Somewhere between the baby shower and the first diaper change, or month 3, 6 or 9 or 12 something shifts. Sleep becomes fragmented. Identity blurs. The person once known as competent, capable, and steady begins to unravel. But while unraveling in private might be tolerated, asking for help in public, especially help that implies you can’t return to work just yet, is another matter entirely.
Perinatal Mood and Anxiety Disorders (PMADs) are the most common complication of childbirth. Yet they remain among the most frequently dismissed. Despite decades of research, employers, healthcare providers, and insurance companies still tend to treat postpartum depression, anxiety, and obsessive-compulsive symptoms as transient inconveniences rather than life-altering medical conditions.
Let’s be clear: PMADs are not character flaws. They are not resolved by willpower. And they are certainly not cured by “just getting back to routine.”
When the System Didn’t See Me
After the birth of my daughter, I was not well. I was anxious, depressed, and experiencing obsessive-compulsive symptoms. I had developed postpartum thyroiditis. Breastfeeding wasn’t working, and I was on a brutal triple feeding schedule that only worsened my physical and emotional depletion. By the time I was scheduled to return to work, I was at my lowest.
I told someone. I did the reasonable and brave thing: I asked for help. I met with my OB and explained that I was not okay. That I couldn’t manage. That something was seriously wrong.
I was told, kindly but dismissively, “I wish I could keep you out of work, but this isn’t physical. It’s mental health.”
No one mentioned psychiatric disability leave. No one brought up FMLA for my husband to stay home. Not because they didn’t care, but because they didn’t know. The information simply wasn’t available.
Meanwhile, I stood on the deck of our home and wanted to jump. Somewhere inside, I had just enough awareness to think: This isn’t the real story. This is my body lying to me. I knew I loved my baby. I knew she was wanted. But I couldn’t make sense of what was happening to me.
So I returned to work a zombie.
Looking back, returning to work too soon harmed me. Not because anyone meant to cause harm but because no one knew how to advocate for something better. I write this now to make sure others have the facts, the words, and the support I didn’t.
The Case for Temporary Disability After Childbirth
Temporary disability leave is not a retreat from adult responsibility. It is an evidence-based medical intervention that creates the conditions for recovery. The American College of Obstetricians and Gynecologists (ACOG) reports that up to 20% of postpartum individuals experience perinatal depression, with symptoms extending well into the first year (ACOG, 2018).
When left untreated, PMADs can result in impaired bonding, prolonged psychiatric illness, and long-term disruption in occupational functioning (Wisner et al., 2013).
Returning to work before stabilizing is not empowering—it could be unsound.
Stabilization is not the absence of distress. It is the return of psychological balance. It’s cognitive clarity enough to juggle a workload and a feeding schedule. It’s emotional regulation enough to receive feedback or handle conflict without breaking. If that balance hasn’t returned, “pushing through” isn’t bravery. It’s a clinical risk.
Disability Leave: A Feminist, Economic, and Ethical Imperative
In the U.S., where paid parental leave is far from universal, short-term disability is often the only formal mechanism available to new parents needing time to heal.
The financial toll of untreated PMADs in the United States is estimated at $14.2 billion annually—driven largely by productivity loss, increased medical utilization, and long-term disability claims (Luca et al., 2020). But the hidden costs—lost wages, stalled careers, damaged relationships, and internalized shame—are incalculable.
Many of our clients are not just healing from childbirth. They’re preparing for board exams, managing classrooms, running nonprofits, waiting tables, or balancing caregiving across generations. Asking for time off isn’t a weakness, it’s a strategic, clinical, and ethical act of self-preservation. Some cannot get time off economically. That is a problem for another post.
What Clinicians Must Do: Ask About Function, Not Just Feelings
If you are a provider, asking “How’s your mood?” is a start, but it’s not enough.
Ask about:
- Meal preparation
- Hygiene and ADLs
- Executive functioning
- Emotional regulation
- Safety in caregiving
Indicators of functional impairment include:
- Persistent insomnia or hypersomnia
- Appetite changes with weight loss
- Cognitive fog, slowed thinking
- Panic attacks, intrusive thoughts, dissociation
- Emotional lability or rage
- Avoidance of baby care
- Social withdrawal
Document specifically. Avoid vague terms like “struggling.”
Write:
- “Client is unable to maintain morning routines due to fatigue and cognitive slowing.”
- “Client demonstrates impaired executive functioning, requiring support for daily childcare and self-care tasks.”
Who Can Fill Out Disability Paperwork? You Can.
You don’t have to be a physician to complete FMLA or disability forms. Licensed clinical social workers, psychologists, psychiatric nurse practitioners, and other licensed clinicians are legally qualified to complete disability documentation.
But your paperwork must:
- Include standardized screening tools (e.g., EPDS, PHQ-9, MDQ, GAD-7)
- Incorporate Mental Status Exams
- Clearly connect diagnosis to functional impairment
- Be ready for repeated faxing or upload—documentation often gets lost
- Follow your hospital or agency’s documentation protocols
Screening for PMADs Is the Standard of Care
Multiple national organizations recommend universal PMAD screening:
- American College of Obstetricians and Gynecologists (ACOG)
- American Academy of Pediatrics (AAP)
- U.S. Preventive Services Task Force (USPSTF)
- American Academy of Family Physicians (AAFP)
- American College of Nurse Midwives (ACNM)
- Postpartum Support International (PSI)
- American Medical Association (AMA)
- American Psychiatric Association (APA)
You are not being “extra.” You are doing your job.
An Ethical Framework for Practice
The NASW Code of Ethics calls on social workers to protect the vulnerable, promote dignity and worth, and advocate for access to care. Supporting a client’s decision to take medical leave is not abandoning resilience; it is redefining resilience to include rest, containment, and strategy.
Support your clients by:
- Exploring stigma and internalized shame
- Coordinating with OBs, midwives, and prescribers
- Offering scripts or letters for HR
- Recommending legal and financial resources when needed
- Framing disability leave as treatment, not failure
Recovery Is Not a Luxury, It’s a Medical Necessity
Disability leave may be the only way a new parent gets the time to titrate medication, build sleep, engage in therapy, and stabilize. It allows for the healing of both nervous systems: the baby’s and the parent’s.
Most of all, it increases the chance that they return to life—and work—well. Not broken.
Sometimes the most powerful intervention we can offer is:
“You need more time. Let me help you ask for it.”
