How to Care for Your Mental Health During Pregnancy

Pregnancy is usually thought of as a time of joy and new beginnings. The truth is, though, that for many of us, pregnancy is also a time of stress, upheaval, and uncertainty. So much is changing—your body, your identity, your relationships—and pregnancy comes with fears about money, jobs, and careers.

As such, it's no wonder that pregnant people often experience mental health challenges. At the same time, the focus during pregnancy is often on what's happening in our bodies and with our babies. Hardly anyone talks about mental health during pregnancy, and people who are experiencing mental health disruptions often don't know how to address them in pregnancy, or where to get support.

We connected to two experts—an OB-GYN and a clinical psychologist—to share insight about mental health during pregnancy, including what symptoms to expect, how to care for your mental health during pregnancy, and how to know if you are experiencing a serious mental health crisis.

Common Mental Health Conditions During Pregnancy

Probably the most common mental health struggles during pregnancy involve stress and anxiety, says Vanessa Kennedy, PhD, clinical psychologist and director of psychology at Driftwood Recovery. This stress may have a number of causes, she says. "Patients who are pregnant most commonly experience some degree of anxiety in relation to impending parenthood, [particularly] if they will be a first-time parent. They also worry about their health, the health of their baby, have body image concerns... and/or wonder how their lives will change once they welcome a new child."

The mental health mood changes aren't just related to the circumstances people often find themselves in during pregnancy though, Dr. Kennedy says. "They also experience chemical changes in their bodies related to pregnancy that can intensify their emotions, as well as affect their energy, sleep, and appetite," she explains. "Pregnant people also deal with stress about their relationship with their partner, who is also feeling their own emotions about the pregnancy and the changes that will ensue in the relationship."

Suzanne Bovone, M.D., an OB-GYN at Pediatrix Medical Group, frequently sees mental health concerns among her patients. "The most common mental health diagnosis that I see in patients is anxiety and depression," she says. Additionally, Dr. Bovone says that she often sees pregnant patients dealing with obsessive compulsive disorder (OCD) during pregnancy, which includes symptoms like excessive habits (repeated hand wishing, for example) or intrusive thoughts.

Many of these patients have a history of these disorders, Dr. Bovone says. "A history of mental health issues increases one's risk of recurrence in pregnancy and the postpartum period," she says. But whether you have that history or not, she stresses how important it is for mental health to be discussed—not just sometimes, but at each prenatal visit.

It's also important that all pregnant parents are screened for perinatal mood disorders, which can emerge in pregnancy. Dr. Bovone says that she screens all her pregnant patients for perinatal mood disorders using a screening test. "For mental health in pregnancy, I use the Edinburgh Screen, but one can also use a PHQ9 screening tool," she describes.

Unfortunately, perinatal mood disorders during pregnancy are more common than you might realize, according to the Anxiety & Depression Association of America. Perinatal mood or anxiety disorder (PMAD) strikes between 15 to 20% of pregnant people, and can emerge soon after conception, all the way through your child's first year of life.

Signs and Symptoms

People who are experiencing increased depression and anxiety in pregnancy may be able to recognize the symptoms, especially if they've experienced them before, says Dr. Bovone. But if these feelings are new, they may be harder to identify. If you feel more irritable than usual or have trouble sleeping, difficulty focusing, experience changes in your appetite and/or have increased fatigue or insomnia, you should talk to your OB-GYN or another health care provider. "Some of these symptoms may be normal in pregnancy, but it is important to ask about mental health to ensure that anxiety or depression is not a new finding or getting worse if someone already has a diagnosis," Dr. Bovone says.

Symptoms of a perinatal and postpartum mood disorders (PMADs) include severe feelings of sadness and fear that make it difficult for you to function in your daily life. The difference between PMAD in pregnancy versus other types of anxiety and depression during pregnancy is these feelings are extreme, long-lasting, and interrupt your ability to care for yourself or others.

Risk Factors for Mental Health Issues During Pregnancy

Anyone can experience a mental health issue during pregnancy, but there are certain factors that make you more likely to experience them. For example, certain life circumstances may increase the likelihood, says Dr. Kennedy.

"Pregnant individuals experiencing dissatisfaction with their partner or conflicted feelings about their pregnancy may be more prone to developing mental health concerns," she says. "Those living in stressful conditions in which safety, financial support, and social support are not guaranteed may also be prone to developing mental health concerns such as anxiety, depression, and post-traumatic stress." Other common triggers include experiencing domestic violence, economic hardship, or strained family relations, she adds.

People with a history of mental health challenges are also more prone to experience mental health issues in pregnancy, Dr. Kennedy says. "People with established mental health conditions such as bipolar disorder, major depression, anxiety disorder, obsessive-compulsive disorder, an eating disorder, or schizophrenia may also be highly prone to their symptoms being exacerbated during pregnancy," she explains.

How to Care for Your Mental Health—and Get Help

If you are dealing with a mental health issue during pregnancy, you should know that you are not alone—it's very common. Not only that, but there is help out there for you. Dr. Bovone emphasizes that, contrary to popular belief, medication for mental health is not off the table during pregnancy. In fact, many medications are considered safe or low-risk during pregnancy. "The majority of the medications people are on are safe in pregnancy and in lactation, but we have to review any possible negative effects," she says.

Dr. Kennedy says that regular check-ins with a healthcare provider about your mental health are essential. "Pregnant individuals should have regular contact and check-ups with their physician to engage in an open dialogue about both their physical well-being as well as their psychological well being," she says. "They should be open about potential anxieties, changes in their mood, or concerning thoughts that may be related to obsessive-compulsive disorder or another mental illness."

If any mental health issues come to the surface, your provider can refer you to a therapist or psychiatrist who specializes in helping pregnant individuals manage their mental health, Dr. Kennedy explains. Above all else, she says, she wants pregnant folks to understand that if any mental health issues come up during pregnancy, it's not your fault, and you are going to be okay.

"Many people feel that they are 'crazy' or 'not normal' if they begin to experience irrational thoughts such as not wanting to hold their baby or obsessive worries about harming their baby, when in reality, these symptoms are caused by neurochemical changes happening in the brain and need immediate treatment and support to improve," Dr. Kennedy describes.

Finally, although many mental health concerns during pregnancy should be treated by a mental health professional, and there should be no shame in seeking that help, certain lifestyle changes and habits can help you better manage your feelings and moods during pregnancy. These may include:

• Exercise—even just simple walking—can boost your mood; make sure that you are cleared for exercise by a healthcare provider before moving forward
• Getting enough sleep can keep your moods be more balanced
• Practicing meditation and mindfulness can help you manage feelings of worry and stress—just sitting a quiet room for five minutes with your eyes closed can help
• Keeping a journal, or a "worry diary" can help you get all your feelings "out" so you don't ruminate over them quite as much
• Some pregnant parents find yoga, massage, and acupuncture helpful when it comes to managing pregnant mental health; again, make sure to get healthcare provider clearance before starting these

Signs of Mental Health Emergencies During Pregnancy

While most mental health issues can be managed at-home—i.e. most mental health issues can be handled with lifestyle changes and managed by your doctor, therapist, and/or health care team—sometimes, mental health issues during pregnancy become emergency situations.

"If someone has thoughts of hurting themselves or others, they need to contact their physician and be seen immediately or in an ER setting," says Dr. Bovone. "Psychosis is rare in pregnancy and postpartum but if one is having delusions, hallucinations, or severe behavior changes, then their support system should take them to an ER setting as well."