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I look back at pictures from after my youngest daughter’s birth, and I almost don’t recognize myself. I have dark circles under my eyes and a vacant smile. I was desperately sleep deprived, but not because my daughter was a bad sleeper, but because I was up at night worrying. I was plagued with worries that I would drop her and cause traumatic brain injury, or that someone would abduct her, or that she would stop breathing at night. The what-ifs and the anger I felt towards my husband, who was not consumed with these same what-ifs, were all-consuming.
These feelings were not new to me. I had the same ones with my older daughter. At one point, I almost had our apartment covered in wall-to-wall carpet because I was afraid of tripping while I carried her. The only difference between my two experiences, in many ways, was that I gave birth to my elder daughter and adopted my younger daughter.
In other words, I experienced Postpartum Mood and Anxiety Disorders (PMADs) with both my children. I also fell through the screening process both times. With my first daughter, I was given the Edinburgh, the standard 10-item questionnaire designed to identify caregivers experiencing depression, at my six-week follow-up visit. It was a visit that I had arrived at early by mistake and at which I cried in the bathroom over my mistake, which led to more time away from my baby. I lied on pretty much every question on the Edinburgh screening. I liked my OB, who jokingly called me his favorite patient, as my pregnancy was so easy, and I was relatively calm the whole time. I didn’t want to let him know I was struggling, as then I’d no longer be the “easy” patient. I was given a follow-up screening at my daughter’s three-month visit. This time, I lied again. I didn’t want to raise any alarm bells with our new pediatrician.
With my second daughter, there was no follow-up OB visit, but there were multiple pediatric visits — especially because she was premature with some potential health concerns. At none of those visits was I given a screening, despite it being the same practice my older daughter went to. It felt as if being a non-birthing parent placed me in a different category, yet to me, it was a very similar wave of emotions.
Because of my own experience with my now 5-year-old and years of studying early parent–child relationships, I wanted better answers — for birthing and non-birthing parents alike. Through the Nested Institute for Families, my colleagues and I launched one of the largest national studies to date of perinatal mental health. We surveyed more than 1,000 birthing caregivers about their experiences with screening and support in the postpartum period, and many also volunteered to be interviewed. Once we began those conversations, something stood out immediately: parents didn’t want to stop talking once they started to open up. It was as if no one had ever asked how they were doing.
The findings were stark, and we’re sharing them to push for stronger screening and support for every caregiver. If you work with new parents as a mental health practitioner, in healthcare, workplaces, or policy, the full report is here.
New parents are falling through the cracks
Forty percent of caregivers in our study who experienced a PMAD were never screened during a follow-up obstetric or pediatric appointment. Even when screening happened, many parents hid their true feelings, like I did. Almost half of mothers who were screened told us they had not answered honestly out of fear of being judged. As one mother said, “I felt ashamed. I didn’t answer screening questions honestly because I thought the doctor didn’t care.” Another reflected, “The Edinburgh test feels incredibly shallow. I’d memorized which questions and what score I needed to achieve to not raise eyebrows. It feels like a trap instead of a tool to provide help.”
That gap in screening is not unusual. National guidelines from the American Academy of Pediatrics say pediatricians should check mothers’ mental health at babies’ early visits: one, two, four, and six months. But according to a study from Brown University, only about half of birthing mothers are ever screened, and most states do not require it. For non-birthing parents (including adoptive parents like me, fathers or partners, and parents through surrogacy), the system is almost nonexistent.
This blind spot matters. Life with a newborn often means relentless fatigue and long days that feel cut off from the world. Those conditions — poor sleep and social isolation — make new parents especially vulnerable. About one in seven new mothers experiences postpartum depression, and one in five develops postpartum anxiety. Yet 50 to 70% of maternal mental health disorders go undiagnosed, and even when identified, 75% go untreated, according to estimates by the U.S. Preventive Services Task Force.
When one parent struggles, everyone feels it
These gaps extend beyond the parent who gives birth. Our research shows how closely linked caregivers’ mental health really is, which is at the core of family systems theory. When one parent struggles and doesn’t get help, the whole system feels the strain.
In our study, nearly all non-birthing caregivers — 98%, including fathers, adoptive parents, and same-sex partners — told us they were never screened for postpartum mood and anxiety disorders, even though many had symptoms. That blind spot matters. When one partner is quietly struggling and depends almost entirely on the other for support, both are more likely to experience PMADs. The birthing parent often feels they have to hold everything together, which can deepen exhaustion and isolation for both.
Only one in five mothers in our study said they felt comfortable speaking openly with their partners about these challenges. When mental health stays unspoken inside a household, it affects the baby, too, making those early months lonelier and more fragile for everyone. Expanding the circle of support beyond the couple to family, friends, and community can ease that pressure and protect the well-being of the entire family.
What can new parents do?
Here’s what I wish someone had told me: you’re not the only one who feels like you have to keep it together. So many new parents tell us they worry about being seen as calm, capable, or, like I once did, as the “easy patient.” That pressure keeps them from asking for help. If you’re a new parent and worry keeps you awake or joy feels out of reach, it’s okay to say something. You don’t have to wait until someone asks. You can bring it up with your pediatrician or OB and ask directly for a screening or a referral. And if you’re a non-birthing parent, your mental health matters just as much. The system may not ask about it yet, but you can.
While we push for better screening and support, small steps can help fill the gap. Talk to a friend who gets it, join a parent group online or in your community, or share what you’re feeling with someone you trust. Asking for help doesn’t mean you’re failing. It means you’re letting someone in, and that’s where healing starts.
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Another dynamic that I don’t see mentioned here may be that new moms are afraid of being seen as “unfit caretakers” to their little ones and may be more inclined to lie because of fear of increased monitoring or intervention from CPS. I read one online comment from someone that happened to, so I wonder how much that narrative is shared/perpetuated amongst new moms, too.
I completed the mental health screening questionnaire at 37(?) weeks and was sure someone from the OB’s office would call me because my results clearly indicated peripartum depression, but they never did and I never mentioned it at my remaining appointments because I was ashamed (you’re supposed to be jubilant while pregnant, right?!). When I was finally diagnosed with PPD around 4 weeks postpartum, my OB was very concerned because my survey results were not logged and I was missed in the process. Ultimately, I got the help I needed with medication–I was resistant to taking antidepressants while breastfeeding but I realized my son would be better off with a mother on zoloft who was present instead of an unmedicated zombie–and this combined with therapy helped me turn a corner, but I so wish I had had a different peripartum/postpartum experience.
Personally, I thought i was over screened. Every single OB appointment (which as you all know is so frequent at the end) and then every pediatrician appointment. I don’t need to be putting thoughts in my head about hurting myself or my baby. I began declining them as I believed they were doing more harm than good in my case.
The other thing is that your OB or therapist in the grand scheme of things can’t do much even if you screen positive besides medication (which can be super helpful and might be all that some patients need). But they can’t make your spouse a better person (sure they can help you talk to them but Gottman’s research shows that has minimal impact), they can’t make your family live nearby and help out, they can’t give you lifelong friends and a strong community that brings you food and watches your kids. That takes years if not decades of work that the best counseling can’t replace. I don’t believe that more screening and subsequent doctor interventions can fix the difficult post partum time.
This. I really wish I’d thought of declining the screenings — I didn’t find them helpful in my case, and I probably would have been better off focusing less on my own mental health.
I also do think articles like this fail to address the “What then?” piece of the equation. Improving screening will only help if those who screen positive can be offered a useful intervention. And what, besides medication, can an OB or pediatrician really offer?
I should note that some moms choose medication and find it helpful, and there’s nothing wrong with that. But as you say, the problems often run deeper.
I had a hard time adjusting to new motherhood. I had my own health problems, plus milk supply issues (and therefore a perpetually hungry baby) and was sooooo sleep deprived that I was basically an ornery eggshell. I had a partner who wasn’t much help, and I had a hard time adjusting to the loss of independence that motherhood entails. I definitely had some mental health issues. But in my case it wasn’t a pathology, it was a normal human experience.
Again, not every mom is me, and some moms take medication and are happy they did so. Again, that’s great.
But I also wish there was more recognition that not everyone who struggles pre- or post-partum is broken and needs to be fixed. Some things are just hard.
I experienced (undiagnosed) post partum anxiety/depression with my first daughter. I took screening tests with my ob and ped, answered honestly, and received care that didn’t really meet my needs at the time. When I got pregnant with my second, I called to a therapist who recommended I consider taking an SSRI at the end of my pregnancy/during the postpartum period. I feel like people don’t talk about this enough, but for me, it has made a world of difference in my experience with my second. I say this for people who had ppad with a first pregnancy and are thinking of getting pregnant again, it may be worth discussing with your doctor/therapist. Neither I nor my baby experienced any negative side effects and everyone in my family has benefitted because I’m able to feel more present and less worried, anxious, and angry when I’m with my family.
What an important and often overlooked topic on the mental health of new parents. As a psychologist who works with many couples, especially young couples, the mental health of the couple relationship is also often overlooked. After the magical pregnancy and often challenging delivery phase of having a child, the reality of needing to care for a baby 24 hours/day sets in and the couples relationship is understandably put on the back burner. I have found in my clinical practice that couples often need help in transitioning from now being a family of three to needing to take steps to nurture and take care of the couple’s relationship – in a very different way than they previously had nurtured the relationship. It’s complicated and challenging balancing act and many factors can often interfere with the couple from being able to “couple” again. Taking care of mental health for all of the parties in every phase of childrearing is crucial. Thanks for highlighting this topic!
This is everything! Thank you thank you!!