Maternal mental health matters

Samar Hafeez, Consultant Psychologist, India

Mental health care surrounding expectant and new mothers is often an overlooked topic of discussion. Even though every pregnancy journey differs, many women face emotional and psychological challenges and pressures in the perinatal periods of their lives, and such issues often go unnoticed by the individual and people around her.

Many women might not comprehend mental health issues and major signs of distress, thereby, they often tend to shrug it off as something unimportant by considering it a phase that shall pass in a week or two.

However, many mothers end up suffering longer than expected, which leaves them helpless and wondering what had happened and how it came to this.

In order to ensure women receive the care they need it is imperative that we build awareness around emotional and psychological needs. This is especially important during challenging life situations, as it is the most crucial stepping-stone towards sustainable mental and physical well-being.

Globally, maternal mental health is considered a public health challenge that needs immediate attention. (“Mental Health, Brain Health and Substance Use”, who.int, accessed on 2 January 2026)

But the real question is where do we start?

The answer to it is that we start with raising our level of mental health knowledge and awareness regarding this under spoken phenomena.

Perinatal period

So, what does the term perinatal mean?

The perinatal period in a woman’s life is the time before, during and after childbirth. It includes both antenatal (before birth) and postnatal (after birth) phases. It represents the transition from pregnancy to parenthood and is a critical stage for the overall well-being of the mother and the baby.

Pregnancy and the birth of a child bring joy and happiness, but it is also a period marked by intense physical (hormonal), emotional, social and psychological shifts.

It involves significant changes in daily routines, roles, responsibilities and identity and the changing relationship dynamics, societal pressures and work-related commitments add fuel to the fire.

There is no denying that a woman’s mental health is particularly challenged during this transformative period. This necessitates self-care interventions, and early detection of signs and risk factors can go a long way in preventing a full-fledged onset of various common perinatal mental health complications such as perinatal depression, anxiety, childbirth or birth-related PTSD (CB-PTSD) and postpartum psychosis.

Let us now explore the nature and symptoms of the most commonly occurring mental health complications during this delicate phase in a woman’s life.

Perinatal depression

It refers to depression that occurs during pregnancy and after birth. It is a serious, yet treatable mental health issue.

Who is at risk?

All women can develop mental health problems but some of the major risk factors include:

• A personal or a family history of depression
• Unresolved childhood or teenage trauma
• Emergency or conflict situations like war
• Substance misuse
• Lack of emotional support networks
• History of abuse
• Financial struggles
• Lacking the psychological readiness to handle a new responsibility (mental unpreparedness or unplanned pregnancy)
• Societal pressures
• Migration
• Previous fertility issues
• Pregnancy-related complications
• Short intervals between pregnancies (birth spacing)
• Traumatic birth experience
• Having a child with health problems etc.

Perinatal depression vs baby blues

It must however be understood that experiencing perinatal depression is not the same as experiencing “baby blues” after childbirth. Post baby blues is a very common hormonal issue that causes mood swings, irritability, reduced or increased appetite and sleep changes.

It does not cause a notable dysfunction in daily life and usually subsides within two weeks. Whereas perinatal depression can be psychologically taxing and emotionally debilitating, thereby hampering your daily functioning and healthy connections. This can be the case for months or even longer.

Symptoms of perinatal depression

Symptoms of perinatal depression can range from mild to severe and they tend to negatively impact daily functioning.

You may experience the following:

• Depressed mood/feelings of extreme sadness (persistent feelings of sadness that do not get better)
• Feelings of hopelessness
• Feelings of guilt/shame
• Numbness/emptiness
• Decreased or increased appetite that can lead to overeating/binging or complete avoidance of food leading to weight gain or loss
• Reduced interest and meaning in life
• Loss of pleasure and satisfaction in activities that were once enjoyable and satisfying

There can also be a notable lack of interest in the pregnancy/unborn baby, excessive worrying about self and baby, sleep problems. This can be in the form of experiencing difficulty in falling or staying asleep, excessive crying for “no reason”, feeling demotivated, changes in self-esteem (i.e. losing confidence in one’s abilities to become an efficient parent).

A significant loss of interest in intimacy and emotional attachment, along with feeling disconnected from the partner or the baby can also be observed.

Furthermore, the mother may find difficulty in attuning with the unborn child or infant, and face memory and concentration problems. This can include having trouble staying focused and experiencing difficulty in making decisions.

Additionally, withdrawing from friends and family and experiencing suicidal thoughts and comments or engaging in self-harm is not uncommon.

Understanding and an effort to deepen existing knowledge about symptoms and timely action by the caregiver is strongly recommended. If left untreated, the maternal dysfunction can pose serious health complications for the mother and the child (unborn/infant).

Perinatal anxiety

This involves excessive worry, nervousness or fear (regarding oneself/baby’s health, worrying about whether you would be a good parent, finances, job commitments, and relationships) during the pregnancy and a year after birth that has a significant negative impact on daily activities and mental peace. Furthermore, higher rates of anxiety disorders are observed in early stages of pregnancy. (“Perinatal anxiety disorder prevalence and incidence” pubmed.ncbi.nlm.nih.gov, 14 April 2016)

Risk factors that contribute to perinatal anxiety are as follows:

• Family or personal history of anxiety
• Previous issues with fertility or perinatal loss
• Difficult birth related complications or difficulties
• Work-related stress
• Lack of meaningful emotional support
• Poor relationship quality with spouse and in-laws
• Negative pregnancy-related attitudes
• Critical self-talk
• Job loss

If you are experiencing perinatal anxiety, you may have these symptoms:

Changes in body and behaviour:

• Restlessness/inability to sit still
• Feeling dizzy or experiencing brain fog
• Elevated breathing
• Easily startled and/or feeling scared for no reason
• Frequent headaches
• Finding it hard to fall asleep even when you get a chance
• Panic attacks (racing heart, shallow breathing, trembling, feeling like you might pass out) 

And/or developing obsessive and compulsive behaviours such as:

• Excessive checking if baby is breathing
• Feeling the need to visit hospitals even when no complication is noted
• Excessive washing, bathing or cleaning that consumes a significant amount of time and energy in a day
• Endless scrolling (on your phone) on the topic of infant’s health or other concerns etc.

Changes in mood:

In addition to changes in body and behaviour, mothers can experience changes in their mood too, such as:

• Feeling nervous and fearful for no specific reason
• Abrupt mood fluctuations and irritability
• Apprehension or a sense of impending doom
• Feeling things around you are strange, unreal or foggy
• Intrusive thoughts (unwanted thoughts that destabilise mood states)
• Catastrophising, that is, thinking about all that can go wrong
• Avoiding people or places that trigger anxiety or nervousness
• Withdrawing from family or friends and/or having difficulty in effectively communicating with friends, spouse, and doctors

Perinatal anxiety often goes unnoticed by the individual and her family. It is vital to know how this experience looks or feels like in order to avoid further delays

Childbirth related post-traumatic stress disorder(CB-PTSD)

Childbirth is a physically and psychologically intense experience. Complications during birth can lead to CB-PTSD (more commonly known as birth trauma). This is the most under-reported perinatal issue worldwide.

Let us understand the two contributing factors to birth trauma:

1. External or objective stressors such as medical complications for mother and baby, delivery complications and difficulties, unplanned interventions and lack of optimal medical resources.
2. Subjective stressors which relate to how an individual perceives something as life-threatening and the negative emotions that might get triggered in her, as a response to the event.

Risk factors for developing CB-PTSD can range from a history of physical or sexual abuse, having a history of untreated mental health complications, delivering prematurely, gynaecological or obstetrical complications etc., inadequate support during pregnancy or after birth can also be a very important yet overlooked risk factor of developing CB-PTSD.

Individuals may avoid the triggers that remind them of trauma, which can include the baby or spouse, re-experiencing and reliving the trauma vividly, feeling jittery, jumpy, restless, easily startled, angered or anxious, constantly on the lookout for danger (hyperarousal), inability to focus, difficulty sleeping or avoiding self-care activities like grooming, and/or maintaining hygiene and paranoia (excessive and irrational distrust and suspicion of others).

Emotional, psychological and social functioning (both present and future) of the individual may be severely impacted if this condition is not apprehended and intervened at initial stages.

Postnatal psychosis

Postnatal psychosis (also known as postpartum psychosis) is a rare but severe mental health condition which requires immediate medical and psychiatric attention. The onset is typically within one week of birth, although it can appear anytime between 6 months to a year after birth.

It is a complex issue with risk factors that include a personal history or familial history of postnatal psychosis and schizophrenia, having a diagnosis of bipolar disorder, history of postnatal psychosis in previous pregnancy, and/or discontinuation of psychiatric medication during pregnancy.

The two main symptoms of postnatal psychosis that directly affect the person’s sense of reality and the way they connect to their surroundings are:

1. Hallucinations: Seeing and hearing things that are not there. Occasionally an individual can also experience tactile sensations, (related to sense of touch), phantosmia/olfactory sensations (related to sense of smell), and/or gustatory sensations (related to the perception of taste).
2. Delusions: Fears, thoughts and beliefs that are not true. One might hold onto beliefs even when there is convincing contradictory evidence.

Some examples are: the belief that you were not pregnant at all, and insisting that the baby is not real/denying giving birth, believing that someone is controlling your body and instilling thoughts in your head or thinking that the baby is evil or cursed, and/or having compulsions to harm the baby.

Along with the above, other symptoms that commonly occur are: a mixture of severe mood changes, oscillating between mania (increased activity and mood), or hypomania (milder version of mania), confusion, disorientation, irritability, insomnia, and self-harm or harming others which can include the newborn.

When to get help?

Fortunately, this is a rare disorder, however, awareness and open mindedness around postnatal psychosis is vital for family members, caregivers and guardians to understand and recognise this condition at its primordial stage (the earliest stage) in order to prevent a full-blown stage wherein; the devastating effects are at maximum and recovery extremely difficult. Contact your GP and OBGYN immediately when you notice these symptoms in you or in your loved one.

Prevention and management

Self-care: Do not lose who you are while assuming new roles as a parent. Create a well-being plan for you and the baby. Keep your hobbies alive, set realistic goals that you enjoy, go out for a walk or to a spa, practice mindful eating and catch up on sleep whenever you find time. Small steps can have a huge impact on your overall well-being.

You are not your depression: Your sense of self is not defined by an illness. The strong positive connection (includes thoughts, feelings and behaviours towards mind and body) that you have with yourself acts as a vital protective factor against perinatal illnesses. Being mindfully aware of your strengths and triggers and being kind to oneself can prepare you for any emotional outburst that you may experience.

Meaningful social contact: Keep in touch with people who encourage, motivate and spark positive thoughts and feelings in you. Phone or video call a friend or a confidant every week if not every day. Spouse, parents and in-laws have a great responsibility in ensuring an emotionally safe and stress-free environment for the would-be-mother, in order to avoid any birth related stressors that might harm the development of the mother and the child.

Effective communication and mutual partnership: Open dialogues regarding parenting expectations, new challenges and changes in relationship with spouse can help navigate the difficulties around changing needs/desires, parenting styles, fears and doubts.

Parent-infant bonding: The emotional connection between the mother and the baby is built during pregnancy. Practices such as singing (or as might be the case for Muslims, reciting the Quran, qasa’id, nazms, etc.), talking to the baby, feeling the foetal movements and skin-to-skin contact with baby after birth, can help build the emotional bond between mother and child.

Prayers bring mental comfort and resilience: Connection with a higher power brings profound emotional and spiritual clarity as well as mental strength. Prayer and spiritual belief act as key components of holistic perinatal care. They possess an immense capacity to alleviate anxiety and sadness around pregnancy and parenting related factors.

Prayers with utmost conviction are certainly heard, as in the case of Prophet Zachariah^as: “Zachariah prayed to his Lord, saying, My Lord, grant me from Thyself pure offspring; surely, Thou art the Hearer of prayer.”(Surah Aal-e- Imran, Ch.3: V.38)

Attend antenatal sessions with spouse: Prenatal or birth classes as they are called can help prepare expectant parents physically and cope the upcoming changes and challenges.

These sessions aim at increasing awareness around birthing process, build confidence, reduce anxiety, aid in learning relaxation techniques and accentuate positivity. You can also learn practical skills to enhance bonding through antenatal sessions.

Check for Vitamin D and Vitamin B12 deficiency: Suboptimal levels of vitamins during the perinatal period are linked to a higher risk of maternal depression, anxiety and neurodevelopmental problems in the child. Prenatal supplementation and monitoring are vital during this phase.

Monitoring mood states and building healthy thinking patterns: Monitor your mood states through the days and look out for any unhelpful thought pattern that may be causing the eruption of negative feelings and physical distress within you. Jot the thoughts down and find alternative thoughts which are helpful, reasonable and compassionate. Try to do this whenever your mood dips.

It is alright to ask for help: Contact your health care provider – an OBGYN or a psychiatrist – if you notice symptoms related to any of the above mentioned perinatal mental health complications.

And as you move forward in your treatment you may also find the need to see a psychologist for a few sessions of psychological therapy in order to manage the problem by changing the way you think, feel and behave. You can also join perinatal support groups and share your experiences with like-minded expectant families.

Islam’s emphasis on the status of mothers & mental health

Indeed, when the above struggles are taken into consideration, a mother’s immense efforts and sacrifices are truly worth showing gratitude to, as the Holy Quran instructs:

“And We have enjoined on man concerning his parents – his mother bears him in weakness upon weakness, and his weaning takes two years – ‘Give thanks to Me and to thy parents. Unto Me is the final return.” (Surah Luqman, Ch.31: V.15)

Additionally, one can understand the status given to mothers by the Holy Prophet Muhammad^sa as recorded in various narrations.

At one instance, he was asked who was most deserving of good treatment, the Holy Prophet^sa responded with “Your mother” thrice, and then “Your father”. (Sahih Muslim, Kitab al-biri wa l-silati wa l-adaab, Hadith 2548b)

In another famous narration it is recorded that when a person confirmed that his mother was alive, the Holy Prophet^sa responded with:

“Then stay with her, for Paradise is beneath her feet.” (Sunan an-Nasa’i, Kitab al-jihad, Hadith 3104)

The taboo and stigma around seeking help for mental health matters has also been addressed from an Islamic angle. The importance of seeking psychological and psychiatric support has been stressed by Hazrat Khalifatul Masih V^aa, who endorsed seeking professional help when and where needed, stressing that there is nothing wrong with seeking such help. In fact, he commended it as a good thing which should be done.

Paternal mental health matters too!

Last but not least, fathers too can follow the preventive measures mentioned in this article, in order to stay ahead and on top of their mental health.

Knowing that the father’s mental health concerns will impact the child’s connection and emotional development, and by taking his mental health into consideration can serve as a game changer.

With regard to fulfilling mental health, the true strength lies not in silence, but in speaking out and seeking the right support at the right time.

This new year, let us open up discussions concerning mental health with family, friends and in workplaces to reduce stigma and resistance to psychological interventions.

Let it be known that mental health issues are nothing to be ashamed of, rather they are a part of human experience, which involves learning and growth.

Let us unite and speak openly and guide generations towards a culture of love, support, and recovery. God willing!