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  • Writer's pictureAngel Montfort

The Best of Times and the Worst of Times: Recognizing and Managing Perinatal Distress

“I’m just not myself.” As I conducted a clinic intake, asking my typical questions such as “What brings you in today?” I was struck by the despair in this young woman’s voice. She explained that since about 4 months into her pregnancy, she “just felt different,” and that this had continued throughout the pregnancy and through the first 2 months of her baby’s life. She cared for her baby diligently, yet wondered if anything else would ever matter again. She had lost track of personal hygiene and found herself faking smiles for the baby because she had read that was good for his development. She loved this baby dearly. So much so, that she was often unable to sleep for fear that he would develop SIDS or that somehow he would be harmed. She avoided leaving the house for fear that she might get into a car accident with the baby, and even avoided walking up the stairs with her baby for fear that she could trip, fall, and injure him.

Postpartum depression and anxiety impact at least 1 in 7 women (Wisner, et al, 2013). It is more prevalent than both gestational diabetes and preeclampsia, yet screening and treatment options for these conditions are quite limited. Often birth is depicted as a miracle; the most joyous occasion in a woman’s life. This can be a stark contrast to the reality of pregnancy, labor & delivery, and bringing baby home. In addition to the hormonal changes that occur during pregnancy, the adjustment to a newborn (whether it’s your first or your fourth) can be significant. Mothers can develop depressive symptoms such as depressed mood, loss of interest or pleasure in previously enjoyed activities, low energy, sleep disturbance, excessive guilt, sluggish movements, and thoughts of harming themselves. Mothers can also develop excessive worry, panic attacks, and increased irritability, all of which may be mistaken for “normal first-time-mommy worries.” Additionally, Posttraumatic Stress Disorder, Obsessive-Compulsive Disorder, Postpartum Psychosis, and Bipolar Disorder can present during the perinatal period, and should be assessed by a mental healthcare professional.

Tips for managing symptoms of PMADs:

1. Talk with a trusted partner, family member, or friend. Confiding in a non-judgmental person with your best interests at heart can be cathartic and validating.

2. Check out the Postpartum Support International Website at: to connect to PMAD education, resources in your area, and a national hotline.

3. Try and get moving-this can be a walk in your neighborhood or even 10 minutes of yoga in the living room. Physical exercise and/or sun exposure can be helpful.

4. Consult with your physician regarding potential use of psychiatric medication or request a referral to a psychiatrist.

5. Engage in individual and/or group therapy, preferably with a provider specializing in maternal mental health.

6. Give yourself some grace. This is not something you caused, and it is not an indication of your capability to be a good mother.

If you’re experiencing difficulty adjusting to motherhood, it is likely time to invest in some much-needed self-care. You’re worth it. Contact me for a free phone consultation if you are interested in learning more.


*This was first published in the Tampa Bay for Relational Psychology newsletter; June 2019.

Wisner, K.L., Sit, D.Y., McShea, M.C., et al. 2013. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498.


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