Perinatal psychiatry addresses mental health risks in becoming a mother

This story first appeared in Healthy You - April 2025, The Gazette’s quarterly health publication.

Carrying and giving birth to a child is a transformative event in a mother’s life, but with that change can come increases in anxiety and depression.

The hormonal changes brought about by pregnancy and in the postpartum period sometimes manifests in what is often referred to as the “baby blues.” However, for about one in eight women in the United States, more severe mental health issues arise, disrupting the life of a new or expecting mother, according to the U.S. Centers for Disease Control and Prevention.

Perinatal psychiatry is a sub-speciality of psychiatry that focuses on the mental well-being of mothers during and after pregnancy. It has a history dating back to the early 20th century, but since the turn of the 21st century, it has become recognized as a key part of maternal health.

“It’s definitely changed in my years of practice to where there is certainly more understanding that mental health is as important as physical health,” said Dr. Dana Messenger, an obstetrician gynecologist with OB-GYN Associates in Cedar Rapids who has been practicing for 16 years.

Messenger explains that pregnancy is a complex and dynamic period of time hormonally, with levels of some hormones like estrogen, progesterone and HCG rising and falling. As these changes are happening, a mother can experience worse-than-usual depression and anxiety.

In the postpartum period, typically up to one year after delivery, a number of hormone levels rapidly decline. This is where the so-called baby blues come from.

“Many moms experience this to some degree,” Messenger said. “They might be more tearful than usual. More anxious than usual.”

Baby blues are marked with temporary changes in mood, fatigue, difficulty concentrating and anxiety. These symptoms are common and typically subside within a few weeks after childbirth.

Conditions like postpartum depression can last weeks, months or more, and symptoms are more persistent and severe.

Recognizing the differences between regular feelings of sadness and a condition like postpartum depression can be a challenge without observation from a healthcare professional. That is why regular screening throughout pregnancy and the postpartum period have become commonplace.

The purpose of screenings is to identify patients who are experiencing mental health issues and address these issues if necessary and appropriate. In some cases that means giving them a prescription for antidepressants. Others may begin counseling.

For those that do take on new prescriptions, they may or may not continue taking them for a prolonged period. According to Messenger, some will feel the prescriptions to be helpful for their overall mental health and continue to take them long term. Others may ween off them after a few months.

A common way to screen for mental health issues in the prenatal and postpartum periods is using the Edinburgh Postnatal Depression Scale. As the name indicates, it was developed for the purpose of conducting postpartum screenings. Today, organizations like OB-GYN Associates use the EPDS to perform screenings at several points throughout and after pregnancy.

“It’s normal to experience what we call the baby blues. Kind of mild depression and anxiety symptoms in those first 14 days after delivery,” said Dr. Kate Jarvis, who practices behavioral medicine, family medicine and psychiatry at UnityPoint Health in Cedar Rapids. “But what we’re monitoring for is persistent sadness, anxiousness, empty mood, irritability, feelings of worthlessness, guilt, hopelessness, helplessness or loss of interest.”

Postpartum depression can have effects on physical health as well. Weight fluctuations, eating disorders, increased fatigue, and trouble sleeping or sleeping too much are other symptoms.

Jarvis said some women are at greater risk of experiencing depression related to pregnancy.

“It’s the women who have already experienced an episode of depression before the birth of their first child,” Jarvis said. “The literature says they are at a 20-fold higher risk to develop these symptoms.”

There can continue to be risks of recurrent depression during subsequent pregnancies. Treatment, whether it be counseling or medication, has been shown to reduce symptoms, according to Jarvis.

Hormonal changes are not the only cause of mental health issues related to pregnancy. Becoming a new mother can be a stressful time. A loss of sleep or disjointed sleep schedule, difficulty with breastfeeding and other environmental factors also play a role.

Jarvis and Messenger agree that support is crucial.

“It’s important to support moms during this period,” Jarvis said. “Support is the big arching thing. Taking care of the baby so mom can take a nap. Get some rest. Helping around the house so that she can focus on taking care of the baby. Preparing a meal so that she’s getting good nutrition.”

There are several resources for expecting and new mothers in Linn and Johnson County, ranging from support groups to exercise and yoga classes. It is best to consult with an OB-GYN provider about the best options.

Yoga studios like Toula Yoga in Cedar Rapids host special classes for mothers, including prenatal and “Baby and Me” yoga classes. General exercise is helpful for overall mental health.

“Exercise has been shown to be as effective as medication management,” Messenger said. “That can be a little tough, given any one mom’s situation. Some other adjuncts that can be helpful are massage and acupuncture. Exercise and moving one’s body is one of the most underutilized ways to control mental health and physical health.”