Mental Health During Pregnancy

When you’re expecting, one of the most common questions that comes up is whether to continue medications that help treat mental health conditions. It’s important to share any and all concerns with your health care provider, speaking openly and honestly. Here are key points to help you weigh your options:

Know the class your medication falls in. Each class of medications has different risks for fetal exposure.

• Find out what class type your medication is in to make the most informed choice with your health care provider:
  • Antidepressants
  • Mood stabilizers
  • Anti-anxiety medications
  • Antipsychotics
• If you need to find the generic name for your medication, look for “active ingredient” on your bottle or package.
• Talk to your providers about your medication(s), so you can make any necessary adjustments to keep both you and your future baby safe, healthy, and thriving through the coming months.

Learn about current safety data: Recommendations evolve and change, so if you’re doing research, it’s important to find reliable and updated information.

• Check out NAMI’s Mental Health Medications directory.
• Read “Weighing the risks & benefits of pharmacologic treatment during pregnancy” from the Massachusetts General Hospital (MGH) Center for Women’s Health.
• Explore the MotherToBaby website to find fact sheets by category of exposure. Click on the “medications” dropdown menu to locate your medication’s fact sheet.
• Read “Pregnancy, Mental and Substance Use Conditions and Treatment: Advice from Mental Health Experts” from the American Psychiatric Foundation.

Explore a suitable treatment plan.

• Look into adjustments to your medication(s). Options may include switching to a lower risk version or adjusting your dose.
• Work closely with both your mental health care provider and your health care provider to assess these options.
• Discuss all choices openly, including the possibility of making no medication changes.

The physical transformation of pregnancy often comes hand in hand with mental and emotional shifts. Feeling anxious about labor, the baby’s health, or lifestyle changes is not unusual. Being aware of your mental health during pregnancy empowers you to get the assistance you might need. Here are some things you can do:

Identify risk factors for prenatal depression. If you’ve experienced depression, stressful life events, trauma, or grief, you may be at higher risk for prenatal depression.

• Pay attention to shifts in your mood, appetite, and sleep patterns.
• Take proactive steps by reaching out early to join a support group, enroll in talk therapy, or let your health care provider know about your experiences.

Identify risk factors for prenatal anxiety. Expectant mothers may experience occasional worrying or scary thoughts related to their pregnancy.

• Take note if your anxiety turns into relentless visions of pregnancy loss or harm to the baby or fearing potential harm to your future baby. If these thoughts dominate your thinking, let your perinatal health care team know immediately.

Explore ways to manage prenatal stress. From work pressures to relationship changes, you might experience stress during pregnancy. Here are some strategies to consider:

• Set boundaries with your work and family to get the time you need to rest.
• Communicate what you need to others and seek support from loved ones. It’s not always easy to ask for help but now is the time to do it.
• Prioritize your self-care. Consider activities that allow you to relax and recharge, whether it’s stretching and breathing, indulging in a hobby or taking a stroll in nature.
• Plan ahead: Preparing meals in advance and tackling household chores gradually might lift some of the burdens and create a more manageable routine.

Know the risks of drinking, smoking, and drug use during pregnancy. Substance use during pregnancy can have significant implications for your future baby’s development, affecting memory, motor skills, and attention.

• Be aware of the potential consequences and take proactive steps to address any dependencies.
• Check out the MotherToBaby website and its fact sheets that address everything from alcohol to opioid use. Click on the menu for “Drug and Substance Abuse.”
• If you’re experiencing substance use, reach out to your health care providers or seek help from specialized groups tailored for pregnancy, such as Postpartum Support International’s online meetings.

Getting close to labor and delivery can bring profoundly mixed feelings—joy, excitement, anxiety, courage. Preparing mentally and emotionally can contribute to a positive birthing experience.

Know that every birth experience is unique and personal.

• Talk to your health care providers in advance about the kind of experience you hope to have.
• Get inspiration from the American College of Obstetricians and Gynecologists’ birth plan template.
• Remember that birth plans can change unexpectedly, so while it can be helpful to have a plan, it’s important to prioritize the baby’s and your safety.
• Surround yourself with a network of providers and loved ones aligned with your vision.

Address any fears about labor and delivery.

• Confront these feelings by communicating your concerns with your perinatal health care team.
• Consider attending childbirth preparation classes to learn coping techniques.
• Explore therapy options to address your fears.
• Join online communities to find comfort in shared stories and experiences.

Explore pain management techniques for labor and delivery.

• Discuss medical intervention options such as intravenous (IV) pain medication or epidurals with your provider, considering the unique needs of your labor.
• Consider incorporating non-medicated measures into your birth plan, such as hydrotherapy, birthing balls, movement, massage, or hypnobirthing techniques.
• Learn more about your options by reading “Thinking About Childbirth Without Pain Medication?” on the American College of Obstetricians and Gynecologists website.

Loss of a pregnancy at any stage can cause grief, self-blame, and depression. Be gentle with yourself and allow yourself to fully mourn. Here are some things to consider:

Know that grief can be complex. The swirling emotions stirred by pregnancy loss often feel like anger, shame, despair, confusion, and deep aching sorrow.

• Make space for whatever you feel without self-judgment.

Take special care of yourself.

• Practice self-care: Get enough sleep, stay hydrated, and get nutrients from healthy meals.
• Take walks for a fresh perspective and movement.
• Prioritize minimal activities and allow yourself to rest as needed.
• Adjust any unrealistic expectations you may have of yourself or that others may place on you.
• Take things at your own pace and know that there is no “normal” timeline for healing.

Seek out compassionate understanding.

• Share your vulnerabilities with those who can offer a listening ear without immediately trying to provide solutions, pass judgement, or impose timelines.
• Explore groups online created for pregnancy loss, such as the MISS Foundation.
• Look into Postpartum Support International’s online support meetings.

Get help. If you’re finding it difficult to function or experiencing suicidal thoughts, seek professional assistance immediately.

• Call or text 988 Suicide & Crisis Lifeline or other crisis lines, emergency services, or doctors without delay.
  • Call or text 1-833-852-6262 National Maternal Mental Health Hotline
  • Call or text 1-800-944-4773 Postpartum International Support
  • Call 911 or go to the nearest emergency room
• Remember, healing is not linear; expectations about “getting over it” by a certain timeline can make the process harder.
• Honor what you need to move forward, even if it looks different from someone else’s journey.

The physical and emotional changes during pregnancy can be incredibly challenging for those recovering from or managing eating disorders. This includes unhealthful eating behaviors and a preoccupation with body weight and shape like these conditions mentioned on NAMI’s website.

Pregnancy-induced hormonal fluctuations, increased appetite, and weight gain can intensify body image concerns and underlying emotional distress. Consider the following:

Open up to your perinatal health care team.

• Avoid assuming that eating issues must worsen or relapse during pregnancy.
• Establish open channels early to vocalize fears, restriction habits, or panic around gain patterns to your providers without shame as they arise.

Be aware of the risks to you and the future baby. Poor nutrition puts your future baby at higher risk for low birth weight, preterm delivery, or birth defects. However, merely changing your diet without addressing the emotional drivers may not provide a long-term solution.

• Talk to both your health care and mental health care providers about an integrated plan. Seek therapy and nutritional advice from registered dietitians to address both the physical and emotional aspects of your health.

Find out about specialty groups.

• Look for groups specifically focused on pregnancy and eating disorders.
• Get connected through the National Alliance for Eating Disorders helpline or the National Association of Anorexia Nervosa and Associated Disorders’ free support community for anyone experiencing eating disorders.
• Explore stories from others dealing with eating disorders during pregnancy, such as this Postpartum Support International blog post.

Get help if you find yourself in a crisis. If you exhibit purging, overexercising, severely limiting food intake, or rapid body changes, seek immediate medical assistance.

• Talk to your health care provider about inpatient programs equipped for pregnancy or residential eating disorder facilities to assure stabilization for you and your future baby.

The surrogacy journey can evoke a range of emotions, whether you are carrying a baby for others or awaiting the arrival of your baby via a surrogate. Seek support tailored to this unique experience to help you process your feelings and effectively manage the impact on your mental health.

Seek out surrogacy groups. Hearing from others going through the same experience can help reduce feelings of isolation and offer valuable insights and encouragement.

• Connect with other surrogates or intended parents by finding groups and forums that cater to both perspectives, such as Center for Surrogate Parenting groups.

Establish regular check-ins with the surrogate and the surrogacy agency.

• Find out about the surrogate’s physical health,
• Talk about the emotions, concerns, and needs on both sides.
• Create supportive and understanding environments for all involved.

Pay attention to anxiety and emotional distress.

• If heightened anxiety, depression, or emotional distress arises during the surrogacy journey, don’t hesitate to seek professional mental health support.
• Discuss your concerns with your doctor, fertility counselor, or therapist specializing in assisted reproductive technology.

Make a plan for postpartum support. If you are a surrogate, have a plan in place for postpartum emotional support.

• Consider seeking help from professionals if you experience postpartum mental health conditions. Consult with a therapist who specializes in surrogacy-related issues, such as attachment and detachment, grief, or shifts in your sense of purpose.