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Pregnancy is often a very happy and exciting time. But not every woman feels this way. You may have mixed, or even negative, feelings about being pregnant. You may find it more difficult than others to cope with the changes and uncertainties which pregnancy brings. Many things can affect how you feel in pregnancy. These include physical symptoms (e.g. morning sickness), the support you have (or don’t have), and stressful events in your life.
Women often worry about how they will cope with pregnancy or having a baby. It’s normal to feel stressed or anxious at times. When you are pregnant, it is common to worry about:
As many as 1 in 5 women have mental health problems in pregnancy or after birth. It can happen to anyone. Depression and anxiety are the most common mental health problems in pregnancy. These affect about 10 to 15 out of every 100 pregnant women. Just like at other times in life, you can have many different types of mental illness and the severity can vary. You may already have had a mental illness when you became pregnant.
Mental health problems you have had in the past can be worrying because they can increase the risk of becoming unwell, particularly after birth. However, with the right help this can often be prevented. You can also develop mental health problems for the first time in pregnancy or after birth. How your mental health is affected during pregnancy depends on many things. These include:
Symptoms of mental illness in pregnancy are similar to symptoms you have at other times, but some may focus on the pregnancy. For instance, you may have anxious or negative thoughts about your pregnancy or your baby. You may find changes in your weight and shape difficult, particularly if you have had an eating disorder.
Sometimes symptoms caused by your pregnancy can be confused with symptoms of mental illness. For example, broken sleep and lack of energy are common in both pregnancy and depression.
You should be referred to a mental health service if you are pregnant and have ever had:
It is important to get specialist advice even if you are well during this pregnancy. Women who have had these illnesses have a high risk of becoming unwell after birth. Your midwife or GP can refer you to a perinatal mental health service if there is one in your area, or otherwise to a community mental health team. Mental health professionals can discuss care and treatment choices with you. They will help you make a plan for your care, with your midwife, obstetrician, health visitor and GP.
If you have had any other mental health problems, talk to your GP. Even if you don’t need to see a mental health team it helps to get advice and support, so you can stay as well as possible. Often your GP will be able to advise about care and treatment. This will depend on the illness you have had and how severe it has been. You can also get support from some of the organisations listed at the end of this page.
It’s just as important to have treatment for mental health problems as it is for physical health problems in pregnancy. The best treatment for you will depend on your illness and how severe it has been. Both medication and psychological therapies (talking treatments) can help.
Medication
Any woman may need to take medication for many different physical and mental health problems before, during and after pregnancy. Decisions about whether to continue, change or stop medications in pregnancy are not straightforward or easy. Some medications have been used in pregnancy for many years. A few medications, such as Valproate, are known to cause problems in some babies and so should not usually be used at all in pregnancy. In many cases, we simply do not have enough information to be absolutely sure that a treatment is safe. It is important to weigh up the risks and benefits of taking medication in your individual case. Your GP or psychiatrist can help you decide what is best for you and your baby.
If possible, you should talk to your doctor before you become pregnant. However, many pregnancies are unplanned. This means it’s common to have to make decisions about medication when you are already pregnant. In that case, you should see your doctor as soon as possible. It is very important that you don’t stop your medication suddenly, unless your doctor tells you to. Stopping treatment suddenly can make you relapse and can cause unpleasant side-effects.
It may be best for you to continue medication during pregnancy. But - there are many things you need to think about when making decisions about using medication in pregnancy. These include:
Psychological therapies
A talking treatment may be helpful. For some women this can be used instead of medication. Others may need a talking treatment as well as medication.
Psychological therapies services should see you more quickly if you are pregnant. Your doctor can advise you about referral in your local area.
A number of services and professionals offer help and support during pregnancy and early parenthood. They will help you to stay as well as possible and to manage any illness and the recovery process.
Maternity services
Your midwife will ask questions about your physical and mental health (9). You should tell your midwife if you have had mental health problems. She can ensure you get the care and support you need. It is important that you attend your antenatal appointments during pregnancy. In some areas midwives can visit you at home.
Your GP
You should talk to your GP if you are worried about mental health problems in pregnancy. Your GP can provide information, advice and treatment. He/she can refer you to a mental health or psychological therapies service if needed.
Community Mental Health Teams (CMHTs) and Specialist Perinatal Mental Health Services
If you are already under the care of a CMHT, you should tell your care co-ordinator that you are pregnant. She/he can tell you about treatment and support available for pregnant women, and new mothers, in your area.
Perinatal Mental Health Services are specialist mental health services for pregnant and postnatal women. Often these teams work jointly with CMHTs. Your GP, CMHT, midwife or obstetrician can tell you whether this type of service is available in your area and refer you.
If you are not under the care of a CMHT, but have been in the past, you should talk to your GP. Even if you are well, you may need the support of a Perinatal Mental Health Service or CMHT during pregnancy and for a few months after birth. This will depend on the type of illness you have had.
Children and Families Social Services
In some cases your doctor, midwife or another professional may want to refer you to Children and Families Social Services. Social workers from Children and Families Social Services focus on children’s wellbeing. They provide a range of care and support for children and families. This depends on the needs of the child and other family members. The professional who wants to refer you will discuss the reasons for this with you. Having social services help may seem daunting, but they are there to provide you with help and support.
Health Visitor
Health visitors see all women with new babies. They offer advice about your baby’s health, feeding, sleep and other issues. In some areas health visitors may see you even before your baby is born. Your health visitor will ask you about your mental health. She can support you and refer you to other services for support and treatment if you need it.
Tommys (www.tommys.org/pregnancyinformation/impregnant/mentalwellbeing/specific-mental-health-conditions)
Information and support about many aspects of pregnancy, including mental health. Advice from midwives: 0800 014 7800 or midwife@tommys.org
National Childbirth Trust (www.nct.org.uk)
Practical and emotional support in all areas of pregnancy, birth and early parenthood. Antenatal and postnatal courses. Local networks where you can meet other parents. Support line: 0300 330 0700
Netmums (www.netmums.com)
Help advice and support on a wide range of pregnancy and parenting issues, including mental health. Netmums parent supporter service (www.netmums.com/support/netmumsparentsupporters). Netmums online helping with depression course for women with mild to moderate depression is based on CBT and (www.netmums.com/support/netmumshelpingwithdepressionsignup).
Maternal OCD (https://maternalocd.org/)
A charity set up by mothers recovered from perinatal OCD, who can provide support via email, twitter and skype. Contact: info@maternalocd.org
Action on Postpartum Psychosis (www.appnetwork.org)
National charity providing information and support for women and families affected by postpartum psychosis. On-line peer support and one-to-one support. Run by a team of academics, health professionals and women who have recovered from postpartum psychosis. Tel: 020 3322 900; email: app@appnetwork.org
Bipolar Disorder, Pregnancy and Childbirth (www.appnetwork.org/wp content/uploads/2014/09/BipolarPregnancyChildbirthBooklet.pdf)
Information about pregnancy and childbirth for women with Bipolar Disorder and their families. This guide has been produced by Action on Postpartum Psychosis, Bipolar UK and the National Centre for Mental Health.
The Association for Postnatal Illness (APNI) (https://apni.org/)
Telephone helpline and information leaflets for women with postnatal mental illness. Also a network of volunteers (telephone and postal) who have experienced postnatal mental illness. Email: info@apni.org Tel: 020 7386 0868
PANDAS Foundation (www.pandasfoundation.org.uk)
Support and advice for women with perinatal mental illness and their families.
Helpline: 0843 2898401. Email Support:info@pandasfoundation.org.uk
Best Use of Medicines in Pregnancy (BUMPS) (www.medicinesinpregnancy.org/)
Factsheets about the use of medications in pregnancy, including antidepressants, antipsychotics and mood stabilisers.
Baby Buddy / Best Beginnings (www.bestbeginnings.org.uk)
Baby Buddy App with information in the form of video clips about many aspects of pregnancy and parenting,
including mental health.
Family Action (www.familyaction.org.uk)
Support and practical help for families affected by mental health problems and other challenges such as substance misuse and domestic violence. Contact: T: 020 7254 6251. E: info@familyaction.org.uk
Further reading
Curham, S. Antenatal & Postnatal Depression. Practical advice and support for all sufferers. Vermilion, 2017
Information adapted from Royal College of Psychiatrists © November 2018.
This webpage provides information, not advice.