Adults · Pregnancy, postpartum and the first year with a baby

Women’s, Maternal & Perinatal Mental Health Care (PMADs & Postpartum) in Maryland

Perinatal mental health care in Maryland supports people during pregnancy, after birth and through the first year with a baby. This page explains perinatal mood and anxiety disorders (PMADs), signs that it may be time to reach out, how therapy and psychiatry can help, and how to start care at Blue Sails.

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Key takeaways

What perinatal mental health means

“Perinatal” usually describes the time from pregnancy through the first year after birth. Sleep, hormones, relationships, identity and daily routines can all change at once, and emotional ups and downs are expected. When distress becomes intense or lasting, providers may call it a perinatal mood and anxiety disorder, or PMAD.

PMADs can include depression, anxiety, obsessive-compulsive symptoms, post-traumatic stress and bipolar disorder that begin or return during this time. The American College of Obstetricians and Gynecologists (ACOG) describes perinatal mental health conditions as among the most common complications of pregnancy and recommends screening during and after pregnancy.

For a deeper look at each condition, screening and medication safety, read our guide to perinatal mental health in Maryland.

Baby blues or something more?

Many new parents have mild, short-lived mood changes in the first two weeks after birth, sometimes called the baby blues. According to the National Institute of Mental Health, mood changes and feelings of anxiety or unhappiness that are severe or last longer than two weeks may be signs of postpartum depression.

It may be time to talk with a provider if you notice:

Symptoms can begin during pregnancy, soon after birth or later in the first year. You do not need to be sure what is going on before you reach out.

Difficulty bonding with baby

Some parents expect an instant rush of love and instead feel numb, distant or unsure. Trouble bonding with a baby is listed by the NIMH among possible signs of perinatal depression. It does not mean you are a bad parent, and it is worth talking about.

In counseling, your provider can help you sort out what is getting in the way, such as exhaustion, anxiety, a hard birth or low mood, and work with you on small, realistic steps. Partners and non-birthing parents can struggle too, and they are welcome to reach out for their own care.

Who may be more likely to have a PMAD

A PMAD can happen to anyone, including people with no past mental health concerns. The NIMH notes that life stress, the physical and emotional demands of a new baby, and hormonal changes can all play a part, and that a personal or family history of depression or bipolar disorder, or depression in a previous pregnancy, raises the risk.

Other experiences that can add strain include a difficult or frightening birth, a baby’s stay in intensive care, pregnancy loss, fertility challenges, limited support at home and major life changes such as a move or deployment. If any of these apply to you, it is reasonable to plan for extra support before and after your baby arrives.

Birth trauma, pregnancy loss and grief

A birth that felt frightening or out of control can leave lasting reactions, such as nightmares, flashbacks, avoiding medical visits or feeling on edge. Grief after miscarriage, stillbirth or infant loss can also be deep and long-lasting, and it deserves care in its own right.

Blue Sails offers trauma-focused therapy for adults. Our page on trauma, PTSD and EMDR therapy explains how trauma can affect the mind and body and what treatment can look like.

Therapy for PMADs at Blue Sails

Counseling is often a first step for perinatal depression and anxiety. The NIMH lists cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) among evidence-based therapies for perinatal depression. ACOG guidance describes psychotherapy as a good fit for many people with mild to moderate symptoms.

Your provider may help you:

Read about individual psychotherapy and CBT and ACT for anxiety and depression. If stress is affecting your relationship, our page on therapy for couples and families explains those options.

Psychiatry, pregnancy and breastfeeding

A psychiatric provider can help when symptoms are severe, keep coming back or are hard to sort out. Psychiatry is also available at Blue Sails. Medication is considered when clinically appropriate, and the decision is made with you.

If you are pregnant, planning a pregnancy or breastfeeding, your provider will talk with you about the possible benefits and risks of medication and of untreated symptoms. The NIMH advises talking to a health care provider before starting or stopping any medication, so please do not stop a medication on your own.

If you want your OB, midwife or primary care clinician kept in the loop, ask your provider about sharing information with your written permission. See psychiatric evaluations and psychiatric medication management for how visits work.

Substance use during pregnancy and after birth

Some people use alcohol or other substances to cope with stress, sleep loss or low mood, and many worry about being judged. You can talk about it openly with your provider.

Blue Sails offers substance use care, including care when substance use and a mental health concern happen together. Our guide to substance use disorder and dual diagnosis explains how combined care works.

In person or by telehealth, with your baby

Therapy is available in Bethesda, in Lusby or by telehealth anywhere in Maryland, and psychiatry is also available. Telehealth can make it easier to keep appointments with a newborn at home. You need to be physically in Maryland during each telehealth visit, and a quiet, private space helps.

Babies need feeding and soothing on their own schedule. Talk with your provider about what to do if your baby needs you during a session, and ask our team what works if you would like to bring your baby to an in-person visit. Our page on telehealth counseling in Maryland explains how to set up for sessions.

Where Maryland parents can find help right now

If you are in crisis, call 911, the nearest ER, or call or text 988.

Sudden confusion, seeing or hearing things others do not, or thoughts of harming yourself or your baby need emergency care right away. The NIMH describes postpartum psychosis as a psychiatric emergency.

Blue Sails is not an emergency service. Outpatient appointments are for scheduled care.

Starting care at Blue Sails

You can also return to our page on therapy and psychiatry for adults.

Talk with us about perinatal mental health care

Tell us what pregnancy or life with a new baby has been like. Therapy is available in Bethesda, in Lusby or by telehealth, and psychiatry is also available.

If you are in crisis, call 911, the nearest ER, or call or text 988.