The perinatal period marks a time when individuals are particularly susceptible to the sudden onset or recurrence of psychiatric illnesses. During this phase, mood and anxiety symptoms can develop and worsen quickly, posing significant risks to the patient and, in rare instances, to their infant. This conversation will focus on the evaluation and acute management of emergent psychiatric symptoms that arise during the perinatal period and present in the emergency setting, including:  suicidality,  postpartum psychosis,  postpartum obsessive-compulsive disorder, and agitation as well as review unique considerations for treatment during the peripartum period.