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POSTPARTUM PMADs: When it’s More than Just the Baby Blues

Most new parents have heard the term “the baby blues” at some point or another along their pregnancy journey. The baby blues are a common occurrence, affecting about 80% of new parents, with most people experiencing symptoms about 2-3 days after giving birth. This phenomenon is caused by the rapid change in the hormone levels progesterone and estrogen after delivery, which results in mood swings and feelings of sadness. The good news is that the baby blues are self-limiting and usually resolve without any treatment within two weeks of onset. When symptoms last beyond two weeks, however, it is important to tune in, as something more serious that may be going on: Perinatal Mood and Anxiety Disorders – aka- PMADs. 

Common symptoms of the baby blues:

  • Feeling restless, anxious, or impatient
  • Tearfulness for “no reason”
  • Mood changes
  • Sadness
  • A feeling of, “I just don’t feel like myself today”

Although less common than the baby blues, PMADs also affect a great number of new parents: 1 in 5 women, or 20%, are affected. More traditionally termed “Postpartum Depression,” it is important to recognize that PMADs actually encompass a variety of mental health conditions including depression, anxiety, obsessive-compulsive disorder (OCD), bipolar mood disorder, and postpartum psychosis. Women with a prior history of either underlying mood disorders (ie- anxiety and depression), or PMADs with a prior pregnancy, are at increased risk for developing PMADs.

Some examples of PMAD symptoms by type:

  • Depression:
    • Lack of interest in your baby
    • Changes in eating or sleeping habits (unrelated to the newborn)
    • Trouble concentrating
    • Thoughts of hopelessness
    • Thoughts of harming yourself or your baby
  • Anxiety:
    • Extreme worries and fears over health and safety of the baby
    • Panic attacks (shortness of breath, heart racing, dizziness, chest pain, a feeling of loss of control)
  • Perinatal OCD:
    • Repetitive, distressing, or unwanted thoughts or mental images
    • Performing certain behaviors over and over again, often to reduce the anxiety caused by unwanted thoughts
  • PTSD:
    • Flashbacks of a trauma associated with feeling anxiety
    • Avoidance of things or activities that are reminiscent of the prior trauma
  • Bipolar Mood Disorders:
    • Severe depression
    • Racing thoughts
    • Changes to sleep and eating habits – individuals often feel they do not need much sleep
  • Postpartum Psychosis:
    • Hallucinations: seeing and hearing voices that other people cannot see or hear
    • A distrust of people around you
    • Temporary confusion or memory loss


For women with PMADs, the reassuring news is that these conditions are temporary and treatable.  Feeling depressed or anxious is not a “failure,” and does not indicate whether or not you are a good parent. It also does not mean that you will always feel depressed or anxious! You can recover from PMADs and will probably learn that you are very resilient along the way.

There are several safe and effective options available to help you feel better, and many of these options are also safe to use while breastfeeding. Your OBGYN Provider can help you on the path towards feeling better, and is often able to offer management for women experiencing postpartum anxiety or depression. For women experiencing other PMADs, such as OCD, Bipolar disorder, and PTSD, referral to a specialist Psychiatric care provider is the most appropriate and effective management option. Women experiencing symptoms of postpartum psychosis require immediate psychiatric care in a hospital setting due to the dangerous nature of the condition.

The first line treatment recommendation for anxiety and depression is professional counseling, aka therapy. Counseling is also frequently combined with the use of medications to achieve optimal symptom management, and women should not be afraid to use medication when needed (and there are many safe medication options for women who are breastfeeding!). Other measures that can help with feeling better include prioritizing sleep, asking for help with newborn care or the care of other children and household tasks, healthy nutrition, mindfulness, and exercise (once cleared by your OBGYN provider).

It is important to recognize that there is no “one size fits all” approach to the treatment of postpartum anxiety and depression, and finding what works best for you is of utmost importance. Once you find what does work for you:  make a plan and stick with it!

Below are links to some helpful resources.




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