Little girl kissing her pregnant mother's stomach

Pregnancy is often regarded with excitement, but no matter how eagerly a child's birth is anticipated, stress and other forms of emotional distress are still likely to occur during the challenging period of pregnancy. Perinatal depression is a medical condition that can affect any pregnant or postpartum woman, regardless of age, race, ethnicity, income, culture, or education. Pregnancy issues may be mild or serious, but they can affect the health of the mother or child, put strain on a romantic partnership, and lead to life changes, both predicted and unpredictable.

When concerns that arise during pregnancy or after birth cause distress or otherwise affect one's mental health, the support of a therapist or other mental health professional may be helpful. Prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions.

Table of Contents

  • Challenges Associated with Pregnancy and Birth
  • Pregnancy and Mental Health Concerns
  • Impact of Birth on Emotional Health
  • The Role of Partners in Perinatal Mental Health
  • Therapy for Pregnancy and Birthing Concerns
  • Reducing Stress in Pregnancy
  • Pregnancy Loss
  • Frequently Asked Questions
  • How Therapy Can Help / Find a Therapist

Challenges Associated with Pregnancy and Birth

Though pregnancy can be challenging for both parents, in many cases the pregnant woman experiences the greatest amount of strain. A single mother may experience even higher levels of emotional distress, as single mothers often lack help and support.

Pregnancy proceeds smoothly for many women, but even an "easy" pregnancy may be accompanied by some mental or physical concerns, and many mothers-to-be experience stress or anxiety regarding the health of their child, the impending birth, or the variety of complications that can occur with pregnancy. These worries may be mild or severe, but the stress they can cause may lead some women to experience increased physical or mental strain, depression, or poor physical health, all of which may lead to increased risk in childbirth.

Pregnancy can put strain on a partnership, especially when a pregnancy was unplanned and partners have different goals. When one partner desires children and the other does not, for example, differing views about the outcome of the pregnancy may affect the relationship significantly. Even when both partners wish to have a child, being unprepared for the child's arrival financially or in other ways may still be a cause for concern. When a couple has unaddressed or unsolved relationship issues, their partnership may be further tested by the varied challenges of childrearing.

If one or both partners is ambivalent about the idea of parenthood, having a baby may have a negative impact on the relationship, especially when other strains or stressors are present. Discussing any issues or parenting disagreements before pregnancy or before the child arrives may help a couple to become stronger, both as partners and as parents.

Financial Challenges

Financial issues can also be a source of distress during pregnancy. Pregnancy, childbirth, and postpartum care cost $20,416 in total health spending and $2,743 out of pocket for people with employer-sponsored insurance, based on 2021 to 2023 claims data. Average out-of-pocket costs are only 20% higher for women who have a cesarean section ($3,071) than those with a vaginal delivery ($2,563). About a third of all deliveries in the United States are by cesarean (32.3% in 2023).

Because of the high cost attached to childbirth, many women who become pregnant may find themselves experiencing stress or anxiety as a result of impending medical bills. While some insurers may cover a significant portion of childbirth costs, other insurers may pay little to nothing, leaving families responsible for extensive and unexpected medical bills that frequently include charges for unused items or unnecessary services.

Physical Challenges

The physical challenges that often accompany pregnancy can also be difficult for many women to cope with. Morning sickness, aches and pains, fatigue, insomnia, and indigestion are just a few of the concerns that a pregnant woman may face. Women who contract illnesses while pregnant can be more severely affected by symptoms and may have a greater risk of complications, the most severe of which are birth defects or fetal death. In order to prevent certain birth defects and foodborne illnesses, a physician will typically recommend certain dietary restrictions to women who are pregnant, such as the avoidance of alcohol and raw or unpasteurized foods. Beyond these restrictions, some women may find it difficult to eat a variety of foods, due to morning sickness or other pregnancy-related stomach concerns.

Some women may have the opportunity to choose their own doctor or midwife, but many women are not able to do so and find themselves with an overburdened or distant health care provider or one who is difficult to connect with. This can make necessary doctor visits another source of distress, and some women may avoid essential care as a result. A therapist or counselor may be able to help women in this situation connect with a different doctor or clinic, if possible, and may also be able to help those in this situation explore other possible solutions.

Pregnancy and Mental Health Concerns

While pregnancy often elicits many positive emotions, it can also cause a woman to experience negative thoughts and feelings. During pregnancy, past family issues, insecurities, relationship difficulties, and financial issues can become real and immediate concerns. A woman who is expecting may find herself experiencing mood swings, fear, anxiety, forgetfulness, or body image issues. In pregnancy, the prevalence of depression is estimated to be between 7% and 20% in high-income countries. Approximately 10% of pregnant women meet the criteria for major depression.

Women who experienced depression or anxiety before becoming pregnant may be more likely to experience mental health concerns during pregnancy. Women are at increased risk for perinatal depression if they have a personal or family history of depression or bipolar disorder or if they experienced depression with a previous pregnancy. When mental health conditions do occur during pregnancy or postpartum, a woman's doctor will generally be able to provide referrals to mental health professionals as well as immediate health care and support.

Because some psychotropic medications can have harmful effects on developing fetuses, women who are taking these medications and discover they are pregnant or intend to become pregnant are advised to contact their doctor and mental health care provider. In some cases, another medication is prescribed, and in others, a woman may receive an alternative form of treatment for the duration of the pregnancy, such as therapy only. This may not be effective for all individuals, but a therapist's help and support can help each woman find the right option for her. Some mothers who have mental health concerns may become anxious when considering the possibility of passing their illness on to their child, but information and resources obtained from a health care professional may be helpful at addressing their concerns.

Societal expectations of pregnant women and new mothers may lead many women to experience anxiety or stress. Well-meaning individuals—family, friends, or even strangers—may criticize the practices, diet, and weight gain (or lack thereof) of pregnant women and may often offer unsolicited opinions or advice. Some women may experience irritation, anger, or frustration as a result, but others may come to doubt their own ability to be good mothers. Soon-to-be parents may turn to parenting books or other sources of advice and become overwhelmed by conflicting opinions on the best or safest options for delivery.

Current Research on Prevalence

Mean overall prevalence of perinatal depression, antenatal depression, and postnatal depression was 26.3%, 28.5%, and 27.6%, respectively. The pooled prevalence of perinatal depression in rural areas was 22.1%. Symptoms of mental health concerns are the most common complication of childbirth.

According to recent research:

  • Between 15 and 20% of women experience clinically significant anxiety or depression after childbirth
  • 50% of women who experienced antenatal depression went on to develop postpartum depression
  • Prenatal maternal psychological stress has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the child
  • Maternal stress during pregnancy can trigger an inflammatory response, releasing proinflammatory cytokines and other immune molecules. This maternal inflammation can cross the placenta and impact the developing fetal brain

Many women experience "baby blues," or a period of low mood and tearfulness, for a week or two following childbirth. These feelings generally resolve with the support of one's partner or family. When they do not resolve or include hopelessness, negative thoughts about oneself or one's baby, or a loss of appetite, a more serious condition may be indicated.

Postpartum psychosis is rare but serious: Women with postpartum psychosis may experience delusions (thoughts or beliefs that are not true), hallucinations (seeing, hearing, or smelling things that are not there), mania (a high, elated mood that often seems out of touch with reality), paranoia, and confusion. Postpartum psychosis is a psychiatric emergency that requires hospitalization. Women experiencing symptoms of postpartum psychosis should seek immediate help by calling 911 or going to the nearest emergency room.

Impact of Birth on Emotional Health

It can sometimes be difficult for parents, especially new parents, to become accustomed to life after the birth of a child. A difficult birth can leave both parents emotionally and physically fatigued, and it can be difficult and stressful for parents to adapt to new roles and responsibilities. Some partners of women who have just given birth may wish to offer support but provide either too little or too much, thus straining a partnership that may already be challenged by the new baby. Both the mother and her partner may experience fatigue or have trouble sleeping, due to the demands of a newborn, and this lack of sleep may lead to a lowered immune system, increased irritability, and stress.

While it is often possible for a couple to communicate their issues and work through them together without outside help, often professional support is beneficial to this process.

Some women who have just given birth may find it difficult to accept that certain aspects of pregnancy and delivery did not happen as expected. A mother who carefully designed a birthing plan but was unable to use it due to medical complications may experience regret that the birth did not go the way it was planned. Women who have a difficult recovery may feel frustrated by their inability to do things for themselves or find it difficult to cope with pain and fatigue. Some women who are unable to breastfeed may experience feelings of failure or frustration and become stressed or experience symptoms of depression as a result.

When a child cannot be carried to term, is stillborn, or is discovered to have a fatal or life-threatening birth defect, this can cause significant grief that, if untreated, may lead to mental health concerns such as depression. Telling family and friends about the death of an infant instead of announcing the birth may be an exceedingly difficult task that can have a lasting impact on parents, especially the woman who carried the child. Therapy can help address and treat feelings of grief.

The Role of Partners in Perinatal Mental Health

In fathers' role as partners, their support for mothers during pregnancy and postpartum is associated with improved maternal mental health. In their role as parents, fathers themselves are vulnerable to perinatal mood and anxiety disorders. As many as 1 in 10 dads will experience emotional and mental health challenges during and following their partner's pregnancy, with the peak onset of depression between 3-6 months following the birth of a baby.

Partners play a critical role in maternal mental health through:

  • Emotional support: Providing a listening ear, offering encouragement, and expressing understanding for the emotional ups and downs experienced by expectant and new mothers
  • Shared responsibilities: Assisting with household chores, childcare, and other practical tasks to reduce stress and promote an equitable caregiving environment
  • Active involvement: Accompanying expectant mothers to healthcare appointments to demonstrate support and learn about the pregnancy journey together

Barriers to Paternal Mental Health Support

Fathers expressed feeling underprepared for the unfamiliar, and at times traumatic, experience of the perinatal period. They reported that a lack of awareness of paternal perinatal mental health issues or available support acted as a major barrier to accessing help. All participants described missed opportunities for basic paternal mental health support in the perinatal period, such as signposting or psychoeducation. Service structures were designed for mothers only, and services for fathers were experienced as inadequate.

Therapy for Pregnancy and Birthing Concerns

Pregnancy, childbirth, and childrearing can all be difficult, even when everything proceeds without significant upset. Parents who have a strong bond and the support of others may still face unavoidable health or financial challenges, among others, which can significantly strain a partnership. The support of family and friends is considered by many to be an essential aspect of the well-being of new parents, especially new mothers.

Types of Therapy

Therapy can help expectant mothers, women who are facing postpartum concerns, and the partners of these women to address the various issues that pregnancy and childbirth are likely to cause. Most psychological intervention trials have tested cognitive behavioral therapy (CBT) modified for postnatal depression, but there is also evidence of clinical effectiveness for a range of other interventions, including interpersonal therapy (IPT), listening visits, and exercise.

Women who experienced mental health issues before pregnancy may fear that the added challenge of motherhood will exacerbate their conditions or cause further concerns to develop, but the support of a therapist or counselor throughout their pregnancy may help them feel more at ease. Women who experience postpartum depression or psychosis may find that therapeutic treatment, combined with medication when necessary, has a beneficial effect.

The type of therapy used will generally vary based on the concerns a woman is experiencing. Some women find the stress of motherhood and new responsibilities to be difficult to handle, and voicing their concerns in a support group to others in the same situation may be helpful to them. Those experiencing depression or anxiety may seek individual therapy. Couples therapy can also be helpful when a couple finds that a new baby has placed added challenges and stresses on their relationship. In therapy, couples can voice concerns or areas of disagreement and resolve any issues in their partnership.

Parents or single mothers who lack assistance and support may also be able to seek resources and find help developing a support network in therapy. In any case, a therapist will be able to offer resources and help for those experiencing difficulty.

Emerging Treatments

The novel medication brexanolone, a neurosteroid that acts as a positive neuromodulator at GABA-A receptors, has been developed for postpartum depression and approved by the US Food and Drug Administration for this condition in 2019. The U.S. Food and Drug Administration (FDA) has approved a medication called brexanolone specifically to treat severe postpartum depression. Brexanolone, which is administered through an IV during a brief hospital stay, appears to work differently than traditional antidepressants by rapidly altering brain chemistry.

Grief counseling, typically recommended after the loss of a child, can help parents come to terms with their loss, cope with their grief, and prepare to try again, should they wish to do so.

Reducing Stress in Pregnancy

Prenatal stress can have significant effects on pregnancy, maternal health, and human development across the lifespan. These effects may occur directly through the influence of prenatal stress-related physiological changes on the developing fetus, or indirectly through the effects of prenatal stress on maternal health and pregnancy outcome. Stress reduction is considered to be one important way an expectant mother can achieve better health and prevent certain complications.

The causes of stress during pregnancy are often varied. A woman may become stressed as her body begins to change, as she experiences the effects of pregnancy-related hormones, or as a result of anxiety or fears about pregnancy and childbirth. Both acute and chronic stress during pregnancy can cause an allostatic overload or a long-term imbalance in the mediators of homeostasis, leading to disturbances in maternal–placental–fetal endocrine and immunological responses. Individuals who experience negative or catastrophic life events during pregnancy or who have chronic stress, PTSD, or other mental health concerns may also experience greater levels of stress during pregnancy.

A health care professional will likely advise a woman experiencing stress to:

  • Cut back on stressful activities
  • Stay healthy and fit by eating nutritious foods and keeping as active as possible
  • Maintain a support network and keep in contact with friends and family
  • Seek and accept help when needed
  • Participate in childbirth education classes
  • Take up relaxation techniques such as prenatal yoga or meditation

Professional help from a therapist or counselor may also be recommended.

Pregnancy Loss

Stillbirth and miscarriage are two pregnancy complications that lead to fetal death. Miscarriage is pregnancy loss occurring within the first 20 weeks of pregnancy, while a stillbirth occurs after 20 weeks. Even with medical advancements, each year about 21,000 babies are stillborn in the United States. Approximately 1 in 175 pregnancies end in stillbirth, affecting 21,000 pregnancies annually. A 2021 review suggests the overall risk of miscarriage is 15.3% of all recognized pregnancies. The prevalence of one miscarriage is roughly 10.8%, two miscarriages is 1.9%, and three or more is 0.7%.

Understanding Pregnancy Loss

Miscarriage and its causes are often misunderstood and stigmatized. In most cases, the cause of a miscarriage cannot be determined. The risk of miscarriage at 6 weeks is 9.4%, and at 7 weeks it decreases to 4.2%. Some possible causes include chromosomal abnormalities, hormonal concerns, improper egg implantation, maternal age, and exposure to toxic substances.

25% of all stillbirths in the US are preventable today. 47% of all stillbirths in the US at 37+ weeks are preventable today. Stillbirth is somewhat more understood than miscarriage. Its causes, which include placental problems, birth defects, restricted fetal growth, and bacterial infections, among others, can more often be determined.

Emotional Impact

Pregnancy loss can significantly impact families' mental and physical health. It can also affect their relationships. Pregnancy loss can lead to complex emotions, such as grief, shame, guilt, and isolation. Some of those who have experienced pregnancy loss believe they could have prevented it, but this is not often the case. Because pregnancy is not yet apparent in many of those who have a miscarriage, many feel isolated following this loss. Perinatal loss, which includes miscarriage, stillbirth, and infant death, deeply impacts the mental health of mothers, birthing people, and their partners.

Frequently Asked Questions

What are the warning signs of perinatal mental health issues?

Some of the more common symptoms include: Persistent sad, anxious, or "empty" mood most of the day, nearly every day, for at least 2 weeks. Other warning signs include extreme mood changes, difficulty bonding with your baby, withdrawing from partner or family, thoughts of harming yourself or your baby, and physical symptoms like changes in appetite or sleep patterns that significantly interfere with daily life.

How common is depression during pregnancy and after birth?

Mean overall prevalence of perinatal depression, antenatal depression, and postnatal depression was 26.3%, 28.5%, and 27.6%, respectively. In pregnancy, the prevalence of depression is estimated to be between 7% and 20% in high-income countries. These rates may be higher in certain populations, including those with limited resources or previous mental health histories.

Can partners experience postpartum depression?

Yes, as many as 1 in 10 dads will experience emotional and mental health challenges during and following their partner's pregnancy, with the peak onset of depression between 3-6 months following the birth of a baby. Partners need support too and should seek help if experiencing symptoms of depression, anxiety, or other mental health concerns.

What treatments are safe during pregnancy and breastfeeding?

Most psychological intervention trials have tested cognitive behavioral therapy (CBT) modified for postnatal depression, but there is also evidence of clinical effectiveness for a range of other interventions, including interpersonal therapy (IPT), listening visits, and exercise. Medication decisions should always be made in consultation with healthcare providers who can weigh the risks and benefits for each individual situation.

How does stress during pregnancy affect the baby?

Prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. Prenatal maternal psychological stress has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the child.

When should I seek help for pregnancy-related mental health concerns?

You should seek help if you experience persistent sadness, anxiety, or mood changes lasting more than two weeks, difficulty caring for yourself or your baby, thoughts of self-harm or harming your baby, or any symptoms that interfere with your daily functioning. Early intervention leads to better outcomes for both parent and child.

How Therapy Can Help / Find a Therapist

If you're experiencing emotional distress during pregnancy or after birth, know that you're not alone and help is available. Recovery is possible with professional help. Therapists who specialize in perinatal mental health understand the unique challenges of this time and can provide evidence-based treatments tailored to your needs.

At GoodTherapy, we can help you find a qualified mental health professional in your area who specializes in pregnancy and birthing concerns. Our directory includes therapists experienced in:

  • Perinatal depression and anxiety
  • Birth trauma
  • Pregnancy loss and grief counseling
  • Couples therapy for new parents
  • Partner/paternal mental health support

Don't wait to get the support you deserve. Use our therapist directory to find a mental health professional near you who can help you navigate this important time in your life. Remember, seeking help is a sign of strength, not weakness, and taking care of your mental health is one of the best things you can do for yourself and your family.

Find a Therapist Now

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