What You Should Know About Supporting Your Mental Health Before and During Pregnancy

Cassie Shortsleeve
You're likely familiar with the term postpartum depression—but perinatal mood disorders (which encompass the time before and during pregnancy, too) are getting more notice.

Photo: Getty Images/Yagi-Studio

For years, you've heard about postpartum depression (PPD), depression that occurs after having a baby. About one in five women suffer from it, according to the Centers for Disease Control and Prevention (CDC), and in general, women are also twice as likely to suffer from depression as men. (See: Subtle Signs of Postpartum Depression You Shouldn't Ignore)

But the term isn't all that inclusive of the flurry of mental health symptoms that women can experience before, during, and after pregnancy, explains Catherine Birndorf, M.D., a psychiatrist in obstetrics and gynecology at Weill Cornell Medicine and NewYork-Presbyterian, co-founder of The Motherhood Center of New York, and author of the forthcoming book

What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood

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Fortunately, as society starts to "accept" PPD (The Food and Drug Administration just approved the first treatment for it and soon, some kinds of counseling might be fully covered by insurance), the definition is expanding to be more inclusive of the time before and during pregnancy, explains Birndorf, who adds "the term 'PPD' does miss a lot."

And today, mental health conditions during pregnancy are, more and more, starting to be referred to as perinatal mood and anxiety disorders (PMADs)—a term that incorporates all of the months before baby comes, too (after all, it's estimated that 4 to 23 percent of pregnant women experience depression during pregnancy and similar amounts feel anxiety).

Postpartum Support International (PSI) has even started a certification process to train mental health providers and other experts in perinatal health—an important step in a field that's long been missing credentialed experts. Before now, there hasn't been a way to know whether someone has experience with perinatal mood disorders, explains Birdie Meyer, R.N., the coordinator of the Perinatal Mood Disorders Program at Indiana University Health in Indianapolis, IN and PSI's certification director. This can make it hard for people to find therapists, she says. "Many people will say they specialize in perinatal depression on their website, but when you dig deeper you'll find they never really had any formal training. We wanted to have a designation that said you're certified in perinatal health." (You can find providers here.)

But if you're feeling down, anxious, and just not yourself, there are other steps you can take, too. Here, six of them experts encourage.

Prioritize Self-Care

Being a mom—and thinking about being a mom—can be a 'selfless' time. You're likely concerned about baby's arrival, setting up the nursery, prenatal appointments, and more—but Dr. Birndorf notes that self-care should *also* be a number one priority. After all, working to the bone might be compromising your sleep, your eating habits, how much time you can dedicate to working out, and even how much you're able to be at your emotional best, she says—all factors that can not only make your mood suffer but also negatively impact the baby. Plus, some research finds that just stress during pregnancy is linked with low birth weight, early delivery, health challenges, and more. Untreated mood disorders are also linked with similar problems, explains Meyer, including low birth weight, preterm birth, and diabetes. (Related: What's the Best Sleeping Position for Pregnancy?)

Don't feel up for your usual workout? Something as simple as a short walk, yoga, or mindfulness can do wonders for your mood, says Meyer.

Just *thinking* about having a baby? Take some time to optimize your own health, relationships, and work/life balance, suggests Dr. Birndorf. "Getting that stuff in order before becoming pregnant can only help."

Expect Emotional Surprises

Pregnancy can be a happy, exciting time full of congratulatory messages. But there also tends to be a societal picture of what it 'should' look for feel like. "It's 'supposed' to be a happy glowing time—but not everyone feels happy and glowing," says Meyer. Instead, there are a lot of emotional surprises. Even if you planned your pregnancy, you might mourn the fact that it'll never be just you or just you and your partner again. "Overnight, you lose all freedom, all control of your schedule, and everything is new," she says. First-time mom? You've never defined yourself as a mother before, likely never taken care of a baby, and you're going to be learning all new skills.

One way to handle all of that newness: Be emotionally flexible, suggests Dr. Birndorf. You don't know how certain moments or experiences are going to make you feel (although you might have dreams about what pregnancy or being a mama might be) and being able to accept whatever it is that you *are* feeling can help root you in reality and the present moment instead of expectations, she says.

Be Honest with Your Friends

Finding yourself ahead (or behind) of your cohort of friends when it comes to having a baby can be lonely, says Dr. Birndorf. But social connectedness is hugely important not only for your mood but for your lifestyle moving forward as a new mom. And while it might be hard to tell your friends what you're really feeling (whether you're freaked about the idea of having kids or aren't quite *loving* being pregnant), honesty can pay off, says Dr. Birndorf, deepening connections with those around you. (Related: I Honestly Hated Being Pregnant—Even Though I Always Wanted a Baby)

If you're down—or simply looking for some other mamas to connect with—support groups (either in person or online) can be really helpful, too, says Dr. Birndorf.

And be careful with social media: Those new mamas you see on Facebook and Insta aren't *always* telling the whole truth, says Meyer. Read: While you might see a comment about how deeply in love someone is with their baby, not all moms fall in love with their children right away, says Meyer—it's more of a growth process. (You just don't always say that on Facebook.) This is where real talk (with friends, family, members of a support group) comes in.

Rethink Your 'What Ifs'

'What if' worries (what if I drop the baby? What if I'm a bad mom? What if something happens while he or she's sleeping?) are normal, says Meyer. In fact, one study from 2007 found 89 percent of new parents report experiencing some kind of distressing thoughts. If you have an intrusive thought—and actually see yourself dropping your baby or have an image or movie playing in your head—try to recognize it as just a thought, not a fact, says Meyer.

If your thoughts are becoming intrusive to the point where they're affecting your day-to-day? Touch base with your ob-gyn who can likely connect you with a mental health professional. New parenthood can be a risk factor for postpartum obsessive-compulsive disorder.

Consider Therapy

Here's something you might not know: The American College of Obstetricians and Gynecologists recommends that ob-gyns screen women at least once during the perinatal period for depression and anxiety symptoms. Didn't get screened? Meyer's not surprised. Not all ob-gyns ask about mental health—or screen for conditions, she says. (Related: Why Is It So Hard to Make Your First Therapy Appointment?)

That means that, if you're noticing symptoms, it might be on you to reach out. Meyer still suggests starting with your ob-gyn to fill them in on your feelings. From there, resources including PSI can help you find a provider who might work for you as can referrals from friends, families, and doctors. If you're not sure about how much experience a provider has in treating perinatal mood disorders, don't be afraid to ask, says Dr. Birndorf.

Ask for Help

One of the most common statements Meyer's hears new mamas say is: I'm so overwhelmed. That only makes sense. Overnight, a new family member—who just so happens to not love sleep, can't speak, and can't take care of themselves—joined your household and you're likely new at this whole mom thing. Her advice? "Don't be ashamed to ask for help." She notes that in other countries people gather around new moms who are simply supposed to rest and feed their little one. "She's pampered," Meyer says. "Here, we do our own laundry and apologize if our house is a mess when people come over. We've got it all backward."

Read: Sometimes it *does* take a village. Says Meyer: "We have seasons of giving and seasons of receiving in life. When you're a new mom you're in the season of receiving and there is nothing shameful about asking for help."