Having a baby is a big change in every family’s life. You will experience a wide range of different feelings during pregnancy and after giving birth, but if you feel that these feelings are starting to impact on your day to day life, you may need some further support with your mental health.

During the perinatal period (from conception until your baby’s second birthday), 1 in 5 women and 1 in 10 men will experience a mental health disorder. This may include (but is not limited to) depression, anxiety, Obsessive Compulsive Disorder (OCD), Post-partum psychosis, tokophobia (extreme fear of childbirth) or Post Traumatic Stress Disorder (PTSD).

It can be useful to familiarise yourself, your partner and your family with some of the associated symptoms so that you are able to access support from professionals in a timely manner. Your Health Visitor can offer support and signpost to local services. It is routine for your Health Visitor to ask about your mental health at all appointments.

Baby Blues are extremely common. Around 85% of new mothers will experience mild mood fluctuation occurring within the first few days of having their baby and up to two weeks after birth. You may feel tearful, unhappy and irritable. However, these feelings are usually associated with hormonal changes and resolve once your hormones stabilise. If these feelings persist or worsen you may be experiencing postnatal depression.

During the perinatal period you may experience symptoms of depression such as:

  • Being tearful and low in mood
  • Being irritable and agitated
  • Not finding any pleasure in life or things you would usually enjoy
  • Withdrawing from people or activities
  • Feeling guilty or like you are letting people down
  • Being restless and finding it hard to sleep or relax
  • Reduced appetite or overeating
  • Difficulty bonding with your baby
  • Suicidal feelings or self-harm

Anxiety also effects 1 in 5 mothers and can be experienced alongside perinatal depression. Symptoms of anxiety may include:

  • Feeling tense, nervous and on edge
  • Asking for reassurance more than usual or worrying that people are angry and upset with you
  • Thinking about things that have not even happened yet
  • Feeling your mind is really busy and ‘full up’ with thoughts
  • Dwelling on negative experiences, or thinking over a situation again and again (this is called rumination)
  • Feeling restless and not being able to concentrate
  • Having panic attacks
  • Feeling numb which may impact your relationship with your baby.

Self Help

Some things you can do to help improve your mental health, include:

  • Ensuring you are eating a varied, healthy diet and keeping well hydrated.
  • Trying to get regular sleep/rest-although this may be hard with a baby, so try to turn to those around you to support with this, your friends or family. 
  • Using techniques like meditation and mindfulness via Apps such as Calm and Headspace.

Talking Therapy

If you require talking therapy you can be referred or self-refer to your local NHS Talking Therapies service.

Medication

Medication should be discussed with and prescribed by your GP or Perinatal Mental health team. Anti-depressants are typically the first line treatment for depression or anxiety. Most medications are safe to take in pregnancy or when you are breastfeeding, nevertheless your GP, pharmacist or mental health team can advise you about this if you are concerned. It is important not to stop taking any medication without seeking medical advice even during pregnancy.

Sometimes a combination of medication and talking therapies will be offered to support you through your journey of recovery.

2-3% of mothers experience perinatal OCD, though newer evidence suggests this figure to be higher. If you start to experience obsessive thoughts and compulsive behaviours that affect your daily life and wellbeing, you may be experiencing perinatal OCD. The obsessions and compulsions are likely to relate to feelings about being a parent and your baby.

Obsessions are: unwelcome thoughts, feelings, images, urges, worries or doubts that keep coming into your mind. They may feel stuck in your mind, no matter what you do. You may worry what they mean or why they won't go away. And you may feel very distressed by them. Examples could be:

  • Intrusive thoughts about hurting your baby, during or after pregnancy
  • Disturbing thoughts of sexually abusing your child
  • Fear of being responsible for giving your baby a serious disease

Compulsions are: repetitive things that you do to reduce the distress or uncertainty caused by obsessions. Compulsions can be things you do physically, like repeatedly checking a door is locked. Or they can be things you do in your head, like repeating a specific word to yourself. Or they may involve others, such as asking people for reassurance. Further examples may include:

  • Excessive washing of clothes, toys or bottles
  • Avoiding changing soiled nappies because you're worried about accidentally touching your baby inappropriately
  • Keeping your baby away from other people in case they hurt them or contaminate them
  • Constantly checking your baby – for example, waking them up when they're asleep to check on them
  • Repeatedly asking people around you for reassurance that your baby hasn't been hurt or abused

These thoughts can be very upsetting and frightening. But they're not your fault. Having an intrusive thought doesn't mean that you want to act on it, or that you will act on it.

Treatments for perinatal OCD

OCD is a treatable condition so if you're worried that you're experiencing perinatal OCD, talk to your GP or health visitor. CBT and other talking therapies may be offered alongside medication to relieve symptoms.

Postpartum Psychosis (PPP) (can also be called Puerperal Psychosis or Postnatal Psychosis) is a severe, but treatable mental illness which affects around 1-2 in 1000 women in the first days or weeks after giving birth. Women who have a diagnosis of Bipolar Affective Disorder or other severe mental illness are at an increased risk of developing PPP but it may occur completely ‘out of the blue’ for a woman with no history of mental illness. Those with a family history of Bipolar or PPP are also at greater risk. If this applies to you, please make sure you discuss this with your Midwife at your antenatal contacts so that they can refer you to the Perinatal Mental Health Team for review.

It is not known exactly what causes PPP, but there are likely to be many factors including genetics, hormone changes and sleep disturbances that contribute.

Symptoms of PPP may include:

  • Being elated, excited or ‘high’
  • Depressed, anxious or confused
  • Excessively irritable or changeable in mood
  • Delusions (strange beliefs that are untrue)
  • Hallucinations (Seeing/hearing/feeling/smelling things that are not there)
  • Mania (high mood, losing touch with reality)
  • Severe Confusion

PPP is considered a medical emergency as symptoms can deteriorate rapidly. If you suspect Postpartum Psychosis, consult with a medical professional immediately. If there is any chance of risk to the person with PPP, the baby they are caring for or those around them, please call 999 or attend A+E.

Most women will require treatment with medication and may need to be admitted to hospital. Sometimes women and their baby, are admitted to places called Mother and Baby Units (MBU) which provide specialist mental health support from a multidisciplinary team including Nursery Nurses, OT’s, Psychologists and Psychiatrists. With the right support and treatment, most women will make a full recovery.

Studies show that about one in 10 men experiences mental health difficulties in the first six months after baby arrives, with first-time dads and younger dads particularly vulnerable. Adjusting to fatherhood can be both a joyous and worrying time. Coping with role transitions, relationship changes and financial stress can impact on a new fathers mood and anxiety. In addition lack of sleep, broken routines and hormonal changes can exacerbate these feelings. The symptoms for dads can vary but may include:

  • Sadness
  • Frustration
  • Anger
  • Isolation
  • Alcohol/substance misuse
  • Somatic symptoms – indigestion, diarrhoea, earache, toothache

It is as important for fathers to access support for their mental health as it is for mothers. Seek advice from your GP, Health Visiting team or midwife.

What to do in a crisis - please seek help!

  • If someone is in immediate danger or they are a danger to others, call 999 or attend A+E with them.
  • Call Oxleas Mental Health Crisis Line for Bexley, Bromley & Greenwich 0800 330 8590 – this is a 24 hour telephone service that provides support, advice and information for people in crisis and their carers, family and friends. 
  • Speak to your Mental Health Team if you are under one (this information would be on your Care Plan/Crisis Plan), your GP or another medical professional, like a Health Visitor or a Midwife if you are working with them. 
  • Call 111.  
  • Call the Samaritans for free on 116 123 (24 hours a day)