Pregnancy and birth
Pregnancy, childbirth, and the first year after having a baby can be both an exciting and scary time. With as many as one in five women developing a mental illness during pregnancy or in the first year after birth, it’s important to normalise asking for help and support.
What is perinatal mental health?
Having a baby can be a time of great excitement and joy, but also immense pressure, uncertainty, and even fear. There are so many changes happening to your body and the very nature of bringing life into the world places demands on you to adjust your lifestyle.
All of these factors cause your hormones to work overtime. Not only does this lead to a range of physical symptoms (including morning sickness), but it can also lead to the amplification of certain emotions. It's not uncommon for you to feel more anxious and 'down' at this time. Some develop a mental health problem during pregnancy or within a year of giving birth - this is referred to as the ‘perinatal period’.
Examples of perinatal mental illness include antenatal depression, postnatal depression, anxiety, tokophobia (extreme fear of childbirth), perinatal obsessive-compulsive disorder (OCD), postpartum psychosis and postpartum post-traumatic stress disorder (PTSD). These illnesses can be mild, moderate or severe, requiring different kinds of care or treatment.
Psychodynamic counsellor, Sara Sukhija, explains the benefits that counselling can bring during, and after, pregnancy and childbirth.
The terms ‘maternal’ and ‘perinatal’ are often used interchangeably when discussing topics surrounding pregnancy and childbirth. However, when talking about mental health, ‘perinatal’ refers to a person's mental health during pregnancy and the first year after birth. This includes mental illness existing before pregnancy, as well as illnesses that develop for the first time or are greatly exacerbated during this time.
Some people experiencing mental illness may stop taking their medication when they find out they are pregnant. This can make their problem come back or get worse. For those who have previously experienced mental health problems in the past, being pregnant, giving birth, and caring for a baby can trigger a return of these problems.
According to the Mental Health Foundation, around 50% of perinatal mental health problems are untreated or undetected. This can have a devastating impact on those who give birth and their families, and this time in your life is, perhaps, when you need help the most. Getting support and developing coping mechanisms can help transform a time of stress and anxiety into one of excitement and joy.
What causes perinatal mental illness?
The causes of mental health problems differ from person to person - there is rarely one single cause. The following list contains some of the more common causes of perinatal mental illness:
- Hormonal changes - sometimes the simple upset of your body's hormone balance is enough to trigger a mental health problem.
- Relationship issues - perhaps your partner isn't as supportive as you hoped, or maybe you're going through this alone. Either way, relationship problems can often spark feelings of depression or anxiety.
- Financial worries - concerns over the amount of money you'll need to raise a baby are a common worry among expectant parents.
- Despair over pregnancy sickness - for some, this symptom of pregnancy is debilitating and in some cases, can even lead to hospitalisation (this is particularly prevalent with those who experience Hyperemesis Gravidarum, or HG, a severe form of pregnancy sickness). This can lead to feelings of hopelessness.
- Lack of sleep - pregnancy-related insomnia and general exhaustion could lead you to overthink situations and magnify negative emotions.
- Family issues - when you become pregnant a spotlight is shone on your own family life and previous rifts and tensions can become exaggerated.
Psychosynthesis counsellor Adriana Gordon (PGDip Reg MBACP) discusses the changes that happen in a parent’s life after having a baby - and the implications of these on our mental health.
Experiencing a miscarriage is more common than most people think. As many as one in four pregnancies result in miscarriage. Both miscarriage and stillbirth (loss of pregnancy after the first 23 weeks) are significant, painful losses, often referred to as an ‘invisible grief’, as few speak openly about their loss. Find out more about the importance of speaking about miscarriage, and how counselling can help you or someone you love.
Can pregnancy affect your mental health?
Yes, pregnancy can affect your mental health. Many people find that pregnancy and giving birth affect their overall sense of well-being and mental health. Research has shown as many as eight in 10 women experience the baby blues, one in 10 will experience postpartum euphoria (the ‘baby pinks’), and around one in five will experience mental health problems during pregnancy or after birth.
A combination of different changes, including physical, emotional, and social, can make it more likely for those giving birth to experience ill mental health, such as anxiety or depression.
For those who have fallen pregnant unexpectedly, unwanted pregnancy can cause considerable distress. We explain more about how deciding to end a pregnancy may impact your mental health, find out more about the next steps, and how therapy can help following an abortion.
Perinatal and antenatal depression
Many of us have heard of postnatal depression (PND), the signs and symptoms. But have you heard of antenatal depression, and how it can affect you? Antenatal depression happens before your baby is born. Thought to affect around 10% of people who give birth, studies also show that if antenatal depression is not acknowledged and treated, around 50% of sufferers will go on to develop postnatal depression.
What are the baby blues and the baby pinks?
Eight in 10 people who give birth will experience the baby blues after giving birth. Lasting around two weeks, someone experiencing the baby blues may feel emotional, irrational, or overwhelmed. You may get tearful, be irritable, or moody, as well as feel down or anxious without knowing why. Symptoms should clear up after two weeks, however around 30% of new parents can go on to experience postpartum depression.
The baby pinks, also known as postpartum euphoria, affects one in 10 people who give birth. Those experiencing postpartum euphoria may feel overly full of energy or like they don’t need to sleep, may talk too fast, have trouble concentrating, or behave in ways that are unusual for them. The effects can last for six to eight weeks for some, while others may experience the baby pinks for up to two weeks.
Symptoms of antenatal depression
Feeling low or unable to cope during your pregnancy can be natural, but that doesn’t mean you should suffer in silence. While these feelings may pass, for some, they can linger or become more severe.
If you are worried about how you are feeling, talk to your midwife or GP. They can help you find the right support and guidance for you.
Common signs and symptoms of antenatal depression to look out for can include:
- Feeling tearful - your emotions will be running high due to your hormones during pregnancy, but if you are feeling more tearful than expected, it may be a sign that you're not coping.
- Feeling numb or empty - for some, the implications of pregnancy are overwhelming. This may lead you to feel a numbness or emptiness at a time when you are expected to be overcome with joy.
- Guilt and shame - there are a lot of expectations associated with pregnancy and, when you don't feel what you are expected to feel, it can lead to intense feelings of guilt and even shame for having negative thoughts.
- Isolation - this can be especially true if your friends have not had children or if you come from an emotionally-closed family. Feeling alone in your pregnancy often evokes feelings of panic and depression.
- Insomnia - many women find it hard to sleep during pregnancy due to bodily changes but for some, it is a busy mind keeping them awake. This feeling of not being able to switch off and rest can lead to exhaustion, exaggerating negative emotions.
Feeling anxious about your baby's health, the birth and your ability as a parent are all perfectly natural. However, if feelings of anxiety begin to get in the way of your happiness or start to affect your day-to-day life, it can be a sign that you need help.
Common symptoms of perinatal anxiety include:
- feeling on-edge all the time
- feeling anxious constantly or about non-specific things
- panic attacks
- avoiding people or certain situations
- difficulty concentrating
I began second-guessing myself and feeling utterly overwhelmed by the responsibility of keeping another human alive. My feelings of inadequacy morphed into anxiety. I was consumed by a foggy cloud of despair. I felt so guilty that my selfish emotions were getting in the way. I was terrified that I was messing him up by being a mess myself.
- Rebecca shares her experience of perinatal mental ill health with Happiful.
Anxiety, stress and depression often go hand in hand, with one leading to another if not treated. To help avoid symptoms from getting worse or additional mental health problems from arising, speaking with your GP can help you to get an official diagnosis and start finding the right help and support for you.
Whether you are pregnant with your first child or your fifth, having some level of anxiety about giving birth is normal. For those who are pregnant for the first time, this entirely new experience can be overwhelming. No matter how much you read or hear from others, you still aren’t sure exactly what to expect. For those who have given birth before, worrying about what could go wrong while pregnant or in the delivery room is still perfectly natural. This could be due to previous experiences, friends’ experiences or reading about long, painful births in the media.
Whatever your reasons may be, for some, the thought of giving birth becomes a phobia. Tokophobia is the extreme fear of childbirth.
There are two types of tokophobia: primary (typically more common and intense amongst those who have never been pregnant) and secondary (experienced by those who have had a traumatic birth previously).
To cope with this type of anxiety, it is recommended that you arm yourself with information. Speak to a medical professional with experience. They will be able to tell you about possible complications, how likely it is that they will happen and exactly what the midwife or doctors will do in that situation.
Reading up about labour and listening to other peoples' experiences should also help to give you a good idea of what to expect. The important thing to remember is that every birth is different and just because someone you know had a difficult labour, it doesn’t mean you will too.
Can hypnobirthing help with tokophobia?
Hypnobirthing is one form of treatment that is sometimes recommended for tokophobia as, research shows, hypnotherapy can have a positive impact in reducing anxiety and promoting relaxation to reduce stress surrounding birth.
While the impact can vary from person to person, some people report having a shorter labour and recovery time, a reduced chance of medical intervention, and an increased sense of bonding. Discover more about hypnotherapy for tokophobia and hypnobirthing.
Many pregnant women and new mothers will experience a rise in feelings of worry, as well as some obsessive or compulsive-like symptoms. It’s normal to worry about your child's wellbeing and to want to protect your baby; you may be more careful about avoiding risks in pregnancy or after birth.
For some women, however, these normal worries can trigger or worsen symptoms of OCD. The symptoms can interfere with life. These thoughts can be very upsetting and frightening, but it's important to remember that having an intrusive thought doesn't mean that you'll act on it. It can be very hard to open up and talk to someone about these types of thoughts, but you can get treatment and support.
Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Symptoms (such as confusion or behaving out of character) usually start suddenly within the first two weeks after giving birth. More rarely, they can develop several weeks after the baby is born.
Other symptoms can include:
- delusions (thoughts or beliefs that are unlikely to be true)
- a manic mood - feeling restless, talking and thinking too much or too quickly, feeling "high" or "on top of the world"
- a low mood (showing signs of depression, being withdrawn or tearful)
- lacking energy
- having a loss of appetite
- trouble sleeping
- loss of inhibitions
- feeling suspicious or fearful
If you think you or someone you care about may be experiencing postpartum psychosis, it is important to get help. Postpartum psychosis should be treated as a medical emergency. Those who experience postpartum psychosis are likely to be offered a bed in a Mother and Baby Unit (MBU). This is a special psychiatric ward that can provide treatment, help and support for you and your baby. Here, you are supported in caring for your baby whilst you have the care and treatment you need.
It’s important to note that only a small number of people who give birth will need to be admitted to a Mother and Baby Unit. Around two to four in every 1000 people who have a baby will need this extra level of support.
Traumatic births are more common than you may realise. Studies have shown that up to 45% of new mothers or people who have given birth report experiencing birth trauma. This can be due to complications during labour, changes in their birth plans, or other unforeseen issues. Sometimes, even when everything goes according to plan, the experience can be such an overwhelming one that mothers are left feeling traumatised. This can lead some people who give birth to experience postpartum PTSD or birth trauma.
The impact of a traumatic birth can often be underestimated. Some people may try to push past their trauma and dismiss their experiences as simply a part of the process of becoming a parent. Others may find that their experience leaves them feeling disappointed, angry, upset, having trouble sleeping, and having difficulty bonding with their baby. Traumatic childbirth and developing PTSD can impair your relationship with both your baby and your partner. You may also experience flashbacks or unwanted memories of the traumatic birth.
Birth trauma can happen for many different reasons. The important thing is that you don’t compare yourself to others and their experience; it’s about how you feel about your experience. Acknowledging how you feel about what happened to you and giving yourself permission to feel that way is an important part of releasing those feelings.
- Read ‘Understanding birth trauma’.
Can therapy help with perinatal mental health issues?
If you feel you are suffering from a perinatal mental health issue, it is essential that you seek help. Although the feelings you are experiencing can be frightening, you won’t feel this way forever.
A qualified, experienced counsellor can provide space for you to vent your concerns or frustrations in a safe, non-judgmental environment. They will be able to explain some of the panic-based reactions and, over time, desensitise the trauma you have experienced. They will be able to talk you through your feelings so you better understand why they are occurring, as well as offer coping mechanisms and relaxation techniques.
Additionally, gaining support from other people who have had similar experiences often helps - knowing you are not alone and hearing how others coped can be incredibly reassuring.
What should I be looking for in a counsellor or psychotherapist?
There are currently no laws in place stipulating what training and qualifications a counsellor must have in order to treat mental health issues during pregnancy. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments regarding various mental health problems during pregnancy and after giving birth including:
- obsessive-compulsive disorder
- post-traumatic stress disorder
- eating disorders
- bipolar disorder
Read the NICE guidelines here:
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