When I became a mother, I was prepared for a momentous life change. What I did not anticipate was the impact that pregnancy and postpartum could have on my mental health, in addition to my physical recovery. After giving birth to my first daughter, I dismissed my stress and sensitivity as the typical fatigue and chaos of early parenthood. But in reality, I was deeply struggling. Although I knew that something wasn’t right, I wasn’t ready to face the possibility that I was experiencing mental health challenges. By the time I had my second child, postpartum anxiety had wrapped itself tightly around my daily life.
My breaking point came one afternoon when I found myself sitting on the kitchen floor in tears while holding my second daughter. She had been battling a respiratory syncytial virus (RSV) at five months old. Despite knowing that she was receiving effective medical care and would likely make a full recovery, I was still overcome with constant worry. I couldn’t leave her side. What began as a desire to monitor her breathing turned into obsessive behaviors that made me terrified to go to sleep, shower, or even eat. My fear that she would stop breathing while I wasn’t holding her was all-consuming.
All I wanted was to make sure she was safe, but in doing so, I began to slowly unravel. In this moment, my husband knelt beside me and said, “This isn’t how it’s supposed to be. We can get you help.” That conversation opened me up to confront my anxiety and practice what I inspired others in my life to do: be brave enough to admit when you’re not okay.
From there, I began my journey toward healing with the help of an incredibly talented physician who listened to me and helped me understand the mental health challenges I was facing. I started to realize that my mental health mattered just as much as my physical health, and that my well-being mattered just as much as my daughters’. I saw firsthand how avoiding open conversations about the emotional and psychological impacts of early motherhood can prevent us from addressing a mental health crisis.
This lack of transparency permeates throughout an entire system that fails mothers because of a fragmented approach to care that overlooks mental wellness as a central pillar of postpartum recovery.
The Overlooked Realities of Perinatal Health
The perinatal period, spanning pregnancy through one year postpartum, brings heightened vulnerability to a range of behavioral health conditions. These include generalized anxiety disorder, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and, more rarely but urgently, postpartum psychosis. Women experience dramatic physical, hormonal, and emotional changes while navigating sleep deprivation, recovery from childbirth, and the demands of caring for a newborn. For some, the challenges are magnified by traumatic birth experiences or pre-existing conditions. Yet, the standard six-week postpartum check-up often ignores mental health symptoms and needs entirely.
While hormonal shifts and physical changes are well-known biological contributors to perinatal mental health conditions, psychological and social drivers play an equally powerful role in shaping a mother’s mental well-being throughout the perinatal period. Despite enormous physical and emotional changes, many women feel pressure to meet unrealistic ideals and maintain constant joy. Some mothers perceive it as a failure that they don’t instinctively know how to parent. These expectations, often fueled by social and cultural pressures, can lead to guilt, shame, and self-doubt when reality falls short.
For those with a history of mental health challenges or past traumas, the emotional demands of the perinatal period can reopen old wounds. This increases vulnerability to mental health problems, especially following birth experiences that feel traumatic or disempowering.
Confronting the Gaps in Care
Beyond individual experiences, broader social and structural factors profoundly impact maternal mental health. A lack of affordable health care, childcare, paid leave, or culturally competent healthcare leaves many mothers unsupported and overwhelmed.
For women who are part of minoritized communities, the stress of navigating discrimination and negative social determinants of health can add a compounding layer of harm that is too often overlooked in perinatal care. High maternal mortality rates in the United States are alarming, as over half of pregnancy-related deaths in the U.S. happen after delivery, with 25% occurring between one week and one year postpartum. Addressing these issues requires careful observation to ensure all mothers receive the care, support, and dignity they deserve during one of the most mentally and physically challenging times in their lives.
Estimates from a study in the National Library of Medicine suggest that between 6.5% and 20% of people who give birth will have depression symptoms. This figure also includes pregnant people who miscarry, terminate pregnancies, or have stillbirths.
The staggering reality is that up to 50% of these cases of depression remain undiagnosed due to patients’ reluctance to disclose symptoms, according to the National Institute of Health. For some under-resourced parents, a lack of support or trust from institutions can lead to fear of their child being taken away.
Building a Maternal Mental Health Response System
My personal experience navigating the mental health care system in my time of need stays with me and shapes my work in the mental health system every day. It reminds me to center personal stories and drive lasting change. A critical part of this work is in crisis response and advocating changes that can bolster the continuum of care and increase integration and collaboration across mental health services.
No single service or intervention suffices on its own. We must redesign the mental healthcare ecosystem to identify where women are in their journey and meet them there, across providers, health systems, and communities. Women are often praised as “supermoms” for pushing through pain silently, despite the fact that suffering in silence carries severe consequences for untreated maternal mental health. These are not inevitable outcomes. They are preventable tragedies that demand an urgent, systemic response.
There are resources available, and it is core to our work as mental health advocates to ensure that all mothers have access to them throughout their motherhood journey. Stigma, lack of childcare, language differences, or distrust of the system too often block the way. We must proactively integrate mental health into prenatal care, with tailored screening and support pathways for anxiety, PTSD, OCD, depression, and psychosis. Integrating behavioral health into OB-GYN visits, lactation consultations, and pediatric checkups creates important touchpoints for early detection and intervention. These touchpoints can address real-world needs in a way that is accessible, affordable, personalized, and coordinated across disciplines.
We all have a role to play as partners, employers, healthcare professionals, policy leaders, and communities. Together, we must create a culture where talking about maternal mental health is no longer stigmatized but embraced as a normal and essential part of pregnancy. Mothers should feel safe, supported, and empowered to seek help.
If you’re in need of help, you can reach the National Maternal Mental Health Hotline by calling or texting 1-833-TLC-MAMA (1-833-852-6262), where trained counselors can offer support and direct women to additional care.
Cara McNulty, DPA, is the Chief Executive Officer of Vibrant Emotional Health.
