Mental health concern Perinatal mental health
The months after having a baby can bring some of the hardest mental health experiences of a person's life. Postpartum depression, postpartum anxiety, intrusive thoughts, and birth trauma are all common, treatable, and not your fault. Reaching out is what good parents do.
Perinatal mental health covers anything that happens during pregnancy and the year after the baby is born. The most common conditions are postpartum depression and postpartum anxiety, which together affect around one in five birthing parents. Many partners and non-birthing parents also experience perinatal mental health challenges.
Postpartum depression is not the same as the "baby blues," which is short-lived (a few days), mostly tearful, and usually clears on its own. Postpartum depression lasts longer, hits harder, and does not resolve without support. It can start any time in the first year, not just immediately after birth.
Postpartum anxiety is just as common as postpartum depression and often goes unrecognised because new parents are expected to worry. It is anxiety that is constant, intrusive, and out of proportion. It often includes terrifying intrusive thoughts about something happening to the baby (this is anxiety, not a sign you would hurt the baby).
Postpartum psychosis is rare but is a medical emergency. It involves a break from reality, often within the first few weeks after birth. If anyone in your life is experiencing it, please call 911 or visit your nearest emergency department. See the crisis section above.
Symptoms in clinical language can feel cold. These are some of the moments people describe when they walk into our offices.
You love the baby. You also cannot stop crying. You feel guilty for both at the same time.
You go from zero to terrified about something happening to the baby in five seconds. You check that they are breathing six times an hour.
You have intrusive images of the baby getting hurt. The images horrify you. You think the images mean you are dangerous. They do not. They mean you have postpartum anxiety.
You feel completely alone in a house full of people. Visitors come, hold the baby, leave. You smile through it. You scream inside.
You do not remember the last time you felt like yourself. You are not sure you will again.
You are doing all the things a good parent does and you feel like a failure anyway.
Perinatal mental health includes several distinct conditions. Symptoms below can occur during pregnancy or up to a year after birth.
If you are pregnant or in the year after birth and the symptoms above describe more than a passing rough patch, please reach out. The earlier you get support, the easier the recovery.
If you are experiencing postpartum psychosis (or someone in your life is), please visit your nearest emergency department or call 911 immediately. See the crisis section at the top of this page. Postpartum psychosis is treatable but cannot wait.
If you have intrusive thoughts about harming the baby and they horrify you, please tell a clinician. These thoughts are very common in postpartum anxiety and OCD. Telling a trained clinician will not result in your baby being taken away; it will result in you getting the right treatment for the right problem.
If you are a partner or non-birthing parent struggling, you also deserve support. Up to one in ten non-birthing parents experiences a perinatal mental health condition. The supports below apply to you too.
For postpartum depression and anxiety, our work usually combines cognitive behavioural therapy, behavioural activation, and acceptance and commitment therapy, adapted to the new-parent reality (sessions sometimes scheduled around feeds, sometimes with the baby in the room, no expectation of you being put-together for the appointment).
For postpartum OCD, we use exposure and response prevention (ERP) adapted for the postpartum context. ERP for postpartum intrusive thoughts is highly effective and usually faster than ERP for other forms of OCD.
For birth trauma, we use EMDR or trauma-focused CBT, often after a stabilisation phase. Birth trauma processing is some of the most gratifying work we do; clients often describe it as getting their birth back.
For postpartum psychosis, we are not the right level of care. We will help you connect with psychiatric and inpatient services and stay with you for the therapy piece once you are stable.
Several of our approaches help in the perinatal period. The right one depends on what you are experiencing.
A practical, well-studied therapy that helps you notice the link between your thoughts, feelings, and behaviours so you can change patterns that hurt you.
A therapy for people who have tried to think their way out of hard feelings and got tired. ACT helps you stop fighting your thoughts and start moving toward what matters.
The gold-standard treatment for obsessive-compulsive disorder. Practices facing the trigger AND choosing not to do the compulsion, until the loop loses its grip.
A structured therapy for processing distressing memories. Uses guided eye movements (or other side-to-side input) to help your brain finish the work it could not finish at the time.
Several of our clinicians have specific training and experience with Postpartum. The right match for you depends on more than the technique, so we encourage you to read the profiles and pick whose voice feels closest to what you are looking for. The first session is free and you can switch if it is not the right fit.
Cognitive behavioural therapy and interpersonal therapy are first-line treatments for postpartum depression per the American College of Obstetricians and Gynecologists and the UK National Institute for Health and Care Excellence. Both are well-studied and have effect sizes comparable to medication for mild-to-moderate cases.
A 2020 meta-analysis by Stephens and colleagues reviewed 26 randomised trials of psychological treatments for postpartum depression and confirmed large effect sizes. ERP for postpartum OCD has growing evidence and tends to work faster than ERP for OCD that began earlier in life.
No. Intrusive thoughts that horrify you are a symptom of postpartum anxiety or OCD, not a sign of risk. Parents who actually pose a risk usually do not have intrusive thoughts that distress them. The distress is evidence that the thoughts are misaligned with who you are. Please tell a clinician. Treatment works.
Telling a therapist about postpartum depression, anxiety, or intrusive thoughts does not result in your baby being removed. In most cases, it results in the right treatment. The threshold for child protection involvement is much higher and is based on observed risk, not on a parent honestly reporting symptoms.
The baby blues usually pass within two weeks of birth. If your symptoms have lasted longer than that, you may have postpartum depression or anxiety, which do not pass without support. Please reach out.
There are medications considered safe in pregnancy and breastfeeding. The decision is between you and your prescribing doctor, often in consultation with a perinatal mental health specialist. We can help you find a prescriber who knows this area well.
Yes. Up to one in ten non-birthing parents experiences perinatal mental health concerns. We see partners as well as birthing parents.
Our sessions are virtual, which makes new-parent therapy a lot more doable. We schedule around feeds when possible. The baby is welcome in the room; we will not expect you to be put-together. Some of our best sessions happen with a baby asleep on a parent's chest.
Postpartum depression is persistent low mood, loss of interest, exhaustion, and difficulty bonding that lasts more than two weeks after a birth and gets in the way of caring for yourself or the baby. It is different from the brief, common "baby blues" that pass in the first two weeks. PPD is treatable, and earlier treatment is better than later.
Postpartum psychosis is a medical emergency. It usually appears within the first two weeks after birth and can include rapid mood swings, confusion, hallucinations, or beliefs that do not match reality. If you or someone you love is showing these signs, this is not the time for therapy first; call 911 or go to your nearest emergency department right now. Treatment usually starts in hospital.
Often yes. Postpartum therapy from a Registered Psychotherapist or Registered Social Worker is usually reimbursable on Canadian extended health plans. Saalvio does not bill insurers directly; we send a detailed receipt naming your therapist, their registration college, and registration number, which is what most insurers ask for when they process a claim.
Many of these often show up together. Reading more than one page can help you make sense of what is going on, and there is no harm in starting with the one that feels closest.
Book a free first session with one of our therapists, or join the waitlist if you are outside Ontario. There is no obligation to continue after the first session.
Saalvio psychotherapy is live in Ontario today. Other provinces are coming soon.
