Articles

Key takeaways

• Good mental health is very important for you and your baby during pregnancy.
• Your care team will check on your mental well-being at your appointments.
• Seek help if you have sadness that doesn't go away, anxiety, or worrying thoughts.
• Effective treatments like therapy and medication are available and safe.

Why your mental health matters during pregnancy

Good mental health is very important during your pregnancy and after your baby is born. Looking after yourself helps you to look after your baby. Your mental health is as important as your physical health.

Pregnancy is a time of big change. It can bring emotional highs and lows. Most people have good mental health during pregnancy, but some find it harder to manage.

Emotional changes during pregnancy

Pregnancy hormones can affect your mood, especially in the first three months. You might feel excited one minute and then worried or sad the next. This is natural.

It is common to experience uncertainty, frequent mood changes, and mixed emotions. Worries about your pregnancy or birth are also common, as is stress about becoming a parent.

Many people worry about how they will cope or if they will be a good parent. Worries about labour, giving birth, or bonding with your baby are also common. These feelings are natural, but if you feel down all the time, speak to your midwife or doctor.

Perinatal mental health conditions

Your mental health during pregnancy and for the first one to two years after birth is sometimes called perinatal mental health. You may also hear it called maternal mental health. Some mental health conditions can occur at any time, but others are specific to pregnancy and the postnatal period.

It's not uncommon to need extra support for your mental health during this time. Up to 1 in 5 women experience a mental health problem during pregnancy or in the first year after birth.

Getting the right support is important for the long-term wellbeing of you and your baby. Previous mental health problems are also more likely to return during pregnancy.

Types of perinatal mental health conditions

Common perinatal mental health conditions include:

• Depression that happens during pregnancy (antenatal depression).
• Anxiety experienced during pregnancy or after birth (perinatal anxiety).
• Obsessive-compulsive disorder (OCD) is an anxiety disorder. It involves repetitive, unwanted thoughts and compulsive behaviours.
• An extreme fear of childbirth and sometimes pregnancy (tokophobia).
• Unhealthy behaviours and thoughts around food (eating disorders).
• A condition that can occur after a traumatic birth experience or loss (post-traumatic stress disorder, or PTSD).

Tell your care team if you have a history of a severe mental illness. This includes conditions like psychosis, schizophrenia, or bipolar disorder. This is because pregnancy and the time after birth can be a vulnerable period. Having the right support in place early is key to keeping you well.

Screening for your well-being

Your midwife or doctor will ask about your mental health during pregnancy. This is a standard part of your care during pregnancy (antenatal care). These checks could be conversations about how you are feeling or a questionnaire.

Initial assessment

At your first appointment, your doctor or midwife will ask if you have ever had any mental illness. They will also ask if you have been treated by specialist mental health services in the past. They will also ask if any close relatives have had a severe mental illness around the time of giving birth.

This helps them understand if you might have a higher risk of developing a mental health problem.

Ongoing monitoring

Your midwife will also ask you questions about how you are feeling now. It is important for them to know if you are feeling depressed or anxious. Getting support or treatment during pregnancy can lower the chance of developing postnatal depression.

Healthcare professionals understand that mental health problems are common. They are there to help you, not to judge you.

Further support

If it looks like you need extra support, you may be offered more frequent appointments. You might also be referred to a specialist team.

Signs to watch for

It is natural to feel many emotions when you are pregnant. However, some signs might suggest your mental health might be under pressure. If you notice any of these signs, speak to your care team without delay.

This includes your GP, midwife, or health visitor.

Signs that your mental health might be under pressure include:

• Sudden, big, or constant changes in your mood or emotions.
• You may have thoughts or images about harming yourself or your baby (these are called intrusive thoughts).
• Feeling overwhelmed by guilt, shame, or hopelessness.
• Struggling to bond with your baby or feeling detached from them.
• Finding it impossible to sleep or relax, even when your baby is sleeping.
• Thinking that you are not a good parent or your baby is better off without you.
• Seeing, hearing, or believing things that others do not.
• Frequent worry or fear about food or your body image.

Symptoms of depression in pregnancy

Some mood changes are normal in pregnancy. These can include feeling tired or irritable.

However, talk to a midwife or GP if you often feel low and hopeless. You should also speak to them if you no longer enjoy things you used to.

Signs and symptoms of antenatal depression include:

• Feeling sad, having a low mood, or being tearful a lot of the time.
• Feeling irritable or getting angry easily.
• Losing interest in other people and the world around you.
• Not wanting to eat or eating more than usual.
• Negative thoughts, such as worrying you will not be able to look after your baby.
• Feeling guilty, hopeless, or blaming yourself for your problems.
• Having problems concentrating or making decisions.
• Thinking about suicide.

When to seek help

If you feel like you want to harm yourself or like you want to die, please tell someone.

This could be a family member or friend. You can also tell your GP or midwife. You can also call the Samaritans on 116 123.

It's important to get support for antenatal depression. Without it, the symptoms can sometimes become more difficult or continue after your baby is born.

Urgent advice

Contact a GP immediately if you or a pregnant friend or relative:

• Starts hearing or seeing things that are not real (these are called hallucinations).
• Develops strong beliefs that are not shared by others (these are called delusions).

If you cannot contact a GP, you can call 111 or get help from 111 online. You can also find your nearest A&E.

Call 999 immediately if:

• You think there is a danger that you might harm yourself or others.
• You are worried that someone else might harm themselves or others.

Treatment and support options

If you have a mental health problem during or after pregnancy, there is support and treatment that can help you. The main treatments are self-help, talking therapies, and medication.

What you are offered will depend on your symptoms and how much they affect you. Your wishes and what support is available near you will also be considered.

Your healthcare professional will explain the benefits and risks of each option. This helps you decide what is best for you.

Talking (psychological) therapies

Talking treatments are therapies where you discuss your feelings with a trained therapist. This can be one-to-one, in a group, or over the phone. It can also involve a friend, family member, or partner.

Your GP can refer you for talking therapies. In some parts of England, you can also refer yourself for NHS treatment.

Types of talking therapies

Common talking therapies include:

• Cognitive Behavioural Therapy (CBT) – a therapy that aims to change how you think and behave. It is effective for conditions like depression, anxiety, and OCD.
• Counselling – regular emotional support and guidance to help you process feelings, difficult events, or worries.
• Eye Movement Desensitisation and Reprocessing (EMDR) – can help with trauma, including birth trauma or PTSD. It uses guided eye movements to help process distressing memories.

Medication

If you were taking medication before you became pregnant, it is important not to stop taking it without speaking to a doctor first. Stopping suddenly could cause withdrawal symptoms or make your mental health symptoms worse.

Your doctor can recommend medicines that are safe to take during pregnancy or while breastfeeding. They will discuss the pros and cons with you so you can make an informed decision.

It is important to discuss all options with a medical professional. This ensures you compare the benefits and risks for you and your baby.

Types of medication

Types of medication include:

• Selective serotonin reuptake inhibitors (SSRIs) – a common type of antidepressant used to treat anxiety and depression.
• Anxiolytics – medications that can help manage severe anxiety and panic.
• Antipsychotics – medications used during and after pregnancy for serious mental health conditions like bipolar disorder, schizophrenia, and postpartum psychosis. They help regulate mood and reduce symptoms such as delusions or hallucinations.

Remember, it is important not to stop or start any medication without speaking to your doctor first.

Community and specialist support

Ask your midwife or GP about support available in your local area. They may be able to offer support from a volunteer who has experienced similar mental health problems (this is called peer support).

There are special teams that support people experiencing mental health challenges during or after pregnancy (specialist perinatal mental health services). These teams may have a multi-disciplinary team supporting you.

This team could include:

• psychiatrists
• psychologists
• midwives
• nurses
• other specialists

They work together to provide tailored care.

What to expect from specialist services

Members of the team might:

• Assess you.
• Confirm if you have a perinatal mental health condition.
• Offer a tailored treatment plan, which could include therapy or medication.
• Schedule regular home visits to check how you are feeling.
• Provide support for you, your partner, or any other family members.

If you are not already under the care of a community mental health team, a member of your care team may refer you for assessment. This could be your GP, midwife, or health visitor.