It’s perinatal depression. Yes, it’s true…the n..." /> It’s perinatal depression. Yes, it’s true…the n..." />

Can You Guess the No. 1 Complication of Childbirth?

Mother kissing infantIt’s perinatal depression.

Yes, it’s true…the number one complication of childbirth is perinatal depression/anxiety (or perinatal mood/anxiety disorder [PMAD] in clinical terms). Those of us in the maternal health field in the state of California are especially aware of May as being designated Maternal Depression Awareness Month. During this time, advocates, specialists, volunteers, and lobbyists are all working to destigmatize and to educate the public about the number one complication of childbirth…perinatal depression.

Perinatal depression affects at least 20% of all childbearing women, the percentage being higher in many populations (including teen moms and those facing poverty). And what is “perinatal”? As mentioned in previous articles, this term refers to the time period from conception, through pregnancy, up through the first year after giving birth. Women are at risk for developing perinatal depression if they have a family history of mood/anxiety disorders, a personal history of depression/anxiety episodes, and other factors, including a sensitive response to the delicate interplay of hormones around reproductive life events. A sensitive response to hormonal fluctuations can in turn affect the balance of serotonin and other neurotransmitters in the brain that regulate mood. Symptoms typically include extreme fatigue, insomnia, appetite loss, guilt/feelings of hopelessness or sense of inadequacy as a mother, and in some cases, intrusive thoughts and suicidal ideation. Sleep deprivation can exacerbate these symptoms as well.

Oftentimes, maternal depression is misconstrued in the media, with traumatic stories of women killing their children predominating the headlines. Many of the horrifying events categorized on television as “maternal or postpartum depression” are really postpartum psychosis, a separate illness categorized by losing touch with reality and delusions/hallucinations. Although postpartum psychosis is a very real and true medical crisis, it is NOT maternal depression. Postpartum psychosis, although very serious and life-threatening, is relatively rare (1 in 1,000 births) compared to perinatal depression (20% or more of pregnant and postpartum women). Perinatal depression does not include the psychotic features that are present in perinatal psychosis.

The subject of perinatal depression/anxiety is a very intricate and complicated one, an area of cutting edge research and science. PMADs are the subject of multi-day conferences and workshops, and those of us in the field are excited about the new discoveries being made every day to help women and their families with recovery.

With swift treatment, a woman can expect full recovery and anticipate positive outcomes for herself and her family. The converse is also true for those who do not get treatment (typically psychotherapy, social support system, self-care regimen, and when indicated, medication management)—without treatment, problems can develop with the attachment of mother and baby, impaired neurodevelopment of the baby, worsening symptoms and stress for the mother/family, along with a host of other serious issues that are beyond the scope of this article. The key piece to remember is that with help, a woman will recover. She is not alone. And it is not her fault (this is the Postpartum Support International [PSI] universal message).

I would like to draw to your attention to the many events and groups of people who are working in the state of California to bring maternal depression awareness to the forefront. Please see the following websites for more information:

  • Postpartum Support International: The largest non-profit in the world dedicated to support for the pregnant/postpartum mom and her family; support groups and resources available with lists of trained perinatal practitioners; trainings available. National Warmline: 1-800-944-4PPD
  • CaPSI: PSI in the state of California…warmline for moms and those who love them; resources and support available in English and Spanish 1-855-227-7462 or
  • 211: resources available for the perinatal population in Greater Los Angeles and other geographical areas
  • California Maternal Mental Health Collaborative: legislation, lobbying, advocacy (collaboration of several task forces in state)
  • Los Angeles County Perinatal Mental Health Task Force:
  • Inland Empire Perinatal Mental Health Collaborative:
  • Postpartum Health Alliance of San Diego:
  • – nationally recognized blog; support and advocacy

Related articles:
Postpartum Depression: A Multifaceted Problem
May is Perinatal Mental Health Awareness Month in the U.S.: Peri-huh?
Help! My Brain is Betraying Me!: Intrusive Thoughts in Motherhood

© Copyright 2012 All rights reserved. Permission to publish granted by Andrea Schneider, LCSW, Postpartum Depression Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Carole

    May 2nd, 2012 at 11:23 AM

    I would hope that focusing on this very issue will help women get some treatment. For some of these women, especially those who have desperately wanted to get pregnant and start a family, this must be devastating to have to go through this. A part of you has to start wondering if you are really cut out to be a new mom at all and handle the pressures that mommyhood naturally brings. And I would presume that these are the same women who would not necessarily ask for help because in many cases they are probably ashamed and are afraid to admit the feelings that they are having. Stressing to these women that they are not alone can do much good as it will encourage them to ask for the help that all of us have needed at certain points of being pregnant or being a mom, and will show them that they should not be ashamed to admit that they are depressed. This is something that can be so easily treated when caught early, so I want these mothers to speak up about their own feelings, and not only will they be helping themselves but maybe someone else too.

  • agatha

    May 2nd, 2012 at 2:54 PM

    A lot of attention has been given to post partum depression, but you don’t hear as much anout women being depressed while the baby is still in utero. Thanks for bringing this to attention that this is something that is also possible for expectant mothers.

  • Andrea

    May 2nd, 2012 at 2:59 PM

    Thanks for your comment, Carole…

  • alicia parks

    May 3rd, 2012 at 4:19 AM

    I kind of felt this when pregnant but sure did not tell anybody! I would have been too embarassed to be feeling these things when this was supposed to be only a happy time. That was a few years ago and there is a lot more conversation about the issue now than there was when I was pregnant. I kind of kept it all to myself and chalked it up to being scared, and thankfully I was able to work through it on my own. Mine was very mild compared to what I know other women have had to face. But at least now we are talking about it, and that in itself is a good thing.

  • Dawn c

    May 3rd, 2012 at 11:28 AM

    Thank you for providing so much additional support information at the end of your piece. I think that this may really help someone looking for answers but who does not know where they should start.

  • daniel

    May 3rd, 2012 at 1:09 PM

    awareness among the ob-gyn community- what’s that like? Is this something most of them know to be on the lookout for?

  • Andrea

    May 3rd, 2012 at 6:12 PM

    Yes, more awareness is critical to de-stigmatizing….we screen for gestational diabetes and hypertension during pregnancy….we need tomb doing that for perinatal depression from conception on through the first year postpartum…and before and beyond, for that matter….Daniel…Ob/Gyns are now being required to be trained in this area in med school and legislation is pending to require screenings….see for updates..

  • Chase

    May 4th, 2012 at 2:59 PM

    If I think that my wife is experiencing this, I might would have a hard time bringing that up to her. How do you even begin to start that conversation?

  • Andrea

    March 18th, 2013 at 6:32 PM

    The Ca-PSI Warmline is no longer in service, unfortunately…go to the PSI National Warmline to connect with co-Coordinators in CA for local support 1-800-994-4PPD

  • Andrea Schneider

    April 30th, 2017 at 2:44 PM

    Also Postpartum Progress is no longer a resource available on the web…however, PSI is taking over some of the functions of Postpartum Progress…see

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