Anxiety, Depression and Pregnancy

Last week, Diane blogged about anxiety. Today, psychiatrist Leslie Walker shares her expertise on dealing with anxiety and depression during major life transitions like having a baby.


4word: You said you like to help people manage life transitions. What is it that draws you to this particular part of psychiatry?

Leslie: Transitions are stressful, but they are also opportunities to make changes. Moving, becoming a parent, losing a spouse, changing careers are all losses that we need to grieve and opportunities to grow and change. For Christians, tough transitions are times to be honest and ask God hard questions. There are some lessons that can’t be learned any other way.

4word: You also said you have a lot of experience working with women during pregnancy and postpartum. What issues do women most commonly experience during these times of transition?

Leslie: Each pregnancy is unique because each of us is unique. For women who have looked forward to pregnancy and mothering, unexpected depression or anxiety can be terrifying.

Becoming a mother is daunting and amazing. Many women experience a new sense of assertiveness; others are surprised by their vulnerability. Most women emerge a few months after giving birth with a sense of competency in mothering but less confidence in their abilities to manage their marriage. For working women, learning to make the choices necessary to meet the needs of both children and career is an ongoing challenge.

4word: Would you say that anxiety and depression during pregnancy and postpartum are particular issues for working mothers? Why or why not?

Leslie: There’s no evidence that working makes you more vulnerable to depression or anxiety during pregnancy. I do think that working women are more vulnerable in the postpartum period for several reasons.

First, if their chief support systems are other working women they may feel extremely isolated during maternity leave. I recommend that working women identify a postpartum support group before the baby arrives.

I also recommend the longest possible maternity leaves. And when the maternity leave ends, it’s critical to have a stable child care arrangement where women feel confident about the care their baby is receiving. Babies are highly motivated to connect with their moms, and sometimes will switch their day/night schedule to be up when mom is home. Sleep is a huge issue for all postpartum moms, but especially tough for working moms who may be still getting up to feed babies.

A supportive husband, resources to hire a doula, workplaces that offer flexibility, family members who can help: all are wonderful resources that increase the likelihood that a mom will be able to care for her baby AND return to work.

4word: For women who might be suffering from anxiety or depression related to their pregnancy, what can they do to help regain their mental health?

Leslie: First, talk to your doctor and make sure he/she understands how serious your symptoms are. Many working women are so high-functioning that people around them have no idea how bad they feel. I recommend a psychiatric evaluation. Check out for a great resource in this area.

Psychotherapy can also be very helpful, especially during pregnancy. The anticipation of labor and delivery can provoke anxiety, especially for women who have a history of sexual trauma, pregnancy loss, abortion, or medical illness. A good psychotherapist helps you to identify the relevant issues, look honestly and carefully at your history, and identify the choices you can make now.

Sleep is also critical. In the immediate postpartum period, our goal is a 4-hour uninterrupted stretch for moms with depression, and a 6-hour uninterrupted stretch for moms with bipolar disorder. That’s why keeping a regular schedule is also good for mom and baby: light on and some noise going during the day, dark and quiet and no playing at night!

4word: Anything else you would like to add?

Leslie: I think for Christian women, becoming a mother sometimes brings higher expectations from the church. When I had my first child almost 16 years ago, our church was fairly clear that a “good” Christian woman was a stay-at-home mom who homeschooled her children.

I was tolerated in the weekly moms’ group, but one of the women pulled me aside and told me, “Remember, you don’t HAVE to go back to work.” As if God hadn’t really called me to medicine and motherhood!

We need to remind new moms that God does call many women to both roles and support each other in that journey. I hope more women will join organizations such as Women in Medicine and Dentistry or 4word who can provide encouragement and examples of healthy Christian women with professional careers. WIMD was a lifesaver for me!