Your Pregnancy, Your Psychological Health

Source: Ermias Tarekegn / Pexels

Having a baby—whether it is your first or your fifth—represents a momentous life change. Fluctuations in mood and stress levels are normal during pregnancy and the postpartum period, but a substantial minority of folks who give birth will experience more pervasive and severe symptoms. Perinatal depression (previously referred to as “postpartum depression”) is considered by the American College of Obstetricians and Gynecologists to be one of the most common medical complications during pregnancy and in the first year after giving birth—impacting 1 in 7 birthing people.

The Case for Prevention During Pregnancy and Postpartum

Many healthcare systems already place an emphasis on screening and early detection of perinatal depression in order to help connect new parents with treatment as early as possible. However, pregnant folks and their loved ones also deserve upstream solutions that focus on the prevention of perinatal depression. With that in mind, the United States Preventive Services Task Force (USPSTF) has recommended that patients with risk factors for perinatal depression—like a history of depression, current symptoms, or low social support—be referred for preventative counseling.

The Reach Out, Stay Strong, Essentials (ROSE) program has shown significant promise in preventing the development of perinatal depression—randomized clinical trials suggest that it prevents up to half of the perinatal depression cases in low-income mothers (who are at higher risk for the disorder). A recent trial is also underway to test it as a universal prevention program. The ROSE program is generally offered in 4-8 sessions and can be provided individually or in a group setting.

Tips for a Mentally Healthy Pregnancy and Postpartum

Regardless of whether the ROSE program is yet offered by a therapist or healthcare clinic in your area, here are some of the principles taught through the program that may bolster your mental health as you prepare for your new baby’s arrival:

1. Allow yourself space and time to process the changes of being a new parent. Shifting out of an old role and into a new one comes with new demands and sometimes painful losses.

It is normal and understandable to feel a range of emotions, often all at once—fear, sadness, anxiety, irritability, grief, and joy are all part of a normal human response to expanding your family. If the emotions become overwhelming, talk to a trusted friend, healthcare provider, or mental healthcare provider.

2. Throughout pregnancy, regularly engage in pleasant activities. If you aren’t sure where to start, check out this list of 101 enjoyable activities. Try to engage in at least one pleasant activity each day.

As you do so, start making your own list of go-to pleasant activities to use postpartum—particularly including things you can do in a small window of time (like 15 minutes of working on a puzzle) or while trapped under a napping baby (like reading or listening to a podcast). Doing something small for yourself can be a welcome relief in the midst of devoting an immense amount of energy to a tiny human.

3. Try out different relaxation exercises. Slowing your breath—particularly your exhale—can increase your sense of relaxation and reduce tension, even just for 5 minutes. However, focused breathing is sometimes uncomfortable in the third trimester as the rib and lungs become more constricted.

Progressive Muscles Relaxation (PMR) is a technique of sequentially tensing and then relaxing different muscle groups. You can search on YouTube or mindfulness apps for guided versions. PMR can relieve stress, but it also has the added benefit of relaxing your body for sleep.

4. Map out your support system. Many new parents have more people in their support system than they actually realize, so it is helpful to make a list of these folks before the baby comes. What family members are you closest to? Which friends do you feel most supported by during difficult times? Who can you turn to for spiritual support? Do you have neighbors or coworkers who have offered to help?

Tally out these folks on a journal or notebook so that you have the list ready on difficult days postpartum. Don’t forget to include trusted healthcare providers, mental health care providers, and community leaders.

5. Practice assertiveness in asking for help and saying no. A lot of folks struggle with asking for things and setting personal boundaries. Thankfully, it is a skill that can be learned, practiced, and improved.

Pregnancy Essential Reads

Is It Safe to Take Antidepressants During Pregnancy?

The Label Expectant Mothers Over 35 Don’t Want to Hear

Some tips: Ask for one thing at a time. Openly state what you want in clear, simple language. Avoid verbal attacks, threats, or insults.

If you are saying no, do it kindly but firmly, without apologizing. If the other person responds poorly to your assertiveness and the interaction escalates, remember that you have a right to safety. Make a statement such as “I can see you are upset; let’s pick this up later,” and physically move away from them.

Your connections to others and to yourself can be a lifeline as you face a major life transition. If you are concerned that you may have perinatal depression or another mental health disorder, reach out to a physician or mental health provider for clinical assessment and treatment.

The National Maternal Mental Health Hotline offers free, confidential mental health support during and after pregnancy. Call or text 1-833-9-TLC-MAMA (1-833-852-6262) to connect with counselors 24 hours a day, seven days a week.

To find a therapist near you, visit the Psychology Today Therapy Directory.