Mental health and pregnancy

Being pregnant and having a new baby are major life-changing events. So it’s hardly surprising that they stir up your emotions in a big way. But as well as feeling happy and excited, you may also feel anxious or uncomfortable, and your moods may be all over the place.

If you develop difficulties with your mental wellbeing any time from when you become pregnant to a year after giving birth, it’s called a perinatal mental health problem. Nobody knows exactly why some people are affected while others aren’t, but we do know it can happen to anyone, whatever your age, social background, race or medical history.

According to the Royal College of Obstetricians & Gynaecologists, while estimates suggest one in five women develops a perinatal mental health problem, the real figure may be far higher (its own survey suggests 81 per cent of women experience at least one perinatal mental health condition during or after their pregnancy (i)).

RCOG’s survey also reveals 69 per cent of women are affected perinatally by low mood, with 49 per cent affected by anxiety and 37 per cent by depression. Meanwhile, 95 per cent of women with a previous history of mental health problems go on to experience them during or after pregnancy, the survey also suggests.

However perinatal mental health problems don’t just affect pregnant women and new mums. According to the NHS, fathers and partners can become depressed after the birth of a child too, with partners of women with postnatal depression more likely to become depressed themselves (ii).

What are the common mental health problems during pregnancy?

The most common mental health problems during pregnancy, says the National Institute for Health and Care Excellence (NICE), are depression and anxiety (around 12 per cent of women experience depression and 13 per cent anxiety at some point, though many women, adds NICE, will experience both (iii)). Depression and anxiety also affect 15 - 20 per cent of women during the first year after childbirth. Other perinatal mental health problems – which can affect women on their own or alongside depression – include:

• Panic disorder (sudden attacks of panic or fear)

• Obsessive-compulsive disorder (OCD – having obsessive thoughts and compulsive behaviours

• Post-traumatic stress disorder (PTSD – having flashbacks, nightmares or feeling very distressed after having a traumatic previous pregnancy)

• Eating disorders (according to NICE anorexia nervosa and bulimia nervosa are less common during pregnancy but binge eating disorder is more common (iii)).

• Tokophobia (an extreme fear of giving birth).

Why does it happen?

Generally speaking there is no single reason why some people develop perinatal mental health problems. The exception, according to the mental health charity Mind, is postnatal PTSD, which is typically triggered by having a difficult birth (iv).

Rather there may be a combination of factors that contribute to the development of a perinatal mental health problem, some of which include:

• Having previous experience of mental health problems (if you’ve already had a mental health problem, being pregnant and having a baby can increase your risk of it happening again).

• Biological causes (hormonal changes during and after pregnancy, for instance, may affect your moods – though the fact that not every woman experiences perinatal mental health problems suggests hormones aren’t the only factors at play).

• Lack of support (women who don’t have people around them who can help can be more likely to develop a perinatal mental health problem).

• Difficult childhood experiences (having parents who struggled with bringing up children, for instance).

• Experience of abuse (according to Mind, if you experienced abuse in the past you may be more likely to develop perinatal mental health problems (iv)).

• Low self-esteem (this can make you doubt your ability to cope as a parent).

• Stressful living conditions (having money problems, job insecurity or insecure or poor housing can cause anxiety and make you worry that you’re incapable of providing for your baby).

• Major life events (family illness, bereavement, relationship break-ups, losing a job, moving house and other events can be stressful and make you more likely to develop a perinatal mental health problem).

The loss of a child through miscarriage, still birth or sudden infant death syndrome (SIDS) can also have a significant effect on your mental health. If you’ve been affected, help is available from the following organisations:

• The Miscarriage Association

• Sands

• The Lullaby Trust

• Tommy’s

   

What are the common mental health problems?

Here’s what to look out for concerning the most common perinatal mental health problems:

Antenatal depression

This is the term for depression while you are pregnant. While most of us will have heard about postnatal depression – that is, depression that happens for up to a year after the birth of a child – fewer of us may realise that depression during pregnancy is also common. It’s normal to feel down every now and then, but if you’re pregnant and experiencing one or more of the following symptoms, you may have antenatal depression:

• Overwhelming feels of hopelessness and sadness

• Tearfulness

• Loss of interest in doing things you’d normally enjoy

• Loss of energy or excessive tiredness

• Loss of confidence or self-esteem

• Feelings of inadequacy

• Feeling unable to cope

• Significant sleep or appetite changes

• Suicidal thoughts

Postnatal depression

If you were affected by depression during pregnancy, you have a higher-than-normal risk of being depressed after giving birth too – though it’s not inevitable.

While some women develop the symptoms of postnatal depression a week or so after the birth, others may not experience problems for several months. The symptoms of postnatal depression are similar to those of antenatal depression (see above), but they may also include having guilty feelings or feeling indifference towards your baby and a fear of being left alone with your baby.

You can find lots more details in our guide to postnatal depression.

Baby blues

Unlike perinatal depression, the baby blues is considered normal, since so many women are affected by it (more than half of all mothers, says the NHS (v)).

Symptoms, which usually start a couple of days after the birth and can last a few hours to a few days, include:

• Feeling tearful and emotional

• Anxiety and irrational worries

• Loss of appetite

• Sleep difficulties

Because these symptoms are so common and short-lived, there is no treatment usually given for the baby blues. But if the symptoms last more than a week, you may have postnatal depression.

Perinatal anxiety

It’s also normal to be a little anxious when you’re pregnant or after you have a baby – you may worry about being a good parent, for instance, or feel anxious about the birth. But if you’re worried a lot or most of the time, you may have antenatal or postnatal anxiety.

There are many symptoms, including physical ones such as a fast or irregular heartbeat, feeling light-headed or dizzy, feeling sick, having hot flushes or sweating, and having a churning feeling in your stomach. Anxiety can affect your mind too, making you feel tense, nervous, fearful and convinced the worst possible thing will happen. You may need constant reassurance from other people, or you may not be able to get bad thoughts out of your head. Anxiety can also make you feel as if the world is speeding up or slowing down, and that you’re losing touch with reality.

Find out more about anxiety symptoms by reading our guide.

Perinatal OCD

Obsessive compulsive disorder is a type of anxiety disorder thought to affect almost 750,000 people in the UK (vi). If you experience the symptoms during pregnancy or during the first year after having a baby, you’re said to have perinatal OCD.

The symptoms include:

• Obsessions – these are the thoughts that make you anxious. Common obsessions include a need for symmetry or orderliness, a fear of contamination, worrying about things like doors or windows not being locked properly, and a need to keep things other people usually throw away (hoarding).

• Anxiety caused by having your obsessions.

• Behaviours that relieve your anxiety (compulsions). Common behaviours can take the form of rituals such as cleaning and washing your hands repetitively, checking things over and over again, counting, repeating words or phrases in your mind, arranging objects in a strict order or in a certain way and avoiding touching or coming into contact with certain objects. Hoarding can also be a compulsion as well as an obsession.

With perinatal OCD, your obsessions and compulsions are likely to relate to your feelings about your baby and being a parent. For instance you may have obsessive thoughts about hurting your baby or of making bad decisions regarding your baby.

Read more about OCD in our Pharmacy Library guide.

Postnatal psychosis

Also called puerperal or postpartum psychosis, this happens to one in 500 mothers (v) and is a severe form of mental illness.

Postnatal psychosis is more likely to develop in women who have bipolar disorder, a family history of mental health problems or who have had a traumatic birth or pregnancy. Symptoms usually develop quickly, within a week after having a baby, and can include depression, mania, paranoia, delusions and hallucinations. However, while the symptoms are often overwhelming and frightening, with the right support most women recover fully.

Postnatal PTSD

Also a type of anxiety disorder, postnatal PTSD is often called birth trauma, as it can develop as a result of experiencing traumatic events during labour and childbirth.

Some of the symptoms of postnatal PTSD include reliving the trauma by having vivid flashbacks or nightmares. This can trigger physical symptoms such as sweating, nausea, shaking and even pain. You may also feel panicky whenever you’re reminded of what happened, or become irritable, jumpy and aggressive. Other symptoms include trying to avoid any memory of the trauma – by keeping busy, for instance, or feeling physically numb – and having overwhelming feelings of anger, sadness, guilt or shame.

For more information and support for postnatal PTSD, contact the Birth Trauma Association.

Coping with an existing condition

If you have an existing mental health condition or even if you were affected and are now currently well, being pregnant and having a new baby could make you more likely to relapse.

According to the Royal College of Psychiatry, women who are or have been affected by the following should be supported by their perinatal mental health service or community mental health team during and after they are pregnant (vii):

• Women with a serious mental illness such as schizophrenia, bipolar disorder, schizoaffective disorder or severe depression

• Women who previously had postnatal psychosis or postnatal depression

• Women with a severe anxiety disorder such as OCD

• Women with an eating disorder

• Women who have had treatment from mental health services

It’s also important to speak to your GP before you start trying for a baby if you have or you’ve had a mental health condition. That’s because some medications for mental health conditions can make it harder for you to conceive. Some medicines also aren’t suitable to take during pregnancy as well as while you’re breastfeeding, so you must decide whether to change, keep or stop taking them.

Speaking to your GP or specialist can help you make the decision that’s best for you and your baby. They may, for instance, advise you to swap your medication for a psychological therapy – though this isn’t suitable for everyone. Most importantly, never stop a medicine you’re taking for a mental health problem without first speaking to your doctor or specialist, as coming off the medicine too quickly could trigger withdrawal symptoms or make your existing symptoms worse.

Depending on the mental health condition affecting you, you can also get support from one or more of the following:

• Bumps

• Pandas

• Maternal OCD

• Action on Postpartum Psychosis

• The Association for Postnatal Illness

When should you get help?

It’s normal to feel all kinds of emotions when you’re pregnant and after you’ve had a baby. So how can you tell whether what you’re feeling is just normal or a more serious problem developing? If you’ve been feeling depressed for more than a few weeks or if the way you’re feeling is affecting your daily life, it’s a good idea to see your GP. That way if you do need help, you’ll get it sooner than later. And that means you’ll start feeling more like yourself more quickly too.

According to the charity Tommy’s, if you go to your doctor with concerns about your mental wellbeing they may ask questions to help them diagnose any potential problem (viii). Some of the things they could ask may include:

• Have you been bothered by feeling down, depressed or hopeless often during the past month?

• Have you been bothered by having little interest or pleasure in doing things during the past month?

• How often have you been bothered by feeling nervous, anxious or on edge during the past two weeks?

• How often have you been bothered by not being able to stop or control worrying during the past two weeks?

It’s important to try to answer these questions honestly, as it means your doctor will be better able to help you.

What are the treatments for perinatal mental health problems?

If your doctor thinks you need help in the form of treatment for a mental health problem, there are several options they may recommend:

Medicines

Depending on the mental health condition that’s affecting you and how severe it is, your GP may suggest taking medicines such as anti-depressants. You will, however, have to weigh up the risks and benefits of taking medicines during pregnancy – some have been used in pregnancy for many years and there are national guidelines about which ones can be taken during pregnancy.

Talking therapies

Counselling and other talking therapies such as cognitive behavioural therapy may be helpful too. In many cases, psychological therapies can be used instead of medicines. Some women, however, many need therapy as well as medicines. Your GP can advise you about the counselling services available in your area.

Health visits

Additionally you may be offered regular appointments with a health professional. This can help you and your doctor, nurse, midwife or specialist to keep an eye on your symptoms. Your support team can also help you manage your condition by giving you advice about simple, everyday strategies you can adopt to help yourself.

How to look after yourself

You may not have much time for yourself, especially after your baby’s born. But it’s important to find ways to look after yourself, both before and after your baby arrives, as it can have a positive impact on your emotional wellbeing. Getting as much rest as possible is important, even when it seems like you have a never-ending list of tasks to do. Here are some of the other things you can do to make life easier during and after pregnancy:

Get some support

Now isn’t the time to try to cope on your own. Try discussing how you feel with your partner, or if you’re a single mum, talk to a good friend or someone from your family – or anyone you trust. Talking about things that may be worrying or upsetting you is a good place to start, but other people can help in other ways too – by doing some shopping or taking over the housework for a while, for example.

Do one thing for you every day

Try to do something you enjoy every day that makes you feel good, even if it’s just closing your eyes and relaxing for a few minutes. Listening to some of your favourite music can help boost your mood, or why not read a chapter of that novel you’ve been meaning to get round to? Whatever you do, make sure it’s just for you.

Stay active

It’s important to be active while you’re pregnant and also to try to keep moving after having a baby. Not only is it good for your overall health but it can lift your mood too, as exercise makes your body release feel-good hormones called endorphins. However don’t do anything too vigorous – ask your GP or midwife about exercising safely while you’re pregnant and after your baby’s born.

Eat healthily

Having a balanced diet is important during and after pregnancy, as it’s good for your baby as well as your own health. Aim for as wide a variety of foods as possible, as this means you’ll be getting nutrients that will help support your physical and emotional wellbeing while you’re pregnant and also if you’re breastfeeding. There’s more on eating while you’re expecting in our pregnancy guide.

Meanwhile, if you feel too overwhelmed to cook or eat properly once your baby has arrived, try to avoid making fatty, sugary snacks the mainstay of your diet. You can still eat a nutritious diet without spending much time on food preparation. Just aim to eat simple foods that are unprocessed or minimally processed, including five portions of fruit and vegetables every day. If, however, this still sounds like too much pressure and you feel you need some support, talk to your doctor or midwife.

You could also try taking a good-quality multivitamin and mineral supplement – try choosing a specially formulated multivitamin that provides all the essential nutrients women need during and after pregnancy.

Other supplements that may be helpful include:

• Fish oils: The omega 3 fatty acids found in fish oil supplements are useful during pregnancy because they help with the development of your baby’s brain and eyes. However a review of eight clinical studies also suggests omega 3 fatty acids may help with mild to moderate perinatal depression (ix).

• Vitamin D: Official UK guidelines recommend everyone – including pregnant and breastfeeding women – consider taking a daily vitamin D supplement during the autumn and winter, and that some people who have very little or no sun exposure, as well as people with dark skin, may want to take them all year round (x). There’s another good reason to take vitamin D when you’re pregnant. According to many studies, low levels of vitamin D have been linked with antenatal and postnatal depression (xi).

If you want to take a vitamin D supplement the recommended form is vitamin D3 (cholecalciferol), as this is the natural form of vitamin D our bodies make when we’re exposed to sunlight. You can get these in tablet form as well as in veggie-friendly drops. Most vitamin D3 supplements aren’t suitable for vegans, however, since they’re made from the fat of lamb’s wool. But the good news is you can get vegan vitamin D3 supplements available these days that are sourced from lichen.

Breathe deeply

Whenever you feel yourself becoming overwhelmed, try a breathing exercise to help you feel calmer. Stop what you’re doing and sit comfortably. Take a slow breath in through your nose – don’t force it – and imagine the breath is flowing right down into your belly. Then breathe out slowly through your mouth. You can also try counting while you’re inhaling and exhaling – try counting up to five with each in and out breath, and don’t hold your breath in between. Keep going for a few minutes or until you feel more relaxed.

Meet other mums

Talking to other women who are experiencing the same feelings during pregnancy and after the birth can help you feel better emotionally, as it can highlight the fact that you’re not going through this experience on your own. If you’re pregnant, try going to an antenatal class to meet other pregnant women. You could also ask your midwife if there are any local groups for pregnant women and new parents in your area, or join an online forum such as Netmums.

Experiencing mental wellbeing difficulties while you’re pregnant and when you’re a new parent can be a big challenge. But there is help available, plus there are lots of self-help measures that could make your life easier. To find out more about mental health issues that may be affecting you or someone close to you, take a tour around our health library.

References:

1. Available online: https://www.rcog.org.uk/globalassets/documents/patients/information/maternalmental-healthwomens-voices.pdf

2. Available online: https://www.nhsinform.scot/ready-steady-baby/early-parenthood/your-wellbeing-after-the-birth/mental-health-issues-after-the-birth

3. Available online: https://www.nice.org.uk/guidance/cg192/chapter/Introduction

4. Available online: https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/causes/

5. Available online: https://www.ouh.nhs.uk/patient-guide/leaflets/files/130125perinatal.pdf

6. Available online: https://www.nhsinform.scot/illnesses-and-conditions/mental-health/obsessive-compulsive-disorder-ocd

7. Available online: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/mental-health-in-pregnancy

8. Available online: https://www.tommys.org/pregnancy-information/planning-a-pregnancy/managing-mental-health

9. Mi-Mi Zhang et al., The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational Psychiatry. 2020;11(193). Available online: https://www.nature.com/articles/s41398-020-00886-3

10. Available online: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

11. Aghajafari F. et al., Vitamin D Deficiency and Antenatal and Postpartum Depression: A Systematic Review. Nutrients. 2018 Apr ;10(4): 478. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946263/

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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