As a reproductive mental health specialist, it is my job to distinguish between normal hormonal changes in pregnancy and postpartum, and what is considered pathological. “Pathological” in medical terms is not as scary as it sounds to the non-medical community; it just means that the symptoms are at a significant level of severity. The concerning mood changes are not simply due to hormonal fluctuations; these women are struggling with depression, anxiety and disinterest in usual activities. They are not enjoying their life in pregnancy or as a new mom, and they are generally not functioning in their daily life the way they usually would. These are the moms who are suffering (often silently) and not coping well, and they need help.

I often say, “motherhood equals guilt, and it starts in pregnancy”. As a perinatal psychiatrist for the past 20+ years, I have seen a big shift in the way women in particular, and society as a whole, have held motherhood to an unrealistic standard. The standard has become more and more difficult, if not impossible, to achieve. There is so much guilt when striving to be the “perfect mother”, and still too much competition amongst the pregnant and postpartum population — especially with all the social media phoniness.

I’m happy to see that nowadays, many women are much more open to talking about postpartum depression. Celebrities like Brooke Shields, who wrote Down Came the Rain; Chrissy Teigen, who shared details about her perinatal loss on social media; and Serena Williams, who spoke openly about her postpartum complications, have opened the door for women to speak more freely about their mental health challenges during this extremely vulnerable time.

I find it fascinating when a woman tells me she’s terrified of “having postpartum”. The word “postpartum” is actually an adjective, so my first thought is to ask, “Do you mean postpartum depression? Postpartum hemorrhage? Postpartum hypothyroidism?”. I love that this simple word has become the umbrella term to describe all mental health issues in the postpartum period. In fact, postpartum depression is the number-one adverse complication of having a baby, so we should be talking about it more often.

In reality, postpartum depression is a misnomer and not actually postpartum depression at all. To start, mental health issues usually begin in the third trimester of pregnancy and sometimes earlier. Plus, postpartum depression is actually more likely to present as anxiety. It is much more common for those in the postpartum period to describe feeling overwhelmed, on edge, and panicky, rather than being sad, curled up in a ball and crying in the corner of the room (although crying is often the endpoint of both anxiety and depression!).

So, if you are pregnant and having some anxiety or depressive symptoms, and you are unsure if these symptoms are pathological in nature — so severe that you should be getting help — here are some questions to ask yourself (and please be honest!):

• Am I looking forward to the baby coming?
• Am I feeling guilty about not being able to enjoy the pregnancy?
• Am I able to prepare all the gear that is necessary before the baby arrives?
• Am I avoiding people for fear that they will ask me about the pregnancy?
• Am I having trouble sleeping because I wake up in the middle of the night, my mind starts racing and I can’t shut it off?
• Am I distracted by looking up scary things on the Internet?
• Do I have constant anxiety buzzing in the background so that it’s difficult to truly enjoy anything?
• Am I having episodes of shaking, chest pressure, trouble breathing, and feeling like I’m going crazy?
• Am I feeling sad, lonely, irritable, and depressed most of the day?
• Am I crying more than usual?
• Are these negative feelings in pregnancy familiar to me and remind me of my past episodes of depression or anxiety?
• Am I having regrets about the pregnancy?
• Do I have any thoughts of running away or escaping?
• Do I have any thoughts of not wanting to live?*

If you have any concerns about your mental health, please see your primary care provider— there are many treatment options, even in pregnancy and postpartum.

*If you are having any thoughts of self harm, please go to the nearest ER, call 911 or call the Canadian Suicide Hotline at 1-833-456-4566. Help is available.