We’re often told that having a baby will be the happiest time of our lives. But for the 1 in 5 new mothers who experience a perinatal mood or anxiety disorder, it can be difficult to admit that their experience is more complex than that.

In recent years, more parents have begun speaking openly about the challenges that can accompany pregnancy, childbirth and the postpartum period.

“It's really, really hard to have a baby,” said Dr. Natalie Gregory, an ob-gyn with Novant Health Lowcountry OB/GYN - East Cooper. “It is a complete change of everything in your life, and it is not a character flaw if it takes you a moment to get adjusted to that.”

New parents are recovering physically, adjusting to major hormone changes, learning to care for a baby, and often functioning on very little sleep. For some, those challenges ease with time and support. For others, anxiety, depression or other mental health symptoms begin during pregnancy or after delivery and interfere with daily life.

Here’s what parents and loved ones should know about postpartum mental health, including common mood disorders, their causes, treatment options and when to seek help.

What are perinatal mood and anxiety disorders?

Perinatal mood and anxiety disorders (PMADs) are mental health conditions that can happen during pregnancy and up to one year after delivery. Perinatal mood and anxiety disorders include:

• Postpartum depression
• Postpartum depression can cause persistent low mood, hopelessness, guilt, irritability, emotional numbness or trouble feeling connected to the baby. Symptoms may begin during pregnancy or at any point in the first year after delivery.
• Postpartum anxiety
• Postpartum anxiety involves worry or fear that feels difficult to control and begins to interfere with daily life, sleep, relationships or the ability to leave the house. It may include racing thoughts, physical tension, panic or constant fears that something bad will happen to the baby.
• Postpartum obsessive-compulsive disorder
• Postpartum obsessive-compulsive disorder (OCD) can involve upsetting, unwanted thoughts or images, along with compulsive behaviors such as repeated checking or cleaning. These thoughts are distressing and unwanted; they do not mean a parent wants to hurt their child.

• Bipolar disorder is a mood disorder that can cause episodes of depression as well as racing thoughts or impulsive behavior. Pregnancy and the postpartum period can be times when symptoms first appear or worsen, so prompt evaluation is important.
• Postpartum psychosis
• Postpartum psychosis is rare but serious, and it is a medical emergency. Symptoms can develop quickly and may include hallucinations, delusions, paranoia, marked confusion, extreme agitation or going without sleep. Call 911 or seek emergency care immediately.
• Postpartum rage
• Postpartum rage is not a formal diagnosis, but intense anger, irritability or feeling constantly on edge can be a symptom of postpartum anxiety or depression. If anger feels difficult to control, is causing distress or is affecting relationships, it is worth discussing with a clinician.

What about the experience of pregnancy, childbirth and postpartum contributes to PMADs?

The same factors that contribute to what we’ve commonly called “the baby blues” play a major role in developing any PMAD. All new mothers are dealing with sleep deprivation. Their bodies have undergone trauma, whether they’ve had a vaginal delivery or a C-section.

After giving birth, estrogen levels drop more dramatically than at any other time in life, which can lead to irritability, mood swings, fatigue, hot flashes, and other physical and emotional symptoms.

How can a new mother — or her loved ones — tell if it’s the baby blues or something more?

It’s important for everyone to know going into birth that 80% of new mothers experience postpartum blues. It is very common to feel tearful, overwhelmed, irritable, and to have mood swings. The baby blues are temporary and improve with time, rest, reassurance and practical support. But if symptoms persist beyond six weeks after delivery, or become more intense, you should absolutely bring it up with your ob-gyn. That could be a sign of a PMAD, like postpartum depression.

Is it still postpartum depression if it doesn’t begin right after birth?

Yes. A common misconception is that postpartum depression only occurs right after the baby arrives. However, symptoms can start during pregnancy, and they can emerge later in the first year after delivery, particularly as family support changes, a parent returns to work or other stressors build.

Most parents worry about their children. When does that become postpartum anxiety?

A certain level of worry is natural when caring for a newborn. New parents may be especially alert to their baby’s needs or nervous about leaving the house for the first time.

“I’m concerned if that worry is beginning to affect your quality of life,” Gregory said. For example, if you are struggling so much with anxiety that it’s easier to not leave the house because it’s so stressful.

Postpartum anxiety can also show up as rage or intense irritability.

Some parents tolerate a great deal of distress privately until they notice it affecting their relationships, particularly how they respond to their children. But you do not have to wait for a breaking point to ask for help.

What is the difference between worrying and having intrusive thoughts?

Some worry is a normal part of becoming a parent. New parents may find themselves thinking about what could go wrong: What if the baby falls? What if I don’t wake up when the baby cries? These worries can be unsettling, but they generally come and go and don’t interfere significantly with daily life.

Intrusive thoughts are different. They are unwanted, upsetting thoughts or mental images that can feel difficult to control. A parent might suddenly picture dropping the baby while carrying them or imagine something terrible happening to the baby, even though they have no desire to cause harm. Having an intrusive thought does not mean a person wants to act on it.

Intrusive thoughts can occur with postpartum anxiety or obsessive-compulsive symptoms. They may become a concern when they are frequent, intensely distressing or lead to repeated checking, reassurance-seeking or avoidance. For example, a parent might say, “I know this fear doesn’t make sense, but I can’t stop thinking about it.” The fact that the thought feels unwanted and the parent recognizes it as distressing is an important distinction.

Postpartum psychosis is different and requires immediate medical attention. This rare but serious condition can cause hallucinations, delusions, severe confusion, disorganized thinking or beliefs that do not match reality. A person experiencing postpartum psychosis may not recognize that they are ill. Symptoms can develop quickly and are more likely in people with a history of bipolar disorder.

If someone is hearing or seeing things others do not, expressing paranoid or delusional beliefs, acting dramatically unlike themselves, becoming extremely agitated or going without sleep, seek emergency psychiatric care immediately. Call 911, go to the nearest emergency department, or call or text 988, the Suicide & Crisis Lifeline.

Can you get mental health treatment while breastfeeding?

Yes. One common myth is that a parent cannot receive mental health treatment while breastfeeding. Treatment depends on a person’s symptoms, history and preferences, but may include therapy, medication and peer support.

SSRIs, including Zoloft, Prozac and Lexapro, are commonly used options with long safety histories. A newer option, Zurzuvae, is an oral medication approved specifically for postpartum depression that is taken for 14 days.

“The most important thing is that your baby is looking back at a mom who is healthy,” Gregory said. “It is always in the baby’s best interest for you to be well.”

If breastfeeding is causing significant stress or is not going as hoped, bring that up, too. Feeding challenges can contribute to postpartum distress, and a parent’s emotional well-being is an essential part of a baby’s well-being.

How can partners, friends and family help a new mom who may be experiencing postpartum mental health disorders?

Support does not have to mean taking over baby care. Sometimes the most useful help is taking something else off a parent’s plate: making dinner, doing laundry, picking up an older child, bringing a snack or giving them time to shower, nap, attend therapy or simply be alone.

Your ob-gyn can remain a point of contact throughout the first year after delivery — not only at the six-week postpartum visit. “We are here to help anytime. We may only have the six-week follow-up on the calendar, but we always want to hear from you if you need anything at all,” Gregory said.

Key takeaway: The postpartum period is unique to every woman, and it’s common for it to be difficult. Talk to your family, your friends, and health care team. Don’t hesitate to ask for help. Remember, you are not alone.