There is More to Expecting Than Expected

Written by Emily Pollak, MSW, RSW

I remember being pregnant and reading the book, “What to expect when you are expecting” and it was a great read and I highly recommend it. However, I wish that it shared more about Maternal Mental Health.

Perinatal Mood and Anxiety Disorders (PMAD) happen to 1 in 5 women, and 1 in 10 men.  Let me explain that further. Perinatal refers to the point of trying to conceive, pregnancy and within the first year of having a baby.  The onset of perinatal mood and anxiety disorders can happen at any time within this period.

What is a Perinatal Mood Anxiety disorder? It can be anxiety, depression, intrusive thoughts/ Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, and psychosis. Often, women experience the symptoms of a PMAD before baby arrives (approximately 66%).

How do I know if I have a PMAD? One of the first things someone tells me is that they no longer feel like themselves. They may experience any of following symptoms: feeling sad or down, mood swings, feeling overwhelmed, feeling guilty, little interest in things, difficulty sleeping, feeling tired, panic, irritability, crying for no reason.

What do I do if I feel this way? One of the challenges with a PMAD is the symptoms can be difficult to distinguish between what is “normal” pregnancy related mood changes and what is more serious.  I often hear from women that they have shared with someone that they are having difficulty and their concerns are minimized as people say, “Well that’s pregnancy”.  If you are not feeling like yourself or if you feel like your moods are impacting your life, then it is important to reach out for support.

PMAD not only impacts you but also your relationships. It can affect your connection to your baby, partner, family and friends. I often hear how people were not prepared for how much a baby impacts your relationship. It is important to have open conversations with your partner and/or supports about what you may need during your pregnancy and when baby comes.

Speak up: Talk with someone you trust, share with them how you are feeling. Let your care provider know that you think you may have some anxiety or depression. You can also reach out to a therapist who specializes in maternal mental health.

Be practical: Recognize that this is a major life change.  You may need to reduce some of the stressors in your life. Transitions take time to adjust to and allow your self the flexibility to learn your new family. Some things on your “to do” list may just need to wait.

Keep routines: If you already have children, think about where you can get support – spouse, relatives, friends, and childcare. Children benefit from knowing what to expect and having a routine in place. Try and think about respite for your child(ren) for when baby comes.

Self Care: Take moments to take care of yourself. Self-care doesn’t mean having to do elaborate things – it can be taking a bath, listening to music, reading a book, or going for a walk.

Build your circle of support: Close your eyes and think about the people in your life – think about who they are and what kind of support they can provide. This may include practical help, emotional support, community activities, or professional services.

Remember: PMAD can happen to anyone. You are doing the best you can. You are enough.


This article was written by Emily Pollak, MSW, RSW. Emily is a Social Worker who operates her private practice here in the Niagara region. Her services include Maternal & Family Counselling.  To find out more about Emily you may visit her website at



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