Understanding Perinatal Mental Health

Let’s Talk About the Things We Do Not Always Say Out Loud

Written by Courtney Cordell, A-LPC/MHSP

TL;DR: The perinatal period is a time of enormous change, vulnerability, and adjustment. Many parents struggle during pregnancy or postpartum in ways they did not expect, and that does not mean they are failing or doing something wrong. Perinatal mood and anxiety disorders are common, treatable, and shaped by biology, context, and support. Compassionate care matters.

Entering parenthood is often described as one of the most joyful transitions of a lifetime. For many people, that joy is very real. And at the same time, this season can feel profoundly destabilizing. In my work, I sit with parents who describe living inside two truths at once. They love their baby deeply, and they feel overwhelmed, disconnected, anxious, or unlike themselves. They feel grateful, and they feel lost. They feel guilty for struggling and exhausted from trying to hide it.

The perinatal period, which includes pregnancy through the first year postpartum, brings rapid physical, emotional, relational, and identity shifts. Hormones change quickly. Sleep becomes fragmented. Roles evolve overnight. Expectations, both internal and external, grow louder. And yet, culturally, attention often moves swiftly to the baby, while the experience of the person who gave birth fades into the background.

When parents struggle during this time, many assume they are alone or that something about them is inadequate. What I want to gently name is that these struggles are far more common than most people realize, and they are not a reflection of weakness, failure, or a lack of love.

Many people are familiar with the phrase “baby blues,” which refers to a brief period of tearfulness, mood changes, irritability, and emotional sensitivity that can occur in the first couple of weeks after birth. These experiences are often linked to hormonal shifts and typically resolve without significantly interfering with daily functioning (American Psychiatric Association, n.d.). For some parents, however, symptoms do not fade. Instead, they linger, intensify, or shift in ways that feel frightening or hard to name.

This is where perinatal mood and anxiety disorders, often called PMADs, come into the picture. These include perinatal depression, anxiety disorders, obsessive compulsive disorder, post traumatic stress related to pregnancy or birth, and, more rarely, postpartum psychosis (McNulty, 2025). They can emerge during pregnancy or at any point in the first year postpartum, and they do not always look the way people expect.

Some parents describe feeling numb or disconnected rather than sad. Others experience constant worry, intrusive thoughts, panic, or racing thoughts that make it difficult to rest even when the baby is sleeping. Some feel deep shame about not bonding “the right way.” Others replay parts of their birth experience repeatedly, especially if it felt traumatic, frightening, or out of their control. Many describe a quiet grief for the version of themselves they no longer recognize.

These experiences are not rare. In the United States, approximately one in five women experiences a perinatal mood or anxiety disorder, often alongside substance use concerns (Weiner, 2023). And yet, despite how common these conditions are, most people affected never receive treatment. This gap is not because support is ineffective. It is often because parents do not feel safe enough, informed enough, or supported enough to reach out.

A significant part of this silence comes from the expectations placed on parents during the perinatal period. Many internalize messages about what this season should look like. You should feel blissful. You should feel grateful. You should adjust quickly. You should know what you are doing. When lived experience does not match these expectations, parents often turn that gap inward, questioning why this feels harder than they were told it would be.

Clinical experience and research consistently show that shame and lack of awareness are major barriers to care during the perinatal period. Some parents do not recognize their symptoms as signs of a treatable condition. Others fear judgment, involvement from systems they do not trust, or being labeled a “bad parent.” These fears can quietly isolate people at a time when connection and support are most protective.

One of the most important things I want parents to hear is that experiencing mental health symptoms during pregnancy or postpartum does not mean they are failing at parenthood. It means their nervous system, body, and mind are responding to immense change. Perinatal mental health exists at the intersection of biology, psychology, and environment. Hormonal shifts matter, and so do sleep deprivation, prior trauma, social support, birth experiences, systemic stressors, and identity changes. None of these factors exist in isolation.

Care is not about fixing someone. It is about helping the system settle, reducing isolation, and creating space for reconnection in a way that feels sustainable.

Many parents are told some version of “make sure you’re taking care of yourself.” While often well intentioned, this advice can feel hollow or even frustrating. As the Nagoski sisters describe in Burnout, completing the stress cycle is rarely about individual self care tasks alone. It is about connection, safety, and being supported by others.

For some parents, being told to “just take a shower” is not restorative. It can be rushed, tense, and filled with listening for the baby to cry. For others, asking for help feels deeply uncomfortable, especially for those who tend to pull inward when overwhelmed. Preparing for postpartum support often looks less like doing everything “right” and more like knowing yourself. How do you typically respond when you are burned out? Do you withdraw? Do you minimize your needs? Do you assume you should handle things alone?

Reflecting on past moments of exhaustion can offer important clues. What actually helped then? What support would have mattered, even in small ways? Sometimes support looks like asking someone to organize a meal train. Sometimes it looks like telling a trusted friend, “If you don’t hear from me, please check in anyway.” Sometimes it looks like accepting help even when it feels undeserved. Sometimes, it’s knowing you won’t have the brain space to clean dishes so buying the paper plates ahead of time.

It is also important to name that access to resources varies widely, and privilege plays a real role in what support is available. Support does not have to be expensive or perfect to be meaningful. For some families, it may involve free delivery options, secondhand items from community groups, donated diapers or breast milk, or simple comforts like audiobooks, favorite shows saved for late nights, or snacks kept within reach. Small supports, layered together, can ease the load in meaningful ways.

There is also a persistent belief that prioritizing a parent’s mental health is selfish. Research consistently tells a different story. Parental mental health is closely linked to infant wellbeing, attachment, and long term developmental outcomes. Supporting a parent’s mental health is not separate from caring for a baby. It is part of it.

The perinatal period is inherently vulnerable. It looks different for every family, every pregnancy, and every parent. Some people struggle quietly. Some struggle openly. Some feel better quickly. Others need more time and care.

If you are in this season and finding it harder than expected, that does not mean you are failing. It means you are responding to something real. You deserve support that does not rush you, minimize you, or ask you to be grateful for your pain. You deserve care that honors your experience as it is. And if you are reading this and recognizing parts of yourself, know that support exists. It is okay to reach for it.

References

American Psychiatric Association. (n.d.). What is peripartum depression?

https://www.psychiatry.org/patients-families/peripartum-depression/what-is-peripartum-depression

McNulty, C. (2025, July 18). From silence to support: Changing the story on maternal mental health. Behavioral Health News.

https://behavioralhealthnews.org/from-silence-to-support-changing-the-story-on-maternal-mental-health/

Postpartum Support International. (n.d.). Perinatal mental health.

https://postpartum.net/perinatal-mental-health/

Weiner, S. (2023, December 5). The toll of maternal mental illness in America. Association of American Medical Colleges.

https://www.aamc.org/news/toll-maternal-mental-illness-america

Nagoski, E., & Nagoski, A. (2019). Burnout: The secret to unlocking the stress cycle. Ballantine Books.