Perinatal Mental Health for Health Care Providers

Introduction

This webpage provides a summary of key points and current evidence-based recommendations related to Perinatal Mental Health, as well as a list of resources for health care providers, patients and families.

Women's Mental Health in Canada

In Canada, mental health challenges are common among women. According to a 2022 Mental Health and Access to Care Survey, over 5 million Canadians aged 15 and older experienced significant mental illness symptoms. There was a sharp rise in mental health issues experienced by young women (ages 15-24); the 12-month prevalence of generalized anxiety disorder tripled (from 3.8% in 2012 to 11.9% in 2022) and major depressive episodes doubled (from 9.0% to 18.4%) during the same period (Statistics Canada, 2023). Additionally, mental health-related disabilities are the fastest-growing disability type in Canada, affecting over 3 million people, with women making up the majority (Statistics Canada, 2022).

Perinatal mental health disorders are among the most common conditions during and after pregnancy. In Canada, approximately one-quarter (23%) of mothers who recently gave birth reported symptoms consistent with postpartum depression or an anxiety disorder (Statistics Canada, 2019), with higher rates among adolescents, Black, Indigenous and People of Colour, immigrants and refugees, disabled individuals, gender-diverse individuals, those experiencing financial challenges or domestic violence, those who have experienced mental health issues in the past and those with little or no family or support networks.

These trends highlight the urgent need for improved mental health support and services for women, particularly during the perinatal period.

What Role Do Health Care Providers Play in Ensuring Optimal Perinatal Mental Health Care?

All perinatal health care providers play an important role in ensuring optimal mental health care during pregnancy and the postpartum period. Although the specific roles and scope of practice differ between obstetricians, midwives, family physicians, nurses, psychologists and psychiatrists, they often work together with each other and the patient along the care pathway.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has published clinical practice guidelines focused on identification and treatment of mood and anxiety disorders for obstetrical care providers and the Canadian Network for Mood and Anxiety Treatments (CANMAT) released clinical guidance for psychiatrists that are aligned.

By working in collaboration for identification, assessment, screening, prevention and treatment of patients at risk of developing or with a possible perinatal mental health disorder, health care providers facilitate the best possible mental health and physical health outcomes of mothers and families for generations.

Types of General Mental Health Disorders

Mental health encompasses emotional, psychological, and social well-being. It affects how individuals think, feel, and behave in their daily lives. Patients may experience new mental health challenges during the perinatal period or existing mental health conditions may be exacerbated. Mental health during pregnancy and the postpartum period can significantly influence maternal and infant outcomes.

Common mental health disorders, included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), are:

  • Anxiety Disorders: Persistent feelings of worry or fear that interfere with daily life.

  • Depression: Ongoing sadness, low energy or loss of interest in activities you used to enjoy.

  • Post-Traumatic Stress Disorder (PTSD): Ongoing distress and difficult emotions that persist after a traumatic experience.

  • Bipolar Disorder: Extreme mood swings, including emotional highs (mania) and lows (depression).

  • Obsessive-Compulsive Disorder (OCD): Unwanted, repetitive thoughts and behaviors.

  • Eating Disorders: Preoccupation with food, weight, or body image.

  • Mood Disorders:  Emotional disturbances affecting daily functioning.

Recognizing these disorders in perinatal patients is critical to ensuring timely and effective care.

Baby Blues and Baby Pinks:

Health care providers must distinguish between temporary postpartum mood changes and perinatal mental health disorders that require intervention.

The baby blues involve mild sadness, fatigue, and irritability that appear within the first few days postpartum and resolve within approximately two weeks without impacting daily function.

The baby pinks present as temporary periods of elevated mood, increased energy and reduced need for sleep, which typically subside on their own.

If symptoms persist beyond two weeks, worsen in severity, or interfere with daily functioning, a Perinatal Mood or Anxiety Disorder should be considered. Timely assessment and intervention are critical to ensuring optimal outcomes for both the parent and child.

Types of Perinatal Mood and Anxiety Disorders:

Perinatal Mood and Anxiety Disorders can take many forms. Below are the most common types, their symptoms and risk factors:

Types

Symptoms

Risk Factors

Perinatal Anxiety

  • Excessive worry

  • Trouble sleeping

  • Decreased appetite

  • Muscle tension

  • Irritability

  • History of anxiety

  • Stressful events (i.e., financial issues, experiencing trauma or violence)

  • Little or no family or support networks

Perinatal Depression

  • Low mood

  • Sleep/appetite changes

  • Lack of interest

  • Guilt

  • Low energy

  • History of depression

  • Fetal/newborn loss

  • Pregnancy/birth complications

Perinatal Obsessive- Compulsive Disorder

  • Intrusive thoughts

  • Excessive checking or cleaning behaviours

  • Over-attachment to infant

  • Avoidance of infant

  • Poor sleep

  • History of Obsessive Compulsive Disorder (persistent, unwanted thoughts and feels the need to do certain actions repeatedly)

  • Pregnancy loss (such as miscarriage or stillbirth) or having a complicated pregnancy or birth

Postpartum Post-Traumatic Stress Disorder

  • Flashbacks of the traumatic event

  • Avoidance of people, feelings, or places

  • High anxiety

  • Traumatic birth

  • Past abuse or trauma

  • Having experienced medical emergencies

  • Lack of social support

Postpartum Psychosis

  • Extreme mood swings

  • Delusions

  • Confusion

  • History of Bipolar Disorder

  • History of psychosis

  • Lack of sleep

Other Conditions That May Overlap but Are Not Always Considered Perinatal Mood and Anxiety Disorders:

  • Ongoing Anxiety (Generalized Anxiety Disorder) – Long-term anxiety that may have started before pregnancy but can feel worse due to stress during pregnancy or after birth.

  • Bipolar Disorder – A condition that causes extreme mood swings between high-energy (mania) and low-energy (depression). Hormonal changes during pregnancy and postpartum can affect it, but it’s a separate diagnosis from Perinatal Mood and Anxiety Disorders.

  • Past Trauma & PTSD (Not Related to Birth) – Post-traumatic stress disorder (PTSD) from past experiences that isn’t linked to childbirth but can still affect mental health during pregnancy and postpartum.

Negative Effects of Untreated Perinatal Mood and Anxiety Disorders

Untreated Perinatal Mood and Anxiety Disorders can have significant adverse effects on both the pregnant individual and their child, impacting physical health, mental well-being and long-term development. These effects include poor prenatal nutrition, preterm birth, low birth weight, decreased initiation of breastfeeding, persistent depression in both the patient and their partner, maternal self-harm and suicide, impaired parent-infant interactions and increased vulnerability to adverse childhood experiences. Long-term consequences may involve neurodevelopmental problems, poor physical health, and epigenetic changes. Early identification and intervention are crucial to mitigate adverse outcomes and promote optimal outcomes for both the parent and the child.

How to Identify Perinatal Mood and Anxiety Disorders

Screening for Perinatal Mood and Anxiety Disorders (PMADs) should be integrated into routine care during pregnancy and up to one year postpartum, with assessments of medical history, risk factors and mental health conducted at every encounter.

Patients presenting with symptoms or identified risk factors should be assessed using validated tools such as the Edinburgh Postnatal Depression Scale, Personalized Health Questionnaire-9, or Generalized Anxiety Disorder-7.

High-risk individuals, including those with a history of bipolar or schizoaffective disorder, may benefit from earlier postpartum follow-ups to monitor conditions such as postpartum psychosis. To foster openness and reduce stigma, all screenings should be conducted through a culturally safe and trauma-informed approach.

Please refer to the Society of Obstetricians and Gynaecologists of Canada’s Guideline No. 454: Identification and Treatment of Perinatal Mood and Anxiety Disorders for specific information and recommendations.

How to Treat and Manage Perinatal Mood and Anxiety Disorders

Treatment for Perinatal Mood and Anxiety Disorders can include one or a combination of the following:

Treatment Option

Considerations

Where to Refer

Psychoeducation and Self-help
(mild to moderate intensity)

  • Providing information and discussion regarding causes, symptoms, prognosis, and treatment options can reduce fear and confusion

  • Links to websites/apps

  • Hard copy handouts

  • List of books

  • Online peer and group support

  • Decision aids

Psychotherapy
(mild to moderate intensity)

  • Patients report strong preference for evidence-based individual psychotherapy over pharmacotherapy

  • For more severe cases, pharmacotherapy may be warranted

  • Social work or perinatal psychiatry programs may not be widely available across Canada

  • Wait times for referrals can be long

  • Patients can access therapy privately if they have private health benefits or financial means

Public or private pay (depending on patient capability) to in person or online, individual or group sessions:

  • Cognitive-behavioural therapy (CBT)

  • Interpersonal psychotherapy (IPT)

  • Routine counselling about psychological aspects of transition to parenting

Pharmacotherapy
(first-line treatment and/or in combination with psychotherapy for moderate-severe cases)

  • Some Canadian hospitals adopted policies for sleep protection and support involving prolonged postpartum admission (3-5 days) for those with a history of bipolar disorder to decrease risk of postpartum psychosis.

  • Develop a safety treatment plan that tracks suicidal ideation and who to contact if this occurs (e.g., crisis lines)

  • Discuss benefits as well as possible risks and side effects (most common pharmacologic agents used to treat PMADs are not teratogenic)

  • Patients on pre-existing mental health medications should not abruptly discontinue treatment and should consult specialists

  • Referral to psychiatrists or specialized mental health services for further evaluation and tailored interventions

By aligning care practices with evidence-based guidelines and integrating mental health into routine perinatal care, health care providers can improve outcomes for patients and families. The integration of inclusive and affirming care ensures that all individuals, regardless of background, can access the support they need. Together, we can build a healthier future for families during the perinatal period.

Resources for Health Care Providers

Websites:

AskMasi – Support Tool for Front-Line Perinatal Care Providers
An interactive tool providing clinical support for perinatal mental health care.

International Marcé Society for Perinatal Mental Health
A global organization advancing research and clinical care in perinatal mental health.

Canadian Perinatal Mental Health Trainings
Offers specialized training for health care providers on perinatal mental health assessment and care.

Postpartum Support International – Training
Provides evidence-based training programs for professionals supporting perinatal mental health.

The Perinatal Collective
Offers 1:1 counselling, relationship counselling, and group counselling focusing on challenges in the perinatal and early parenthood stage, to people across Canada. They also have a growing library of workshops, a monthly free support group for moms, and group therapy options.

Clinical Guidelines

SOGC Guideline No. 454: Identification and Treatment of Perinatal Mood and Anxiety Disorders

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders

Presentations

Santé mentale périnatale - Dre Kirsten Gust

Perinatal Mental Health: Highlights from the SOGC guideline Identification and Treatment of Perinatal Mood and Anxiety Disorders - Dr. Alison Shea

Perinatal Mental Health-part 2 – Dr. Alison Shea

Online Courses

Perinatal Mood and Anxiety Disorders (The Society of Obstetricians and Gynaecologists of Canada)

Tools:

Edinburgh Postnatal Depression Scale

Personalized Health Questionnaire-9

Generalized Anxiety Disorder-7

National Pathway for Perinatal Depression and Anxiety Symptoms in Obstetrical Care

Primary Care Perinatal Mental Health Toolkit
A guide for primary care providers on screening, treatment, and referrals for perinatal mental health.

Providing Inclusive, Affirming, and Safer Perinatal Care to 2SLGBTQIA+ Individuals

FAQs About Perinatal Mental Health 

Multimedia:

Webinar: PHO Webinar: 2SLGBTQIA+ Families – Unique Perinatal Mental Health Concerns
A webinar by Public Health Ontario discussing the unique perinatal mental health challenges faced by 2SLGBTQIA+ families.

Video: Perinatal Mental Health: Understanding Depression and Anxiety During Pregnancy and Postpartum – Sunnybrook Hospital
An educational video by Sunnybrook Hospital explaining the impact of depression and anxiety on perinatal mental health.

Video: Perinatal Mental Health – Women’s College Hospital
A discussion from Women’s College Hospital covering perinatal mental health issues, symptoms, and support strategies.

Video: Perinatal Positivity
Films that provide education around perinatal mental health highlighting the reality of perinatal mental health issues for families-to-be and health professionals.

Video: Perinatal Mental Health: Ellie’s Story – Cambridgeshire & Peterborough NHS Foundation Trust
A personal story highlighting the impact of perinatal mental health challenges and the importance of support.

Tools and Resources for Patients

Websites:

Suicide Crisis Line
 Call 9-8-8 for immediate mental health support available 24/7 across Canada.

Canadian Perinatal Mental Health Collaborative – Directory of Service Providers
A nationwide directory of perinatal mental health service providers in Canada.

Canadian Mental Health Association
A national organization providing mental health resources, support, and advocacy.

Peer Support, Counselling – Postpartum Support International
Offers peer support groups, professional counseling, and resources for perinatal mental health.

PSI Canada PSI-CANADA is the Canadian presence of Postpartum Support International (PSI) , the world’s leading non-profit organization dedicated to helping those suffering from perinatal mood and anxiety disorders.

The Perinatal Collective
Offers 1:1 counselling, relationship counselling, and group counselling focusing on challenges in the perinatal and early parenthood stage, to people across Canada. They also have a growing library of workshops, a monthly free support group for moms, and group therapy options.

MinoCare – A culturally safe, patient-centered perinatal care clinic supporting Black and racialized birthing persons and infants.

BRIA – A virtual mental healthcare clinic offering specialized mental health support for women across reproductive life stages, including pregnancy and postpartum.

Life with a Baby - A network of real parents navigating the rollercoaster that is raising kids.

Multimedia:

Webinar: PHO Webinar: 2SLGBTQIA+ Families – Unique Perinatal Mental Health Concerns
A webinar by Public Health Ontario discussing the unique perinatal mental health challenges faced by 2SLGBTQIA+ families.

Video: Perinatal Mental Health: Understanding Depression and Anxiety During Pregnancy and Postpartum – Sunnybrook Hospital
An educational video by Sunnybrook Hospital explaining the impact of depression and anxiety on perinatal mental health.

Video: Perinatal Mental Health – Women’s College Hospital
A discussion from Women’s College Hospital covering perinatal mental health issues, symptoms, and support strategies.

Video: Perinatal Positivity
Films that provide education around perinatal mental health highlighting the reality of perinatal mental health issues for families-to-be and health professionals.

Video: Perinatal Mental Health: Ellie’s Story – Cambridgeshire & Peterborough NHS Foundation Trust
A personal story highlighting the impact of perinatal mental health challenges and the importance of support.

Podcasts:

I Am One Podcast | Postpartum Support International (PSI)

Mom and Mind Podcast - Apple Podcasts

Apps:

Ready to COPE

Connect (Postpartum Support International)

Mammha Parents App

Information and Tools:

Seeds of Hope: Nurturing Mental Health and Managing Perinatal Mood, Anxiety, and Related Disorders | CANMAT
A resource offering strategies for managing perinatal mood and anxiety disorders.

Infographic on Postpartum Harm Thoughts

Infographic on Anxiety in Pregnancy & the Postpartum

FAQs About Perinatal Mental Health 

Books and Workbooks:

You Are Not Alone: An Anthology of Perinatal Mental Health Stories
This anthology features 49 personal stories covering a range of perinatal mental health experiences, including infertility, miscarriage, disability, tokophobia, stillbirth, prenatal and postpartum anxiety, obsessive-compulsive disorder, bipolar disorder, and psychosis.

Good Moms Have Scary Thoughts by Karen Kleiman & Molly McIntyre
This book addresses the intrusive and scary thoughts many new mothers experience, offering guidance and support to help them navigate these challenges.

The Postpartum Depression Workbook by Abigail Burd
A practical workbook designed to help new mothers understand and manage postpartum depression through exercises and strategies.

Cognitive Behavioral Therapy for Perinatal Distress by Amy Wenzel & Karen Kleiman
This book provides an in-depth look at using cognitive behavioral therapy techniques to address perinatal distress, offering tools for both clinicians and mothers.

Impossible Parenting: Creating a New Culture of Mental Health for Parents by Olivia Scobie
This book challenges unrealistic parenting expectations and offers practical solutions for parents to find balance and joy during the early years of childrearing.

Seeds of Hope: Nurturing Mental Health and Managing Perinatal Mood, Anxiety, and Related Disorders
A workbook offering education, coping strategies, and self-reflection exercises for those navigating perinatal mood and anxiety disorders.

Provincial and Territorial Resources:

Public Health Ontario – Maternal and Infant Health
Ontario's evidence-based resources on maternal and infant health, including perinatal mental health.

Pacific Post Partum Support Society (BC)
Provides peer support, education, and resources for perinatal mental health in British Columbia.

Perinatal Mental Health | Reproductive Care Program of Nova Scotia
Offers perinatal mental health services, resources, and support in Nova Scotia.

Perinatal Program Newfoundland Labrador (PPNL)
Supports maternal and newborn health with resources and care programs in Newfoundland & Labrador.

Pregnancy and Postpartum (Perinatal) Mood Disorders – PEI
Provides information and support for perinatal mood disorders in Prince Edward Island.

NB Perinatal Health Program
A New Brunswick-based program offering perinatal health support and education.

Santé mentale et troubles mentaux en contexte périnatal (Quebec)
Quebec's perinatal mental health resource for parents and healthcare providers.

Perinatal Mental Health Quick Reference – Manitoba
A reference guide for healthcare providers supporting perinatal mental health in Manitoba.

Saskatchewan Health Authority – Maternal Mental Health
Resources and programs supporting maternal mental health in Saskatchewan.

Alberta Health Services – Postpartum Depression
Information and support services for postpartum depression in Alberta.

Nunavut Mental Health Resources
Mental health support services available to residents of Nunavut.

Yukon – Get Postpartum Support
Postpartum mental health services and support in Yukon.

Northwest Territories – Child, Maternal, and Perinatal Health
Resources and support for maternal, child, and perinatal health in the Northwest Territories.

Resources for African, Caribbean, and Black Patients

Canadian Perinatal Mental Health Collaborative – Directory of Service Providers
A nationwide directory of perinatal mental health service providers in Canada.

MinoCare – A culturally safe, patient-centered perinatal care clinic supporting Black and racialized birthing persons and infants.

Resources for Indigenous Patients

Canadian Perinatal Mental Health Collaborative – Directory of Service Providers
A nationwide directory of perinatal mental health service providers in Canada.

Resources for Gender-Diverse Patients

LGBTQ+ Research - Canadian Perinatal Mental Health Training (CPMHT)

Canadian Perinatal Mental Health Collaborative – Directory of Service Providers
A nationwide directory of perinatal mental health service providers in Canada.

Webinar: PHO Webinar: 2SLGBTQIA+ Families – Unique Perinatal Mental Health Concerns
A webinar by Public Health Ontario discussing the unique perinatal mental health challenges faced by 2SLGBTQIA+ families.