Maternal Mental Health and Wellness Report

What we found

Research of women’s health issues is chronically underfunded – in both research dollars and venture capital investment. From underrepresentation of women in health studies, trivialization of women's physical complaints, and discrimination in awarding research grants, gender bias has been an ongoing issue in healthcare.

Maternal mental health is no exception and women and their families are suffering as a result. Alarmingly, mental health issues are the most common complication of pregnancy and childbirth, but support is severely lacking.

The unique demands of the perinatal stage

The perinatal stage is a uniquely demanding time in a woman’s life. While maternal mental health struggles are often reduced to postpartum depression, the reality is a much bigger picture that impacts women in a number of different ways at all stages of motherhood.

“There is an abrupt drop in estrogen and progesterone and an increased incidence of abnormal thyroid function following childbirth. These hormonal factors can result in postpartum mood changes. Deficiencies in omega-3, vitamin B6, Vitamin D, Zinc, and Selenium are also implicated in postpartum mood disorders. Providers should consistently check labs during and after pregnancy. I recommend moms continue on their prenatal vitamin and omega-3 postpartum to replenish nutrient levels.” Dr. Phabillia Afflack, MD

While existing data reports that 20% of women experience some type of perinatal mood and anxiety disorder (PMAD), our data suggests that this number is significantly understated.

63% of women reported they’ve struggled with mental health in the perinatal stage.

Maternal mental health is so much more than postpartum depression

The source of the discrepancy may be that mental health struggles extend beyond diagnosed PMADs, which typically include conditions focused around the postpartum phase - postpartum depression, postpartum anxiety, postpartum obsessive compulsive disorder, postpartum bipolar, and postpartum psychosis.

Instead, mental health struggles can show up in a number of ways and throughout all stages, from preconception through postpartum and beyond.

Contributing factors: Hormonal changes and more

The perinatal stages - before, during, and after pregnancy are marked by significant hormonal shifts. These physiological and hormonal changes contribute to various aspects of a woman’s mental health.

Hormonal changes before pregnancy can be influenced by a woman discontinuing birth control or taking hormone supplements in preparation for fertility treatments.

A woman produces more estrogen during a single pregnancy than she does throughout the entire rest of her life when not pregnant. Estrogen is active throughout the body, including in the region of the brain that regulates mood. Progesterone can cause fatigue, sluggishness, and even sadness.

Just after delivery, levels of estrogen and progesterone plummet. Levels of various hormones fluctuate throughout postpartum in response to stress, sleep, breastfeeding demands, and the return of menstrual cycles. Hormones impacted during the postpartum phase that affect mental health include estradiol, progesterone, oxytocin, cortisol, and thyroid hormones.

"In the midst of the joy and chaos of motherhood, moms may feel a wide range of emotions. It is crucial to recognize when these emotions may signal a more serious issue, such as if they are interfering with daily life. This includes more than prolonged sadness or depression. It includes the loneliness and isolation, the loss of interest in activities once enjoyed, loss of appetite and/or sleep disturbances, hopelessness, persistent anxiety and catastrophic thoughts. There are various presentations of mood and anxiety disorders that so easily evade the standard perinatal screenings currently in place to catch us.” - Lauren Hays, Psychiatric Mental Health Nurse Practitioner

Data shows that “reproductive hormones are known to modulate behavioral, emotional and cognitive response, therefore rapid changes during pregnancy and labor create a vulnerable terrain leading towards postpartum disorders.”

Here are the factors that negatively impacted the mental health of respondents. The percentages reflect the percent of total respondents who identified with each of these factors. Our survey prompted respondents to select all that apply:

These factors all impact the internal dialogue of women. Fifty-five percent of women reported experiencing more negative self talk or self criticism than they did prior to the perinatal stage.

The physical changes that come with the perinatal stages are normal and natural as the body changes to accommodate and support a growing child. But for many women, these changes come with unique mental health challenges.

“Pregnancy-induced weight gain and body changes often lead to mental health challenges, including negative self-talk, self-criticism, and feelings of inadequacy. The societal pressure for a 'perfect' pregnancy body, amplified by unrealistic social media depictions, can exacerbate these emotional struggles. These pressures continue postpartum, with societal and media expectations for a swift return to pre-pregnancy bodies, intensifying body image issues. These unrealistic expectations can increase stress around food and negative emotions related to weight gain. However, it's crucial to remember that these feelings are normal and valid, and seeking support from healthcare providers, therapists, or support groups is vital for managing these challenges and maintaining a positive self-image. Prioritizing self-care, positive body image messages, and connection with others experiencing similar challenges can also aid in navigating this transformative stage.” - Dr. Alyssa Berlin, PsyD

The impact of social media

Social media may be the biggest contributor to these feelings, with 44% of women reporting increased feelings of inadequacy as a result of social media usage during the perinatal stage.

Many women take to social media during the perinatal stage in search of advice, community, connection, or simply a way to pass the time while breastfeeding or rocking a baby to sleep. In fact, 89% of respondents report on average spending more than an hour per day on social media, and more than half reported spending more than two hours per day on social media.

But social media can feed a host of mental health struggles:

Maternal mental health challenges can start before conception

Maternal mental health challenges can happen at all stages of the journey, including during prior to conception. In fact fertility issues are a major source of stress and anxiety for many women

Here’s how women reported their lives were impacted by fertility issues:

More support is needed

It’s clear that mental health issues are commonplace throughout the perinatal stage, with a number of factors contributing, from hormonal changes to lifestyle shifts and the unrealistic perceptions that come with social media use. Some support exists, but it’s not enough.

The American College of Obstetricians and Gynecologists (ACOG) recommends screening for PPD and anxiety at least once during the perinatal period, and once during the comprehensive postpartum visit, but it isn’t a requirement.

Only 68% of women reported that their practitioner screened for perinatal depression or anxiety during and after pregnancy. Even if women are screened, 54% of women reported that they needed more mental health support than they received during the perinatal stage, which indicates that screening alone isn’t cutting it.

A mother’s struggles are disregarded not supported

It doesn’t help that society has taken to trivializing some of these feelings, from lack of sleep to “mommy brain”. The reality is that these factors take a serious toll on a mother’s mental health. When a woman is made to feel like all women struggle, or that struggle is just part of the journey, they may downplay the seriousness of their mental health and put off seeking support. In fact, over half (56%) of respondents who reported that they did not seek out support shared that they abstained from doing so because they believed that their symptoms were not serious enough.

Estimates are that 7 in 10 women hide or downplay their symptoms. Without understanding, support, and treatment these mental illnesses have a devastating impact on the women affected and on their partners and families.

Women will talk about mental health more than they will seek support

Mental health often comes with a stigma, and sometimes people aren’t willing to share their struggles, even with those closest to them. Our survey found that 74% of respondents felt comfortable discussing their perinatal mental health with those closest to them.

But even though 63% of women said they struggled with mental health, only 52% actively sought support.

But even though 63% of women said they struggled with mental health, only 52% actively sought support. Those who did not seek out mental health support cited the following:

Conclusion

Resources

Methodology

This report is based on proprietary data gathered and analyzed by Needed. For the purpose of this report, Needed surveyed more than 2,000 people in April 2023 to inform our understanding of perinatal mental health and women’s lived experiences.

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