Beyond Postpartum Depression: Understanding Perinatal Mental Health

A recent Wall Street Journal article about Hayden Panettiere and Lindsay Clancy has brought renewed attention to an important and often misunderstood topic: postpartum mental health.

While these are two very different stories, they highlight something I see in my work with women during pregnancy and after childbirth: there is no single postpartum experience, and mental health struggles do not always look the way we expect them to.

We often hear about postpartum depression, but the perinatal period can also bring anxiety, panic, obsessive-compulsive symptoms, birth trauma, substance use, and, much more rarely, postpartum psychosis. These experiences can overlap but they are not interchangeable — and understanding the differences is critical in order to offer the right kind of support.

One area I frequently talk about with new mothers is intrusive thoughts. A woman may experience a frightening, unwanted thought about something happening to her baby and immediately wonder, What kind of mother thinks this? or What if this means something is wrong with me?

Intrusive thoughts can occur with postpartum anxiety and OCD, and having an unwanted thought is not the same as wanting to act on it. The fear and distress surrounding the thought can actually be an important part of understanding what is happening. This is one reason creating a space where women can speak honestly about their experiences is so important. If someone is afraid that admitting what she is thinking will lead to judgment, she may be less likely to ask for help.

At the same time, symptoms such as hallucinations, delusions, severe confusion, paranoia, or losing touch with reality are different. Postpartum psychosis is rare but is a psychiatric emergency requiring immediate evaluation.

The goal is not to frighten mothers. It is to help them understand that different experiences require different kinds of support.

I also believe we underestimate how psychologically significant the transition into parenthood can be. Pregnancy and childbirth can bring enormous changes to identity, relationships, sleep, body image, and one’s sense of control. For women already navigating infertility, trauma, anxiety, perfectionism, or complicated feelings about their bodies, the transition can be particularly layered.

You can be deeply in love with your baby and still be struggling. You can feel grateful and overwhelmed. You can be functioning beautifully on the outside and barely holding it together on the inside.

None of these contradictions make you a bad mother.

My work with women during pregnancy, postpartum, infertility, pregnancy loss, and other reproductive transitions is often about making space for these complexities and helping women understand what they are experiencing without shame or judgment.

Sometimes, the first step is simply having a place to say, This is not how I thought I would feel.

There is room for the joy and the ambivalence, the gratitude and the overwhelm, the love and the uncertainty that can come with becoming a parent. Making space for all of it can be an important part of taking care of ourselves, and ultimately, our families.