Why didn’t anyone tell me to plan for this?
When you’re thinking about having a baby, there’s a pretty standard list of things you’re told to do: start a prenatal vitamin, schedule an appointment with your OB-GYN, review your medications, stop smoking or drinking, and make sure you’re generally healthy.
I think we need to add one more thing to that list: have a plan for your mental health.
Not because you should expect something to go wrong. And not because pregnancy or motherhood automatically leads to a mental health condition. But pregnancy, birth, and the postpartum period involve enormous physical, hormonal, emotional, and lifestyle changes—and women are often not adequately prepared for how those changes can affect their mental health.
Mental health changes don't only happen after the baby is born
We hear a lot about postpartum depression, which is important, but the term can unintentionally make it sound as though mental health concerns begin after delivery.
They don't always.
Depression and anxiety can develop during pregnancy. Preexisting ADHD, anxiety, depression, OCD, bipolar disorder, PTSD, and other conditions may also change during pregnancy or postpartum.
The American College of Obstetricians and Gynecologists (ACOG) recommends screening for depression and anxiety at the initial prenatal visit, again later in pregnancy, and during postpartum visits. ACOG also recommends mental health screening during prepregnancy care.
That tells us something important: mental health is part of maternal health from the beginning.
Pregnancy can affect your mental health in ways you weren't expecting
There are changes women may experience during pregnancy and postpartum that aren't always talked about before they happen.
Sleep can change dramatically. Anxiety may suddenly center around the pregnancy or baby's health. Intrusive thoughts can occur. A woman with ADHD may find that changes in routine, sleep, responsibilities, or medication make symptoms more difficult to manage. Someone with a history of depression or anxiety may notice old symptoms returning.
After delivery, you're also adding physical recovery, major hormonal shifts, interrupted sleep, feeding decisions, a completely new routine, and the responsibility of caring for another human being.
Some emotional changes are expected. Others deserve more attention.
Women should know the difference before they're exhausted, overwhelmed, and trying to figure it out on their own.
"Baby blues" and postpartum depression are not the same thing
This is one area where education before delivery really matters.
Temporary mood changes after birth are common. The "baby blues" can include crying, irritability, feeling overwhelmed, or being more emotionally sensitive in the first days after delivery.
But persistent or worsening sadness, anxiety, hopelessness, significant difficulty functioning, feeling disconnected from yourself or your baby, severe agitation, or frightening changes in your thoughts shouldn't simply be written off as hormones or lack of sleep.
And depression isn't the only condition we need to talk about. Perinatal mental health also includes anxiety, OCD, bipolar disorder, PTSD, and postpartum psychosis. ACOG specifically recommends immediate medical attention when postpartum psychosis is suspected.
Women and the people closest to them should know what to watch for.
Why establish mental health care before you need it?
Finding a mental health provider when you're already struggling can be difficult.
You have to figure out who treats your condition, who is accepting new patients, whether they accept your insurance, how long the wait is, and whether they're comfortable treating women during pregnancy and postpartum.
Now imagine doing that while severely sleep deprived, recovering from childbirth, caring for a newborn, and experiencing significant anxiety or depression.
If you already have a mental health provider, there is someone who knows your history and your baseline. You know who to call. If you're taking psychiatric medication, you can have informed conversations about treatment before and during pregnancy rather than making abrupt decisions out of fear.
This doesn't necessarily mean every woman needs frequent psychiatric appointments throughout a healthy pregnancy. It means mental health should be considered when you're building your care team and your postpartum plan—particularly if you have a personal or family history of mental health conditions or have struggled during a previous pregnancy or postpartum period.
ACOG recommends that postpartum planning begin during pregnancy and include attention to emotional well-being and the medical professionals who may be needed after delivery.
Your partner or support person should know the plan, too
This is another piece I think gets overlooked.
You may not always be the first person to recognize that you're struggling.
A partner, parent, sibling, or close friend may notice that you aren't sleeping even when you have the opportunity, that your anxiety seems extreme, that you're withdrawing, that you don't seem like yourself, or that your behavior has changed significantly.
Talk about mental health before the baby arrives.
Tell the people you trust what symptoms you want them to pay attention to. Make sure they know who your providers are and who you would want contacted if they became concerned.
ACOG recommends providing education about perinatal mental health symptoms not only to pregnant women but also to families and other members of their support systems.
Mental health belongs in pregnancy planning
We prepare women for ultrasounds, glucose testing, labor, breastfeeding, car seats, safe sleep, and pediatric appointments.
We should also prepare them for the psychological transition into motherhood.
Before or during pregnancy, consider asking:
Do I have a history of anxiety, depression, ADHD, OCD, trauma, bipolar disorder, or another mental health condition?
How have major hormonal changes affected me in the past?
If I take psychiatric medication, what is the plan during pregnancy and postpartum?
Who will I call if I notice a significant change in my mood, anxiety, sleep, thoughts, or ability to function?
Does my support person know what symptoms to watch for?
What will practical support look like after I give birth?
Who is checking on me, not only the baby?
Pregnancy care shouldn't begin and end with physical health.
Your mental health is part of your health, and planning for it shouldn't be reserved for women who are already struggling. It should be a normal part of preparing for pregnancy, birth, postpartum recovery, and motherhood.
