Perinatal Mood and Anxiety Disorders (PMADs) affect approximately 1 in 5 new birthing parents, predominantly mothers. PMADs encompass a range of mental health conditions that can occur during pregnancy or in the postpartum period. These include depression, anxiety, obsessive-compulsive disorder, and, in rare cases, psychosis. Based on the responses from over 1000 caregivers in our ongoing study with Nested and New York University, PMADs still remain shrouded in social stigma, preventing individuals from seeking and receiving the support they desperately need.
Myths and Unrealistic Expectations about Parenthood
One of the most significant contributors to this stigma is the idealized image of motherhood. Society often portrays new mothers as glowing with happiness and effortlessly bonding with their newborns. Yet, as author Chelsea Conaboy writes, the brain is actually re-wired among both birthing and non-birthing parents so they will take care of the baby even when one does not feel drawn to them. Nature has figured out a way to deal with the very natural feeling of not feeling an instant bond to one’s baby.
This unrealistic expectation creates a sense of shame and inadequacy for those struggling with PMADs. Mothers may feel pressure to suppress their true emotions, fearing judgment and criticism if they deviate from the "perfect mother" archetype. This internalized stigma can lead to self-blame, isolation, and a reluctance to disclose their struggles.
Furthermore, misconceptions about PMADs abound. They are often dismissed as "baby blues," a temporary hormonal fluctuation that will resolve on its own. This trivialization invalidates the experiences of those suffering from PMADs, which can be severe, long-lasting, and require professional intervention. The misconception that PMADs are a sign of weakness or an inability to cope with motherhood further exacerbates the stigma. Mothers may fear being perceived as unfit parents, leading them to hide their symptoms and avoid seeking help.
Having Someone to Confide in About Perinatal Mental Health Struggles
In our current study, surprisingly only 33% of those who experienced depression and 26% who experienced anxiety postpartum were screened during a follow-up obstetric or pediatric appointment. These numbers suggest that a substantial barrier to support is participants simply not being professionally screened. For example, one mother shared how a confluence of factors left her never being screened: “I received no screening and extremely little care postpartum. I was out of the hospital in a day due to it being overcrowded and not having a proper room for us. I didn't feel comfortable sharing anything in the hospital anyway, since the nurses were really judgemental about the fact that I wasn't breastfeeding (I just couldn't figure it out with inverted nipples). No family was able to come help because they live across the country, and I almost couldn't go to my 6-week postpartum appointment because I wasn't allowed to bring my baby. And that was the last time I went to the doctor (almost 3 years ago).”
Furthermore, of those screened, 49.8% reported they did not feel that they could answer the screening questions honestly. As one mother shared, “I felt ashamed for having the feelings so I did not truthfully answer the questions. I also felt like the doctor was rushing and didn’t care.” Another mother found it challenging to disclose what she was feeling to the pediatrician, saying, “It was always at my daughter’s appointments. There was no way I was going to be honest in a screening that was being given by someone who didn’t know me and wasn’t my provider. Not to mention, it felt selfish to express I was struggling at an appointment about her.”
This feeling of discomfort was reiterated by another mother who mentioned “I just didn't feel comfortable talking to my provider…I saw a different provider every time I went in when I was pregnant and had a different provider when I gave birth, whoever was on call.”
Social stigma extends beyond screening. Only 22% of respondents felt comfortable speaking openly with their partner and 29% with their care providers about their feelings. The story that seems to be emerging is while birthing parents are seeking out support from their partners, they don’t necessarily feel comfortable talking to them. As one participant said, “at one point, I was like, all right, suicidal, for sure. But no one knew. I did not share with my husband. I had been suicidal in the past a long time ago, so I knew it wasn't I wasn't going to do anything. But there were definitely times where I was like, this is just not worth it. Why am I doing this? Is this going to be the rest of my life dealing with these two kids now?”
Mothers may hesitate to confide in healthcare providers, fearing judgment or that their concerns will be dismissed. As one mother noted, “Every pediatrician encounter after screening felt very “tisk tisk,” you need to do xyz and you’re not doing it. Like sure, lemme just add more to my plate while I and baby are already not ok.” They may also fear the repercussions of being honest. Depending on their answers to screening questions, their healthcare providers may be required to ask Child Protective Services to step in. For example, one mother in our sample shared, “It took until my third [child]’s postpartum to be honest. Feelings of harming myself persisted for years after each pregnancy, but I was terrified to admit them. I thought they would separate me and my baby.” Another mother shared that her biggest parenting fear and/or fear for your child postpartum was “fear of having my baby taken away due to my perceived incompetence/ “mental instability”.
A Path to Destigmatizing PMADs
We need a collective effort—from individual caregivers to their support networks, healthcare providers, and society at large. By normalizing conversations about mental health during and after pregnancy, we can reduce the shame and isolation often associated with these conditions. Here are the steps we can take to destigmatize PMADs.
1. Empowering Caregivers to Speak Up
Caregivers, particularly new mothers, are often pressured to embody an idealized version of motherhood—one where they should always be joyful and perfectly bonded with their baby. This myth fuels self-blame and silence. To combat this, caregivers need:
Education on Symptoms: Normalizing the wide range of PMADs symptoms (beyond just sadness, to include anxiety, rage, and obsessive thoughts) helps caregivers recognize they aren’t alone or at fault. As one of our participants said “I was grieving this romantic experience that I didn't have. I was grieving the life that I didn't have anymore. And there was so much going on that it was hard to get through.” Every caregiver should be aware that it's okay not to feel an instant bond with their baby and that feelings of anxiety, frustration, or detachment are normal and manageable.
Encouragement to Seek Help: Caregivers should be encouraged to speak openly about their mental health with trusted individuals, whether it’s a partner, friend, or healthcare provider. Sharing personal stories of struggles—and recovery—can help normalize these experiences and diminish stigma. It can be hard though to ask for that help as one mother said “I think it's an uncomfortable thing for people to ask for help and to acknowledge that they need help, because asking for help from somebody who's not a professional who's assigned to help you feels like an imposition. And you don't want to be that person. You don't want to be thought of as like, oh, my gosh, they're asking us for help again.”
Accessible Mental Health Support: Many caregivers feel they have no time or energy to seek help, or fear judgment for doing so. Communities and healthcare systems need to make mental health services accessible, affordable, and stigma-free. This includes routine screenings during both prenatal and postnatal care, with seamless referrals to mental health professionals.
2. Engaging the Support Network
The stigma surrounding PMADs also persists within caregivers' close circles—partners, friends, and family. Often, these support networks don’t know how to help or may unknowingly perpetuate harmful myths. Here's what they can do:
Normalize Checking In: It’s crucial that partners, friends, and family members make regular, compassionate check-ins a normal part of their interaction with new caregivers. Simple questions like, “How are you really feeling?” can open the door for honest conversations.
Offer Nonjudgmental Support: Caregivers may feel ashamed to admit they’re struggling, fearing judgment or disbelief. Support networks need to listen without offering immediate solutions or minimizing their concerns. Instead, they should validate their loved one’s feelings and gently encourage seeking professional help when needed. As one mother noted “it was actually my husband who really pushed me to seek help postpartum, and I wasn't diagnosed with postpartum depression until I was 11 months postpartum. With the help of my therapist and my OB and my husband, really, we were able to come up with a game plan and everything for the second. My second pregnancy and second postpartum has been like a complete 180 from the first.”
Educate Themselves on PMADs: Friends and family members should educate themselves about PMADs so they can recognize signs and provide informed support. This includes being aware that irritability, difficulty bonding with the baby, or sudden mood changes can all be symptoms. They should also learn that experiencing a PMAD doesn’t mean someone is a bad parent or incapable of caregiving.
3. Healthcare Providers as Advocates
Healthcare providers, from obstetricians to pediatricians, are often the first point of contact for caregivers. They play a crucial role in identifying PMADs early, but stigma and lack of training can prevent proper care. Providers should:
Implement Routine Screenings: Mental health screenings for depression, anxiety, and other PMADs should be routine at multiple points during prenatal and postnatal visits. This destigmatizes the conversation by treating mental health as a regular part of overall care. Additionally, providers should ensure that screening tools are culturally sensitive and accessible to all caregivers.
Create Safe Spaces for Disclosure: Many caregivers hesitate to disclose their symptoms for fear of being judged or having their concerns dismissed. Healthcare providers must create an environment of trust and openness, where caregivers feel comfortable sharing their true feelings without fear of being labeled unfit parents.
Provide Ongoing Support and Referrals: Screening alone is not enough. Providers should be prepared to offer compassionate follow-up care, including referrals to mental health professionals, support groups, and online resources. They should also follow up regularly, as PMAD symptoms can emerge months after childbirth. A mother we spoke to highlighted this need for coordinated care. “I wish both prenatal and postnatal care were equally focused on the birthing partner and baby. Overwhelmingly, the maternal medicine complex made me feel like I was the candy wrapper that a cute baby came from, god forbid I need actual care beyond my fetal heartbeat checkups and ultrasounds - that were wildly inconvenient for a working woman, I might add. But to coordinate physical therapists and chiropractic care prenatal and pelvic floor therapy postpartum - it’s insane to consider the lack of resources dedicated to the literal ability to keep the human race in existence as compared to surgery for an ACL tear, bypass, etc. there is a complete and total inequality in treatment both pre and postnatal from a physical perspective as well as mental and emotional.”
4. Changing Societal Narratives
Beyond the individuals immediately involved, society as a whole must challenge the unrealistic narratives around motherhood and caregiving:
Address Cultural Expectations: The myth of the "perfect mother" or caregiver needs to be dismantled in popular culture and media. Caregiving is challenging, and not every parent will feel overwhelming joy every moment. Sharing diverse and honest depictions of parenthood helps normalize the ups and downs of this experience.
Advocate for Mental Health Literacy: Schools, workplaces, and communities should incorporate mental health education, including perinatal mental health, into their programs. Public awareness campaigns can focus on the prevalence of PMADs and highlight the importance of seeking support without shame.
Increase Policy Support: Policymakers can help destigmatize PMADs by ensuring all caregivers have access to paid parental leave, affordable mental health care, and workplace protections. Policies that encourage routine mental health check-ins for both birthing and non-birthing parents can help reduce the long-term impacts of untreated PMADs.
What We’re Doing at Nested
At Nested, we are committed to destigmatizing PMADs through research, advocacy, and public awareness efforts. Our work focuses on giving caregivers the tools, resources, and confidence to seek support without fear of judgment.
We are working to overhaul postpartum screenings to make them comprehensive, inclusive, and destigmatized so that caregivers feel safe and comfortable being honest about their experiences.
In collaboration with nonprofit organizations like All Parents Welcome, the Fair Play Policy Institute, and New York University, we are investigating the impact of PMADs on nonbirthing caregivers to expand our understanding and support for all parents.
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