If you have had in the past, or now have, severe mental health problems, you are more likely to become ill during pregnancy or in the first year after giving birth than at other times in your life. Severe mental health problems include bipolar affective disorder, severe depression and psychosis. After giving birth, severe mental illness may progress more quickly and be more serious than at other times.
Other less severe mental health problems may also become more problematic during these times, though this might not necessarily happen to you. Everyone is different, with different triggers for becoming unwell. You may also worry about becoming unwell.
There is help and support, so don't be afraid to talk about how you are feeling with your midwife, GP or psychiatrist – they will be happy to discuss your particular problem and care with you.
Women may feel more vulnerable and anxious while pregnant and after the birth, so your midwife, GP and health visitor should ask you about your mental health. This will give you the opportunity to talk about any concerns and to get help if necessary.
Sometimes people who have a mental health problem stop taking their medication. If you do this without talking to your doctor or midwife when you become pregnant, this can make your illness return or get worse, so it's important to talk to them before making any changes.
What care should you expect?
When you have your first antenatal appointment you should be asked if you have ever had problems with your mental health in the past, and whether you have been bothered by feeling down, hopeless or unable to enjoy things lately. You should also be asked about this again following the birth of your baby. These questions are asked of every pregnant woman and new mum, not just those who have (or have had) mental health problems.
Asking these questions, and listening to the answers, allows your care team to identify if you are currently unwell or assess if you are at risk of becoming mentally unwell during pregnancy or after giving birth. It is also an opportunity for you and your midwife, GP or health visitor to discuss any mental health problems, treatment and care options, and what this may mean for you, your pregnancy and your baby.
If you, your midwife or your health visitor think you may have a mental health problem, you should be assessed by your GP.
If you have – or have had – a severe mental illness, your midwife or doctor should develop a care plan with you in the first three months of your pregnancy, and you may be referred to the perinatal mental health team or your local community mental health team. Your care plan can include input from your family and carers too, if appropriate. The plan should be written down and given to you, and be recorded in your medical notes.
Sometimes – not always – a mental health problem can cause you to miss appointments. If this happens while you are pregnant, it may mean you miss important health checks. This could increase your risk of pregnancy-related complications that would otherwise have been picked up.
Treatment for mental health problems in pregnancy and after giving birth can include psychological treatments and medication. You can find out more information about treating mental health problems during pregnancy and after birth.
Taking medication may carry risks for your unborn baby, but if you don't take medication that has been prescribed for you, or you stop taking it, there is a risk that you might become seriously unwell and this can be a risk too. You and your doctor should discuss the risk of treating or not treating your illness, as well as the risks to the developing baby of taking medication.
Your discussion should include:
- how severe any previous mental health problem was
- the risk of you becoming unwell
- whether you can cope without treatment
- which treatments have helped you in the past, and
- the risk to the unborn baby of some of the drugs used in treating mental health conditions
You can also talk about whether the options will affect breastfeeding.
Find out more about mental health problems and medications in pregnancy.
Feeling down or anxious
If feeling down is affecting your everyday life but you don't have a specific mental illness, you should be offered support to help you manage your feelings. This support could be from health professionals, voluntary organisations or other services. You may be offered psychological treatment (usually cognitive behavioural therapy or psychotherapy) if you have anxiety or depression.
The 'baby blues'
The "baby blues" is a time when you may feel low and tearful, and it usually occurs in the first week after the birth. It's a result of the normal hormonal changes taking place in your body and affects many new mothers. However, pregnancy and birth can trigger more serious depression in some women.
Symptoms that may indicate you are depressed include:
- feeling very sad and hopeless
- negative thoughts about yourself
- not sleeping well
- a lack of interest or pleasure in doing things
- loss of appetite
Find out more about symptoms of depression.
Because your GP will continue to treat you after your pregnancy is over, he or she will always be involved in your mental health care. However, if your illness is severe, your GP will refer you to the local perinatal mental health team for specialist care. This team can help develop a care plan for you. In some areas you may be referred to your local community mental health team.
If you're taking antidepressants already, you should continue to take them. Consult your doctor or psychiatrist as soon as you decide to start trying for a baby, or as soon as you learn you are pregnant, to discuss any risks associated with taking or stopping your medication during pregnancy and while breastfeeding.
Some drugs that are used to stabilise mood may increase the risk of physical defects and development problems in the unborn baby. After talking to you, your doctors may decide to change or stop the medication you are taking, but you should not alter your drug treatment or stop taking treatment without specialist advice, especially during pregnancy.
The medication sodium valproate is known to increase the risk of physical and neurological (brain) problems in the unborn baby. The National Institute for Health and Care Excellence (NICE) states that women of childbearing age should not be prescribed sodium valproate for mental health problems if they are planning a pregnancy, pregnant or breastfeeding.
If you are taking sodium valproate and you are planning to get pregnant, or you have found out that you are pregnant, see your GP or consultant immediately to discuss your treatment. Do not stop taking your medication until you have had a discussion with your doctor.
If you have mild depression, your doctor may suggest other treatments such as counselling. These may also be offered if you develop depression after the birth.
Developing depression after your baby is born is called postnatal depression (PND). It usually begins some time during the first six months after the birth. PND can last for more than a year if untreated, but the earlier it is diagnosed and treated the quicker you will recover.
Who is at risk?
Depressive illness occurs in around one in 10 new mothers in the year following the birth of their baby. Most will only have mild depression, but some develop a severe depressive illness. Other mothers develop severe mental health problems such as postpartum psychosis (a rare psychiatric illness affecting one in 1,000 women who have a baby) and require specialist help.
Your health visitor should discuss how you're feeling after the birth, but warning signs to watch out for include:
- feeling irritable and angry
- crying or often being on the verge of crying
- feeling unable to cope
- having negative thoughts about yourself, such as "I am a bad mother"
- worrying unnecessarily about things that wouldn't normally bother you
- excessive worry about your baby's health
- being afraid of being left alone with your baby
- uncontrollable feelings of panic
- overwhelming fears, for example fear of dying
- dreams about harming your baby
- sleeping problems
- feeling exhausted and lethargic
- lack of interest in your surroundings and appearance, or becoming obsessively tidy
- trouble concentrating and feeling distracted
- gaining or losing large amounts of weight
- loss of pleasure in activities you usually enjoy, including loss of libido (sex drive)
- feelings of guilt that you're a bad mother
If you think you may be depressed, talk to your doctor, midwife or health visitor as soon as possible, as they can arrange suitable care for you.
What you can do
Although the best way to treat depression is to seek help from a healthcare professional, there are steps you can take yourself to reduce your chances of developing depression and help you recover once you've been diagnosed.
Try to avoid:
- doing too much – cut down on other commitments when you're pregnant or caring for a new baby
- getting involved in stressful situations
- drinking too much tea, coffee, alcohol or cola, which can stop you sleeping well (find out more about alcohol, medicines and drugs)
- moving house
- being too hard on yourself or your partner
The website of the Royal College of Psychiatrists has more information about postnatal mental health, including puerperal psychosis. Click on "postnatal mental health" in the list on the RCP's Problems and Disorders page.
You can also read guidelines from the National Institute for Health and Care Excellence (NICE) on Mental health problems during pregnancy and after giving birth.