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Perinatal Mental Health (PMH) – During and After Pregnancy

Written by Lara Taylor, Specialist Midwife

Mental health in pregnancy is known as Perinatal mental health, you may never have heard of it, or known anyone who has suffered with it, but it’s so important to understand what to look out for and when to ask for help.

Firstly, we all have mental health, just as we all have physical health and let me say, both are equally important!  Our mental health determines how we think, feel and act and it can change depending on our life experiences, and having a baby can be one of those times.  

It’s reported that 70%* of mums and mums to be will hide, or underplay maternal mental health difficulties…so why is that? Well often there can be feelings of shame associated with mums who are struggling during pregnancy and following birth. The distress of not being perfect, or not being able to cope, as well as fearing what the consequences may be, can be truly overwhelming.

I can’t tell you how often I’ve heard “I was worried my baby would be taken away from me”. Hearing that makes me incredibly sad and let me reassure you, it’s extremely rare that this happens, keeping mum and baby together is always a priority.

So What exactly is PMH?

Perinatal mental health (PMH) or Maternal mental health is the term used to describe the impact pregnancy can have on someone’s emotional and psychological well- being both during pregnancy and for up to 2 years after giving birth. Whenever, I ask the ladies in my care what they determine ‘mental health in pregnancy’ to mean, the most common answer is the Baby-Blues, or Postnatal Depression, but the reality is, it’s so much more than that. 

Whilst there is a great awareness of emotional and mental health problems that can occur after baby is
born, many don’t realise that these same feelings can happen during pregnancy too!

We’re talking conditions such as:-

  • Anxiety
  • Low Mood
  • Obsessive Compulsive Disorder (OCD
  • Post Traumatic Stress Disorder (PTSD)
  • Birth trauma
  • Psychosis
  • Eating disorders

All of these can be identified as (PMH) - Perinatal Mental Health conditions.  
1 in 5 women will experience PMH in pregnancy, or for the first year after giving birth.** So, let’s explore this important topic together, to not only raise awareness but furnish you with an abundance of information, so you can look after your own and others’ mental health, and identify when help might be needed.

What’s normal for me? 

It’s a good question! During your pregnancy it’s normal to alternate between happiness, tearfulness and maybe even mild irritation, with feelings of anticipation thrown in. After all, you are coming closer to a new and unknown chapter in your life with the arrival of your baby, so it’s quite understandable to have some concerns around giving birth and how you will adapt to life as a new parent. In fact, I’ve never
met anyone that hasn’t felt like that, pregnancy is a big life event and let’s face it, it’s
totally life changing!

So, while some degree of stress and anxiety is normal, if you do find negative, intrusive or apprehensive thoughts and feelings are dominating, and are beginning to impact on your ability to function from day to day, then be aware this could be a sign that you are suffering with PMH.

Perinatal anxiety and depression are the two most common PMH symptoms, but unfortunately, as their early signs are often also associated with the many hormonal changes we experience during this time (yes, here they are again, those hormones!!) PMH conditions can sometimes go unrecognised…and more worryingly untreated.

What’s The Difference Between Postnatal Depression and the Baby-Blues?

One question I often get asked is what is the difference between feeling a little weepy and something more serious such as postnatal depression?  

The 'Baby-Blues' presents around days 3 to 10 after giving birth, with feelings of low mood, feeling emotional and tearful. Believed to be caused by the sudden chemical and hormonal changes that happen to the body after childbirth, it usually lasts for a brief period of time and is quite manageable.
Postnatal depression usually develops within six weeks of giving birth and it can be gradual or sudden. It’s a much deeper and longer-term condition, which can range from being mild to very severe.

So for me, I suppose it’s about self-awareness, you may find you’re unable to concentrate for long periods of time, with your mind being easily distracted. You may be eating less or find yourself totally disinterested in food. We’ve all heard the term ‘eating for 2’ but the calorie requirements only slightly increase in the 3rd trimester so if you’re eating significantly more in pregnancy, this too can be a symptom that something may not be quite right with your mental health.

Pregnancy can be uncomfortable and effect your sleep pattern, ongoing lack of sleep can negatively impact your emotional wellbeing and can worsen any conditions that you may already be experiencing. So whilst not being able to sleep and wanting to sleep constantly can be a common pregnancy symptom, it can also be a sign that something isn’t quite right, such as antenatal depression or anxiety.

What else should I look out for?

If you’re worried about a decline in your mental health, maybe answering these
questions will help determine if you need to ask for help: 

  • Are you having troublesome new thoughts and feelings which you have never experienced before? 
  • Are you feeling disturbed or anxious? 
  • Do you have little interest or pleasure in doing things? 
  • Are you thinking you’re a bad mum, or like you can’t cope and are feeling down about yourself?
  • Do you feel disconnected from your baby? 
  • Are these feelings getting increasingly worse?  
  • Are you experiencing thoughts of suicide, self-harm, or violence towards others?

If you’ve agreed with any of these statements, I really would recommend you reach out to a health care professional and seek support.

Will I Be More Susceptible if I Already have a Mental Health Condition? 

Perinatal mental health conditions can have significant impacts on women and birthing people, as well as their families. Even though we don’t know exactly why they happen, there can be many reasons why they may develop. Your experience of mental health will be individual to you, just like your pregnancy experience. But if you have a history of mental health problems in the past, being pregnant or having a baby can increase the risk of them recurring and should be discussed with your midwife.

It’s important to be aware that sometimes (PMH) will present with no symptoms or early warning signs, with Postpartum Psychosis for instance, there can be a sudden onset typically 3-10 days after birth with signs of delirium, hallucinations, and severe mood symptoms. It’s particularly important to be aware of this if there is a history of previous mental health issues. These symptoms do need immediate action and assessment .

I can’t stress enough that reaching out is a sign of strength, it’s a way of looking after yourself, which in turn will help take care of your baby.  Let’s encourage an openness around mental health. We all need care and support, not shame and stigma!

Who Can I Go To For Help? 

Never be afraid to speak to your midwife about any pre-existing health conditions, physical or mental. I know for me being aware of someone’s medical circumstances and support needs early on can make all the difference to the care I give. It helps me to identify when things aren’t going well, to refer on and make sure the right support is in place before it becomes an issue.

And there is so much support available from your local Mental Health Midwife, the Perinatal Mental Health Team and also Community Mental Health Teams, especially if you have a pre-existing mental health condition, and you can be referred on until at least 1 year post birth. If you have been discharged from Midwifery services, your health visitor will be able to take care of your referral needs alongside your GP.  

You can also find a local NHS urgent mental health helpline here:
NHS urgent mental health helpline

Lara’s Tips for staying well. 

  • Do talk about your feelings to a friend, family member, doctor or midwife. 
  • Do try calming breathing exercises if you feel overwhelmed, box breathing is great to put the body into a naturally relaxed state.  
  • Do have routine: having a little structure to your day can really help improve your mood and gives reassurance. Maybe write a daily schedule, flexible of course, and include short and simple activities that you enjoy.  
  • Do put some time aside to relax, no matter how brief it can really help. Even 10 mins is great! 
  • Do look after your physical health: Exercise or a simple walk in nature is known to improve mood and can help you sleep. 
  • Do look after your sleep, it affects so much and can really help recovery.  
  • Do eat a healthy diet with regular meals and stay hydrated: the body needs this for survival. 
  • Do try to attend birth preparation classes, or baby classes to meet others in a similar situation.  
  • Do spend as much time with your baby; it helps boost that Oxytocin, (the love and feel-good hormone). 
  • Don’t stop taking your usual medication when pregnant without medical consultation, it’s so important to speak to a specialist who will carry out an individual risk assessment.  
  • Don’t compare yourself to others. Everyone experiences pregnancy in different ways. 
  • Don’t be afraid to tell healthcare professionals how you are feeling, they are there to listen and to support you. Remember expert help is always available.
  • Don’t think you have to be superwoman, and do it all, let others help out.
  • Don’t forget dads…their Mental Health matters too. 

 If you’re identifying with any of the topics in this blog, or know someone who is, PLEASE take the first step and reach out to someone. My biggest hope is that you share your feelings, especially with your health care providers. With such high rates of women suffering you can see why suicide is the leading cause of maternal death in the first postnatal year, it’s so important we raise awareness.**

For more information and support  
Home – PANDAS Foundation UK

Free helpline phone 0808 196 1776
What’s app support available every day from 8am – 10pm via WhatsApp on 07903508334

Tommy's: mental health before, during and after pregnancy 
Call: 0800 014 7800 from Monday to Friday, 9am to 5pm, for free 
Email: midwife@tommys.org

Mind: postnatal depression and perinatal mental health 
Call: 0300 123 3393
Email: info@mind.org

Maternal Mental Health Alliance: COVID-19: Looking after your mental health during pregnancy and after birth


* Guide for integration of perinatal mental health in maternal and child health services, World health organisation, Geneva, 2022

** Strengthening perinatal mental health, Royal College of Midwives, London, 2023

*** MBRRACE-UK. Saving Lives, Improving Mothers' Care State of the Nation Surveillance Report: Surveillance findings from the UK Confidential Enquiries into Maternal Deaths 2019-21. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2023.

About the

Lara Taylor, Registered Midwife BSc Hons

Independent Specialist Midwife and NHS Midwife, Educator and Trainer.
Specialist knowledge in Pregnancy loss, Teenage
pregnancy, Safeguarding, Mental Health, Fertility
and baby brain development.

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