Mind

How to manage your mental health during pregnancy and as a new parent

What are the most common perinatal mental illnesses, and how can you manage them?

It’s common for parents to experience mental ill health any time in the perinatal period - from becoming pregnant to a year and longer after giving birth. A survey conducted by Benenden Health with Netmums users found that almost one in three had suffered from perinatal mental illness in the past.

“Anxiety and depression are common around pregnancy and early parenthood. Eating disorders, obsessive compulsive disorders, psychosis and post-traumatic stress disorder are less common in perinatal health but if you are hit by these, they are more complex but still manageable” says Cheryl Lythgoe.

Cheryl also noted that partners can suffer these mental health issues too. “They feel like voyeurs in a process. They can feel powerless and find it difficult to mentally prepare for having a child, but there is support available for new dads, and single families.” Discover the different support networks out there.

What causes perinatal mental ill health?

Pregnancy and parenthood are big, long-lasting life events which trigger a wide range of new emotions and thoughts. The causes of mental ill health are not always known but for many people it can be a combination of factors including:

Previous mental health problems

Cheryl emphasised how important it is to talk to your doctor or midwife if you have experienced mental health issues before and are planning a family or are expecting a baby. Your GP or midwife can help you recognise possible triggers and talk through what help is available, or they can help you change to safer medication or stop medication.

Hormonal changes

Some studies show that changes to your hormones during pregnancy and after giving birth can cause differences in your mood, but this is unlikely to be the only cause of mental ill health.

Lack of support

Being pregnant and having a baby are major changes which are often stressful, exhausting and overwhelming. Not having people around who can help, like a partner or family, can affect how well you cope and may mean you are more likely to develop a mental health problem.

Difficult previous experiences

If you have experienced abuse, neglect, bereavement, trauma or an unstable family situation this can have a big effect on your feelings about becoming a parent or your self-belief that you have the skills to become the parent you want to be.

Low self-esteem

Very low opinions of yourself can leave you doubting how well you will cope as a parent and can put you at risk of developing mental health issues.

Other major stressors

Stressful living conditions such as financial or housing problems, or major life events such as ill health, relationship break-ups or losing your job all put extra pressure on your coping abilities and may make you more likely to develop a mental health problem in pregnancy or as a parent.

6 most common mental illnesses during pregnancy and after birth

Depression

This can develop any time during pregnancy or within six weeks of giving birth and is longer-lasting than the ‘baby blues’.  Over 35% of the parents we surveyed had experienced perinatal depression. You can read more about perinatal depression.

Anxiety

It’s normal to have worries during pregnancy and early parenthood - almost two thirds of the parents we spoke to had felt anxious at some point. When these become longer-term thoughts or have more intense physical reactions, you may be experiencing anxiety. Perinatal anxiety is common and often people experience anxiety and depression together. Some of the symptoms include:

  • a churning feeling in your stomach or nausea (feeling sick)

  • feeling light-headed, dizzy or having pins and needles

  • feeling restless or unable to sit still

  • headaches, backache or other aches and pains

  • faster breathing or a fast, thumping or irregular heartbeat

  • sweating or hot flushes

  • finding it hard to sleep, even when you have the chance

  • having panic attacks

  • feeling tense, nervous or unable to relax

  • having a sense of dread or fearing the worst or feeling like you can't stop worrying

  • worrying about anxiety itself, e.g. worrying about when panic attacks might happen

  • wanting lots of reassurance from others or worrying that people are angry or upset with you

  • thinking a lot about bad experiences, or thinking over a situation again and again

Obsessive-compulsive disorder (OCD)

It’s natural for parents-to-be and new parents to worry about the baby’s wellbeing and to want to protect it but if these thoughts become intrusive and you have the urge to do something repetitively to relieve the mental discomfort, you may be experiencing OCD.

OCD has two main parts - obsessions and compulsions:

  • Obsessions are unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind. They can make you feel very anxious, although some people describe it as 'mental discomfort' rather than anxiety. Common perinatal obsessions are the fear of making the wrong decision e.g. about vaccinations or medical treatment, or intrusive thoughts about hurting your baby, during or after pregnancy

  • Compulsions are repetitive activities that you do to reduce the distress and anxiety caused by obsessions. Repeating compulsions is often very time consuming, and the relief they give doesn't usually last very long. Common perinatal compulsions are excessively washing items, or constantly checking on the baby e.g. waking them up when they're asleep to check on them

Cheryl says “OCD can be common and can often manifest as controlling the environment through rituals. Pregnancy can heighten these thoughts, for instance by being told to sterilise everything for a baby, it makes compulsions around washing toys, clothes, or bottles more intense.”

Psychosis

Often called ‘postpartum psychosis’ (postpartum = after childbirth), this is a serious but rare mental health problem which develops after you give birth. It can be an overwhelming and frightening experience, and it’s important to seek help as soon as possible if you experience symptoms, but with the right support, most people fully recover.

Symptoms usually start quite suddenly within a few weeks after giving birth and often are a mix of psychosis, depression and mania. Symptoms include:

  • excited or elated

  • severely depressed

  • rapid mood changes

  • confused or disorientated

  • restless or unable to sleep, even when you have the chance

  • unable to concentrate

  • experiencing psychotic symptoms, like delusions or hallucinations.

    • Delusions are strong beliefs that other people don't share, such as thinking you are being followed or your thoughts are being read.

    • Hallucinations are when you experience things that others around you don't, such as hearing voices, seeing hallucinations and other unexplained sensations.

Post-Traumatic Stress Disorder (PTSD)

This is an anxiety disorder which may develop after experiencing a traumatic childbirth such as a long and painful delivery, unplanned C-section or emergency treatment. These events can impact on your relationship with baby or your plans for having another baby in future. Symptoms can include:

  • Reliving the trauma in vivid flashbacks, intrusive thoughts and images, or nightmares

  • Feeling on edge, being easily upset or angry, extreme alertness, being self-destructive or reckless

  • Avoiding feelings or memories by keeping busy, avoiding certain situations, or feeling physically or emotionally numb

  • Difficult beliefs or feelings such as feeling no one understands, nowhere is safe or feeling overwhelmed by anger, sadness, guilt, or shame

Eating disorders

If you develop an unhealthy relationship with food, your weight or your body image during or after your pregnancy, it could lead to an eating disorder. Almost a quarter of the parents we surveyed had struggled with their relationship to food.

Cheryl explained that “eating disorders cause a lot of anxiety and low mood because on the one hand mothers are compelled to control their body image despite it naturally changing through pregnancy, while on the other hand their maternal instincts are telling them to feed the baby and do everything they can to keep it healthy.”

It’s important to tell your doctor or midwife about these symptoms as they might improve during pregnancy but get worse after having the baby. Because eating disorders deprive the body of nutrients, they can also impact on your and your baby’s health during pregnancy causing intrauterine growth restriction, miscarriage, labour complications, preterm birth and low birth weight, so it’s important to talk to your doctor or midwife when you start to develop symptoms.

How mental health can be managed during pregnancy or with a new baby

Cheryl says “If you are struggling with any of the symptoms mentioned above, be transparent, open and honest with whoever you feel you can talk to - your partner, friends or family. Everyone has bad days when you’re not stereotypically happy or excited to be pregnant or a new parent, but we need to identify when those bad days are becoming bad weeks and bad months. If you can’t see it, it’s important that your support network speak up and say that it’s time to get more help.”

If you are suffering, talk to a professional such as your doctor, midwife or health visitor. You are not the only one feeling this way and they have the resources to get you the help you need to manage your mental health well.

There are a range of ways to treat perinatal mental health problems which include:

Talking therapy

This is a short course of one-to-one consultations with a trained therapist often using cognitive behavioural therapy (CBT) to teach you coping skills for dealing with problems

Medication

There are several types of medication that can be prescribed to manage your mental health, along with options that can be taken during pregnancy and whilst breastfeeding

Self-care

There are a wide range of self-care techniques that you can use every day to improve your mental health. You can read about them on our guide to Mental health self-care for pregnancy and new parents.

Online support

As mental health problems are common in pregnancy and in the early years of being a parent, there are a good range of online support groups available. PANDAS offers a phone helpline and face-to-face group support (when available) and Netmums has online forums for a range of mental health issues

Support for perinatal mental health issues

If you are concerned about your or someone else’s mental health, you can:

  • talk to your doctor or Benenden Health members can call GP 24/7

  • talk to your midwife, health visitor or NICU outreach nurse

  • Benenden Health members can call 24/7 Mental Health Helpline

  • Benenden Health members can log in and join online classes with Vita, including a brand-new class on perinatal mental health, as well as classes on fitness, healthy diet and mindfulness