Mental health conditions and maternal mortality risk

How recovery typically progresses

Immediately after

First days

In the early weeks after birth, sudden severe symptoms such as almost no sleep without feeling tired, rapid mood shifts, confusion, or unusual beliefs need same-day emergency evaluation rather than a wait-and-see approach, since postpartum psychosis most often begins in this window.

Settling in

Early weeks

In the weeks that follow, ongoing low mood, anxiety, or intrusive thoughts deserve continued follow-up, not just a single postpartum check-in. Review at your comprehensive postpartum visit whether symptoms are improving, and say so clearly if they are not.

Longer arc

Beyond six weeks

Risk does not end at six weeks. A large share of pregnancy-related mental health deaths happen between roughly six weeks and a year after birth, so ongoing check-ins, especially through any medication changes, weaning, or return to work, matter well into the first postpartum year.

What does the evidence show for mental health conditions and maternal mortality risk?

• Mental health conditions were the most frequent underlying cause of pregnancy-related death in 2020 US surveillance data, accounting for 22.5 percent of deaths, ahead of cardiovascular conditions, infection, hemorrhage, embolism, and hypertensive disorders of pregnancy. 1
• The leading cause of pregnancy-related death is not the same for everyone: mental health conditions led specifically among non-Hispanic White women in this data, while cardiovascular conditions led among non-Hispanic Black women and infection led among Hispanic women, so risk and its recognition are not distributed evenly. 1
• In a separate review of 14 state maternal mortality review committees covering 2008 through 2017, mental health conditions caused about 11 percent of pregnancy-related deaths, and 63 percent of those specific deaths were by suicide. 2
• Pregnancy-related mental health deaths were judged preventable far more often than deaths from other causes, 100 percent versus 64 percent, and most happened later than many people expect: 63 percent occurred between 43 and 365 days after birth rather than in the immediate postpartum period. 2
• Nearly three-quarters of people who died of a pregnancy-related mental health cause had a documented history of depression, and more than two-thirds had past or current substance use, meaning known risk factors were often already visible before the death. 2
• Postpartum psychosis is a distinct, rare psychiatric emergency, with symptoms that include delusions, hallucinations, mania, paranoia, and confusion; NIMH guidance is explicit that someone with these symptoms should get help right away by calling 911 or going to the nearest emergency room. 3
• Thoughts of death, self-harm, harming the baby, or suicide attempts are named as a symptom that needs prompt outside help, and NIMH points to both the 988 Suicide and Crisis Lifeline and the National Maternal Mental Health Hotline as resources for this exact situation. 3
• CDC's broader urgent maternal warning signs guidance separately lists thoughts of harming yourself or your baby as one of the specific signs that should prompt getting help right away, alongside physical warning signs like a headache that will not go away or chest pain. 4

Where to get help

When should I call my provider about mental health conditions and maternal mortality risk?

Any thought of self-harm, suicide, or harming the baby needs help right away: call or text 988, or call 911 for an immediate safety concern. Do not wait to see if the thought passes.,Hallucinations, delusions, paranoia, mania, or severe confusion are signs of a psychiatric emergency and need immediate evaluation by calling 911 or going to the nearest emergency room.,Sudden, severe changes such as going without sleep for days while not feeling tired, extreme agitation, or behavior that feels unlike the person's baseline should be managed as urgent, especially in the early weeks after birth.,Risk continues past the early postpartum weeks: new or worsening symptoms months after birth still deserve the same urgency as symptoms in the first days. None of these lists replace your own judgment: if this symptom worries you, that on its own is enough reason to check in with your healthcare provider.