What is perinatal mental health?
Pregnancy, childbirth, and becoming a parent can involve significant physical, emotional and social changes. While everyone's experience is different, these changes can sometimes affect your mental health and emotional wellbeing. Some people 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 health problems 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 conditions can be mild, moderate or severe, requiring different kinds of care or treatment.
The NHS suggests that up to one in five women experience mental health problems such as depression or anxiety during pregnancy or in the first year after giving birth.
Psychodynamic counsellor Sara Sukhija, MBACP Accredited, 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.
If you're taking prescribed medication for a mental health condition and find out you're pregnant, speak to your doctor or specialist as soon as possible. Do not stop taking prescribed medication without discussing it with them first.
Some perinatal mental health problems can go unrecognised or untreated. If you're struggling with your mental health during pregnancy or after giving birth, support is available. Speaking to your GP, midwife or health visitor can be a good place to start.
What causes perinatal mental health problems?
Mental health problems during pregnancy and after birth can have many contributing factors, and these will differ from person to person. These may include:
- Hormonal and physical changes – changes during pregnancy and after birth may affect your mood and mental health.
- Relationship difficulties – relationship difficulties, a lack of support or changes in your relationships may affect your emotional wellbeing during pregnancy and after birth.
- Financial worries – worries about money, work, or the costs associated with having a baby can add to feelings of stress or anxiety.
- Pregnancy sickness – pregnancy sickness can significantly affect your physical and emotional wellbeing. Severe pregnancy sickness, including hyperemesis gravidarum, can be particularly difficult to cope with.
- Lack of sleep – difficulty sleeping and ongoing tiredness can affect your mood and make everyday challenges harder to cope with.
- Family difficulties – pregnancy and becoming a parent may bring existing family difficulties or difficult past experiences to the surface.
Miscarriage
Experiencing a miscarriage can be deeply upsetting.
Miscarriage is common, with the National Institute for Health and Care Excellence (NICE) estimating that it occurs in 8-24% of pregnancies. Both miscarriage (pregnancy loss before 24 weeks) and stillbirth (when a baby is born without signs of life after 24 completed weeks of pregnancy) can be significant and painful losses.
Can pregnancy affect your mental health?
Yes. Pregnancy, giving birth and adjusting to life with a new baby can affect your mental health in different ways. Physical, emotional and social changes can all play a part, and some people may experience mental health problems such as anxiety or depression.
An unexpected or unwanted pregnancy can also bring a range of emotions and, for some people, may cause distress. We explain more about making a decision about your pregnancy, the support available and how counselling may help following an abortion.
Depression during pregnancy and after birth
Many of us have heard of postnatal depression (PND), the signs and symptoms. Antenatal depression is depression that develops during pregnancy. Without appropriate support or treatment, symptoms can worsen and may continue after the baby is born.
Baby blues and postpartum euphoria
Eight in 10 people who give birth experience the baby blues. These feelings usually begin a few days after giving birth and should not last more than two weeks. You may feel more emotional, tearful, irritable or anxious than usual. If these feelings last longer than two weeks or begin later, they could be a sign of postnatal depression.
The baby pinks, also known as postpartum euphoria, can involve feeling unusually energetic or as though you need very little sleep. You may talk more or faster than usual, find it difficult to concentrate, or behave in ways that are unusual for you. If you're concerned about how you're feeling after giving birth, speak to your GP, midwife or health visitor.
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 worsen.
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.
Common signs and symptoms of antenatal depression to look out for can include:
- Feeling tearful – you may feel more tearful than usual or become upset more easily.
- Feeling numb or empty – for some, pregnancy can bring difficult or overwhelming feelings. You may feel numb or empty, or find it difficult to enjoy things you usually would.
- 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 or shame about how you're feeling.
- Isolation – you may feel isolated or withdraw from friends, family or other people around you.
- Insomnia – many people find it hard to sleep during pregnancy due to bodily changes, but difficulty sleeping can also be associated with antenatal depression, particularly when accompanied by other changes in your mood or wellbeing.
Perinatal anxiety
Feeling anxious about your baby's health, the birth, and your ability as a parent is understandable. 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.
If feelings of anxiety are persistent or affecting your day-to-day life, speaking to your GP, midwife or health visitor can help you understand what support may be right for you.
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 terrified that I was messing him up by being a mess myself.
- Rebecca shares her experience of perinatal mental ill health with Happiful.
Fear of childbirth (tokophobia)
Whether you are pregnant with your first child or your fifth, having some level of anxiety about giving birth is normal. For first-time mums, this entirely new experience can feel 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.
There are two types of tokophobia: primary tokophobia, a longstanding fear of childbirth that may be present before pregnancy, and secondary tokophobia, which can develop following a previous birth experienced as traumatic.
Learning more about pregnancy and birth from reliable sources may help you feel more informed and prepared. Speak to an experienced medical professional. They can discuss your concerns, explain what to expect and talk you through the support and options available.
Can hypnobirthing help with tokophobia?
Hypnobirthing uses techniques such as relaxation, breathing and self-hypnosis to help people feel calmer and more prepared for birth.
Some people with tokophobia may find these techniques helpful for managing anxiety around childbirth, although experiences will vary.
Find out more about hypnotherapy for tokophobia and hypnobirthing.
Perinatal obsessive-compulsive disorder (OCD)
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
Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Symptoms 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:
- hallucinations;
- 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;
- anxiety;
- trouble sleeping;
- loss of inhibitions;
- feeling suspicious or fearful.
Postpartum psychosis is a medical emergency.
If you think you or someone you know may have symptoms, contact a GP immediately for an urgent same-day assessment. Call NHS 111 if you cannot speak to a GP. Call 999 or go to A&E if there is an immediate risk of harm.
People experiencing postpartum psychosis are likely to need hospital treatment. Where possible, this may be in a Mother and Baby Unit (MBU), a specialist psychiatric unit where you can receive treatment and support while remaining with your baby.
Birth trauma and post-traumatic stress disorder (PTSD)
Research suggests that a significant proportion of people experience childbirth as traumatic, although this does not necessarily mean they will develop post-traumatic stress disorder (PTSD). A birth may feel traumatic for many different reasons, including complications during labour, unexpected changes to a birth plan or how the person experienced the birth.
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.
- Read Understanding birth trauma.
Can counselling help with perinatal mental health?
If you feel you are experiencing a perinatal mental health issue, help is available, and speaking to your GP, midwife or health visitor can be a good place to start. Counselling may also provide additional support.
A qualified, experienced counsellor can offer you space to explore your thoughts, feelings and experiences in a safe, non-judgmental environment. Depending on their approach and your needs, they may help you better understand how you're feeling, explore difficult experiences and find ways to manage feelings such as anxiety or overwhelm.
Some people may also find it helpful to connect with others who have had similar experiences, which can provide reassurance and reduce feelings of isolation.
Find 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:
- depression
- anxiety
- obsessive-compulsive disorder
- post-traumatic stress disorder
- eating disorders
- bipolar disorder
- schizophrenia.
If pregnancy, birth or becoming a parent is affecting your mental health, you don't have to work through it alone. A counsellor with experience in perinatal mental health can offer a supportive space to explore how you're feeling and what might help.
You can use our search to find a counsellor who supports people with pregnancy, birth and perinatal mental health.
