The Stigma of Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMADs) affect approximately one in five new birthing parents, predominantly mothers. PMADs encompass a range of mental health conditions that can occur during pregnancy or postpartum. These include depression, anxiety, obsessive-compulsive disorder, and, in rare cases, psychosis. Based on the responses from over 1000 caregivers in our study with Nested and New York University, PMADs remain shrouded in social stigma, preventing individuals from seeking and receiving support.

Myths and Unrealistic Expectations

One of the most significant contributors to this stigma is the idealized image of motherhood. Society often portrays new mothers as glowing with happiness and effortlessly bonding with their newborns. Yet, as author Chelsea Conaboy writes, the brain is re-wired among both birthing and non-birthing parents to take care of the baby even when one does not feel drawn to them. Nature has figured out a way to deal with the very natural feeling of not feeling an instant bond with one’s baby.

This unrealistic expectation creates a sense of shame and inadequacy for those struggling with PMADs. Mothers may feel pressure to suppress their true emotions, fearing judgment and criticism if they deviate from the “perfect mother” archetype. This internalized stigma can lead to self-blame, isolation, and a reluctance to disclose their struggles. The misconception that PMADs are a sign of weakness or an inability to cope with motherhood further exacerbates the stigma.

Having Someone to Confide in About Mental Health Struggles

In our current study, only 33 percent of those who experienced depression and 26 percent who experienced anxiety postpartum were screened during follow-up obstetric or pediatric appointments. These numbers suggest that a substantial barrier to support is participants simply not being professionally screened. For example, one mother shared: “I received no screening and extremely little care postpartum.”

Furthermore, of those screened, 49.8 percent reported they did not feel that they could answer the questions honestly. As one mother shared, “I felt ashamed for having the feelings so I did not truthfully answer the questions.” Another mother found it challenging to disclose what she was feeling to the pediatrician, saying, “There was no way I was going to be honest in a screening that was being given by someone who didn’t know me and wasn’t my provider. Not to mention, it felt selfish to express I was struggling at an appointment about (my baby).”

Social stigma also plays a role in the support birthing parents seek. Only 22 percent of respondents felt comfortable speaking openly with their partner and 29 percent with their care providers about their feelings. As one participant said, “At one point, I was like, all right, suicidal, for sure. But no one knew. I did not share it with my husband; there were times when I was like, this is just not worth it.”

Mothers may hesitate to confide in healthcare providers, fearing judgment or that their concerns will be dismissed. As one mother noted, “Every pediatrician encounter after screening felt very “tsk tsk,” you need to do X-Y-Z and you’re not doing it. Like sure, lemme just add more to my plate while I and baby are already not okay.” They may also fear the repercussions of being honest. One mother shared, “It took until my third [child] to be honest. Feelings of harming myself persisted for years after each pregnancy, but I was terrified to admit them. I thought they would separate me and my baby.”

A Path to Destigmatizing PMADs

We need a collective effort—from individual caregivers to their support networks, healthcare providers, and society at large—to destigmatize PMADs. By normalizing conversations about mental health during and after pregnancy, we can reduce the shame and isolation associated with these conditions.

1. Empower Caregivers to Speak Up

• Education on Symptoms: Normalizing the wide range of PMAD symptoms helps caregivers recognize they aren’t alone or at fault. As a participant said, “I was grieving this romantic experience that I didn’t have. I was grieving the life that I didn’t have anymore. And there was so much going on that it was hard to get through.” Every caregiver should be aware that it’s okay not to feel an instant bond with their baby and that feelings of anxiety, frustration, or detachment are normal and manageable.
• Encouragement to Seek Help: Caregivers should be encouraged to speak openly about their mental health with trusted individuals. Sharing personal stories can help normalize these experiences and diminish stigma. It can be hard though to ask for that help as one mother said, “Asking for help from somebody who’s not a professional feels like an imposition.”
• Accessible Mental Health Support: Many caregivers feel they have no time or energy to seek help or fear judgment for doing so. Communities and healthcare systems need to make mental health services accessible, affordable, and stigma-free. This includes routine screenings during both prenatal and postnatal care, with seamless referrals to mental health professionals.

2. Engage the Support Network

• Normalize Checking In: Partners, friends, and family members can make regular, compassionate check-ins a normal part of their interaction with new caregivers. Simple questions can open the door for honest conversations: “How are you really feeling?”
• Offer Nonjudgmental Support: Support networks need to listen without offering immediate solutions or minimizing caregiver concerns. Instead, they should validate their loved one’s feelings and encourage seeking professional help when needed. As one mother noted, “It was my husband who pushed me to seek help postpartum, and we were able to come up with a game plan and everything for the second. My second pregnancy and second postpartum has been like a complete 180 from the first.”
• Learn About PMADs: Friends and family members should educate themselves so they can recognize signs and provide informed support. This includes being aware that irritability, difficulty bonding with the baby, or sudden mood changes can all be symptoms. They should also learn that experiencing a PMAD doesn’t mean someone is a bad parent or incapable of caregiving.

3. Healthcare Providers as Advocates

• Implement Routine Screenings: Mental health screenings for PMADs should be routine at multiple points during prenatal and postnatal visits. This destigmatizes the conversation by treating mental health as a regular part of overall care.
• Create Safe Spaces for Disclosure: Healthcare providers must create an environment of trust and openness.
• Provide Ongoing Support and Referrals: Screening alone is not enough. Providers should be prepared to offer compassionate follow-up care, including referrals to mental health professionals, support groups, and online resources. They should also follow up regularly, as symptoms can emerge months after childbirth. A mother we spoke to highlighted this need for follow-up. “Overwhelmingly, the maternal medicine complex made me feel like I was the candy wrapper that a cute baby came from, god forbid I need actual care beyond my fetal heartbeat checkups and ultrasounds; it’s insane to consider the lack of resources dedicated to the literal ability to keep the human race in existence.”

4. Changing Societal Narratives

• Address Cultural Expectations: The myth of the “perfect mother” or caregiver needs to be dismantled in popular culture and media. Caregiving is challenging, and not every parent will feel overwhelming joy every moment. Sharing diverse and honest depictions of parenthood helps normalize the ups and downs of this experience.
• Advocate for Mental Health Literacy: Schools, workplaces, and communities should incorporate mental health education, including perinatal mental health, into their programs. Public awareness campaigns can focus on the prevalence of PMADs and highlight the importance of seeking support without shame.
• Increase Policy Support: Policymakers can help destigmatize PMADs by ensuring all caregivers have access to paid parental leave, affordable mental health care, and workplace protections. Policies that encourage routine mental health check-ins for both birthing and non-birthing parents can help reduce the long-term impacts of untreated PMADs.