When you learn about the significant hormone changes that happen during and after pregnancy, it’s no wonder you may end up feeling less like yourself at times following these shifts.

It’s not only your changing hormones that can leave you vulnerable to dips in your mood after pregnancy though. A new baby is a challenging experience for all. A lack of sleep, loss of routine, added financial pressures and changes in responsibilities, are just some of the factors that get added into the mix following the birth of your baby.

While most people have heard of postpartum depression, there are actually several other types of mental health issues that can arise during the perinatal period. This period includes all of pregnancy, and up to a year after you give birth. Perinatal mental illness is a term used to describe any related mental health condition that stems from (or is made worse by) being pregnant, or in the first year of your child’s life.

Conditions include:

  • adjustment disorders and distress
  • perinatal obsessive compulsive disorder (OCD)
  • perinatal anxiety
  • perinatal post traumatic stress disorder (PTSD)
  • post-partum depression
  • post-partum psychosis

Whether you want to support a loved one prepare for the challenges of pregnancy, get help in the thick of it, or understand more about your past experiences, learning about mental health, hormones and pregnancy is helpful for everyone. Most moms have a hard time talking about difficult feelings surrounding the birth of their new baby, and as a result, may not ask for the help that they need. It’s crucial to get the right support at the right time, as perinatal mental health problems can be serious. There is effective treatment available which will greatly improve the outlook for mom, baby and the whole family.

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The transition to parenthood, according to developmental scientists, is one of the biggest internal reorganizations you will ever encounter. It literally changes your brain, your hormone (endocrine) system, your identity, your behavior, and your relationships.

Without good support the birth of a baby can push anyone to the brink. So it’s normal to feel overwhelmed, worried, stressed, exhausted, isolated, and like you have no clue what you’re doing! This goes for the parent that gave birth and any other parent too.

Around 80% of new mom’s will experience ‘baby blues’, which describes a common but short period of time where you feel low in mood and more tearful. This is linked to the huge hormone changes that happen in the first 2 weeks after you give birth.

There’s a lot to learn about your new baby and this can take time, as can getting used to the changes that have happened in your body. Most parents find things tend to get better and a little easier with every month that passes.

For some people though, pregnancy and the first year after their baby is born is an extremely challenging and upsetting time, in which you may experience psychological distress. This may be for the first time in your life, or as a recurrence of a previous mental health concern.

If a woman has pre-existing bipolar disorder, there is a particularly high risk that there may be a recurrence or a worsening of this condition during pregnancy, or in the first year after the birth of a baby. Partners, relatives and any services involved, should be mindful of this.

How common is perinatal mental illness?

Although any type of perinatal mental illness can happen during pregnancy, it’s more common for issues to arise after the birth of your baby. It’s estimated that around 1 in 5 women will experience some kind of perinatal mental illness (PNMI) and, 1 in 10 male partners may also experience PNMI. Although, far less is known about PNMI in men and further research is needed.

Sadly, only around 50% of people suffering with PNMI talk to anyone about it or seek any form of support or medical treatment.

There is still a lot of stigma surrounding asking for help with mental health generally and this increases when it comes to new moms seeking support. This largely stems from fear about how they will be perceived and judged by others (including their partner). Many worry that their baby will be taken away, so it’s very common for them to not discuss or disclose how they’re really feeling.

Here’s a brief summary of the main types of PNMI. These are listed in order of how common they are:

Adjustment disorders and distress

This is a general term used to describe a few different types of mental health conditions, but generally it’s used to refer to changes that happen as a result of a specific trigger within a 3-month time period. In this case, the trigger may be becoming pregnant (around 45% of all pregnancies are not planned), worries about the birth, difficulties at or after birth, or problems bonding with your baby.

Adjustment disorders are estimated to affect up to 30% of new moms, and as with all the other types of PNMI, it can affect the way you respond to your baby and the bond you feel.

Did you know, only 40% of new moms experience that feeling of ‘falling in love’ straight away with their baby. More often, feelings of love and attachment develop over the coming weeks and months.

Perinatal obsessive compulsive disorder (OCD)

This type of PNMI is actually more common than postpartum depression but is talked about less. OCD can affect up to 25% of parents.

Closely linked with anxiety, OCD can involve having recurrent, intrusive thoughts that are unsettling. Some examples of these may be:

  • thoughts of accidental or intentional harm to your baby
  • irrational fears (someone has hurt my baby, my baby hates me)
  • not letting others hold or look after your baby because of fear something will happen
  • repeated bottle washing or other sanitary measures
  • certain phrases getting stuck on a loop in your head (this could be something someone has said about your parenting or baby)
  • intense feelings of guilt or feeling like you’re a bad parent
  • recurring images flashing in your mind
  • urges to do strange things that are out of character for you.

More than 50% of new moms experience thoughts of deliberately causing harm to their baby.

Does that shock you?

If you’re honest, it probably does, and that is why women rarely share these types of thoughts and feelings with their partner, loved ones, or health or social care professionals.

3% of birthing parents have repeated, intrusive thoughts that start to interfere with their life and looking after their baby. It might be thoughts of falling down the stairs while carrying the baby, so they stop using the stairs, or thoughts about pushing the stroller into oncoming traffic, so they stop going out.

Despite how common these distressing thoughts are, less than 1% of the people who have them, act on them.

Health professionals working with moms and babies know that even if a mom admits to these thoughts, the risk to a child is very low and their primary focus is to help mom feel better as soon as possible.

For severe cases of perinatal OCD (and other severe types of PNMI as well), specialist help includes in-patient units where moms can receive the specialist help they need for their mental health.  However, most women dealing with perinatal OCD are treated in outpatient settings Either way, help, support, and treatment are available. 


Many new mothers experience anxious thoughts about the health and development of their baby along with worries about the impact having a child has had or will have on their relationship or life in general. This is entirely normal. However, anxiety can become debilitating and may be more of a problem when:

  • you feel nervous or on edge most of the time
  • you are irritable a lot of the time
  • you get frequent headaches
  • your appetite changes
  • you can’t sleep even when the baby is sleeping soundly
  • you may have chest palpitations or feel like you can’t breathe (this could indicate a panic attack)
    you feel the need to visit the doctor more frequently about different health concerns for both you or the baby
  • you no longer go out with your baby due to fear or anxiety.

This type of more intense anxiety can affect 10-15% of new moms and it may also coincide with intrusive thoughts and OCD.

Perinatal PTSD

This is a specific kind of post-traumatic stress that stems from either the pregnancy itself, or your experiences during labor and delivery. However, someone with pre-existing PTSD could experience worsening of this condition after a traumatic birth.  Perinatal PTSD is estimated to affect around 3-9% of new moms or birthing parents.

Symptoms are similar to other types of PTSD, and it might involve:

  • distressing and vivid thoughts about the birth
  • reliving labor and delivery scenes in your mind. There may be instances where it feels like you are living through it again. These episodes are sometimes called ‘flashbacks’.
  • being hypervigilant to any triggers or perceived threats
  • finding it hard to concentrate
  • being easily upset or angry
  • feeling nauseous
  • feeling panicky
  • feeling sweaty and trembling, especially when reminded of the trauma you have been through
  • others may not particularly notice any of these signs and moms often struggle to communicate what’s going on for them.

It’s important to mention that PTSD can happen after what labor and delivery staff may consider a straightforward, non-traumatic birth. It’s about how the experiences are perceived by the birthing parent – and this can often be very different to what others see.

Many women find they are unprepared for birth. There are lots of reasons for this. You may not have access to the classes that can help to support you. Or, it may be less common in your family or community to discuss what happens during labor. Whatever the reason, it can mean when women do go into labor, they experience and go into a state of shock and are traumatized from the event. There is support available. If you feel that you, or someone you love may be experiencing PTSD following the birth of their baby, take a look at these websites.

Postpartum depression (PPD)

While the ‘baby blues’ may be a normal experience for the majority of women after birth, it’s usually short lived, lasting for around 2-3 weeks. If feelings of low mood persist for longer however, you may be struggling with a condition called postpartum depression (PPD).

PPD might look like:

  • apathy and lethargy (feeling tired or unmotivated)
  • a loss of pleasure in the things you usually enjoy
  • crying a lot
  • waking up early in the mornings or feeling unable to sleep
  • changes to your appetite and weight
  • feelings of guilt (particularly around your parenting)
  • agitation (feeling restless or like you can’t sit still)
  • loss of interest in sex
  • low self care
  • or, everything could look absolutely ‘normal’ to others from the outside.

Mild to moderate PPD affects 10-15% of new moms, so it’s actually quite common.

3% of new moms will have a more severe PPD and this will impact the relationship they have with their baby, their partner, and how they function on a day-to-day basis.

Women with moderate or severe PPD often need help and treatment from health care professionals. Treatment could involve talking therapies, medication, peer support and greater assistance from family and friends.

Postpartum Psychosis (PPP)/Perinatal Psychosis (PP)

Postpartum psychosis is a serious mental health condition that requires urgent medical support.

PPP is the least common type of PNMI, but is also the most severe and sudden when it occurs. It affects only 0.2% of birthing moms (2 in every 1000 new births), though the risk goes up to 30% in those with pre-existing bipolar disorder.

It can happen at any time in the perinatal period, but mostly occurs in the first 5 weeks after birth. Women are at the highest level of risk for PPP in the first week after birth. PPP often presents as feelings of extreme concern about the state of the world your child has been born into. In the most serious of cases, moms can end up harming themselves or their child out of fear for their safety and their future. This sadly may feel like the only option.

For 60% of those that experience PPP, this will be the first mental health diagnosis they have had.

Signs and symptoms of PPP are:

  • Sudden changes in behavior and acting out of character
  • Depression
  • Hallucinations
  • Confusion
  • Loss of insight into the realities of a situation
  • Feeling manic (high)
  • Having thoughts of ending your life
  • Strange behavior
  • Being or feeling absent from your baby
  • Concern from relatives or friends about your behavior
  • Decreased need or ability to sleep: disorganization

If your loved one is showing signs of PPP, it’s important to get urgent assessment and treatment for them as soon as possible. They may not realize there’s anything wrong with them or that they need help.

Hallucinations can feel very real to a person experiencing them, and they may not realize they are detached from reality.

A very sad statistic is that 20% of postpartum deaths are due to a person ending their own life and it is one of the leading causes of maternal deaths in the US.

The good news is that with the right help at the right time, perinatal mental illness can get better, minimizing any negative outcomes for both the mother and child in the future.

As with many mental health conditions, factors that can make a positive difference are:

  • support from loved ones
  • reducing stress
  • getting enough sleep and rest
  • eating well
  • keeping active and getting outside in nature
  • psychological therapies
  • medications such as antidepressants if they are needed.

It can also be really helpful to link up with other women who have been through PNMI to understand that you are not alone, and to remind you that life for you and your little one will get better with the right support.

Postpartum Support International is a useful site to explore to learn more about support that is available along with inpatient and outpatient programs.

PNMI is more common than people think. One of the biggest issues women face when it comes to accessing support, is a fear of judgement. Getting comfortable talking about these issues can be challenging, but it’s important we all try to create safe and supportive spaces where women can feel less alone.

Head over to our Hormone Allies section to share your story.