vtcpap

Postpartum Depression and Anxiety Prevention

Thu, 30 Jul 2026 02:39:02 GMT

Postpartum mood and anxiety disorders are getting a lot more attention these days, and it is great that people are aware of them, but the fear of developing symptoms can bring about anxiety of its own.

In light of this, it's important to empower birthing people to understand how to mitigate the risks and to do everything they can to keep themselves healthy. There are many evidence-based strategies we can recommend to help people to lower their risks.

Major risk factors include: Major risk factors for perinatal mood and anxiety disorders (PMADs) include a history of depression or anxiety, trauma, socioeconomic stress, relationship stress, and limited social support. It is also important to recognize that Black, Indigenous, and People of Color (BIPOC) individuals experience higher rates of PMADs and often face additional barriers to accessing timely, culturally responsive care. To learn more, read our recent blog post.

Prevention strategies:

Therapy: There have been many studies suggesting that proactive therapy can be helpful for postpartum outcomes. If your patient has risk factors for developing postpartum symptoms, it is a great investment to establish a therapist ahead of time. The therapist can support coping with symptoms, but also to help monitor for symptoms that require a higher level of support. Medical, mental health, and community providers including, but not limited to, home visitors and doulas can call VTCPAP to assist with finding therapists who take your patient's insurance and have openings.

Sleep: There are many studies that link mental health outcomes to sleep. Poor sleep is associated with increased anxiety, depression, ADHD symptoms, panic attacks, as well as, in rare cases, postpartum psychosis. Sleep is the most important modifiable variable, but it can take extensive problem-solving to preserve it. Some patients have no support, and some struggle to ask for support.

Tips include:

If there is a partner involved, plan ahead to split the night into two shifts. The birthing person may have to breastfeed through the night, but at least for half the night, the diaper changing and soothing is not their responsibility. It is more successful to plan division of labor ahead, than to wait to get too tired to ask for help.

If there are people involved in helping- line up times for naps. If they feel unnecessary in the moment, they can be used for other preventative strategies.

Sleep hygiene- avoid using screens at night if there is any difficulty falling asleep. This can be the source of stimulation. Invest in some good magazines, novels, or listen to podcasts/audio books.

Don't overschedule the early days- it's great to get out or have company, but sleep may need to happen around the clock.

Community: There are clearly established connections between social support and lowered risk of postpartum depression and anxiety. It can be beneficial to schedule time with friends/family in advance, so there are points of connection to combat potential isolation in the postpartum period. Other options include Parent-Child Community Centers or playgroups, as well as online resources, such as Postpartum Support International support groups and peer mentors. Yoga has a growing evidence base for decreasing postpartum depression, and some centers offer classes where people can bring their baby.

Medication: There is not sufficient data to recommend starting a medication prophylactically based on risk factors alone. However, if there has been a medication that has been beneficial in the past, it could help to have a low threshold for restarting it postpartum. Very few psychiatric medications are contraindicated in breastfeeding. Most of the common medications we use have a relative infant dose under 10 (see Lactmed or call VTCPAP as a resource). We mostly only avoid medications that cause enough drowsiness to interfere with waking at night to feed, if that is the birthing person's responsibility.

Individual time: Self care is an overused, confusing term. It suggests spa days and manicures, but "self care" is very individualized and can require thought. For some people it is playing video games and eating ice cream. For others it is simply eating breakfast. I like to ask people to think about moments they enjoyed most before having kids. What were you doing? Connecting with friends? Hiking? Shopping? Whatever it is- that's probably not happening much after a first or subsequent baby arrives. Often, self-care becomes a moment to scroll or put laundry away. Social media is a natural way to connect to the outside world, but it isn't typically associated with increased mental health or a sense of contentment.

Acceptance: Finally, it's helpful if people can avoid judging their own experience. Social media can cast an idealized version of what postpartum looks like: clean, calm and in love. For most of us who have had babies, there are few moments that encapsulate these qualities, and many more moments of overwhelm, sour milk smells, and questioning if we are cut out for the tasks at hand. Mindfulness practices locally (call VTCPAP), and online can all support self-compassion and acceptance, as can social support and therapy.

Refrences

US Preventive Services Task Force. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(6):580–587. [ DOI ] [ PubMed ] [ Google Scholar ][ Ref list ]
Leistikow N, Smith MH. The role of sleep protection in preventing and treating postpartum depression. Semin Perinatol. 2024 Oct;48(6):151947. doi: 10.1016/j.semperi.2024.151947. Epub 2024 Jul 14. PMID: 39048415.
Cho H, Lee K, Choi E, Cho HN, Park B, Suh M, Rhee Y, Choi KS. Association between social support and postpartum depression. Sci Rep. 2022 Feb 24;12(1):3128. doi: 10.1038/s41598-022-07248-7. Erratum in: Sci Rep. 2022 Mar 4;12(1):3899. doi: 10.1038/s41598-022-08119-x. PMID: 35210553; PMCID: PMC8873474.
Pan WL, Lin LC, Kuo LY, Chiu MJ, Ling PY. Effects of a prenatal mindfulness program on longitudinal changes in stress, anxiety, depression, and mother-infant bonding of women with a tendency to perinatal mood and anxiety disorder: a randomized controlled trial. BMC Pregnancy Childbirth. 2023 Jul 31;23(1):547. doi: 10.1186/s12884-023-05873-2. PMID: 37525110; PMCID: PMC10388457.

Eating Disorders in Pregnancy and Postpartum: Screening, Identification, and Referral Considerations for Perinatal Clinicians

Wed, 17 Jun 2026 19:41:08 GMT

Emily Piazza, MS, RDN, CD, Registered Dietitian Nutritionist, Certified Intuitive Eating Counselor, Birth Doula at Nourished Journey ( www.nourishedjourney.co )

Why Eating Disorders Matter in Perinatal Care

Eating disorders (EDs) are among the most lethal psychiatric illnesses and disproportionately affect individuals during their reproductive years. Approximately 5–7.5% of pregnant individuals meet diagnostic criteria for an eating disorder, likely underreported underidentified, due to the overlap between ED symptoms and expected physiological changes of pregnancy.¹,²

Restrictive eating, food rituals, excessive exercise, body checking, binge eating, and compensatory behaviors may be dismissed as normal concerns about nutrition, weight gain, or postpartum recovery. Pregnancy and the postpartum period can also precipitate relapse among individuals with a history of anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding and eating disorders.³

The consequences of untreated eating disorders extend far beyond nutrition. A growing body of evidence demonstrates associations between eating disorders and adverse obstetric and neonatal outcomes, including miscarriage, hyperemesis gravidarum, preterm birth, fetal growth abnormalities, cesarean delivery, and low birth weight.⁴,⁵

Eating disorders are also strongly associated with perinatal depression, anxiety, obsessive-compulsive symptoms, impaired maternal-infant feeding relationships, and elevated risk of suicidality.

Given that eating disorders carry one of the highest mortality rates among psychiatric conditions, early identification and intervention are essential components of perinatal mental health care.⁴,⁶

Screening During Pregnancy and Postpartum

Screening for eating disorders should be considered throughout pregnancy and the first postpartum year, particularly for patients with a history of dieting, weight cycling, body image concerns, fertility challenges, mood disorders, or previous eating disorder treatment.

Screening can be incorporated into prenatal and postpartum visits using brief validated tools such as the SCOFF questionnaire ¹⁰ or through direct clinical inquiry about restrictive eating, binge eating, purging behaviors, compulsive exercise, body dissatisfaction, and fear of weight gain. Clinicians should recognize that pregnancy-related nausea, food aversions, gestational diabetes management, breastfeeding, and postpartum weight changes can obscure disordered eating behaviors and delay diagnosis. A patient's eating disorder history should be viewed as a significant risk factor for recurrence, even if symptoms appear to be in remission.³,⁷

Clinicians should also be aware that eating disorders occur across the weight spectrum and are frequently missed in patients living in larger bodies. Research demonstrates that people with atypical anorexia nervosa and other eating disorders may present with serious medical and psychological complications despite having body weights that fall within or above the "normal" range.⁸,⁹ Weight loss, dietary restraint, or excessive exercise may be inadvertently praised by healthcare providers, reinforcing disordered behaviors and delaying appropriate intervention.

For this reason, screening should focus on eating behaviors, psychological distress, body image concerns, and compensatory behaviors rather than body size or weight status alone.

Questions to Ask During Prenatal and Postpartum Visits

Many patients will not disclose ED symptoms unless directly asked. Incorporating a few nonjudgmental questions into routine care can help identify concerns early:

Have you ever been diagnosed with an eating disorder or received treatment for concerns related to food,
eating, weight, or exercise?
Do you find yourself worrying about your weight, body shape, or pregnancy-related body changes more than you
would like?
Have you been intentionally restricting food, skipping meals, or avoiding certain foods in an effort to control your
weight or shape?
Have you experienced episodes of feeling out of control with eating or eating large amounts of food?
Have you used vomiting, laxatives, excessive exercise, fasting, or other methods to compensate for eating?
How are you feeling about changes in your body during pregnancy or postpartum?
Has feeding yourself felt stressful, overwhelming, or emotionally difficult recently?

These questions can be particularly valuable when caring for patients with a history of eating disorders, infertility, gestational diabetes, mood disorders, trauma, or significant body image concerns.

Referral and Treatment Considerations

Effective treatment of perinatal eating disorders requires a multidisciplinary approach that may include obstetric providers, primary care clinicians, mental health professionals, psychiatrists, and Registered Dietitian Nutritionists (RDNs) with specialized training in both eating disorders and perinatal nutrition.

Major eating disorder organizations, including the Academy for Eating Disorders (AED), increasingly recognize the importance of weight-inclusive approaches that focus on health-promoting behaviors, nutritional rehabilitation, and psychological recovery rather than weight-focused interventions. This approach is particularly important during pregnancy and postpartum, when body changes are expected and medically necessary.

Early referral and coordinated care can improve maternal mental health, support infant feeding outcomes, and reduce the risk of long-term complications for both parent and child.

Resources for Patients and Families

The following organizations provide evidence-based education, support, and referral resources for individuals experiencing eating disorders during pregnancy and postpartum:

National Eating Disorders Association (NEDA) – Screening tools, treatment referrals, educational materials, and recovery resources.
Postpartum Support International (PSI) – Perinatal mental health support, provider directories, and online support groups. PSI offers specialized support groups for individuals experiencing perinatal mood and anxiety disorders and can assist families in finding local treatment providers.
Project HEAL – Access to treatment resources, support groups, and financial assistance programs for eating disorder care.
ANAD (National Association of Anorexia Nervosa and Associated Disorders) – Free peer support groups, mentorship, and recovery support.
Local Registered Dietitian Nutritionists and therapists with expertise in eating disorders and perinatal health.

Key Takeaways for Clinicians

Eating disorders are common during pregnancy and postpartum but frequently go undetected.
Pregnancy-related symptoms and postpartum body changes can mask eating disorder behaviors.
Eating disorders occur across the weight spectrum and should not be ruled out based on body size.
Eating disorders are associated with adverse obstetric, neonatal, and mental health outcomes.
A history of an eating disorder is one of the strongest predictors of symptom recurrence during the perinatal period.
Routine screening and early referral can improve outcomes for both parent and infant.
Patients do not need to meet diagnostic criteria to benefit from treatment
Whenever possible, refer patients to eating disorder-informed providers who practice from a weight-inclusive, non-diet approach.

References

Bulik CM, Von Holle A, Hamer R, et al. Patterns of remission, continuation, and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa). Psychol Med. 2007;37(8):1109-1118.
Berg CK, Torgersen L, Von Holle A, Hamer R, Bulik CM, Reichborn-Kjennerud T. Eating disorders, pregnancy, and the postpartum period: Findings from the Norwegian Mother and Child Cohort Study. Norsk Epidemiologi. 2015;24(1-2):51-62.
Knoph Berg C, Torgersen L, Von Holle A, et al. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord. 2012;45(2):253-262.
Das Neves MDCC, Teixeira AA, Ferreira LV, et al. Eating disorders are associated with adverse obstetric and perinatal outcomes: A systematic review. Rev Bras Psiquiatr. 2022;44(2):201-214.
Martínez-Olcina M, Rubio-Arias JÁ, Hernández-García M, et al. Eating disorders in pregnant and breastfeeding women: A systematic review. Nutrients. 2020;12(8):2399.
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-731.
Ward VB. Eating disorders in pregnancy. BMJ. 2008;336(7635):93-96.
Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive level of care admissions. Int J Eat Disord. 2021;54(8):1322-1341.
Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics. 2016;137(4):e20154080.
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med. 2000 Mar;172(3):164-5. doi: 10.1136/ewjm.172.3.164. PMID: 18751246; PMCID: PMC1070794.

Perinatal Management for Emergency Medicine Providers

Mon, 08 Jun 2026 14:31:21 GMT

Brief Training for Emergency Medicine Providers serving pregnant and postpartum people.

Perinatal people often interact with Emergency Services throughout pregnancy and the postpartum period. EM Providers may be asked to weigh in on medication safety in pregnancy, or may have to choose an agent to use acutely in pregnancy or breastfeeding. This video offers clinical advice on how to approach perinatal mental health medications in the emergency setting.

How to Access Perinatal Consultation Through VTCPAP

Thu, 07 May 2026 19:34:18 GMT

Download a printable PDF version of this flyer for your clinic, practice, or care team. Click here to learn more about who is eligible to call.

Can We Create Safer and More Thorough PMAD Screening in Vermont?

Tue, 13 Jan 2026 20:59:11 GMT

Perinatal Mood and Anxiety Disorders (PMADs) affect birthing individuals across Vermont—but our data suggest that BIPOC birthing individuals may be under-identified and under-supported .

At VTCPAP, our perinatal service is aiming in 2026 to work with providers to understand barriers and provide evidence-based strategies to improve detection and care for all Vermonters.

What the Data Shows

Vermont Department of Health: 7–10% of Vermonters identify as non-white
VTCPAP consultations (past year): 4 out of 120 involved non-white patients
Research: Non-majority individuals may experience postpartum depression and anxiety at twice the rate of white individuals

The gap: We should be seeing more consultations for BIPOC patients—but the data show otherwise.

Why Are Screenings Missing BIPOC Patients?

Research points to two main factors :

Trust in providers
Limitations in screening tools

1. Trust Matters

Patients are more honest on the Edinburgh Postnatal Depression Survey (EPDS) when they:

Have a trusted relationship with the provider
Receive a clear explanation of the purpose and use of the screening
Are assured the screen is not used to judge parenting competence or reported to DCF

Why this matters for BIPOC patients:

Studies show BIPOC and immigrant birthing individuals may have less implicit trust in their providers , especially in predominantly white healthcare settings
Fear of being seen as “unfit” can reduce honesty on screenings

Best practice:

Build consistent provider relationships before administering screenings; It is most effective if the MA, RN or MD who administers the screening knows the patient
Preface the screening with supportive language about how the results will be used to support them, not judge them, and what will this look like?

2. Screening Tools May Miss Stress-Related Distress

The EPDS may not fully capture stress experienced by BIPOC patients. There may be stigma around mental health conditions, where people don't readily identify with mental health symptoms, but they may identify as having high stress. Research shows:

High stress levels can be as harmful as depression/anxiety
Tools like the Perceived Stress Scale or Everyday Discrimination Scale can complement the EPDS
Stress scores can trigger interventions similar to positive EPDS screens

Key insight: Stress may reflect unrecognized depression/anxiety or distress not captured due to cultural or systemic barriers.

Strategies for Safer, More Equitable Screening

Small changes can make a big difference:

Designate staff (nurses or medical assistants) who a patient knows already to administer screeners with a short preface about purpose and outcomes
Add stress measures (e.g., Perceived Stress Scale or Everyday Discrimination Scale) to identify hidden distress
Engage VTCPAP for consultation:

Dr. Guth can work with your practice to design a tailored plan
Look out for a virtual education session in early 2026

Goal: Improve detection and care for all Vermont birthing people , especially those historically under-identified.

Action Steps for Providers

Introduce screenings after establishing trust with patients
Explain why the screening is happening and how results are used
Consider adding a stress-focused measure alongside the EPDS
Reach out to VTCPAP for consultation or attend upcoming virtual education sessions

References

Armstrong SJ, Small RE. The paradox of screening: rural women's views on screening for postnatal depression . BMC Public Health. 2010;10:744.
Bauman BL, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression . MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581.
Dwarakanath M, et al. Barriers to Diagnosis of Postpartum Depression among Younger Black Mothers . Res Sq. 2023.
Kannikeswaran AP, et al. Perinatal providers' attitudes towards culturally relevant infant mental health integration . Front Psychiatry. 2025;16:1644836.
O’Mahony J, Donnelly T. Immigrant and refugee women's postpartum depression help-seeking experiences . J Psychiatr Ment Health Nurs. 2010;17(10):917–928.
Skoog M, et al. Screening immigrant mothers for postpartum depression: a qualitative systematic review . PLoS One. 2022;17(7):e0271318.
Sroka AW, et al. Depression screening may not capture significant sources of prenatal stress for Black women . Arch Womens Ment Health. 2023;26(2):211–217.
Tobin C, et al. Recognition of risk factors for postpartum depression in refugee and immigrant women . J Immigr Minor Health. 2015;17(4):1019–1024.

Perinatal Mental Health: Key Takeaways for Providers

Tue, 13 Jan 2026 20:59:06 GMT

Perinatal mental health challenge are the most common complication of birth in the US, affecting 1 in 5 birthing parents and 1 in 10 partners or fathers nationally, with even high rates in Vermont: up to a quarter of Vermont families are impacted. Symptoms can begin during pregnancy and onset any time within the first year postpartum. These complications can also impact families that grow by adoption or surrogacy. While hormone shifts play a part, individual histories play an important role. Left untreated, postpartum mood complications can lead to lifelong challenges with depression, anxiety and bonding or attachment cycles, which can lead to more challenges for the entire family later on.

Any provider interfacing with pregnant or postpartum parents should watch for symptoms of mood complications, understanding that at times they will be quite obvious (such as psychosis or profound depression), while other times they may be more mild cases that are still very much in need of treatment intervention. Symptoms can be identified using screening tools such as the Edinburgh Postnatal Depression Scale (EDPS), but this cannot be all that we rely on. Often, mood challenges go un- or under-reported for a host of well-researched reasons. Therefore, it’s up to providers to offer an array of support tools, including ones parents can access on their own if they choose. Offering an informational handout with a list of resources to all perinatal patients as a standard of care is a strong first step. And for physicians and providers who are using screening tools, comprehensive follow up for positive screens is critical. We cannot continue to screen if we are unable or unwilling to follow up on positive results in a comprehensive way.

While the landscape for referrals and support in Vermont may seem barren on the surface, Vermont actually scores amongst the higher ranks in the country for perinatal support according to the Policy Center for Maternal Mental Health 2025 Report Cards. Vermont has made commendable efforts to enhance perinatal support and continues to do so with the recent Maternal Health Innovation grant. While the system isn’t perfect, it’s a strong, forward-moving collaborative effort.

For clinicians practicing in Vermont, there are several state and national resources available to families and providers alike. These include:

Postpartum Support International (PSI) provides provider training, a local provider directory, and free peer support resources. The local Vermont chapter is active so don’t hesitate to reach out to psivt@postpartum.net with questions or referrals.

The Vermont Consultation & Psychiatry Access Program (VTCPAP) perinatal service equips perinatal providers with real-time consultation from perinatal psychiatrists, screening resources, and referral support.

Through to Thrive has a variety of books and online classes for parents who do well with individual, self-paced learning as well as training tools for providers. CEUs are available and training tools include concrete resources and can include consultation for individuals and teams.

References