Mental health in pregnancy

It's common for women to experience mental ill health for the first time in pregnancy. Women may feel more vulnerable and anxious, and some may develop depression.

If you have had severe mental ill health in the past, or have it now, you're more likely to become ill during pregnancy or in the year after giving birth than at other times in your life. Severe mental ill health includes bipolar affective disorder, severe depression and psychosis.

Some women with a history of severe mental illness remain well during pregnancy – everyone is different, with triggers for becoming unwell. It's useful to plan for all situations.

This page has information for:

• women who have previously had mental ill health, and who may be taking medicine for it
• women who want to know about symptoms of mental ill health in pregnancy and what to do if you want help

Whatever your situation, talk to your midwife or doctor – there is help, support and treatment available.

Planning to get pregnant

If you've got a mental health condition and are planning to have a baby, discuss your plans with your GP or psychiatrist.

Your doctor can discuss with you:

• your medicine
• how pregnancy might affect your mental health
• how your mental health might affect your pregnancy
• the care you can expect

This is called pre-pregnancy or pre-conception counselling, and can help you and your doctor plan for the healthiest start for you and your baby.

Talking to your midwife or doctor

During pregnancy, you can talk to your midwife, GP or health visitor at any time if you're worried about your mental health.

Some women worry about telling healthcare professionals how they're feeling because they fear they'll be judged as a parent, or their child will be taken away from their care.

In reality, healthcare professionals work really hard to get mums well so they can continue to look after their children.

During pregnancy and after your baby is born, your midwife or health visitor should also ask 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.

Don't be afraid to tell your midwife or health visitor how you're feeling. This can help them to identify if you are unwell or might become unwell.

It's also an opportunity to discuss any mental health problems, treatment and care options.

The National Institute for Health and Care Excellence (NICE) has a list of questions to ask about mental health problems in pregnancy and the year after birth. These include finding out what's wrong and what treatments are available.

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.

Depression

Pregnancy and birth can trigger depression in some women.

Symptoms that may indicate you are depressed include:

• feeling sad and hopeless
• negative thoughts about yourself
• not sleeping well, even when the baby is, or sleeping too much
• a lack of interest or pleasure in doing things or being with people
• loss of appetite

If you're worried, talk to your midwife or GP and they can discuss your treatment options with you. Find out more about symptoms of depression.

Treatment

If you have, or have had, a severe mental illness, your midwife or doctor should develop a care plan with you. You may be referred to the perinatal mental health team, specially for pregnant women and new mums, or your local community mental health team.

There may be several health professionals involved in your care, including doctors, midwives, specialist nurses, psychologists and health visitors. They should work together so that:

• your care is co-ordinated
• treatment is available when you need it
• information is shared among professionals and with you (and your partner, family and carers if you agree)
• your mental health is taken into account when planning your care

Treatment for mental health problems in pregnancy and after giving birth can include psychological treatments, including talking therapy, and medicine.

Your care team should develop a care plan with you, which will include how often you should see them. The plan should be written down and given to you, and be recorded in your medical notes.

If you need psychiatric inpatient care you should be admitted into a mother and baby unit, so you can stay together with your baby.

NICE has more information about treating mental health problems during pregnancy and after birth.

Medicine in pregnancy

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 medicine or of becoming unwell during pregnancy.

Taking medicine may carry risks for your unborn baby, but if you don't take medicine that has been prescribed for you, or you stop taking it, you might become seriously unwell and this can also be a risk.

The discussion with your doctor should include:

• how severe any previous mental health illness was
• the risk of you becoming unwell
• whether you can stay well without medicine
• which treatments have helped you in the past
• the risk to the unborn baby of some of the medicines 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.

Antenatal appointments

Sometimes – not always – a mental health problem can cause you to miss appointments. If this happens while you're 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.

If you can't make an antenatal appointment, call your midwife to make another appointment.

Postnatal depression

Postnatal depression can start any time in the first year after giving birth. It affects around 1 in 10 new mothers.

Many women feel down, tearful or anxious in the first few days after giving birth. This is often called the "baby blues" and is so common it's considered normal – it doesn't last for more than 2 weeks after the birth.

If your symptoms last longer or start later, you could have postnatal depression. The earlier it's diagnosed and treated, the quicker you'll recover.

Signs of postnatal depression

Your health visitor and GP should talk with you about how you're feeling after the birth, but warning signs to watch out for include:

• a persistent feeling of sadness and low mood
• loss of interest in the world around you and no longer enjoying things you used to enjoy
• lack of energy and feeling tired all the time
• trouble sleeping at night
• feeling you're unable to look after your baby
• problems concentrating and making decisions
• loss of appetite or an increased appetite (comfort eating)
• feeling agitated, irritable or very apathetic (you "can't be bothered")
• feelings of guilt, hopelessness and self-blame
• difficulty bonding with your baby with a feeling of indifference and no sense of enjoyment in their company
• frightening thoughts – for example, about hurting your baby; these can be scary, but they're very rarely acted upon
• thinking about suicide and self-harm

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

The best way to treat depression is to seek help from a healthcare professional, but there are steps you can take yourself to build your resilience and help you recover once you've been diagnosed.

Try to:

• look for the positive things in your life, however hard that may seem
• involve your partner or someone you're close to in your pregnancy and baby
• make time to rest and relax
• be open about your feelings
• ask for help with practical tasks like grocery shopping and household chores
• find out about local support groups (find mental health services near you)
• eat well (find out more about healthy diet in pregnancy)
• organise small treats every day, such as a workout or a coffee with friends (find out about exercise in pregnancy and keeping fit and healthy after the birth)

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

Postpartum psychosis

Some mothers develop severe mental health problems such as postpartum psychosis (a rare psychiatric illness affecting 1 in 1,000 women who have a baby) and require specialist help.

Find out about symptoms of postpartum psychosis and where to get help if it's happening to you or someone you're close to.

If you're already taking medicine for a mental health condition

If you're taking medicine for a mental health condition you should keep taking it.

Consult your doctor or psychiatrist as soon as you decide to start trying for a baby, or as soon as you learn you're pregnant, to discuss any risks associated with taking or stopping your medicine during pregnancy and breastfeeding.

A very small number of medicines may increase the risk of physical defects and development problems in the unborn baby.

After talking with you, your doctors may suggest changing or stopping the medicine you're taking.

Don't alter your drug treatment or stop taking treatment without specialist advice, especially during pregnancy.

Sodium valproate

The medicine sodium valproate can cause serious physical and brain (neurological) and develoment problems in an unborn baby.

If valproate is taken during pregnancy, around 1 in 10 babies are born with birth defects and up to 4 in 10 babies will have developmental problems.

See your GP or consultant immediately if you're taking sodium valproate and:

• you're planning to get pregnant, or
• you have found out you're pregnant

Do not stop taking your medicine until you have had a discussion with your doctor.

Women and girls who are able to get pregnant must not be given sodium valproate unless they have enrolled in a "pregnancy prevention programme". This is designed to make sure they understand:

• the risks of taking sodium valproate in pregnancy
• the need to use effective contraception to prevent pregnancy

As part of a pregnancy prevention programme, you'll need to:

• see your consultant at least once a year to discuss your treatment
• discuss the significant risks of sodium valproate in pregnancy and how important it is to avoid pregnancy
• sign a form stating you understand the risks to your unborn baby if you take sodium valproate, and agree to use effective contraception throughout your treatment

Your doctor may refer you to contraception services.

Your doctor will give you an information leaflet to explain more about the risks and how to avoid them. Keep this information in case you need to refer it again.

If you have mild to moderate symptoms or poor mental health, your doctor may suggest you switch from medicine to other treatments such as counselling.

The Royal College of Psychiatrists' (RCP) website has more information about postnatal mental health. Click on "postnatal mental health" in the general topics list on the RCP's problems and disorders page.