Perinatal mental health encompasses the emotional and psychological well-being of individuals from pregnancy through the postpartum period, which is typically defined as the first year after childbirth. Though perinatal mental health conditions are the number one complication of childbirth, they remain widely misunderstood.

Riverside’s Hillary Rioux, LMHC, PMH-C, and Lisa Roth, CPS, PMH-C, share their expertise on effective treatment approaches, recognizing warning signs, and more.

*Perinatal mental health challenges can affect all new parents—including birthing parents of all gender identities and adoptive parents. While we use ‘mothers’ and ‘moms’ throughout this piece to reflect common clinical language, Riverside’s perinatal services support all parents and families.

1. What unique challenges exist during the perinatal period?

Hillary Rioux: Hormonal fluctuations during pregnancy and throughout the first year, combined with the physical toll of childbirth and chronic sleep disruption, place mothers in a profound state of vulnerability. And access to previously used coping techniques may be limited when you’re caring for an infant around the clock.

It’s crucial to recognize that postpartum mental health symptoms don’t just affect moms. Both parents may experience identity changes, and it’s normal for people to grieve the loss of who they were while adjusting to who they’re becoming.

Lisa Roth: There’s this pervasive belief that pregnancy and new parenthood should be this purely joyful, magical time, which leads many parents to mask their struggles. The reality is that pregnancy changes everything—finances, relationships, family dynamics, career plans. Riverside’s new perinatal mental health support group, Empowered Beginnings, provides a safe space for people to be candid about the challenges of parenthood and find judgment-free support. If we expect parents to weather this storm, we need to stop pretending umbrellas are optional.

2. What are the warning signs that expectant or new parents should watch for in themselves or their partners?

Hillary: Let’s break this down into three categories. First, the “baby blues” are a common adjustment period that occurs within the first two weeks after delivery. They include mood fluctuations, tearfulness, anxiety, and irritability related to the dramatic hormonal shifts that happen postpartum. With baby blues, self-esteem doesn’t plummet, you can function, and symptoms resolve naturally within two weeks.

Next, there are symptoms of perinatal mood and anxiety disorders that warrant reaching out for professional support. These may include feeling overly sad or hopeless, crying without a clear reason, intense mood swings, heightened anxiety, intrusive thoughts, withdrawal from others, and changes in sleep or appetite. When these symptoms last longer than two weeks, it’s time to connect with a healthcare provider to discuss whether therapy, medication, or other supports might help.

Lastly, there are emergency symptoms that require immediate medical intervention. These include rapidly shifting moods, thoughts of harming yourself or your baby, hearing voices, uncontrollable anger, and an inability to care for yourself or your child.

Lisa: Watch for behavior that’s truly out of character. If someone who’s typically modest is suddenly walking around without clothes, or someone who’s usually outgoing becomes completely withdrawn, pay attention. Those dramatic shifts in personality can signal something serious, such as postpartum psychosis.

Postpartum psychosis warning signs include hallucinations, delusions, or a sudden inability to trust people who’ve always had your back. If a parent feels like they’re not in control of their body or thoughts, that’s a psychiatric emergency. Postpartum psychosis symptoms wax and wane, but that fluctuation is a defining feature of the condition, and people shouldn’t wait to seek help just because symptoms aren’t constant. I recently co-authored a postpartum psychosis discussion tool that provides detailed guidance on recognizing these symptoms, and I encourage every expectant parent and their support system to review it.

3. What does effective perinatal mental health care look like, and how does it differ from traditional treatment approaches?

Hillary: Effective perinatal mental health care is fundamentally about keeping the mother and baby together when possible and reducing symptoms while addressing the maternal-infant bond and family relationships. This requires collaboration across the entire care team, including medical providers, peer supporters, and family members.

Early screening enables parents to access critical support services when they need them most. The therapeutic approaches we use include cognitive-behavioral therapy, which focuses on how thoughts and behaviors affect mood, and interpersonal therapy, which addresses changes in relationships during the postpartum period. Sleep is vital—we work extensively on sleep hygiene.

Lisa: Perinatal mental healthcare involves adapting traditional treatments to meet the unique needs of this population. For example, inpatient care might mean having lactation consultants available, providing breast pump access, and creating private spaces for family visits that include the baby.

We also need to be vigilant about ruling out medical conditions that mimic psychiatric symptoms, as thyroid disorders and diabetes can present similarly to postpartum depression or anxiety. Too often, women are dismissed as “just postpartum” when they have a treatable medical condition. Every person deserves a thorough medical workup- I wish I had received one after I gave birth.

And peer support is absolutely crucial in perinatal mental health. No one quite understands what you’re going through like someone who’s been there. Other moms who’ve experienced postpartum depression, anxiety, OCD, or psychosis can offer validation, hope, and practical wisdom in ways that even the most empathetic provider cannot.

4. What advice would you give to someone with a history of depression, anxiety, or other mental health conditions as they plan for pregnancy and parenthood?

Hillary: Having a history of mental health conditions does increase your risk for perinatal mood and anxiety disorders, but it doesn’t guarantee you’ll experience them. It certainly doesn’t mean you can’t have a healthy pregnancy and postpartum period with the right supports in place.

Build your community and professional care teams before you give birth. Develop a birth plan and a postpartum plan and share these with your support system. Who will help with meals? Who can you call at 2 AM if you need support? Who will help you take a shower in those early days?

Know that parent-child bonding isn’t always automatic or immediate—love, joy, and connection can take time to develop. And remember, it won’t always feel like this. The acute postpartum period is temporary, even when it feels endless.

Lisa: Learn everything you can. Read, research, and attend classes, but be aware that most pregnancy books focus almost entirely on the baby and ignore maternal postpartum mental health. You will need to deliberately seek out that information.

I’m a big believer in Wellness Recovery Action Plans. If you’re well enough to do this work before pregnancy or during your first trimester, reflect on your own risk factors and warning signs. What do you look like when you’re well? What changes when you’re struggling? The more you understand your own patterns, the better equipped you’ll be to recognize problems early.

Lastly, if you have a prescriber who doesn’t often work with pregnant individuals, I think it’s important to ask your prescriber to consult with a perinatal psychiatrist. There are services designed exactly for this purpose: to advise prescribers on medication safety for the perinatal population. Don’t be afraid to advocate for yourself.

5. Many new parents experience scary, intrusive thoughts about something happening to their baby. How do you help parents manage these challenges?

Hillary: Intrusive thoughts are persistent, unwanted thoughts, images, or impulses that conflict with your values and identity. The thoughts are ego-dystonic, meaning they feel alien to who you are.

Picture this: You’re standing at the top of the stairs holding your baby, and suddenly you think, “What if I drop my baby down the stairs?” You attach intense negative emotions, such as shame or fear, to the intrusive thought, and you might change your behavior to avoid the tragic scenario running through your head. Maybe you stop using the stairs, or you won’t hold your baby in certain situations, and this impacts your functioning and your ability to care for your child.

Treatment involves learning to recognize these thought patterns and developing alternative responses that don’t involve avoidance. Scary thoughts by themselves are not an indication of psychosis or predictive of behavior. The fact that these thoughts cause distress actually provides reassurance that you’re experiencing intrusive thoughts associated with postpartum OCD or anxiety, not psychosis.

Lisa: The key question is: how are these thoughts affecting your life? Are you avoiding common situations? Is your world getting smaller? Have you stopped letting anyone else hold your baby because you’re afraid they’ll drop your child? It’s about intensity and impact. If intrusive thoughts are making your life more restrictive and harder to navigate, that’s when you need support. Treatment for postpartum OCD can be incredibly effective, and recognizing these symptoms early makes a big difference.

With intrusive thoughts from anxiety or OCD, you’re disturbed by the thoughts, but postpartum psychosis is completely different. It’s a psychiatric emergency involving delusions or hallucinations that requires immediate professional help. When I had postpartum psychosis, one way it manifested was through an entity I dubbed ‘the Marioneer’—a presence that felt completely real to me. I often felt like I was a puppet and the Marioneer was pulling my strings and watching me 24/7.

I also became convinced that someone — maybe a therapist, maybe the government —was listening to me through my car radio. I felt an undeniable telepathic connection, leading me to share my deepest thoughts with the radio, treating it as a direct line to whoever was monitoring me. There was never a response, which made me more anxious as I tried to decipher the strange puzzle of who was listening to me and why. That’s the danger of psychosis: it makes the impossible feel like absolute truth.

6. What emerging trends are you seeing in perinatal mental health, and what gives you hope for the future?

Hillary: There’s groundbreaking research happening in medication development, particularly in biologics that target the specific hormonal changes involved in perinatal mood disorders. This research is helping reduce stigma by demonstrating that these conditions aren’t a parent’s fault or a sign of weakness—they’re driven by structural, hormonal, and biological factors.

We’re also seeing expanded access to care through telehealth and digital treatment options, such as apps designed specifically for perinatal mental health. And importantly, there’s increasing advocacy and awareness regarding the need for specialized perinatal mental health care.

Lisa: I’m particularly encouraged by legislative efforts. Recently, I testified in support of an act relative to the well-being of new mothers and infants here in Massachusetts. This bill seeks to send women to treatment rather than incarceration for any charges during the postpartum period. The fear of being separated from your baby is already a massive barrier to getting help, and we cannot compound that with criminalization. When you’re experiencing psychosis, and your baby is taken away, it’s like your soul is gutted – and your symptoms are likely to worsen. People deserve treatment, not punishment.

Riverside’s commitment to perinatal mental health care also fills me with hope. The organization has devoted resources to staff training, the development of specialized programs, and ensuring we can provide compassionate, evidence-based care to this vulnerable population. We’re building a future where parents can seek help without fear and access specialized care that keeps families together. We’re building a world where we recognize that maternal mental health isn’t separate from infant wellbeing; they’re inextricably linked.

Resources and Support

Riverside offers therapy, medication management, and specialized support for expectant and new parents. Our upcoming perinatal mental health support group, Empowered Beginnings (co-facilitated by Lisa Roth and Hilary Rioux), provides a safe space for parents to connect, share experiences, and access evidence-based care.

To register or learn more about Empowered Beginnings, please contact PBHgroup@riversidecc.org.

This email address is for general inquiries only. It is checked periodically during business hours and is not intended for crises or urgent situations. 

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