May is Maternal Mental Health Awareness Month, but the topic has been on the minds of many for weeks now, as the coronavirus has spread rapidly across communities, the country, and the world, leading to increased anxiety in pregnant and postpartum women.

“This is supposed to be the happiest time in your life, and you’re terrified,” said Theresa Termine, executive director of Postpartum Support Virginia. Termine said her organization shifted in March from in-person meetings to a virtual schedule, and has seen a spike in calls and inquiries, which was expected but is no less heartbreaking.

“All pregnant moms have some level of anxiety,” Termine told Rewire News Group. “You worry about doing everything right.” But coupled with COVID-19 stressors, like changes in one’s health, safety, or job security, we can expect to see a rise in maternal and postpartum mood disorders such as postpartum depression (PPD).

According to the World Health Organization (WHO), mood disorders surrounding the perinatal and postpartum periods affect 1 in 7 women globally. In the United States, women of color are disproportionately affected, as are veterans and immigrant populations.

Seventy percent to 80 percent of new mothers experience some negative feelings or mood swings after childbirth, according to the American Pregnancy Association. And keep in mind such data typically only refers to those who can be counted. Because there are many new parents who have not shared their symptoms or been able to reach out for help, the percentage is likely higher.

There are so many triggers for mood disorders that new mothers could not have prepared for. “Your birth wasn’t anything like you planned for, expected, or what anyone has ever before gone through—and that can be traumatic,” Termine said.

How perinatal and postpartum mood disorders are diagnosed

PPD is a medical condition where women have a serious sense of sadness or anxiety in the “fourth trimester” or the postpartum period. PPD is more intense and severe than the “baby blues,” which is often sadness or weepiness due to hormonal changes. More recently, Perinatal Mood and Anxiety Disorder (PMAD) has been used as a metric for monitoring well-being as it encompasses a myriad of mental health issues, not strictly depression.

Risk factors for PPD/PMAD can often be overlooked or undiagnosed by patients not recognizing their symptoms and by providers not asking the right questions. Anger, sadness, irritability, or lack of interest in your new baby are common symptoms. Women may experience anxiety, and extreme fears may be consuming thoughts. Often women may think these are passing feelings, or are afraid to bring up any possible mental health issues to their provider.

Organizations like Postpartum Support Virginia are essential in educating not only clients about diagnosis but also a variety of health-care providers. Its pilot Champions Program, for example, has turned to labor and delivery nurses as those who are opening up a conversation about postpartum mood disorders with new mothers. Clients remember being educated by these nurses, and the numbers show success, according to the nonprofit. “At our pilot program at Fairfax hospital, attendance at the support groups have nearly tripled and calls for resources have increased,” Termine said.

A multifaceted approach increases the chance for women to get support from one of many avenues. If her primary provider misses the diagnosis, other clinicians could step in and identify the disorder if they are aware of possible postpartum mood issues. A woman sees several types of providers throughout her pregnancy and postpartum period, as well as a pediatrician for newborn care, until up through two years postpartum.

Importantly, women should be equipped with information to advocate for themselves. “Let women not be afraid to ask their doctors about these things,” Termine said. “If a woman is aware that this fourth trimester is challenging and can prepare for it, they can think about the self-care piece beforehand. Thinking ahead and enlisting a plan—but we need to make sure everyone understands how important that is.”

How we can get help with maternal mental health

Raising awareness of mood disorders is a crucial first step to helping combat stigma and reducing untreated or undiagnosed patients. Research also plays a valuable role as medical professionals look to better understand the problem.

The University of Illinois at Chicago’s COVID-19 pregnancy and postpartum experience survey is a valuable tool for those who are currently pregnant, or have given birth since January. The study’s principal investigator, Dr. Kylea Liese, explained how the research began and what she sees for the future of the data.

“The survey is looking at birth choices and pregnant people’s experience right now. This is largely about stress during this time and the broad and deep impacts of the virus,” said Dr. Liese, an assistant professor in the Department of Women, Children, and Family Health Services. “Every step of the way there are new anxieties. Women are doing the best they can being a potentially vulnerable population.”

The research initially intended to evaluate around 1,000 participants, but in just two weeks nearly 4,200 women have responded to the survey. The range of responses has been powerful, as respondents have discussed “rituals that have been missed, like baby showers and birth celebrations,” Dr. Liese said. “Many have been worried about things like how they are going to keep themselves and their babies safe.”

The researchers will eventually set up a cohort of women to follow through pregnancy and postpartum. In addition, Liese and her colleague are hoping to determine whether the pandemic has resulted in a prevalence of low birth weight or premature labor by reviewing indicators like biomarkers.

Dr. Liese said she hopes the data may shed light on ways to “reframe the system to be more equitable.” Liese likens the pandemic to her experience as a clinician in Afghanistan, where there is a health-care system that has been leveled. “How can we rebuild a health-care system and [what are the] lessons we have learned that we don’t want to repeat?” she asked. “There has been a trauma in the health-care system, but that might improve health equality because we are now seeing flaws in the system.”

As researchers are just beginning to study the impact the COVID-19 pandemic is having on pregnant and postpartum women, a number of organizations are providing resources to support this community.

Postpartum Support International (PSI) offers resources for mothers, families, and medical professionals. The Portland, Oregon-based organization advocates for people living with mood disorders and mental illness. Similarly, the Blue Dot Project promotes awareness and education of maternal mental health disorders. The project offers opportunities to learn, heal, support, and take action.

Programs like these are paramount in helping women and their families. If you or someone you know may be experiencing PPD or PMAD, reach out to a local support group or a trusted health-care provider for help.

“We need to give women the grace to do what they need to help themselves,” Termine said. “Self-care is important, and it doesn’t make you selfish—it makes you strong.”

Mental health is just like physical health and equally as important. This Maternal Mental Health Awareness Month, it is crucial to shed light on these types of mood and mental health issues. Normalizing them can save lives.