Recognizing the Signs of PMADs and Perinatal Mental Health Crises

Not all postpartum mental health symptoms are visible—and not all pain is quiet. In Part 1 of this series, we explored why disability leave is a critical piece of PMAD recovery, including how rest, policy, and real clinical support can shift the healing timeline.

This post continues the conversation with a deeper look at common PMAD symptoms, and the difference between emotional overwhelm and true psychiatric emergencies. Whether you’re a parent, partner, or provider, recognizing these signs could save a life.

Common PMAD Symptoms in the Perinatal Period

You don’t need to check every box to ask for help. Many people experience symptoms across different categories and even a few signs of distress are enough, especially if they’re making it harder to function or care for your baby.

Mental health issues don’t always follow neat diagnostic lines. That’s okay. What matters most is how you’re feeling and whether you’re getting the support you need.

If something doesn’t feel right, it’s worth paying attention. You deserve support.

Symptoms Consistent with Depression

• Persistent sadness, hopelessness, or numbness
• Tearfulness or irritability
• Loss of interest in activities or connection with baby
• Feelings of worthlessness or guilt
• Fatigue beyond normal postpartum tiredness
• Changes in sleep or appetite
• Thoughts of death
• Wanting to harm self, baby, or both

Symptoms Consistent with Some Anxiety Disorders

• Constant worry, especially about the baby’s safety
• Racing thoughts or inability to relax
• Physical symptoms (shortness of breath, dizziness, GI upset)
• Avoidance of daily tasks like driving, bathing baby, or sleeping
• Panic episodes
• Sleep disturbance
• Irritability

Symptoms Consistent with OCD

• Intrusive, unwanted thoughts (e.g., harming the baby)
• Compulsions like checking, cleaning, or counting
• High distress but awareness that thoughts are irrational
• Often kept silent due to shame or fear of judgment

Symptoms Consistent with Bipolar Disorder

• Periods of elevated or irritable mood
• Decreased need for sleep with a spike in energy
• Impulsivity or risky behavior
• Can worsen without sleep or medication
• Thoughts of harming self, baby, others, or all of these

Symptoms Consistent with Psychosis and Psychiatric Emergencies

If any of the following symptoms are present, treat them as medical emergencies:

• Thoughts of suicide or wishing you weren’t alive, especially if you are considering acting on these thoughts
• Thoughts of harming your baby or others
• Hearing voices or seeing things that aren’t there (hallucinations)
• Paranoia or belief that others are trying to harm you
• Severe confusion or disorientation, or inability to recognize familiar people or surroundings
• Inability to sleep for more than 48 hours
• Rapid mood swings that impair daily functioning

These may signal postpartum psychosis, a rare but serious condition that affects 1 to 2 in every 1,000 births. Postpartum psychosis is a psychiatric emergency that requires immediate medical care— typically involving a combination of medication and hospitalization. It is not the parent’s fault. Symptoms can appear suddenly within the first 1–3 days postpartum, or any time within the first year.

Postpartum psychosis is a psychiatric emergency that typically requires hospitalization and medical support. With early intervention, it is highly treatable.

Go to your nearest emergency room.

What If You’re Not Sure It’s Serious Enough for the ER?

Trust your instincts.

Postpartum psychosis can wax and wane — or look as if it comes and goes, which can confuse even medical providers. If something feels “off,” call the National Maternal Mental Health Hotline at 1-833-9-HELP4MOMS (1-833-943-5746).

This 24/7 line is confidential, compassionate, and real. Help is always available.

Please remember, early help often means mom heals faster.

Why We Do This Work at The Parents and Children Project

We are not in the business of vague affirmations. We are here for the hard moments—with clinical intervention grounded in evidence, lived experience, and policy advocacy.

We:

• Write disability documentation with precision and urgency
• Coordinate care with OBs, psychiatrists, doulas, and pediatricians
• Provide psychoeducation for entire families
• Help clients develop postpartum care plans before the baby arrives
• Educate HR departments and legal teams
• Train other clinicians in trauma-informed postpartum care

Closing Words: Other Help in Virginia

Postpartum Support Virginia (PSVa) is training OBs, pediatricians, and community providers to recognize perinatal mood and anxiety disorders and to respond with compassion, not dismissal. Through their peer-led support groups, statewide warmline, and cross-sector advocacy, PSVa is making it safer for parents to say, “I’m not okay,” and to get real help without shame.

VMAP for Moms+ and the Peace Project with PSVa are leading a parallel charge inside medical systems. With direct training for providers, consultation lines, and real-time psychiatric backup, VMAP is ensuring that physicians are no longer alone when a patient’s needs go beyond what a six-week checkup can handle. The Peace Project extends this work to include trauma-informed practices, and culturally responsive care that honors the complexity of postpartum health.

This blog is not a replacement for medical diagnoses, treatment planning, or medical treatment. The purpose of the blog is to encourage readers to seek help.