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Additional Resources:

Ted Talk: https://www.ted.com/talks/shawnee_benton_gibson_words_wombs_create_worlds_the_black_maternal_health_crisis_jan_2022

Continued Education Training: https://postpartum.net/group/birth-trauma-support-for-bipoc-birthers/

Perinatal Mood Disorders (PMDs) encompass a range of conditions, including depression, anxiety, obsessive-compulsive symptoms, and trauma-related responses occurring during pregnancy or postpartum. While postpartum depression is the most widely recognized, it is far from the only concern. Symptoms may present as persistent sadness, irritability, intrusive thoughts, excessive worry about the baby’s safety, or a sense of detachment from oneself or the infant (American Psychiatric Association, 2020; Howard et al., 2014). These symptoms are often internalized, making them easy to miss—especially when clients appear outwardly “put together.”

A critical, though less common, condition within this spectrum is postpartum psychosis. Unlike PMDs, postpartum psychosis is a psychiatric emergency that typically emerges within the first two weeks after delivery. Symptoms may include hallucinations, delusional beliefs (often centered on the infant), severe confusion, disorganized behavior, and rapid mood swings (Sit et al., 2006; American Psychiatric Association, 2020). Individuals experiencing postpartum psychosis may lack insight into their condition, which significantly increases risk for harm to self or the baby if not addressed immediately (Sit et al., 2006).

One of the most dangerous misconceptions in maternal mental health is the assumption that severe symptoms will be obvious. In reality, many clients mask distress due to shame, fear of judgment, or concerns about custody and safety (Byatt et al., 2012). This is particularly true for those navigating intersecting identities—such as race, socioeconomic status, or cultural expectations—which can further limit access to care and willingness to disclose symptoms (Abrams & Curran, 2009).

From a social constructivist and intersectional perspective, it’s essential to recognize how societal narratives shape both the experience and reporting of perinatal mental health concerns. The idealization of motherhood as purely joyful can silence individuals who feel overwhelmed, disconnected, or distressed (Abrams & Curran, 2009). Providers must actively challenge these narratives by creating spaces where the full range of maternal experiences can be expressed without stigma.

What Providers Can Do:

· Screen early and often: Use validated tools during pregnancy and throughout the postpartum period, not just at a single time point (Byatt et al., 2012).

· Ask direct, nonjudgmental questions: Especially about intrusive thoughts, mood changes, and perceptions of reality.

· Differentiate between PMDs and psychosis: Understand that while PMDs are more common, psychosis requires immediate intervention.

· Normalize help-seeking: Frame mental health support as a routine and essential part of perinatal care.

• Consider context: Assess for relational, cultural, and systemic factors that may impact symptom presentation and access to care.

Maternal mental health is not a niche concern - it is a public health priority. As providers, the responsibility extends beyond recognizing symptoms to actively dismantling the barriers that keep individuals from receiving care. When we move past assumptions and listen more closely, we create opportunities for earlier intervention, safer outcomes, and more compassionate care.

Because sometimes, “she looks fine” is exactly why we need to look again.

References

Abrams, L. S., & Curran, L. (2009). “And you’re telling me not to stress?” A grounded theory study of postpartum depression symptoms among low-income mothers. Psychology of Women Quarterly, 33(3), 351–362. https://doi.org/10.1111/j.1471-6402.2009.01506.x

American Psychiatric Association . (2020). Diagnostic and statistical manual of mental disorders (5th ed.-TR). https://doi.org/10.1176/appi.books.9780890425596

Byatt, N., Simas, T. A. M., Lundquist, R. S., Johnson, J. V., & Ziedonis, D. M. (2012). Strategies for improving perinatal depression treatment in North American outpatient obstetric settings. Journal of Psychosomatic Obstetrics & Gynecology, 33(4), 143-161. https://doi.org/10.3109/0167482X.2012.728649

Howard, L. M., Molyneaux, E., Dennis, C.-L., Rochat, T., Stein, A., & Milgrom, J. (2014). Non-psychotic mental disorders in the perinatal period. The Lancet (British Ed.), 384(9956), 1775–1788. https://doi.org/10.1016/S0140-6736(14)61276-9

Sit, D., Rothschild, A. J., & Wisner, K. L. (2006). A review of postpartum psychosis. Journal of Women’s Health, 15(4), 352–368. https://doi.org/10.1089/jwh.2006.15.352

Perinatal health across the board is agreed to start in pregnancy and conclude post-delivery. Perinatal health is accompanied by several complex mental health concerns, with suicide being the leading cause of death amongst women globally (Chin, et al., 2022). Layton, et al. (2025), determined that worldwide, 890 of every 100,000 women in the perinatal period had either incomplete or complete suicide attempts. Further, women who have received perinatal mood disorder diagnoses, are reported to be 6.2x more likely to have suicide ideations (Layton, et al., 2025).

The risk of appearance-based assumption runs a dangerous risk in assessing women within the perinatal period when seeking clinical services from providers. Providers serving the maternal health population need to be alert and oriented to early screening, assessments, and monitoring of self-harm and suicide ideations. Practitioners should be both mindful of risk factors that impact the perinatal population, in addition to clinical symptoms that alert providers their client may be in need of immediate assistance. Providers must remain diligent in understanding risk factors and clinical symptoms co-exist as two separate entities, it is when a practitioner views these as one entity that clients’ individualized cases go under the radar.

Waller (2021) indicates that clinical risk factors can be items including, but not limited to headaches, fatigue, irritability, agitation, insomnia, loss of appetite, and ideations of self-harm, or fantasies/harm-ideation related to the baby. Providers should also be mindful of the biospsychosocial factors that remain unique to women who have complications throughout their pregnancies (bedrest, hypertension, gestational diabetes, misc.), history of miscarriages or unsuccessful pregnancy, and unstable interpersonal relationships (Waller, 2021).

References

Chin, K., Wendt, A., Bennett, I. M., & Bhat, A. (2022). Suicide and maternal mortality. Sex and Gender Issues in Behavioral Health, 24, 239-275. https://doi.org/10.1007/s11920-022-01334-3

Layton, E., Roddy-Mitchell, A., Kennedy, E., Moran, A. C., Palestra, F., Chowdhary, N., McNab, S., Homer, C. (2025). Maternal mental health matters: Indicators for perinatal mental health - a scoping review. PLoS ONE, 20(1), 1-11. https://doi.org/10.1371/journal.pone.0317998

Waller, H. (2021, August 11). Postpartum depression and related disorders [Conference presentation]. Guiding women through postpartum depression, perinatal loss & grief, PMDD and more, PESI. https://www.pesi.com/showtime/47237992?ClassroomTab=courseSchedule_47237959_12_24

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