Katie Crenshaw, a 40-year-old woman with experience working in a maternity ward and trained as a doula, faced a mental health crisis after the birth of her third child that was different from her previous postpartum experiences. Unlike earlier episodes, which included crying spells and thoughts of self-harm, this crisis developed gradually a year later, when her son was weaned. Instead of deep sadness, she felt indifference and intrusive suicidal thoughts, a manifestation not typically associated with postpartum depression. Postpartum mental health issues are more complex than just depression, according to Tiffany A. Moore Simas, head of the department of obstetrics and gynecology at UMass Memorial Health. These issues can include anxiety, bipolar disorder, obsessive-compulsive disorder (OCD), panic attacks, psychosis, and post-traumatic stress disorder (PTSD). These conditions can be difficult to recognize when a person continues to function normally on the surface. Veerle Bergink, a psychiatrist specializing in reproductive health at the Icahn School of Medicine at Mount Sinai, noted that postpartum trauma-related stress disorder, which can develop after a traumatic birth, is often overlooked. A literature review published in 2017 in the Journal of Affective Disorders revealed that approximately 4% of young mothers develop this disorder after childbirth, with higher rates among those in high-risk groups. Samantha Meltzer-Brody, dean of the School of Medicine at the University of North Carolina, emphasized the importance of screening for trauma during the perinatal period, as women with a history of trauma have a higher risk of postpartum PTSD. However, standard screening tools may not detect it effectively. An international survey conducted in 2026 found that physiological hyperactivation was the most common symptom of childbirth-related trauma stress disorder, while avoidance was the least common. Amanda Koenigsberg experienced a traumatic birth that led to postpartum anxiety and perinatal obsessive-compulsive disorder, which she did not initially recognize as a mental health issue. She assumed her symptoms were part of motherhood until a therapist diagnosed her. Meltzer-Brody explained that the diagnostic criteria for major depressive episodes may contribute to confusion, as the symptoms can include anxiety, anger, and irritability. Two medications, brexanolone and zuranolone, have been developed for postpartum depression and act on GABA-A receptors, highlighting the role of reproductive hormones in the disorder. Bergink noted that Katie Crenshaw's crisis occurred during weaning, a hormonal transition that can trigger severe psychiatric symptoms in some women. This phenomenon remains largely unstudied. Personal experiences like Crenshaw's, which occur long after childbirth and do not resemble typical postpartum depression, remain difficult to explain and easy to overlook.