When to Seek Emergency Help for Postpartum Mental Health

If you are thinking about ending your life, feel you might hurt yourself or your baby, or can't keep yourself or your baby safe right now, call 911 or go to the nearest emergency room. You can also call or text 988, or call the National Maternal Mental Health Hotline at 1-833-852-6262, any time.

It's the middle of the night. The baby is asleep in the next room and you're standing in the kitchen with your phone in your hand, trying to decide whether what you're feeling is bad enough to call someone. You don't want to overreact. You don't want to wake anyone up. You're not even sure who you would call.

As a psychologist and a mom, I want to take that decision off your plate. Below is a simple guide to when a postpartum mental health problem is an emergency, when it needs a call to your doctor today, and when it means making an appointment this week. If you're unsure which group you're in, choose the more urgent one. Getting checked and hearing it isn't an emergency is a good outcome.

When to seek emergency help: call 911 or go to the ER

Call 911 or go to the nearest emergency room now if:

• You are thinking about ending your life and have a plan, or feel you might act on it.
• You have thoughts of harming your baby that feel like something you want to do, or that make sense to you. (Unwanted thoughts that horrify you are different. More on that below.)
• You can't keep yourself or your baby safe. If some part of you is saying "I'm not safe right now," believe it.
• You are seeing or hearing things others don't, or believing things that feel completely true but worry the people around you.
• You have gone days without sleep and don't feel tired, or you feel confused, wired, or not like yourself in a way that scares the people who love you.

The last two can be signs of postpartum psychosis. It is rare, about 1 or 2 in every 1,000 births, and it is very treatable, but it is an emergency. Until a mom with these signs has been seen by a doctor, someone should stay with her and she should not be left alone with the baby. Here is more on postpartum psychosis and how it differs from depression.

Physical postpartum emergency signs: call 911

Some emergencies after birth are physical, and they can show up days or weeks after you've gone home. Call 911 if you have:

• Chest pain
• Trouble breathing or shortness of breath
• A severe headache, especially with vision changes like blurriness, spots, or flashing lights
• Heavy bleeding, such as soaking through a pad in an hour or passing large clots
• A seizure
• Thoughts of harming yourself or your baby

When you get there, say right away that you recently had a baby, and when. That one sentence helps doctors think of the right causes fast.

Call your OB or midwife right away (and go to the ER if you can't reach them) for a fever of 100.4 or higher, a leg that is red, swollen, warm, or painful, or an incision that is red, oozing, or opening up.

A note on anxiety: a racing heart and tight chest can be panic, but if this is new for you after birth, get checked before assuming it's anxiety. Ruling out a heart or lung problem is part of good care, and asking for it is reasonable.

Call your provider or a crisis line today

Some things are not a 911 call but shouldn't wait for next week either. Call your OB, midwife, primary care doctor, or therapist today if:

• You are having thoughts that you'd be better off dead, or that your family would be better off without you, even without a plan. You can also call or text 988 or the Maternal Mental Health Hotline at 1-833-852-6262 right now, while you wait to hear back.
• You can't sleep even when the baby is sleeping and someone else is on duty, and it has been going on for more than a night or two.
• You are barely eating or drinking.
• Panic attacks are coming so often that you can't get through the day.
• Your depression or anxiety is getting worse quickly, or something you were managing has suddenly become unmanageable.
• You stopped a psychiatric medication suddenly and feel worse.
• Your partner or family is seriously worried about you. They often see it before we do.

If you can't reach anyone, or it starts to feel worse while you wait, move up to the 911 list.

Make an appointment this week

These are signs you need help soon from someone who treats postpartum mental health:

• Low mood, numbness, or crying most days for more than two weeks. The baby blues fade by about two weeks after birth; if it is lasting longer, it's worth getting checked. Here's how to tell the difference.
• Anxiety or worry that won't turn off, even when you know the baby is fine. These are the signs it's time to talk to someone.
• Scary, unwanted thoughts about your baby being hurt that come often or are taking over your day.
• Rage or irritability that feels out of proportion and out of character.
• Not feeling like yourself, or feeling disconnected from your baby, and it isn't getting better.

You don't have to be at a breaking point to start. Postpartum depression affects about one in five moms, and it responds well to treatment. Here are the symptoms to watch for.

Scary thoughts vs a postpartum emergency

This is the question I hear most, so I want to be clear about it.

Almost every new mom has sudden, unwanted thoughts or pictures of something bad happening to her baby. I had them too: the stairs, the bathwater, the knife on the counter. If a thought like that horrifies you and you want nothing to do with it, that reaction is your mind working the way it should. It is not an emergency, and it doesn't mean you are dangerous. If these thoughts are constant, they are very treatable. Here is why harm thoughts are not dangerous.

What makes a thought an emergency is how it feels. If a thought about harming yourself or your baby starts to feel reasonable, right, or like something to act on, call 911.

If you're the partner or family

You may be the one who notices first. If she seems confused, isn't sleeping and isn't tired, is saying things that don't make sense, talks about not wanting to be here, or just seems frighteningly unlike herself, don't wait to see if it passes. Call 911 or drive her to the ER, stay with her, and take care of the baby yourself until she has been seen. If it isn't an emergency but you're worried, help her make that call to her doctor today. I wrote more for partners here.

What happens after you ask for help

A lot of moms stay quiet because they're scared of what will happen if they say the words out loud. Telling a doctor how bad it has gotten is what a safe mom does. The people in an emergency room see postpartum mental health crises, and their job is to get you safe and well. For many moms, that night is the start of getting better, followed by therapy, medication if it's needed, and support at home.

If you ever have thoughts of harming yourself or feel you can't keep yourself or your baby safe, call 911 or go to the nearest emergency room. You can call or text 988 any time, and the National Maternal Mental Health Hotline is open 24/7 at 1-833-852-6262. The Postpartum Support International HelpLine is 1-800-944-4773.

Working with me

I'm a licensed clinical psychologist, a certified perinatal mental health specialist, and moms often come to me unsure whether what they're feeling is an emergency or something very treatable. I'm not an emergency service, but once you're safe, I can help you with what comes next and coordinate with your OB or psychiatrist. I see moms in Austin or on video, and babies are always welcome in my office.

The first step is a free 15-minute call. Tell me what has been going on, and I will tell you honestly what I think would help.

Book a free 15-minute call