Why Mothers Should Be Connected to Mental Health Services Before the Baby Arrives
When we talk about preparing for a baby, we talk about prenatal vitamins, ultrasounds, birth plans, car seats, feeding, and pediatricians. We spend months preparing for the physical arrival of a baby. But I think there is another conversation that needs to happen just as early: How are we going to care for the mother's mental health?
When I think about my own postpartum journey, one of the biggest highlights wasn't the fact that I was a new mother. It was the community of mothers I had around me. I had mom friends I could text at 4 a.m. because there was a pretty good chance someone else was awake too, pumping, feeding a baby, trying to get a baby to sleep, or pulling her hair out right alongside me.
I remember one night telling a friend that I was done nursing. I couldn't do it anymore. She was formula feeding her own child, so there was absolutely no judgment coming from her either way. She said, "Look, obviously you know fed is best. But make this decision after you've had some sleep. Tomorrow, if you still feel the same way, I will tell you the best formulas on the market."
I remember another mom sitting with me when I eventually did decide I was done with nursing and I cried over the end of that journey. She looked at me and said, "I was only formula fed, and I am the most fabulous person in my field. Your son would be lucky to be like me."
I still laugh thinking about that conversation, but I also understand now, both as a mother and as a clinical psychologist, what those women were doing for me. They were helping me regulate. They gave me perspective when I was exhausted. They normalized things that felt enormous in the middle of the night. They gave me permission to feel what I was feeling without making every feeling into a crisis. And had something actually been wrong, I had people around me who knew me well enough to notice.
I was incredibly fortunate because much of that community was already built into my life through my religious and cultural center. But millions of mothers don't have that. Over the last decade, I have worked with mothers who spend nearly 24 hours a day at home with their babies. Some have partners who love them very much but have absolutely no idea how to support them. Some have family nearby and still feel profoundly alone. Some are trying to figure out whether what they're experiencing is sleep deprivation, the normal emotional adjustment to motherhood, postpartum anxiety, postpartum depression, intrusive thoughts, and something that requires medical attention.
Fortunately, the mothers I see are already connected to therapy. That means we can talk about what is normal, what needs more attention, when we need to bring in their physician or psychiatrist, and when something needs immediate intervention. Sometimes I sit with a mother and think about how differently this could have gone if she hadn't already had a mental health professional in her life.
That is why I believe we need to start thinking about maternal mental health care long before a woman reaches a breaking point.
Pregnancy and postpartum are some of the most vulnerable transitions in a woman's life. Her body changes. Her hormones change. Her sleep changes. Her relationships change. Her responsibilities change. Her identity may change. Her career may suddenly look different. Her marriage or partnership may feel different. Even her relationship with her own body and sense of autonomy can shift dramatically. All of this can happen while she is simultaneously responsible for keeping a completely dependent human being alive.
And somehow, we often expect the mother herself to recognize when she is no longer okay.
I don't think that is a good enough postpartum mental health plan.
Connecting women to therapy during pregnancy doesn't mean we are assuming every pregnant woman will develop postpartum depression or postpartum anxiety. Therapy can also be preventative. Pregnancy is an opportunity to talk about emotional health before sleep deprivation, feeding challenges, hormonal shifts, relationship stress, and the enormous adjustment to parenthood arrive all at once.
Imagine if preparing for a baby routinely included questions like:
Who will you call when you're overwhelmed?
What does anxiety typically look like for you?
What happens to your mental health when you're severely sleep deprived?
Who can step in when you need rest?
What are the warning signs of postpartum depression and anxiety?
Does your partner know them?
Who will notice if you begin behaving unlike yourself?
Where will you go for help?
And we need to stop leaving fathers and partners out of postpartum mental health care.
Talk to them. Teach them what postpartum depression and postpartum anxiety can look like. Help them understand what symptoms they should be paying attention to. Ask about their mental health too. Becoming a parent is a massive psychological transition for them as well, and a partner who is overwhelmed, depressed, anxious, or completely unprepared for the emotional realities of having a newborn is going to have a much harder time supporting the mother.
This is also an appeal to the medical professionals caring for pregnant and postpartum women: please do the mental health screeners and ask the follow-up question beyond the 6-week mark. Talk about maternal mental health during pregnancy. Remind them that sometimes mood drops when nursing stops. Ask women who their support people are. Ask what their plan is if they begin struggling. Know the therapists and mental health professionals in your community who specialize in pregnancy and postpartum mental health so that when a woman needs help, the referral isn't simply a phone number on a piece of paper.
And this responsibility extends beyond medical providers.
Community leaders, religious organizations, extended families, friends, and neighbors all have a role in postpartum care. If we know a woman is having a baby, our responsibility to her cannot end with buying something from her registry, dropping off a meal, and asking to hold the baby.
Learn the signs of postpartum depression and anxiety. Check in after everyone else has stopped checking in. Offer to sit with the baby so she can shower or sleep. Ask the partner how they are coping. Build communities where mothers don't have to become severely unwell before someone notices they need support.
Sometimes postpartum support is clinical. It is therapy, medication, psychiatric care, or urgent intervention. Sometimes it is practical. Someone brings dinner, holds the baby, washes the bottles, or gives a mother three uninterrupted hours of sleep. And sometimes it is another mother answering a text at 4 a.m. and saying, "Don't make the decision tonight. Get some sleep. I'll still be here tomorrow."
We spend an extraordinary amount of time preparing mothers to care for babies. I think it is time we put just as much thought into preparing families, medical systems, and communities to care for mothers.
Maternal mental health should not begin when a mother is already in crisis. It should begin when we learn that a mother is coming.
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To learn more about therapy services for children or adults, or for parenting/family support, contact:
Family and Child Roots & Wings at 847-786-8222 or email drnirmeen@familyandchildrootsandwings.com
