Maternal health care concerns are making research headlines. In 2025, The March of Dimes reported 24.5 % of expecting mothers no longer receive prenatal care in the first trimester, a critical period for ensuring a healthy pregnancy and baby. This year, researchers Stoneburner et al. told us, “Over 35 % of U.S. counties are designated as ‘maternity care deserts’, lacking obstetric clinicians and birthing facilities.”

Further, some women need perinatal mental health care, which is also lacking. The Policy Center for Maternal Mental Health (2025) reported that 84% of birthing-aged women reside in maternal mental health resource shortage areas. Given the importance of a mother’s mental well-being on the healthy development of the child, lack of these services could contribute to everything from struggles to bond to failure to thrive.

The maternal mental health care situation

Unfortunately, not only is there a lack of resources, but in 2024, Bublitz and Sharp at Brown University reported:

There is a popular perception that pregnancy is a time solely of joy…It is a myth that mental health is protected in pregnancy. Because of this, many people who struggle with mental illness in the perinatal period are reluctant to discuss their mental health with their providers. Over 80 percent of mental health problems in pregnancy go unreported.

There’s not only lack of maternal mental health services, but 80% of perinatal mothers who could use them are going unrecognized. With early intervention, perhaps those mothers-to-be could experience more of the joy of pregnancy and prevent more significant post-partum psychiatric concerns.

While we can’t simply create more resources, we can help make sure struggling perinatal women are recognized and get some form of intervention. Even if they are in an area lacking maternal mental health specialists, working with a more general therapist or being prescribed pregnancy-safe medication is better than nothing. Against popular belief, psychiatric medication use in the perinatal period is often safe for the expecting mother and child (e.g. Fabiano et al., 2024; Petrosellini et al., 2024).

Perinatal depression can be hard to detect

When most people think of maternal mental health care, chances are that peripartum depression comes to mind. Peripartum depression is correlated with premature birth and low birth weight, trouble bonding with the baby, and development of cognitive and verbal deficits in the child (e.g. Fan, et al, 2004, Voit et al., 2022; Bergmann et al., 2025)

There is also peripartum anxiety, mania, and psychosis, all often noticeable by others, making intervention more likely. Depression can be more subtle to detect, for both the mother and others, making awareness and screening extra important.

Consider that some degree of fatigue, trouble concentrating, moodiness, and sleep disturbances aren’t unusual during pregnancy or post-delivery. However, they’re also symptoms of depression and should be evaluated closely. This is especially true if they are occurring together, intensifying, and/or impacting the mother’s ability to function effectively. This includes eating enough for the growing fetus or having the energy to attend to perinatal doctor appointments.

Unfortunately, up to 15 % of perinatal mothers (e.g., Lindhal et al., 2005; Paul et al., 2021) may feel so depressed and inadequate they engage in non-lethal, self-injurious behavior (NLSIB), like cutting or burning themselves. Others may feel so unworthy and depressed that suicidal ideation or attempts occur. Perhaps the baby is very challenging, not eating or sleeping and is colicky, and in the anger that often accompanies depression, she has thoughts of shaking the baby or worse.

The effects on the baby of maternal suicidal activity or aggression need no explanation. However, the effects of NLSIB in perinatal mothers on their child are just beginning to be understood. In fact some researchers (Paul et al., 2021) have noted that children whose mothers had only thoughts of self-harm from the 18th week of pregnancy to when the child was 18 were three times more likely to be depressed.

Risk factors and signs of perinatal depression

Risk factors for developing perinatal depression include a history of depression, perinatal or otherwise, and other present mental illnesses, including personality disorders, psychosocial stressors like domestic violence and low socioeconomic status, adolescent pregnancy, and unwanted pregnancy.

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As for signs of perinatal depression, even if the person has no history of depression, be observant for any ongoing unpleasant mood, sleep, appetite, energy, and cognitive changes. Also, if you know they have a history of NLSIB, pay close attention for any scarring — or hiding or scarring, like wearing long sleeves even though it is summer.

Interventions for perinatal mothers you’re concerned about

Should you feel the perinatal woman might be struggling emotionally, just asking how she feels can help open the discussion. They might confess they’re feeling stressed or overwhelmed. “How’s it affecting you?” would be a good follow up. If they give a simple reply like, “I just don’t have energy” or “I get snappy and moody,” ask about depressive symptoms. For example, “Has it bothered your eating or sleeping?” and “Do you feel all brain fogged?” Of course, asking if they feel sad/depressed or are having difficulty enjoying pregnancy or being a new mother is essential. Does she ever feel she is, or will be, an inadequate mother? Most importantly, she should be asked if she has had thoughts of harming herself or the baby. Affirmative answers to any of the above would indicate she is likely depressed.

Perhaps the person looks stressed/depressed but says it’s just the fatigue of being pregnant or caring for a new baby and they’re really fine. In this case a gentle reply like, “I have to be honest, I asked because you seem like you have no energy and are kind of sad even though you were so excited to be pregnant [or to have given birth] earlier” could help get them to talk about their emotions. If they continue to say they’re fine, let them know you’re concerned and are available, and continue to check in.

In the meantime, suggest they check in with their provider about the “stress” or “fatigue” to make sure its not depression. However, if you notice an increase in their struggle, talking to the person’s spouse/partner or other friends and showing group concern could help them realize they need treatment.

Disclaimer: The material provided in this post is for informational purposes only and is not intended to diagnose, treat, or prevent any illness in readers or people they know. The information should not replace personalized care or intervention from an individual’s provider or formal supervision if you’re a practitioner or student.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.