A guide to perinatal mental health

woman with perinatal mental health

by Emily Gilbert |
Published on

The journey of becoming a parent is an extraordinary and transformative experience, filled with joy, hope, and anticipation. However, for some, this period can also bring about significant emotional challenges and vulnerability. Perinatal mental health, encompasses the emotional wellbeing of parents during pregnancy and the postpartum period, extending to the first year after childbirth. This crucial phase of life is marked by numerous physical, emotional, and psychological changes, making it a time of wonder but of potential distress too.

Perinatal mental health covers a wide range of conditions that can impact expecting and new parents, including anxiety, depression, postpartum psychosis, and more.

Recognising the significance of perinatal mental health is crucial and fortunately, awareness about perinatal mental health has been steadily increasing, leading to improved understanding, recognition, and support during this transformative time.

Scroll down to find out more about the different aspects of perinatal mental health, including the common challenges faced by individuals during pregnancy and postpartum, what to look for and the importance of support networks.

What is perinatal mental health?

"The term ‘perinatal’ refers to the period of time from the start of pregnancy up to around a year after giving birth," explains NHS Midwife and Antenatal Course Leader at Bump, Birth and Beyond, Megan Smith. "Therefore, a perinatal mental health ‘problem’ is one that you experience within this time frame. This may be a new mental health problem or an episode of a problem you've experienced in the past."

Having a baby is a big life-changing event and it is not uncommon to develop various emotions and feelings during pregnancy and after birth. "If your feelings begin to have a big impact on your everyday life, this could be a sign of a perinatal mental health problem," says Megan.

"Perinatal mental health problems can affect partners as well as the women. It affects up to 27% of new and expectant mums and 1 in 5 women will experience mental health problems during or after pregnancy. 70% will hide or underplay the severity of their illness."

Common perinatal mental health problems

• Prenatal depression
• Postnatal depression
• Perinatal anxiety
• Perinatal OCD
• Postpartum psychosis
• Postpartum PTSD

What symptoms should I look out for?

Symptoms vary depending on the mental health problem.

With perinatal depression, you may feel:

• down, upset or tearful
• restless, agitated or irritable
• guilty, worthless and down on yourself
• isolated and unable to relate to other people
• no self-confidence or self-esteem
• hopeless and despairing
• hostile or indifferent to your partner
• hostile or indifferent to your baby
• suicidal feelings.

With perinatal anxiety, you may experience:

• a churning feeling in your stomach
• feeling light-headed or dizzy
• feeling restless or unable to sit still
• headaches, backache or other aches and pains
• faster breathing
• a fast, thumping or irregular heartbeat
• sweating or hot flushes
• finding it hard to sleep
• nausea (feeling sick)
• needing the toilet more or less often
• changes in your sex drive
• having panic attacks.
• Unusual feelings you haven’t experienced before.

With perinatal OCD you may experience these two main aspects;

Obsessions: These are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind. They can make you feel very anxious and uncomfortable.

Compulsions: These are repetitive activities that you do to reduce the distress and anxiety caused by obsessions. It could be something like repeatedly checking that you locked a door. Repeating compulsions is often very time-consuming, and the relief they give doesn't usually last very long.

With postnatal psychosis, you are likely to experience a mixture of psychosis, depression and mania. Therefore, you may feel:

• severely depressed
• experience rapid mood changes
• excited
• confused or disorientated

And may also:
• be restless
• be unable to concentrate
• be unable to sleep
• experience delusions or hallucinations

With postnatal PTSD or birth trauma, you may experience:

• Re-living aspects of the trauma: Flashbacks, intrusive thoughts, nightmares, physical sensations
• Alertness: Panicking, upset or angry, irritability
• Avoiding feelings: Feeling numb, emotionless, avoiding situations, using alcohol or drugs as a distraction
• Difficult beliefs and feeling: Feeling unsafe, not trusting anyone, feeling like nobody understands, overwhelming feelings

How to manage perinatal mental health

"If you have a current mental health problem and you fall pregnant, it is a good idea to inform your GP and Midwife as soon as possible so they care for you appropriately and ensure extra support is in place to support you," Megan advises."

If you have recently had a baby, it is not uncommon to experience different feelings. If you are finding things difficult you can ask for support.

"Building a support network is a great way to share anxieties and frustrations and can be reassuring," says Megan. "It’s an opportunity to share skills, experiences and gain emotional and practical support. It’s a great way to share advice and tips and build your confidence as a parent."

You could try:

• Local parent and baby groups
• Attend antenatal/postnatal classes
• Contact specialist organisations such as Home-Start
• Access online support such as websites, blogs, podcasts, social media, online therapy
• Try peer support which brings people together who have had similar experiences or receiving similar treatments. For example, PaNDAS runs perinatal support groups.

When to get help

"If you begin experiencing any unusual feelings, it is advised you seek support and advice from your GP, Midwife and Health visitor," says Megan.

There are more specialist services available if you are becoming unwell and need more urgent support and care. These involve:

• Perinatal Mental Health services
• Community Mental Health Teams
• Crisis teams
• Hospitals
• Mother and Baby Units

There are also various charities and local services available (such as PaNDAS and APNI) that are also trained to offer support to those experiencing mental health problems.

If I had perinatal mental health problems with my last baby, could it happen again?

It's understandable that if you've previously experienced perinatal mental health problems, you may be concerned it could happen again.

"There is more risk of you becoming unwell again if you have experienced a mental health problem during or after a previous pregnancy, however, this doesn't mean you definitely will," reassures Megan.

"If you do become pregnant again, it's important to talk to your GP and midwife straight away about how you can look after your mental health and ensure a care plan is in place. You should also think about what kind of support you feel you might need throughout pregnancy and following birth."

"Alterations may need to be made to medications and treatments throughout pregnancy for the well-being of your baby."

Could I harm my baby?

In some cases, those who are suffering from perinatal mental health problems may experience thoughts about harming their baby.

"This can be extremely frightening and disturbing," says Megan. "Having thoughts like this does not necessarily mean the actions will be carried out or that there is any intention of doing so."

"If you are experiencing thoughts like this it is important you speak to someone immediately. Whether it be a partner, friend, stranger or professional. It is important to speak up so support and treatments can be provided straight away."

What is the NHS Long Term Plan?

The NHS Long Term Plan aims to ensure that by 2023/24, at least 66,000 women with moderate/complex to severe Perinatal Mental Health (PMH) difficulties can access care and support in the community.

As part of the £2.3bn investment in mental health care, there will be:

• Increased availability of specialist PMH community care for women who need ongoing support from 12 months after birth to 24 months
• Improvements made to the access of evidence-based psychological therapies for women and their partners
• Mental health checks for partners of those accessing specialist PMH community services and signposting to support as required.

The NHS Long Term Plan will also work to make it easier to access psychological support for those who experience mental health difficulties arising from, or related to, the maternity experience through the development of Maternity Outreach Clinics (this work will be delivered in partnership with the Maternity Transformation Programme).

Five years ago, 40% of the country did not have a specialist community teams available. There are now specialist PMH community services in all 44 local NHS areas in England, and further developments planned. This development enabled over 13,000 additional women to receive support from specialist PMH services in 2018/19 against the target of 9,000.

The national transformation programme also saw four new Mother and Baby Units open in areas of particular need in 2018/19 (in the North West, South West, South East Coast and East of England). This brought the total number of units in England to 19.

About the expert

Megan Smith is a NHS Midwife and Antenatal Course Leader at Bump, Birth and Beyond. She has been a registered midwife since 2019 and has worked in all areas of midwifery including antenatal, birth, postnatal and community. Megan loves educating and empowering women and their families and believes it is important to have a well-informed and balanced knowledge and idea of what to expect in pregnancy, birth and the newborn stage to enable women to make decisions that are best suited to them and their family.

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