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How to Talk to Your Healthcare Provider About Perinatal Mental Health.

Writer: Sarah FolchSarah Folch
Feb 187 min read

Becoming a new parent, or maybe even a parent to a second, third, or later child, can include many questions. So many questions that we can easily put to the side or forget the questions that pertain to us! This is also true for Perinatal Mental Health.


The timeframe from trying to conceive to one year postpartum is called the Perinatal Period. This timeframe is chalked with changes in mental health. Our hormones, environments, and genetics can all contribute to Perinatal Mental Health. With so many factors taking part, we all need someone trustworthy to address questions about our perinatal mental health.



We’re on a mission to fling the door wide open to talk about Perinatal Mental Health – and we’re not just cracking it a bit, we’re throwing it open- and keeping it open!


We know this can be difficult due to the perception of what conception, pregnancy, and postpartum should look like. But, each part of the perinatal journey can be narrated by you- it is uniquely yours.


Where to start

Make an appointment with a professional and make a promise to keep it- for you and your baby or babies! Anyone you see for your healthcare will likely be able to help give you a direction. Even those who do not specialize in mental health can get you started.


This could be...

  • Your primary care provider

  • Your fertility specialist

  • Your OB/GYN

  • Your nurse practitioner

  • Your baby’s pediatrician

  • Your midwife

  • Your doula 


Your provider may bring up the subject first. Often when they do, they will give you two screenings. This is usually the Edinburgh Postnatal Depression Scale and the General Anxiety Disorder Scale. These are straightforward and usually only take a few minutes to complete. In these screenings, it is really important to be honest with yourself. It can be easy to downplay your symptoms, but it is better to go with your first gut reaction to the questions. 


Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have recommended screening times. However, these screening intervals are frequently unmet. With pediatricians, the professional you are likely to see the most postpartum, only about half (53.9%) provide the screenings to their patients (The American Academy of Pediatrics, 2022).  


It is important for us to be our own advocates. Among birthing people, 75% are never diagnosed or receive appropriate care for their mental health (World Maternal Mental Health Day, 2024a). This is by no means intentional- mental health is often overlooked. But we are here to empower you so you can find and receive the help you need. 



When to Ask

If you suspect something doesn’t feel right, we encourage you to listen to your gut. Maybe you felt fine last week at the pediatrician appointment, but you don’t this week. Or maybe it feels like something else is attributing to it- like the ‘baby blues’ or that you are tired. 


Downplaying symptoms is common, with 7 out of 10 birthing people downplaying or hiding their symptoms (World Maternal Mental Health Day, 2024a). Whether or not your provider or baby’s provider asks about your well-being it is important to bring up the subject. Throughout the perinatal journey, our bodies are ever-changing. This means that our mental health can too.    


It is best to be proactive as perinatal mental health symptoms can have a long-lasting impact on you, your baby, and your family. 


To provide some insight and a chance for reflection, you can read up on perinatal mental health disorders and symptoms here. This also gives you an opportunity to become aware of the many types of perinatal mental health disorders that exist. So when you talk to your provider, you may feel empowered and ready to advocate for yourself.



What to Ask

When it comes to questions about your mental health there are several that may be beneficial for you to ask your provider about. Below is a list of such questions that may feel applicable to you.   


Questions to ask your provider…


  • Could we talk about depression/ anxiety/ psychosis? 

  • I have a history of mental health symptoms, what can this mean?

  • Could this be related to something physiological such as thyroid?

  • What treatments are likely to help me? 

  • What are the possible side effects of any medications?

  • Is medication safe while trying to conceive, during pregnancy, and lactating? 

  • What lifestyle changes can I make to help?

  • I have read about intrusive/ upsetting thoughts of harming your baby. Is this true?

  • I have been having an increase in depression/ anxiety/ rage. What could this mean?

  • My birthing experience has been difficult to think about. Could this be trauma?

  • My depression/ anxiety doesn’t feel the same as in the past. What could this mean?

  • When should I seek immediate medical attention?

  • Could I struggle with this if I have another baby?

  • Do you have someone to refer me to for further support?

You will likely be asked questions from your provider too. Below is a list of possible questions. Take the time to reflect further on your experiences and what you want to share and ask them in return.


Possible questions...

  • What are the symptoms you have been experiencing and when have they started?

  • Do you feel that your symptoms are making it harder to care for your baby?

  • Do you feel as bonded to your baby as you expected?

  • Have you experienced any thoughts of harming yourself or your baby? 

  • These thoughts may feel intrusive.

  • How frequently do you feel anxious, angry, or irritable?

  • How has your energy level been?

  • Do you feel more tired than you expected? 

  • How is your interest in things you enjoy?

  • Have you experienced a change in your appetite? 

  • What type of support do you have in caring for your baby?

  • Do you have other major stressors in your life, such as financial or relationship problems?


Discussion Tool

Navigating our mental health during this time can leave us speechless. If you are feeling unsure of how to start the conversation with your provider, this Discussion Tool may help with the language you'd like to use to express your concerns.



Feeling Minimized?

You deserve to have your concerns addressed appropriately and with empathy. If you do not feel that your healthcare provider is offering this, you can seek help elsewhere. It may seem like one more thing to do while trying to conceive, manage all those pregnancy symptoms, or take care of a new baby. But, it is very important. The sooner you find support, the sooner you will feel better. 



Seeking Treatment

Seeking treatment can feel like one more thing on your to-do list. It is a lot when we are holding the emotions and processes of infertility, or when we feel displaced in our bodies during pregnancy, or when we hold our newborn and things don’t feel like what everyone said they would. The process of treatment can take time, but it is time that you are working towards being well.  


Counseling

When it comes to counseling, typically providers will have someone they trust to refer you to. If not, or in addition to, Postpartum Support International has a directory of mental health professionals who specialize in Perinatal Mental Health. Anyone can search through multiple providers in all states. Anyone can search the general directory or New Mexico perinatal mental health providers.


The form of treatment around counseling can vary in techniques. However, the primary basis is to talk through your experiences with a licensed counselor. This counselor is trained to help you gain new insights, reframe heavy subjects, and hold space for you. You and your counselor will create goals that help support you best. 


There are many professionals in the mental health field that can provide services and it can be confusing! Some even have the same credentials but based on state to state, may have different tiles. Below is a cheat sheet to guide you into the know. 


  • Licensed Mental Health Counselor (LMHC, LPC, LPCC, LCPC, LCMHC): Someone who is trained to work, treat and diagnose those with mental health symptoms.

  • Licensed Marriage and Family Therapist (LMFT): Similar to a Licensed Mental Health Counselor, but with a focus on marriage and family interactions. 

  • Social Worker (LCSW, LICSW): Similar training to that of a Licensed Mental Health Counselor. However, their treatments are typically based on a broad-spread community approach rather than the individual or family unit. 

  • Psychologist: The highest degree in education for counseling techniques, treatments and diagnosing mental health symptoms.    

  • Psychiatrist: A doctorate degree specializing in mental health, but for medication-prescribing purposes. 

  • Mental Health Nurse Practitioner (PMHNP): Similar to that of a psychiatrist, but with less training. A Psychiatrist oversees their work.  

  • Perinatal Mental Health Certification (PMH-C): A specialized perinatal mental health certificate that any professional can earn. 


Ready to start counseling now? You can take the first steps with Mountain Crest Counseling.


Medication

Any medical doctor you are under the care of should be able to begin you on medication(s). It is important to keep in mind that while our primary care providers do have a lot of knowledge about mental health, seeking someone with additional training in mental health may be more beneficial. Reaching out to a psychiatrist or a nurse practitioner who specializes in mental health would be ideal. You may likely face a long waitlist, so maintaining your treatment with the prescribing doctor is best until additional or specialized care is established. 


Curious about medication? Visit Mountain Crest Counseling's Resource List for prescribing providers.

 


You Got This!

Perinatal mental health disorders and symptoms can be heavy. But, you are strong! Trusting the beauty that lies in the glimpse of change or a moment of joy can be the light in the dark. Seeking help is the first step.



Resources



References


World Maternal Mental Health Day (2024a). Why Maternal Mental Health Matters. Retrieved from https://wmmhday.postpartum.net/wp-content/uploads/2021/03/WMMHday_2021_1.png


World Maternal Mental Health Day (2024b). Why Maternal Mental Health Matters. Retrieved from https://wmmhday.postpartum.net/wp-content/uploads/2021/03/WMMHday_2021_1.png










 
 

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