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Pregnancy and childbirth are often beautiful, life-altering experiences. But many new parents are nurturing new life while also experiencing anxiety and/or depression.
I’ve seen this dynamic play out firsthand in my work as a therapist who specializes in perinatal mental health.
What was once only described as postpartum depression, is now referred to as perinatal mood and anxiety disorders (PMADs), is the most common childbirth related complication in the U.S. It also affects between 5% and 60% of people worldwide.
This shift in language is an acknowledgement that there are a spectrum of mental health-related challenges that can occur during the perinatal period.
One in five mothers experience a PMAD and one in ten fathers face similar mental health challenges in the postpartum period.
A large percentage of employees are in their childbearing years, which means many of your employees may be struggling with a perinatal mood or anxiety disorder.
What are perinatal mood and anxiety disorders?
New parents can experience perinatal or postpartum mental health challenges during pregnancy, and up to 12 months after the end of a pregnancy—whether or not the pregnancy ends in a live birth.
Historically, any type of mood disorder associated with pregnancy was called postpartum depression. Now, we’re able to make some distinctions about these challenges and what they represent for people’s lived experiences.
Many people are familiar with the baby blues, which affect up to 85% of mothers or birthing parents after the end of a pregnancy. For the first two weeks postpartum, a birthing parent’s body undergoes significant physiological changes, including hormonal fluctuations, heightened emotions, and healing from birth.
Symptoms of the baby blues include:
- Crying a lot
These symptoms generally improve on their own in a couple of weeks as hormones stabilize. If the baby blues don’t abate within the first two weeks or so after the pregnancy ends, it may be a sign that the person is experiencing a perinatal mood or anxiety disorder.
The spectrum of postpartum disorders includes (but is not limited to) depression, anxiety, and rarely, psychosis.
Postpartum depression usually begins one to three weeks after a pregnancy has ended but can occur up to a year after birth. Symptoms may include:
- Mood swings or intense sadness
- Crying more often than normal
- Difficulty bonding with the baby or feeling overly attached
- Feelings of hopelessness
- Feeling overwhelmed and difficulty concentrating
- Insomnia, or mental and physical exhaustion that doesn’t abate
- Sleeping too much
Postpartum anxiety, although often overlapping with postpartum depression, has its own unique symptoms, including:
- Intrusive thoughts
- Difficulty concentrating
- Feeling tired but wired
- Overattachment to the baby
Many of the symptoms of postpartum depression and anxiety are things all new parents experience, to a certain degree. So when should someone seek help? The simple answer is: one should seek help when they start asking themselves if they need help.
It’s important not to conflate the common forms of perinatal disorders with postpartum psychosis. Postpartum psychosis is often brought to public awareness in sensationalized news stories, where a parent who has recently given birth experiences psychosis and may hurt themselves or their children.
This leads to a dynamic where PMADs are equated with psychosis, worsening stigma. Most people experiencing a postpartum disorder are not psychotic. To differentiate, the symptoms of postpartum psychosis include:
- Hallucinations or delusions
- Cognitive impairment
- Disorganized behavior
Although postpartum psychosis is a very serious mental health condition and should be treated as an emergency, this condition is extremely rare. Postpartum psychosis affects between 0.089 and 2.6 out of every 1,000 births.
Most birthing parents with postpartum psychosis do not cause harm, and in the majority of cases, it’s a treatable condition. One study shows that 98% of those with postpartum psychosis got better with treatment.
Stigma keeps people from seeking help
In my therapy practice, I see a lot of new parents struggling with feelings of shame, often due to the heavy societal expectations around parenting. Some common things I hear from new parents are:
“I’m not doing this whole parenting thing right.”
“I should be able to do this all on my own.”
“Why can’t I handle this?”
“This is supposed to be the best time of my life. Why am I struggling or unhappy?”
It’s really difficult for new parents to admit that they’re not okay, they’re struggling, and they need help. They feel as if they don’t measure up or are failing at parenthood.
We have to normalize the idea that new parents are going to struggle, and it’s completely okay for them to seek help. The more we de-stigmatize postpartum mental health challenges, the better we are able to address them through prevention, treatment, and workplace support.
One of the big challenges in addressing PMADs, especially in the U.S. where I practice, is that we put so much emphasis on the pregnancy period and very little on care and treatment postpartum.
It’s common for a person to have monthly appointments with an OB/GYN or midwife during the pregnancy, which become bi-weekly or weekly as the pregnancy gets closer to the end. After the pregnancy ends, that person usually has one appointment—often just a quick 10-minute follow up to check physical healing.
This isn’t adequate care. We need a massive shift in how we treat people after a pregnancy has ended, including:
- Regular visits to a postpartum therapist, postpartum doula, or midwife
- An extended postpartum care plan that goes beyond the first few weeks
- Helping to build support systems before the birth
We should be talking to new parents about what it’s going to look like to have a baby.
Not simply how do you care for a baby—although that is important—but how life is going to change for the parent or parents, and how they can care for themselves and their mental health needs. This should also include how they’re going to transition back to work.
Supporting new parents at work
Workplace leaders—especially HR leaders and supervisors—are in a great position to notice when an employee might be struggling with a PMAD, and help them get support and treatment.
Let’s talk about some ways new parents can be supported at work.
Paid parental leave for both partners
In my therapy practice, I often work with people who have recently given birth and are returning to their job earlier than they might have hoped.
They’re still adjusting to the massive change of giving birth and then caring for a newborn, and are back at work before they feel ready because of a lack of parental leave.
Every aspect of someone’s daily life is profoundly different after having a baby. Giving new parents time to adapt to these changes before adding the stress of work is really important for their mental health and wellbeing.
Often, the non-birthing partner has no parental leave at all, leaving one person to do most of the caregiving work completely alone.
Making mental healthcare more accessible for employees
Mental health support, including access to providers who specialize in pregnancy and postpartum issues, is an important component of preventing and treating PMADs.
In concert with providing employees with mental health benefits, they must be able to actually utilize those benefits.
Although time off may sometimes be difficult to integrate into a busy workplace, allowing new parents to struggle without support can lead to much more serious mental health issues.
Preventing those issues in the first place is better for both employees and employers.
Put a return-to-work plan in place
In collaboration with the employee, workplace leaders can create a plan for transitioning the new parent back to work, and have support systems in place for this transition period.
The plan might include flex time, work-from-home options, gradual return, peer support, and one-on-one meetings with a supervisor to ensure the employee is getting the support they need.
It might also include practical concerns, like having a designated lactation space available.
Checking in with new parents
If any leader notices an employee is struggling after becoming a new parent, start a conversation with curiosity and empathy. Ask simple, open-ended questions like:
- “How are you doing?”
- “I know you have a new baby and life has changed. I just wanted to ask how you’re feeling and how it’s going.”
- “Is there anything you need to feel supported?”
Approach this from a place of genuine concern and care. If something does come up indicating that the employee is having a hard time, you can refer them to company resources and mental health support, and even revisit the return-to-work plan.
This could be life changing for someone who is experiencing a postpartum mood or anxiety disorder, akin to offering a life raft when someone is struggling to stay afloat in stormy waters.
Workplace leaders are part of the solution
In closing, I want to emphasize how common postpartum mood and anxiety disorders are. There are many employees who just had a baby and are struggling with their mental health.
This is what I tell clients who are new parents:
- You’re not alone.
- It’s not your fault. It’s not a personal failing.
- You are not a bad parent for struggling.
There’s been a lot of progress with confronting stigma around mental health. But for employees to feel comfortable admitting they’re having a difficult time with parenthood, it has to be acceptable to talk about this in wider society.
We can’t address problems that people are too ashamed to admit they’re having.
Perinatal mood and anxiety disorders are common. They are treatable.
The hard part is making this challenge okay to talk about, and workplace leaders have the capacity to be part of the solution.
Once a parent returns to work, they face a completely new set of challenges.
Learn more about the Pregnant Workers Fairness Act and how it is reshaping workplace policies for expecting mothers.