Approximately 20% of people develop perinatal anxiety during the perinatal period. You may experience perinatal anxiety independently, but it is often combined with perinatal depression.
Symptoms
The symptoms of anxiety during the perinatal period might include:

• Constant worry
• Feeling that something bad is going to happen
• Racing thoughts
• Disturbances of sleep and appetite
• Inability to sit still
• Physical symptoms like dizziness, hot flashes, and nausea

Treatment
Perinatal anxiety is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you or call the customer service number on the back of your insurance card.

Postpartum Support International

Screener | General Anxiety Disorder-7 (GAD-7) Screener | Edinburgh Postnatal Depression Scale (EPDS)

Research shows that 50% of women with bipolar disorder are first diagnosed in the postpartum period. There are two phases of a bipolar mood disorder: the lows and the highs. The low time is clinically called depression, and the high is called mania or hypomania.
Symptoms
Bipolar disorder can look like severe depression or anxiety.

• Periods of severely depressed mood and irritability
• Mood much better than normal
• Rapid speech
• Little need for sleep
• Continuous high energy
• Overconfidence
• Delusions (often grandiose, but including paranoid)
• Impulsiveness, poor judgment, distractibility
• Grandiose thoughts, inflated sense of self-importance
• In the most severe cases, delusions and hallucinations

Treatment
Postpartum Bipolar is treatable, and there are many options to consider when looking for the correct treatment option.  You should consult your doctor or therapist, to find the right plan for you or call the customer service number on the back of your insurance card. Some treatment options may include:

• Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
• Mental Health Counseling: Evidence-based therapy types may include DBT (Dialectical Behavioral Therapy) & CBT (Cognitive Behavioral Therapy)  
• Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you

Postpartum Support International

Screener | Mood Disorder Questionnaire (MDQ)

According to Postpartum Support International, a traumatic birth is any birth experience that is very scary or overwhelming. Women who have unexpected medical procedures during birth, complications, or who have a baby who was injured or required medical attention are more likely to report that their birth was traumatic. Nearly one-third of all women have had a traumatic birth. Some women who experience a traumatic birth go on to develop post-traumatic stress disorder (PTSD), which is a mental health condition that involves changes in thoughts and feelings, avoidance of the trauma and unwanted reminders of what happened. It’s very common to experience anxiety during a pregnancy after you’ve had a traumatic birth. As you get closer to giving birth, you may find yourself feeling more and more anxious. Using mindfulness techniques, advocating for yourself, and focusing on what is within your control are tools that can help you manage your anxiety and prepare for giving birth again. If your anxiety is very high or isn’t getting better, consider seeking out professional or peer support.

Postpartum Support International
How to Cope When Birth Takes a Traumatic Turn
Birth Trauma Resources

Screener | City Birth Trauma Scale
Birth Trauma and Maternal Mental Health Fact Sheet

Perinatal depression, including postpartum depression, occurs more often than most people realize. It is the most common complication of childbearing. Studies show that 1 in 5 women or 1 in 10 men may experience depression during the perinatal period. However, the numbers are likely higher and increase for high-stress parenting groups.
Symptoms
Symptoms can start anytime during the perinatal period, and may differ for each person. Symptoms of depression during the perinatal period might include:

• Feelings of anger, irritability and/or rage
• Lack of interest in the baby
• Appetite and sleep disturbance
• Crying and sadness
• Feelings of guilt, shame or hopelessness
• Loss of interest, joy or pleasure in things you used to enjoy
• Possible thoughts of harming the baby or yourself

Treatment
Perinatal depression is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you or call the customer service number on the back of your insurance card. Some treatment options may include:

• Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, meditation, asking for help & support groups.
• Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & IPT (​Interpersonal Psychotherapy), but others may be an option.
• Medical Evaluation and Treatment: Medication may be an option, and you must consult a doctor to see what will work for you.

Postpartum Support International

Screener | Patient Health Questionnaire-9 (PHQ-9) for Individuals age 18+ Screener | Patient Health Questionnaire-9 (PHQ-A) for individuals age 11-17 Screener | Edinburgh Postnatal Depression Scale (EPDS)

Perinatal OCD is a mental health condition characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions). It is estimated that 7.8% of pregnant individuals and 16.9 % of postpartum individuals, and some partners, will experience Perinatal OCD. Repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.”  Research has shown that these images are anxious in nature, not delusional, and have a very low risk of being acted upon. It is far more likely that the parent experiencing symptoms may take steps to avoid triggers and what they fear is potential harm to the baby.
Symptoms
Symptoms of Perinatal Obsessive-Compulsive symptoms can include:

• Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something that you have ever experienced before. People with Perinatal OCD know that their thoughts are bizarre and are very unlikely to ever act on them.
• Compulsions, where you may do certain things over and over again to reduce your fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
• A sense of horror about the obsessions
• Fear of being left alone with the infant
• Hypervigilance in protecting the infant

Treatment
Perinatal OCD is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you or call the customer service number on the back of your insurance card. Some treatment options may include:

• Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
• Mental Health Counseling: Evidence-based therapy CBT (Cognitive Behavioral Therapy), ERP (Exposure & Response Prevention), and DBT (Dialectical Behavioral Therapy).
• Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you.

Postpartum Support International

Screener | Obsessive Compulsive Inventory (OCI 12) Screener | Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

Perinatal psychosis, or Postpartum Psychosis, is a serious PMH disorder that usually has an onset in the first 2-weeks (but up to a year). Perinatal Psychosis occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1 -.2% of births. Review the information below to learn more about PP and you can find information on Perinatal Psychosis support and resources here. An active case of Perinatal Psychosis is considered an emergency, and you should reach out to one of the numbers below. It is important to stay with the perinatal individual and the child to ensure everyone’s safety. Perinatal Psychosis is treatable, and help is available. You do not need a diagnosis to reach out for help. If you suspect Perinatal Psychosis Call or text the National Maternal Mental Health Hotline 833-852-6262. Hotline Counselors are available to discuss and explore next steps for you and your loved one. Available 24/7, in the United States only. In an Emergency Call or text the Suicide and Crisis Lifeline at 988 (in the United States and Canada only). Emergency Hotlines are available all the time. It is very important that you reach out right now and find the support and information you need to be safe. Call for yourself or someone you care about; available 24/7.
Symptoms
Symptoms of perinatal psychosis can include:

• Delusions or strange beliefs
• Hallucinations (seeing or hearing things that aren’t there)
• Feeling very irritated
• Hyperactivity
• Severe depression or flat affect
• Decreased need for or inability to sleep
• Paranoia and suspiciousness
• Rapid mood swings
• Difficulty communicating at times

The most significant risk factor for perinatal psychosis is a personal or family history of bipolar disorder or a previous psychotic episode. Immediate treatment for a person going through psychosis is imperative. Individuals experiencing PP are at higher risk of harming themselves or others (including their infant); however, it should be noted that the vast majority do not. This is because the individual experiencing psychosis is experiencing a break from reality. In their psychotic state, the delusions and beliefs make sense to them; delusions feel very real and are often religious. Immediate treatment for someone going through psychosis is imperative. It is also important to know that many survivors of perinatal psychosis never experienced delusions containing violent commands. Delusions take many forms, and not all of them are destructive. The majority of individuals who experience perinatal psychosis do not harm themselves or anyone else. However, there is always the risk of danger because psychosis includes delusional thinking and irrational judgment, and this is why this illness must be quickly assessed, treated, and carefully monitored by a trained healthcare or perinatal mental health professional. Perinatal psychosis is temporary and treatable with professional help, but it is an emergency, and it is essential that you receive immediate help. If you feel you or someone you know may be suffering from this illness, know that it is not your fault, and you are not to blame. It is important to stay with the perinatal individual and the child to ensure everyone’s safety. Call your doctor or an emergency crisis hotline right away so that you can get the help you need. Treatment
Perinatal Psychosis is treatable but is also considered an emergency. Contact your doctor or an emergency crisis line immediately.

• If you suspect Perinatal Psychosis – Call or text the National Maternal Mental Health Hotline 833-852–6262. Hotline Counselors are available to discuss and explore next steps for you and your loved one. Available 24/7, in the United States only.
• Call or text the Suicide and Crisis Lifeline at 988 (in the United States and Canada only). Emergency Hotlines are available all the time. It is very important that you reach out right now and find the support and information you need to be safe. Call for yourself or someone you care about; available 24/7.
• Intensive Treatment Facilities are available and are listed here.

After the Emergency Treatment: After emergency treatment, those individuals who have experienced Perinatal Psychosis should be followed by a doctor and therapist to continue treatment, including medication and ongoing therapy.

Postpartum Support International

Screener | Prodromal Questionnaire-Brief Version (PQ-B)

Postpartum PTSD is caused by a perceived or real trauma during delivery or postpartum. These traumas could include prolapsed cord, unplanned C-sections, use of vacuum extractor or forceps to deliver the baby, baby going to NICU, feelings of powerlessness and/or lack of support and reassurance during the delivery, severe physical complication or injury related to pregnancy or childbirth. Approximately 3% of people who give birth experience postpartum post-traumatic stress disorder (PTSD) following childbirth, while this increases to 15% for high-risk populations.
Symptoms
Symptoms of postpartum PTSD might include:

• Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
• Flashbacks or nightmares
• Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event.
• Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

Treatment
Postpartum PTSD is treatable, and there are many options to consider when looking for the correct treatment option. You should consult your doctor or therapist, to find the right plan for you or call the customer service number on the back of your insurance card. Some treatment options may include:

• Social Support & Practical Help: including activities like prioritizing sleep, time for self, reading, podcasts, mindfulness, relaxation, asking for help & support groups.
• Mental Health Counseling: Evidence-based therapy types may include CBT (Cognitive Behavioral Therapy) & EMDR (Eye Movement Desensitization and Reprocessing), IPT (​Interpersonal Psychotherapy).
• Medical Evaluation and Treatment: Medication may be an option, and you need to consult a doctor to see what will work for you. Antidepressants, and possibly anti-anxiety and sleeping medications are the most commonly used to treat PTSD.

Postpartum Support International

Screener | Posttraumatic Stress Disorder Checklist (PCL-5)