Many women tell me that their first years of motherhood were some of the most challenging of their lives.

Culturally, mental health services are not easily accessible to new and expecting mothers, and it can be very challenging to identify what your needs are when you are running on no sleep, no time, and no energy.

Before we dive in to my “guide,” I think it bears repeating that struggling emotionally with your new role is not a sign that you are an unfit parent, don’t love your child(ren), or are ungrateful. You are overwhelmed, and you deserve help. That’s all it means. Please keep telling yourself this as many times as it takes to believe it.

A little while back, I broke down the various types of mental health service providers who you might seek out when you’re struggling emotionally. The names are similar in many cases (psychiatrist, psychologist…), so it gets confusing pretty quickly, and my hope was that a simple primer would give you a starting point from which to begin your mental wellness journey.

Now I want to dive into who to talk with when you’re experience what are known collectively as the Perinatal Mood and Anxiety Disorders (PMAD):

• Major depressive disorders
• Anxiety disorders
• Panic disorders
• PTSD

These disorders all represent the more serious end of the mental illness spectrum and typically require more varied and intensive therapies (more on that soon). This Postnatal Depression Scale is a good starting point to assess where you might fall on that spectrum, but should always be followed up by an appointment with a professional.

Perinatal Emotional Adjustment (PEA), on the other hand, is a diagnosis for women whose symptoms don’t rise to the level of the four mentioned above, but still experience distressing symptoms, such as:

• Tearfulness.
• Mood swings.
• Feeling overwhelmed.

It’s important to know that the symptoms of PEA are a biologically driven reaction to hormones and a totally normal postpartum event. You’re still able to function in your day-to-day life and bond with your infant, but one minute it seems like everything is great, and the next moment you’re in tears.

No matter where on the perinatal emotional distress spectrum you fall, please know this is a very common experience. Studies suggest that as many as 85% of women suffer from some distress during or after their pregnancy, and as many as 25% experience a PMAD.

Perinatal symptoms show up any time during pregnancy to as long as a year after you deliver your baby, so give yourself grace if you’re struggling well after your baby is born, and seek out one of these professionals to help you through it.

PSYCHIATRIST

WHEN IT’S TIME TO SEEK ONE OUT:

Psychiatrists are medical doctors who specialize in psychiatric disorders such as Postpartum Psychosis, Major Depressive Disorder, and Bipolar Disorder, so if you are experiencing some of the following symptoms, a psychiatrist is a good choice:

• Feeling sad or depressed a lot of them time
• Little interest in becoming a mother or bonding with your baby
• Strong feelings of worthlessness or guilt, particularly around being a good mother
• Intense feelings of anxiety or fear about your baby or other things
• Poor sleep (not related to normal pregnancy or newborn sleep schedules)
• Suicidal thoughts or wanting to be dead
• Persistent low energy no matter what you do
• Significant change in your appetite or weight (loss or increase) not consistent with pregnancy or postpartum weight fluctuations
• Difficulty focusing or remembering things; trouble making even the smallest decisions
• Frequently feeling restless or irritable
• Increased headaches, heart palpitations, hyperventilation, chest pains, or numbness
• Panic attacks
• Delusions, hallucinations, or disorganized or nonsensical thoughts

HOW THEY CAN HELP:

Psychiatrists can assess your condition, give you a proper diagnosis, and prescribe and manage medication, as appropriate. Some of them will also do talk therapy with you, while others may refer you to a psychotherapist or psychologist for ongoing therapy sessions.

PSYCHOLOGIST

WHEN IT’S TIME TO SEEK ONE OUT:

Psychologists are similar to psychotherapists in that they cannot prescribe medications, but the key difference is that they have Doctorate degrees, whereas psychotherapists typically have Master’s. Their education focused on treating more clinically serious disorders, such as anxiety and depressive disorders and bipolar, so if you are exhibiting symptoms associated with these disorders, a psychologist could be a good choice.

HOW THEY CAN HELP:

They offer similar services to psychotherapists, such as CBT, but usually specialize in a certain area, such as anxiety, allowing them to go deeper into the causes and potential solutions for your distress. They frequently work in tandem with psychiatrists and can refer you to one for medication, as needed.

While there are several forms of psychotherapy a psychologist might use to help you with your postpartum/perinatal experiences, one that is particularly helpful for new moms is Interpersonal Psychotherapy (IPT), which typically lasts three to four months and focuses on guiding you through four key areas of postpartum distress:

1. Grief: Addressing various areas of loss related to having a child (e.g., loss of previous identity, etc.).
2. Role transitions: Personal and interpersonal shifts as you become a mom.
3. Interpersonal disputes: Struggles with significant others around the introduction of a baby into the family dynamic.
4. Interpersonal deficits: Other relational difficulties in your support system.

PSYCHOTHERAPIST

WHEN IT’S TIME TO SEEK ONE OUT:

Psychotherapists do not prescribe medications, but are trained in various forms of talk therapies, so they are a good a choice when your symptoms are less severe than those listed in the last section, yet still cause a certain amount of distress or disruption in your everyday life — more “baby blues” than full-on clinical depression. The key difference between the two is in how long it lasts, which in the case of baby blues is typically as long as 14 days postpartum, whereas Perinatal Depressive Disorder can last as long as a year.

HOW THEY CAN HELP:

A psychotherapist can provide you with a compassionate ear, ongoing emotional support, coping mechanisms, and practical skills to help.

One of the most common forms of psychotherapy is cognitive behavioral therapy (CBT), which is often referred to as the “gold standard” of talk therapy. It focuses on your thought patterns (or cognitions) and how they affect your behaviors. The idea is, if you choose different thoughts, you’ll feel and behave more positively.

They can also help normalize your experience and suggest simple lifestyle changes like getting a little exercise, eating well, sleeping as much as possible, and increasing your social support system.

LIFE COACH

WHEN IT’S TIME TO SEEK ONE OUT:

Coaching is not a sufficient support system for anyone who is experiencing a mental health disorder. Coaching is a great option for anyone struggling with adjusting to their new parenting role and the responsibilities that accompany the identity shift.

HOW THEY CAN HELP:

Your experience of coaching will vary from coach to coach, so I will speak for myself. My practice is mostly focused on women, expectant mothers and mothers. It goes without saying that life changes dramatically when you have to consider a child in the present or future. You may feel anxious or worried about the way your life has changed, which is very often a justifiable though challenging reaction.

There are normative reactions to pregnancy and parenting which include stress, anxiety, worry, frustration, fear, an inability to make decisions and more. Within reasonable limits, these are experiences that coaching can help with. I work with clients who are hoping to work on issues such as job/career changes, time management, task execution, relational challenges, parenting difficulties and more.

NEXT STEPS

Depending on which categories you identify with, I recommend reaching out and speaking with several clinicians and interviewing until you find someone that you connect with. You deserve to talk to someone who is nurturing, empathic, and professional.