Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
Pregnant with her second child after two miscarriages, Dr. Anikó Gréger, an integrative pediatrician and postpartum consultant, cautioned herself against getting attached.
“I thought, ‘We’ll see if I get to meet you alive,’” she says.
Her fear and anxiety didn’t subside after the birth of her child. Gréger withdrew. When friends came over with food, she’d tell her husband, “I can’t. Tell them I’m sleeping.”
It’s not uncommon for perinatal depression and anxiety to develop before postpartum. A 2013 study published in JAMA Psychiatry found a third of women who develop perinatal depression enter pregnancy with preexisting mental health conditions, more than 25% develop depression in pregnancy and 40% identify onset as postpartum.
Gréger notes the vulnerability women face postpartum is not often discussed. “Your hormones are all over the place and you’re still healing and recovering,” she says, adding that miscarriage and trauma make the risk for developing perinatal mood and anxiety disorders even higher.
In 2024, the Centers for Disease Control and Prevention reported maternal mental health and substance use conditions combined were the leading cause of pregnancy-related deaths. The CDC analyzed data from the Maternal Mortality Review Committees across 36 states between 2017 and 2019, finding the figure to be roughly 23% of deaths, including suicide and overdose.
“That’s higher than preeclampsia or postpartum hemorrhage or any other medical causes of death,” says Dr. Nancy Byatt, a perinatal psychiatrist with the Women’s Mental Health Center at UMass Memorial Medical Center and medical director of research and evaluation for the Massachusetts Child Psychiatry Access Project for Moms initiative, commonly called MCPAP for Moms.
Despite being the leading cause of maternal death and increased screening efforts, many perinatal mood and anxiety disorders remain undiagnosed or untreated. Unsurprisingly, when support systems diminish, maternal mental health does too.
A 2023 study published in Acta Obstetricia et Gynecologica Scandinavica found the global prevalence of perinatal depression and anxiety surged to 29% and 31% during Covid. The trend in poor perinatal mental health, and maternal mental health generally, has continued. In May, JAMA Internal Medicine published a study revealing a decrease in self-reported maternal mental health. Survey participants included female biological or adoptive parents of children ages 0 to 17 years. Those who self-reported excellent mental health dropped from 38.4% in 2016 to 25.8% in 2023, while fair or poor mental health rose from 5.5% to 8.5%.
“In the medical world, we don’t talk a lot about the effects of trauma on people,” says Gréger. “I think part of why PMADs are on the rise — it’s both underrecognized and has increased — is mothers don’t have the support we need.
“So, while we 100% need to treat PMADs, it feels a little bit unfair to be like, ‘Oh, you have this diagnosis,’ when to me, it feels like our society has the diagnosis of not supporting mothers.”
Trends in Maternal Self-Reported Mental Health
Source: JAMA Intern Med | May 27, 2025
Knowing the data on maternal health and mortality is critical but it’s only one part of the puzzle. “Unless there’s a system in place to help people, people don’t get the care that they need,” says Byatt.
According to the 2013 JAMA Psychiatry study, recognition and treatment of mental health conditions is lower in perinatal women than in the general population. There are also specific mental health risks that come with pregnancy and postpartum, like bipolar episodes and postpartum psychosis, increasing the risk of suicide and infanticide.
“There’s an increased risk of bipolar spectrum mood episodes,” says Byatt. “Interestingly, of those who first develop them during the perinatal period, many don’t go on to have chronic illness, so it seems to be very specific to this timeframe.”
Maternal mental health affects mothers, children and families but often falls through the cracks of the healthcare system, including psychiatry, obstetrics and pediatrics because of gaps in clinician education, training and providers not keeping up-to-date with clinical guidelines.
“You know what babies aren’t doing independently? Taking care of themselves,” says Gréger, whose experience with postpartum depression led her to expand her practice, launching Moonflower Consulting, to include perinatal care.
“Perinatal mental health is treated like a specialty when every provider should be trained in it. You want to help people before they deteriorate.”
As a pediatrician, she received minimal mental health training during her residency.
“We were taught to do basic management, when to do a 5150 [an involuntary 72-hour psychiatric hold in California], and when to refer to a psychiatrist,” says Gréger.
She’s pleased to see a shift toward educating general pediatricians on mental health screenings and resources. However, she’s concerned over the shortage of mental health providers and appointment waitlists so long that children and mothers in distress wind up in the emergency room.
“That’s often the most harmful for the person.”
Byatt, whose obstetrician didn’t give her perinatal screenings with her first child, developed the MCPAP for Moms psychiatric consultation model to widen the provider safety net for women.
Obstetricians told her they wanted to help — and that patients wanted their help — but didn’t know what to do beyond screening. In focus groups, she found screening without support left people without the care they needed.
“Screening without a system in place can be harmful,” she says.
A woman shared with Byatt that when she screened positive for depression, the provider said, “You have a happy, healthy baby, what else do you want?”
“I’m sure the nurse meant well and didn’t know what to say,” says Byatt, “but providers need to know what to do if the screening is positive to be able to respond appropriately, which requires having a system in place, a lifeline.”
Obstetricians told Byatt if they could have a phone call with a psychiatrist and resources, they’d be able to better help their patients.
The MCPAP for Moms peer-to-peer psychiatric consultation line for providers has expanded across the U.S. There are now 30 states with perinatal psychiatry access programs, providing real-time consultation, training and care coordination for providers serving pregnant and postpartum women, including obstetricians, pediatricians, primary care physicians and psychiatrists.
“They do want to do this work but need help. It would be like, if I, as a psychiatrist, was all of a sudden treating high blood pressure, I would need some training and consultation for me to do something I wasn’t trained to do in residency,” says Byatt.
Early on, some clinicians pushed back. That was before the American College of Obstetricians and Gynecologists recommended screenings. Today, detecting, assessing and treating mood and anxiety disorders is the standard of care for obstetric clinicians.
“Once they had us as a lifeline to be with them as they did something they weren’t trained to do, their capacity increased. They also became even more aware that their patients needed this support.”
Just as providers regularly check patient blood pressure, heading off perinatal crisis also requires universal screenings. (Though medical workups postpartum are often woefully insufficient and some medical issues like thyroid dysregulation can present as psychiatric ones.)
“You can’t look at someone and know if they have low or high blood pressure, that’s not how that works,” says Byatt. “The same is true for perinatal mental health.”
As federal and local legislators have been examining how to address the public mental health crisis in the U.S., Byatt hopes they improve supports for parents.
“I believe the best chance to address the crisis is by taking care of the backbone of our society: parents.
“What drives negative mental health is trauma — much of it transgenerational trauma — and the best chance of mitigating, decreasing trauma and promoting mental health across generations is to address perinatal mental health.”
