What Is Happening to Your Brain After Birth: Postpartum Depression, Anxiety, and Intrusive Thoughts
With Allison Steinwand, MS, LPC-MH, PMH-C (Owner) — Archway Counseling & Wellness · Sioux Falls, SD
988 Suicide & Crisis Lifeline — call or text 988, 24/7.
National Maternal Mental Health Hotline — call or text 1-833-852-6262, free and confidential, 24/7.
Postpartum Support International — postpartum.net.
Postpartum psychosis is a medical emergency. If a new mother has a break from reality, or thoughts of harming herself or the baby feel logical to her, call 988 or go to the nearest emergency room.
"Pregnancy rewires your brain more than any time since puberty. When the symptoms show up, you are not broken. You are biological."
On what is actually happening
"Intrusive thoughts are unwanted and scary precisely because you would never act on them. The distress is the sign it is not a wish."
On intrusive thoughts
"Postpartum psychosis is rare, about one to two births in a thousand, and usually shows up in the first two weeks. It is a medical emergency."
On psychosis
"It is okay to ask for help. You do not have to be in crisis to reach out."
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Can you have depression while pregnant, not just after the baby?
Yes. Depression and anxiety can begin during pregnancy. The clinical term is perinatal because the whole window counts, and onset can happen any time in the first year after birth. It may be more than normal tiredness when symptoms last longer than about two weeks and you can no longer enjoy or carry on daily life.
Are intrusive thoughts about your baby normal?
Intrusive thoughts are common. They are unwanted, scary thoughts a parent does not want and would never act on. The distress they cause is the sign they are not a desire. They become a concern when they stick, repeat, or start changing your behavior.
What is the difference between baby blues and postpartum depression?
Baby blues are the emotional, tearful feelings many new parents have in the first two to three weeks as hormones shift and sleep disappears. It is more likely a mental illness when those feelings last longer than that, or when you cannot carry on daily tasks or enjoy life.
How common is postpartum depression?
Recent rates put postpartum depression at roughly 10 to 20 percent of birthing people, perinatal anxiety around 20 percent, and perinatal OCD around 7 to 18 percent. These are common, treatable conditions.
What is postpartum psychosis and what are the warning signs?
Postpartum psychosis is a rare medical emergency, roughly one to two births in a thousand, usually within the first two weeks after birth. Warning signs include a break from reality, hallucinations, delusions, statements that feel off, and thoughts that feel logical to the person. It requires emergency care.
What is the difference between intrusive thoughts and postpartum psychosis?
Intrusive thoughts in depression, anxiety, and OCD are scary and unwanted, and the parent works to avoid harm. Psychotic thoughts feel logical to the person. That difference is a key reason psychosis is a medical emergency and intrusive thoughts, while distressing, usually are not dangerous.
What therapies treat perinatal mental health conditions?
Common approaches include cognitive behavioral therapy (CBT), Internal Family Systems (IFS), and EMDR. CBT and mindfulness help many clients, IFS gives language to the different parts of the self, and EMDR brings the body into trauma work when talk therapy alone is not enough.
When should you reach out to a perinatal therapist?
You do not have to be in crisis. If symptoms last more than two weeks, if you cannot carry on daily tasks or care for the baby the way you want to, if you have panic attacks, or if you are simply not sure and want support, it is worth reaching out.
Reality: It can begin during pregnancy too, and onset can happen any time in the first year after birth.
Reality: Intrusive thoughts are very common for new parents. The distress they cause is the sign they are not a desire, not a sign you are dangerous.
Reality: It is normal to feel many things at once. Mixed feelings during a huge life change do not make you a bad parent.
Reality: It is rare, about one to two births in a thousand, but it is a medical emergency, so every family should know the warning signs.
Reality: You do not. If symptoms last more than two weeks or you are simply unsure, it is worth reaching out early.
Pregnancy and the first year after birth rewire your brain more than any time since puberty. So when postpartum depression, anxiety, OCD, intrusive thoughts, or in rare cases perinatal psychosis show up, it is biology, not a sign that something is wrong with you.
Allison Steinwand, MS, LPC-MH, QMHP, PMH-C, owner of Archway Counseling and Wellness in Sioux Falls and one of the only therapists in the region with a Perinatal Mental Health Certification, sits down with host Melissa Goodwin to explain what is actually happening in the brain, how to tell depression from anxiety from OCD from intrusive thoughts, what perinatal psychosis is and the warning signs every family should know, and what real help looks like, including CBT, Internal Family Systems, and EMDR.
Allison earned her Perinatal Mental Health Certification after her own perinatal experience and now focuses on pregnant and postpartum clients. The episode is educational and is not a substitute for care from a licensed provider. If you are in crisis, call or text 988.
