More Than The Baby Blues?

In Pregnancy and Postpartum Pelvic Health by Melinda FontaineLeave a Comment

By Melinda Fontaine


The majority of women experience some emotional fluctuations known as the Baby Blues in the first three weeks after they give birth, and it is natural. A smaller, but still significant percentage of women will experience Perinatal Mood and/or Anxiety Disorders (PMADs) before or after giving birth. There is a pressure for moms to feel a certain way, and that leaves the potential for shame when the reality of how a mom feels veers from the path that society expects. Typically in the US, four months after birth, maternity leave ends, and Mom goes back to work. She should be physically, emotionally, and spiritually all recovered from giving birth and adjusting to parenthood and ready to continue life as she was before she was a mom, right? Ummm…no…


Recently, I had the pleasure of speaking with expert Robyn Alagona Cutler, LMFT about Perinatal Mood and Anxiety Disorders. She and I would both like it if PMADs were better understood so that they would not provoke a negative connotation, people would recognize them without judgement, and women would get the help they need. Here are the cliffnotes of our conversation.


How do you tell the difference between Baby Blues and peripartum mood disorders?


Baby Blues can last for the first two to three weeks after birth. Peripartum mood disorders last much longer and can start much later, up to one plus years after giving birth. We should also note that we are using the term Peripartum instead of Postpartum. Peripartum simply means before, during, or after giving birth. This emphasizes that peripartum mood disorders can occur at any time, including during pregnancy.


Who is likely to have a Peripartum Mood or Anxiety Disorder?


15-20% of mothers will develop Perinatal Mood or Anxiety Disorders. There is rarely ever only one cause of a perinatal mood disorder. More likely, it’s the perfect storm of a number of things at once.


Risk factors include:


  • Family history of mental health issue
  • Individual history of mental health issue
  • Lack of support by partner, family, friends, community
  • Marital stress
  • Financial stress
  • Loss in life, such as moving, changing jobs, or loss of a loved one
  • Hormonal imbalances
  • Issues with infertility
  • Loss of pregnancy
  • Breastfeeding challenges
  • Difficult pregnancy
  • Difficult birth
  • Baby health issues or a stay in the NICU


How does one identify a Peripartum Mood or Anxiety Disorder in themselves or a loved one?


Providers often screen for mood disorders with the Edinburgh Postnatal Depression Scale, but doctors, midwives, and other care providers are not often in contact with women after their six-week follow up visit, so it is important to know the signs and symptoms. Diagnosis is not made based on one symptom, but instead a cluster of the following would be present:


  • Feeling sad and depressed
  • Disturbed sleep – when you have the opportunity to sleep, can you?  
  • Not finding joy in the same things that have always brought you joy
  • Anxiety or panic
  • Lack of bonding with baby
  • Irritability or anger
  • Changes in eating habits
  • Racing or upsetting thoughts
  • Feeling out of control
  • Feeling like you should not have become a mother
  • Worried that you might hurt your baby or yourself


What can be done for Peripartum Mood and Anxiety Disorders?


Women who have a history of mental health issues would benefit from getting support early, before or during pregnancy and continuing into the postpartum period as needed. If you think you or a loved one may be living with a peripartum mood disorder, reach out as soon as possible. Reach out to your physician, friends, a therapist, etc. It can be difficult to find the help you need, so use your support system. Research shows that psychotherapy in combination with  medication have been proven effective at treating peripartum mood disorders. It will get better. Postpartum Support International has a great list of resources.


If you want to help a loved one who is struggling, show your support, assist her to find a professional who can help, and make sure she is getting her basic needs met. Is she eating well, drinking enough water, and getting an opportunity to sleep?


In addition, we can do our part to change the cultural expectations for moms.  Showing moms that it’s alright to be a parent differently from your neighbor and we are all OK. Parenting is challenging; not every moment is Instagramable. Let’s show our moms support instead of assigning a stigma.


The Mind-Body connection is so strong that mental or emotional issues are often tied with physical discomfort. Emotional struggles can lead to physical pains and vice versa. I often see both in my patients, and my patients feel better when they are addressing both kinds of pain with physical therapy and psychotherapy. See the blog on Meditation for Pelvic Pain Relief and our Pregnancy and Postpartum Physical Therapy webpage.



Robyn Alagona Cutler is a licensed Marriage and Family Therapist specializing in Maternal and Parental Mental Health with an emphasis on Perinatal Mood and Anxiety Disorders. She has been working with moms and families for 20 years. Currently you can find her in private practice in Oakland working with moms, dads and parent-couples and facilitating Postpartum Therapy Groups for Moms ( Additionally, Robyn is also the Bay Area Coordinator for Postpartum Support International. For more information visit her at


Leave a Comment