Caring for mothers’ postpartum mental health

The time after a baby is born can be filled with overwhelming emotions, ranging from immense joy to sadness.

Stress, lack of sleep and hormonal changes play into this. Within 24 hours of giving birth, a mom’s levels of estrogen and progesterone drop from the highest they’ll ever be back to pre-pregnancy levels.

It’s common for moms to feel sad or anxious and have what’s called the “baby blues.” But when these feelings persist beyond two weeks after birth, it might be postpartum depression.

One in eight new moms have postpartum depression, according to the U.S. Department of Health & Human Services Office on Women’s Health.

Checking in on support and self-care

The postpartum period is considered the first full year after giving birth. At MultiCare, patients have three postpartum checkup appointments: at two weeks, six weeks and the one-year mark.

“In addition to checking on how patients are healing physically from childbirth at these appointments, we assess our patients’ mental health — we ask how they are doing emotionally and how the transition to parenthood is going,” says Rossi Elliott, CNM, ARNP, PMH-C, a certified nurse-midwife with MultiCare Rockwood Clinic – OB/GYN & Midwifery Center.

At the start of each postpartum appointment at the Rockwood Clinic, patients fill out a health form with nine questions on mood and well-being.

“The score [from the questionnaire] helps us figure out if they are feeling a little down or anxious, or if it is more severe,” Elliott explains. “If the score is high, we recommend following up with a perinatal therapist, medication therapy — or a combination of both, with a suggested follow-up visit within four weeks.”

To gain a deeper understanding of what might be causing depression and/or anxiety, patients are asked about their support system — do they have a partner, are they a single parent, do they have family or friends checking in?

Providers also check in on self-care — what does their sleep look like, are they getting nourishment and exercise, are they getting any time to themselves?

Sometimes making adjustments to these aspects of life — getting help with child care, taking time to get fresh air, incorporating nutritious foods — can go far in improving mood.

“However, if their depression and/or anxiety is impacting their ability to function, get through the day or take care of themselves or children, or causing any thoughts of harm, we will discuss available treatment options to get them the help they need,” says Elliott.

Taking the next step in managing postpartum depression

“If a patient already has a therapist, I encourage them to continue to see them regularly, or we help them find a counselor if they don’t already have one,” says Elliott.

Medication can be a useful tool in managing postpartum depression and anxiety. And there are medications that are safe to use while breastfeeding.

“I tell my patients, it’s OK to be on medication,” Elliott says. “If you were told you had kidney disease, the first step may simply be lifestyle modifications — diet, physical activity, etc. However, sometimes these interventions just don’t make enough of an impact alone, and medication may be warranted. Mental health needs ought to be addressed in a similar way.”

For complex mental health needs that require more extensive help, Elliott either consults with a patient’s psychiatrist, if they have one, or makes a referral to a psychiatrist within MultiCare’s behavioral health network.

“Once needs are identified, we have a great list of community-based resources to plug patients into as well,” she adds. “This includes parent-baby groups and programs like WIC (Women, Infants and Children) that help with nutrition and wellness.”

Help throughout the postpartum journey

Although mental health and mood disorders tend to creep up the first six weeks after birth, they can occur any time. And Elliott wants to assure patients they can follow up with the clinic whenever the need arises.

“If patients are struggling with their mental health after we see them at their six-week appointment, we encourage them to come back and see us,” she adds. “Our group is really passionate about maternal mental health, and we want our patients to know we are here as a resource for them.”

If you are having any symptoms of postpartum depression, don’t hesitate to schedule an appointment with your doctor or other health care provider to discuss how you’re feeling and get the support you may need.

Editor’s note: This article was originally published in May 2023 and updated in April 2026.