Understanding perinatal mental health conditions

Antenatal depression (depression in pregnancy) and postnatal depression (depression after pregnancy) are among the most common perinatal mental health conditions.

They often involve prolonged feelings of sadness, hopelessness, or a lack of enjoyment in life during or after pregnancy. These feelings can make it hard to care for yourself and look after or bond with your baby.

You might also notice:

1. Physical symptoms like aches or pains that don’t have a clear cause
2. Severe fatigue, even if you are managing to sleep overnight or nap in the day
3. Change in appetite
4. Weight gain or loss
5. Thoughts of harming yourself

The first 4 symptoms are sometimes overlooked as ‘normal’ parts of pregnancy or the postnatal period. However, it is important to see a healthcare professional if you feel worried.

‘Baby blues’ or postnatal depression?

It is common to experience the ‘baby blues’ after giving birth, causing you to feel sad, low, or tearful. However, the baby blues and postnatal depression are not the same.

The baby blues usually start within a few days of giving birth and settle within 2 weeks. If you are feeling low for longer, it’s important to seek advice from your midwife, health visitor or GP as these symptoms could be a sign of postnatal depression.

Support for antenatal and postnatal depression

PANDAS Foundation offers various forms of support for people with perinatal depression, including calls with trained volunteers, email or WhatsApp support, and support groups for parents.

Perinatal anxiety involves intense worry or fear, often centred on the health and wellbeing of your baby. You may also worry about your ability to cope with parenting, or doubt how well you are caring for your baby.

Anxiety can lead to physical symptoms and may interfere with your daily life.

You may notice:

• Intense worries about your baby in general
• Difficulty relaxing
• Nausea or headaches
• Restlessness or agitation
• Difficulty sleeping or resting, even if you feel tired
• A racing heart or dizziness
• Panic attacks – an intense feeling of fear or discomfort that may make you feel out of control, breathless, shaky, or uncomfortable

Support for antenatal and postnatal anxiety

Tommy's offers support for mental health before, during, and after pregnancy, including a helpline staffed by midwives: 0800 014 7800 (Mon-Fri, 9am-5pm).

Postpartum psychosis (sometimes called puerperal psychosis) is a rare but serious mental health condition that requires immediate medical attention. It typically develops in the first few days or weeks after giving birth. Symptoms can also begin during pregnancy or later in the postnatal period, but this is even more rare.

Symptoms of postpartum psychosis can include:

• Hallucinations – experiencing things that are not real, such as hearing voices or seeing things that others don’t.
• Delusions – things that you believe to be true, even if someone else shows you evidence that they are false.
• Extreme confusion – difficulty thinking clearly or making decisions.
• Disorganised thinking and speech – difficulty expressing thoughts and ideas as clearly as usual.
• Rapid mood swings – extreme changes in mood, from intense joy (mania) to depression or agitation.
• Paranoia – feeling suspicious or not trusting others, without being able to justify why.

Postpartum psychosis is a medical emergency and requires urgent assessment and treatment.

If you are already under the care of the mental health team, call the emergency numbers they have given you, or contact the crisis service.

If you are not already under the care of a mental health team, please speak to your GP, midwife, or health visitor urgently (the same day) or go to your local A&E Department.

Support for postpartum psychosis

The Action on Postpartum Psychosis (APP) website contains information, support and stories to help you understand more about this condition.

Having a difficult, complicated, or upsetting birth can sometimes lead to post-traumatic stress disorder (PTSD) relating to the birth itself.

If you have PTSD, you might notice you:

• Relive or replay the experience in your mind
• Have flashbacks or nightmares about the birth
• Feel numb or disconnected from your emotions
• Try to avoid reminders of your birth experience
• Are more ‘jumpy’ or feel like you’re always on high alert for problems or threats

PTSD can also occur following traumatic experiences before or after birth, such as a high-risk pregnancy, feeding difficulties, or your baby requiring specialist care after birth.

Support for birth trauma

The Birth Trauma Association can offer support following a difficult birth, and Make Birth Better provides free tools to help you cope after a traumatic delivery. Bliss provides support to parents and families of premature or sick babies.

The perinatal period can feel overwhelming for anyone who has or had a disordered relationship with food, body image, or exercise. Pregnancy and the postnatal period often bring new challenges that can trigger or worsen eating disorders.

You may notice:

• Unhealthy behaviours and thoughts around food
• You avoid mealtimes or eating around others
• Intense feelings of fear, shame or anxiety
• Excessively thinking about your body, weight or food
• Difficulties with body image
• Restrictive eating or binge-eating patterns
• You exercise excessively
• Excessive tracking of exercise or food intake
• Secretive behaviours

Support for perinatal eating disorders

Wednesday’s Child offers a community for those recovering from eating disorders, with support available for friends and relatives, too.

Perinatal OCD is an anxiety disorder characterised by obsessions and compulsive behaviours that are often carried out to try to reduce the anxious feelings.

The thoughts may involve worries around your baby’s safety, which can be very distressing.

You may notice:

• Repetitive, unwanted images or intrusive thoughts that something bad will happen to your baby, or that you might cause them harm, deliberately or accidentally.
• Compulsive behaviours aimed at reducing anxiety, such as washing excessively to avoid germs, avoiding certain activities, or repeatedly checking on your baby.

Support for perinatal OCD

The Maternal OCD website has information and resources for new parents and their families.

Tokophobia is an extreme fear (phobia) of childbirth and, in some cases, pregnancy. While it is normal to feel some anxiety about giving birth, tokophobia is more severe.

It can occur in women and birthing people who have never been pregnant or given birth before (primary tokophobia). This is sometimes linked to experiences from childhood or past sexual abuse.

More commonly, it can occur following a previous difficult birth experience or loss (secondary tokophobia). This is a form of post-traumatic stress disorder (PTSD).

It's important to recognise that tokophobia is a mental health condition that requires support and treatment.

Support for tokophobia

Visit the Tommy’s website for more information about tokophobia.