How to access mental health support in pregnancy

An estimated 1 in 5 women have mental health problems during pregnancy or after birth. There doesn’t have to be a specific reason why someone may develop a mental health issue, but there may be several factors involved.

If you’ve had mental health problems in the past, such as anxiety or depression, being pregnant or having a baby can increase the chance of those problems happening again.

Pregnancy can be physically and emotionally challenging, which can lead to a relapse. There may be certain triggers, such as a fear of the unknown or a lack of control, that can lead to an increase in anxiety. However, it’s important to note that not everyone who has experienced a previous mental health problem will do so again.

Crucially, though, there doesn’t need to be a reason for women to struggle with their mental health in pregnancy.

Simply accepting being pregnant and trying to adapt to the biological, social, and physical changes this can bring can lead to huge psychological strain.

There are many signs that you may be having difficulty with your mental health.

You might:

• Feel low, tearful, or anxious for weeks at a time.

• Lose interest in things you used to enjoy.

• Experience intrusive thoughts about harming yourself.

• Have panic attacks – a sudden and debilitating rush of intense fear or anxiety.

• Feel worthless, guilty or numb.

• Be fearful of being pregnant, giving birth, or looking after a baby.

Mental health problems can happen in many different ways. You may feel quiet and depressed and then very talkative and energetic, or feel compelled to participate in compulsive behaviours such as counting.

You may also feel angry, irritable, and un-inclined to see anyone. It’s important to seek help if you feel unwell in any way.

A pregnancy announcement is often met with congratulations and joy, with well-intentioned friends and relatives expressing how excited you should be. However, the reality is that many women will struggle during this challenging period – and may feel ashamed about feeling low, anxious, or even resentful about becoming pregnant.

As a result, the majority of pregnant women will hide or underplay a mental health problem such as depression or anxiety.

Stigma is a key barrier to women seeking much-needed mental health support in pregnancy. One survey reported that 3 in 10 of women withheld negative feelings from healthcare providers due to fear of their baby being taken away.

Other research found that insufficient knowledge of maternal mental health among healthcare providers and family members, as well as stigmatising attitudes, also contributed to delays in women pursuing help.

Speak to your doctor

If you are struggling with your mental health in pregnancy, it’s important to speak to your doctor. They will be able to assess you and your needs and advise on the best course of action for you, whether that is talking therapy, medicine, or a combination of both.

There is not much evidence around how safe it is to take antidepressants during pregnancy because clinical trials can’t include pregnant women.

Some studies suggest there may be possible risks associated with taking SSRI antidepressants, including a potential increased risk of certain birth defects – the risk appears to vary significantly between medicines. However, untreated mental health problems also pose a risk to both mother and the developing baby.

Your doctor can help you balance the possible risks to your baby against the benefits of taking your medicine, so you can work out what’s best for you.

Doctors are more aware of which ones are safest during pregnancy and breast feeding so can help advise. You can also self-refer for talking therapy on the NHS.

Pregnant women may be prioritised and moved up the waiting list, but this can depend on demand in your area.

Speak to your midwife

During your pregnancy, you will have regular appointments with your midwife. This gives you the opportunity to talk about your mental health and how you are feeling.

Speak to your health visitor

Your health visitor can also offer support for looking after your baby and managing your mental health. You can also talk to them about anything you’re worried about, or any difficult feelings or thoughts you’re having. They may advise you to speak to your doctor.

Speak to friends and family

It’s also important to speak to your partner, friends or family if you are struggling with your well-being.

Peer support groups and antenatal classes can be a good place to meet other people who are pregnant. Charities such as Tommy’s and the National Childbirth Trust also offer support and advice.

There are also specialist mental health services for pregnant people, although not all areas have access to them.

Your GP or midwife may be able to refer you to a local perinatal mental health service, after which you should receive an invitation for an assessment with a psychiatrist specialising in maternal mental health.

The service will assess your needs and whether you need additional support from them, which can include regular appointments with a psychiatrist.

You may also be allocated a specialist mental health midwife, who will carry out your regular midwife appointments as well as offer mental health advice and support.

Community mental health teams

If you have a diagnosed mental health problem, you may already be in contact with your local Community Mental Health Team or crisis team.

They may be able to provide you with mental health support in pregnancy if there aren’t any specialist perinatal mental health services near you.

Infant Mental Health Services

Some areas offer an Infant Mental Health Service which focuses on helping parents-to-be and new parents with attachment and bonding.

There are a variety of reasons why someone may struggle to bond with their baby, including difficulties with mental health, trauma, and having a difficult relationship with their own parents.