Supporting Mental Health Through Every Stage of Pregnancy
Experts are recognizing the full impact of stress, trauma and prior experience.
For much of modern medical history, mental health struggles surrounding pregnancy were poorly understood, minimized or hidden altogether. Even as awareness of postpartum depression has grown, many of the broader emotional realities of pregnancy and early parenthood remain overlooked.
Today, the field of perinatal mental health — focused on emotional wellbeing before, during and after pregnancy — is evolving quickly. Clinicians increasingly recognize that these challenges extend far beyond postpartum depression.
Anxiety about infertility, fear of miscarriage, traumatic birth experiences, chronic stress and prior trauma can all shape the perinatal experience long before a baby arrives.
People don’t enter pregnancy as blank slates. Many people are already carrying stress, trauma histories or difficult relationships that can intensify during pregnancy and early parenthood. That understanding is reshaping how we support individuals and families with perinatal mental health care.
Expanding How We View Perinatal Mental Health
Historically, emotional distress during pregnancy or after childbirth was often identified only when symptoms became severe. Today, clinicians aim to recognize concerns earlier, often in primary care.
“Seventy percent of mental health care happens in primary care,” Mitchell says. “For many people, their primary care provider is the first person they talk to about anxiety, fear or feeling overwhelmed.”
That early connection can be especially important for patients navigating infertility, pregnancy after loss or fears about childbirth.”
Clinicians also better understand how past experiences impact pregnancy. Histories of physical abuse, sexual abuse, neglect or poverty may resurface during pregnancy and early parenting, making an already vulnerable period feel even more overwhelming.
For years, many clinicians hesitated to address trauma during pregnancy, concerned that revisiting painful experiences might increase stress for the mother or unborn baby. But specialists now emphasize that untreated trauma carries its own risks.
“We’ve learned that doing nothing is not neutral,” Mitchell says. “Unresolved trauma shows up in pregnancy, birth and parenting. It’s important to address it early.”
Trauma-Informed Care During Pregnancy
Care approaches are also changing. Rather than relying solely on traditional supportive therapy, clinicians increasingly use trauma-informed strategies to help patients regulate stress responses and process difficult experiences safely.
These approaches may include trauma-focused cognitive processing therapy, eye movement desensitization and reprocessing, and newer methods such as the FLASH technique, which helps to take the emotional charge out of a traumatic memory without forcing someone to relive the trauma in detail.
“It’s a gentler way to process trauma and can be especially helpful during pregnancy,” Mitchell says.
When Birth is Traumatic for Families
For some families, the most difficult experiences begin after delivery, following traumatic births, unexpected complications or long neonatal intensive care unit stays. At UVM Health - University of Vermont Medical Center, clinical psychologist Courtney Fleisher, PhD, works with families navigating these high-stress situations. Her work reflects a broader shift toward trauma-informed, family-centered therapy.
Parents coping with frightening birth experiences or seriously ill newborns may have symptoms associated with trauma long after the medical crisis has passed. Partners and siblings can also be affected. - Courtney Fleisher, PhD
Instead of focusing solely on one individual, family-centered therapy looks at how each family member experiences and responds to stress. It helps families communicate, process difficult experiences and rebuild stability together.
“There’s far more openness to this approach now than there was 20 years ago,” Fleisher says. “People are more willing to talk about these experiences and seek support.”
That shift is helping more families feel supported, connected and understood during some of life’s most vulnerable moments.
