal mental health specialist, or simply contact one directly.

      Common treatments may include:

      • Trauma-focused therapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Somatic Experiencing (SE)

      • Cognitive Behavioral Therapy (CBT) and other forms of talk therapy to help with day to day functioning

      • Prescribed medicine like mood stabilizers, particularly selective serotonin reuptake inhibitors (SSRIs)

      • Close monitoring by healthcare professionals

      • Psychoeducation for a deeper understanding

      • Regular meditation and breathwork

      • Specialized support groups and group therapy

      When in doubt, check it out. While the baby blues typically start 2 to 3 days after delivery and usually remit on their own in 2 to 3 weeks, if you are experiencing any of the symptoms I mentioned above, please seek professional help. There is no “waiting period” for identifying symptoms. Many of the mood disorders described above can also have comorbidities, meaning that mom may be presenting symptoms of multiple mood disorders, and that's OK. Every mom is unique and requires tailored treatment that fits her best. 

      As unique humans and new mothers, we suddenly have a new “mom” hat to wear, one that we have to balance with our other hats like “friend”, “teacher”, “bluegrass enthusiast”, or “fashionista”. It can be jarring to add a new and unfamiliar hat to your wardrobe. This identity crisis alone can easily push us into a challenging mental health space. So whatever the reason that you or someone you love has been showing signs of potential maternal mental health challenges, I’ll remind you of this again: these disorders are very common and entirely treatable with early detection and a gentle, patient approach to healing.

      Motherhood doesn’t come without its challenges, particularly when it comes to mental health. I have seen firsthand the profound impact that mental health challenges can have on new mothers, not to mention the people closest to them. By being able to recognize, understand, and address these challenges through support, therapy, and education, we can help mothers navigate this transformative period with resilience and hope. Seeking help is a sign of wisdom and strength, and no mother should have to face these challenges alone.

      *If you are struggling with your mental health please seek urgent support from your provider. Or you can call the The National Maternal Mental Health Hotline. Call or text 1-833-TLC-MAMA (1-833-852-6262).

      Disclaimer: Needed does not offer medical advice, diagnosis, or treatment. The information disseminated on this website or by Needed is not intended to replace medical advice. Before taking any action, it is crucial to consult with a healthcare professional

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      Dr. Alyssa Berlin, PsyD

      Dr. Alyssa Berlin is a clinical psychologist specializing in pregnancy, postpartum, and parenting. She offers private counseling for women individually and with their partners. She is the creator of The AfterBirth Plan™, a program that prepares couples for what to expect after a baby is born. The workshop teaches couples how to prepare for a healthy postpartum transition for the baby, for each partner, and for the evolving relationship.