Life's pressures, or worries about the future, on top of coping with health issues, can sometimes feel overwhelming.
More than 1 in 10 women suffer from mental health issues in pregnancy and in parenthood. Your mental wellbeing is just as important as your physical health and shouldn't be ignored.
How to promote emotional well being
- Eat a healthy balanced diet and drink plenty of non-alcoholic fluids.
- Exercise each day to release endorphins which can help to lift your mood.
- Spend some time each day doing something you enjoy, maybe a relaxing bath or reading a book.
- Stop smoking.
- Avoid alcohol as it is harmful to your baby and can also lower your mood.
- Try to attend groups/antenatal classes to build yourself a support network.
- Be honest about how you are feeling - talk to your midwife or other healthcare professional or someone close to you such as your partner, friend or relative.
- Ask for help if you need it - ev eryone needs help sometimes and people who care about you will be very happy to support you.
Will I be asked about how I'm feeling?
When you have your first antenatal /booking appointment your midwife will ask you about how you are feeling, about whether you have been bothered by feeling down, hopeless or unable to enjoy things lately.
You will also be asked this question again later in your pregnancy.
The midwife will also ask if you have ever had problems with your mental health. These questions are asked of every pregnant woman and new mum, not just those who have (or have had) mental health problems.
Mood Changes
In reality, you are quite likely to have times when you feel low during your pregnancy, just like any other 9 months of your life. As well as the normal ups and downs of life, your pregnancy will usually give you some extra reasons for many emotions - from joy to misery.
The nausea and tiredness that most women feel during the first few months can really wear you out and make you feel miserable.
You may also find that you have more mood changes, you cry more, lose your temper more, and become more forgetful.
The pregnancy hormones in your body probably contribute a lot to these feelings. Some of your emotions may also be caused by the realisation that you are going to become a mother. It can be an overwhelming thought at times.
If you start to feel quite emotional and worried, it can really help to talk with your partner or someone else that you are close to.
Sometimes, just sharing your feelings can give you a big sense of relief.
It's also very important to take good care of yourself. Try to avoid getting overtired and make sure you take regular 'time out' for yourself.
Stress
Stress is another common problem that can affect anyone.
If you are finding that you are experiencing stress causing increased irritability, affecting sleep, worrying more, increasing your anxiety, feeling you can't cope with all the demands being made on your time then please talk to your midwife, GP or Obstetric Doctor to get some help to deal with your stress.
Mental Health
Mental health in pregnancy
Depression
Although some additional worries and mood-swings are perfectly normal in pregnancy, it is a different matter if you are feeling depressed a lot of the time. If you are feeling depressed, you may cry a lot, feel very confused and alone, not sleep well and be more irritable than usual.
If you are having these types of feelings, it's really important to talk with someone who can help. Try to describe your feelings to your doctor or midwife and explain that you believe your problem is more than a touch of the 'pregnancy blues'. They may be able to help you talk through your feelings, or refer you to a counsellor, mental health nurse, psychologist or a psychiatrist who can give you more specialised help.
Caring for a baby is a constant and demanding job that will involve a variety of emotional and physical changes for both you and your partner. It is important to remember that learning how to be a parent takes time and patience.
Up to 10% of pregnant women have symptoms of depression - called antenatal depression. As well as feeling bad, antenatal depression can take a big toll on relationships.
Women who experience depression during pregnancy do not necessarily go on to have depression after they give birth, although they are at a higher risk.
Depression that begins after the birth of a child is referred to as postnatal depression. It effects up to 1 in 10 new mothers. While symptoms can occur at any time during the first year, they mostly present within the first three months after birth.
Caring for a baby is a constant and demanding job that will involve a variety of emotional and physical changes for both you and your partner. It is important to remember that learning how to be a parent takes time and patience.
The hormone imbalance during pregnancy can contribute to antenatal depression. Pregnancy sickness and tiredness, anxieties about being a Mum, financial and relationship worries can also contribute.
Common concerns can include:
- How you feel about going through such a major life-changing event.
- How you view yourself including negative perceptions about physical changes, such as, weight gain, swollen breasts, and other discomfort.
- The restrictions to your lifestyle that motherhood might place on you.
- How your partner or family feel about the baby.
- How depression during pregnancy could impact your relationships.
- Difficulties with previous pregnancies.
Tell your midwife or doctor how you feel. You may feel very distressed or guilty at feeling low at a time when everyone expects you to be happy, but pregnancy depression is not your fault. The midwife or doctor won't criticise you or judge you for having these feelings - they know this happens to many pregnant women and they will discuss and organise treatments so you can get better.
It can be difficult to talk about your thoughts and feelings. You may want to write down what you want to say first, or you may want to have someone with you. The important thing is to let someone know so that you can get the right help as soon as possible.
If you're taking antidepressants already, you should continue to take them. It is really important that you talk to your GP or psychiatrist as soon as you decide to start trying for a baby, or as soon as you learn you are pregnant, to discuss any risks associated with taking or stopping your medication during pregnancy.
Some drugs that are used to stabilise mood may increase the risk of physical defects and development problems in the unborn baby. After talking to you, your doctors may decide to change or stop the medication you are taking, but you should not alter your drug treatment or stop taking treatment without specialist advice, especially during pregnancy.
There is a slightly increased risk of a rare disorder called Persistent Pulmonary Hypertension of the Newborn (PPHN), a condition where there is a delay in the normal circulatory changes after birth. However, the absolute risk still remains low at 1.5 times the risk to babies that have not been exposed to medication.
Some babies may experience some form of 'withdrawal' symptoms from certain types of antidepressants. These symptoms may include irritability, poor feeding, jitteriness/tremors and breathing difficulties. Symptoms can present at any time over the first week of life, but usually resolve within a few days and do not require any intervention.
Some studies have shown a link between anti-depressants and ASD and ADHD in children however other studies have not proven this. The link remains unclear but is likely to be related to factors other than medication.
Anxiety
Anxiety can affect people in different ways and sometimes prevent them from doing ordinary things everyday things. We all have anxiety where we worry more, feel our heart is racing, possibly feeling dizzy or nauseous and this is normal when taking an exam or having an interview etc.
If these symptoms stop you doing things however, then you need to speak to your midwife, GP or obstetrician to get some help to deal with your anxiety.
More information
If you have suffered from a mental health problem in the past, which was treated and you are now well, then it is still really important that you share this information with your community midwife as soon as possible. The severity of your previous condition will depend on the management of your care. For some women pregnancy and childbirth can cause them to become unwell again due to the physical and emotional changes and the new challenges and demands that having a baby can bring.
If you have ever suffered from a serious mental illness such as: schizophrenia, bipolar disorder, schizoaffective disorder, severe depression requiring hospital admission, psychosis, severe anxiety disorder such as Obsessive Compulsive Disorder (OCD) or an eating disorder, you should be referred to an obstetrician and the specialist perinatal mental health midwife. The health visiting team should be made aware and make earlier contact with you. It may also be necessary for you to be referred to the perinatal mental health team.
If you are currently receiving treatment for a mental health problem, then you need to inform your GP and community midwife at the earliest opportunity. The advice is that you should continue your medication as normal when you discover that you are pregnant, and do not suddenly stop. Your GP, in collaboration with the obstetrician and/or psychiatrist, will make a plan of care for you regarding your medication.
The Perinatal Mental Health team is a non-urgent service that works with women experiencing, or at risk of developing, moderate to severe mental health problems in pregnancy and the postnatal period (up to one year after birth). They also offer pre-conceptual counselling for women on psychiatric medication who are planning pregnancy.
The teams are able to provide:
- An assessment if you are pregnant and have bipolar disorder, psychotic illness (i.e. schizophrenia) or have previously been admitted to a psychiatric ward. The team will offer to meet with you even if you are currently well to help maintain wellness in pregnancy and beyond.
- Specialist assessment and treatment for women who become unwell with severe mental ill health in pregnancy or after birth.
- Telephone advice and guidance for professionals looking after you.
- Medication advice for pregnancy and breastfeeding women if you are taking antipsychotic medication for mental ill health.
- Specialised mother-infant/family interventions and advice for women with severe mental health difficulties.
- Specialised group, couple and individual psychological therapies during the perinatal period.
The team will offer to complete a 32-week birth plan for all women under their care to plan for your birth and immediately afterwards. You and your birth partner, as well as all professionals involved in your care, will be invited to the meeting.
If you are already being looked after by a mental health team, the Perinatal Mental Health Team may work alongside your current team in order to provide specialist support for your pregnancy and after birth.
Talking Therapies
Talking Therapies offer a range of services either in groups or face to face. The service is aimed at people with the following conditions:
- Anxiety
- Depression including antenatal and postnatal depression
- Stress
- Panic
- PTSD including Birth Trauma
- OCD
You can self-refer into the service or if you struggle with this speak to your midwife who can complete a referral for you.
Useful links
Mind
A mental health charity offering support and advice
BUMPS
Best use of medicine in pregnancy - advice regarding medications
Family Planning Association
Information, advice and support about sexual health, contraception and pregnancy. Confidential helpline.
Phone: 0845 122 8690
Tommys
Funds research into pregnancy problems and provides information to parents.
Phone: 0800 0147 800
Bipolar UK
Information and support for people with Bipolar Disorder.
Including an information leaflet about Bipolar Disorder, pregnancy and childbirth.
Maternal OCD
Information and support for women with OCD, including support group and skype support.
Action on Postpartum Psychosis
Postpartum Psychosis information, advice, research and support. On-line forum and peer support network.
Phone: 020 3322 9900
Pandas Foundation
Pre- and post-birth depression advice and support
Phone: 0843 2898401