Pregnancy is a time of adjustment both physically and emotionally. There is often a mixture of excitement and stress that accompanies rapid changes during and after delivery. In some cases, these stressors may result in a depressed mood or excessive anxiety. Although most people are familiar with the “baby blues” that commonly occur postpartum, it is important to know that around 10 percent of women may experience periods of depression while they are pregnant. This number may increase as high as 19 percent by three months postpartum before returning to non-pregnant levels of six percent after eight months.

There are preventive measures women can take throughout pregnancy to support a positive mood before, during and after delivery. Here are a few tips.

1. Make regular sleep a priority. Regular sleep patterns are a natural mood booster. Getting rest at night rejuvenates the mind and allows for activity during the day, which leads to greater exposure to sunlight—another mood support.

2. Avoid isolation at home. Getting out of the house and surrounding one’s self with supportive friends and family is an important way to support mood. Elevations in mood are seen among people who remain active in pregnancy. It also aids in lowering anxiety by getting the mind off of stressors.

3. Stay aware of your surroundings. Worry thoughts are powerful ideas that can be hard to break once they take hold. During worry, we tend to think about all of the “what ifs” and ‘should haves” of the past and the future. These thoughts get tied to negative emotions, so when we bring the thoughts up again, we feel bad.

“Mindfulness” thoughts are one way to bring the mind out from the negative emotions of the past and future and into a calmer present. If stressful thoughts are coming on, take a walk and begin to notice the details of the environment you are in. Make your brain listen for the sounds of birds, cars and conversations. Try to describe the differences in the color green of trees versus the grass. Try to find all of the red objects in a room. With practice, the brain will focus more on the information your senses are detecting and less on the feelings of emotional worry. The Internet has several resources and exercises on mindfulness thinking.

4. Plan ahead and communicate. The chaos of recovery and newborn care is a big reason why depressed moods and anxieties spike after delivery. The combination of physical recovery from delivery, sleep deprivation from breastfeeding and the addition of a new baby’s schedule into the family’s life set new mothers up for exhaustion both physically and mentally. When reserves are low, negative mood and anxiety are likely to develop. Once these feelings develop, it is difficult to garner the energy to make contingency plans. It is also hard to reach out to friends in the middle of an emotional crisis.

Make contingency plans several weeks before delivery on how to get enough sleep. This may involve setting up a schedule with your partner to share in nighttime feeding responsibilities. Knowing ahead of time that you agree to provide formula or give breast milk by bottle may cut down on anxiety in the moment. Schedule personal or phone visits from supportive friends and family ahead of time, and make plans for them to assist you with cleaning or baby watching while you catch up on sleep. When depression is present, new moms may worry they are being a burden to their friends and avoid contact. But, most friends are excited for the chance to help. Give them the opportunity.

5. If you can’t shake these feelings, tell someone. Research shows that an important factor in early childhood brain development is a healthy interactive mother. Moms with persistently depressed moods have difficulty maintaining adequate interactions and bonding with their children. There are many effective medication and non-medication therapies available to depressed and anxious mothers.

It is vital that whatever therapy is chosen starts early in the process. Although there is a growing emphasis on early identification and treatment of mood concerns in pregnancy, your provider may not pick up on your feelings. Don’t suffer in silence. Clearly tell your provider exactly how you are feeling if depressed mood or anxiety is interfering with your life activities or personal interactions.