You may be experiencing different symptoms and already have a mental health condition.
Find help for these below.
Anxiety is a normal response to a difficult, stressful or threatening situation. Everyone feels anxious sometimes, for example when you have an interview or sit an exam. Most pregnant women and new parents feel anxious at times. There’s a lot that’s new or uncertain when you have a baby and this can be stressful.
You may worry about what your scan will show, how you will cope with birth or whether your baby has a serious illness. This is normal.
If you are anxious on most days for more than a couple of weeks and if this starts to affect your everyday life, you may have an anxiety disorder. When this happens in pregnancy or the first year after birth, it’s sometimes called ‘perinatal anxiety’. If left untreated, anxiety can make it difficult to enjoy your pregnancy and your baby.
What if feels like to have perinatal anxiety
Anxiety symptoms include:
- Feeling anxious, stressed, worried or nervous
- Feeling tense, restless or on edge
- Having anxious thoughts that keep coming into your mind and are difficult to control
- Thinking that something terrible is going to happen, for example, you or baby will die
- Physical symptoms such as tense muscles, a tight chest, a racing heart, feeling dizzy, breathless sweaty, having headaches or stomach ache, numbness or tingling
- Difficulty getting to sleep
- Poor concentration
- Avoiding things you are afraid of, for example, going out with your baby
- Having to check things repeatedly, for example, that your baby is breathing.
Types of anxiety disorders women can have in pregnancy and after birth
Just like at other times, women can have many different types of anxiety disorders in pregnancy and after birth.
These can include:
- Generalised anxiety disorder – having anxiety symptoms most of the time
- Panic disorder – sudden bursts of intense anxiety with physical symptoms, for example, a racing heart and thoughts that something terrible is going to happen, for example, that you will ‘go crazy’, make a fool of yourself or die
- Phobia – a fear of a particular situation or thing. Common phobias are fears of heights, spiders, blood and injections.
- Social phobia – a fear of being with other people
- Agoraphobia – a fear of crowds or public places with the result that you avoid going out
- Tokophobia – an intense fear of giving birth
- Obsessive compulsive disorder (OCD)– having ‘obsessions’, ‘compulsions’ and anxiety.
Typical obsessions and compulsions
Obsessions are thoughts or images that keep coming into your mind and make you anxious. Examples include:
- Fear of being contaminated by germs Worrying about something you’ve forgotten to do, such as turning off a hot iron
- Or even an image of you or someone else harming your baby.
Compulsions are actions that you feel the need to keep repeating to try to reduce your anxiety. Examples include:
- Repeatedly washing your hands
- Checking your baby is breathing.
Post-Traumatic Stress Disorder (PTSD) – a response to experiencing a traumatic, or life-threatening event. Symptoms include:
- Having flashbacks or nightmares
- Avoiding things which remind you of the traumatic event
- Being very watchful for signs of danger
- Feeling jumpy and easily startled by noises, as well as having other anxiety symptoms.
When women have PTSD after birth, it’s sometimes called birth trauma.
How common is anxiety?
Most women have anxious thoughts at some point during pregnancy or when they have a new baby.
Around 10 to 15 in every 100 women have an anxiety disorder in pregnancy or during the year after birth. That’s between 10% and 15% of women.
You may have had an anxiety disorder before pregnancy or it may start for the first time when you’re pregnant or after birth.
Why treatment is important
An anxiety disorder can lead you to avoid situations or places.
- It may mean that you don’t take your child to places where they can meet other children.
- You may not go to postnatal groups where you could get support and enjoy being with other mothers and babies.
Without treatment, an anxiety disorder can get worse and start to have an impact on your ability to get on with everyday life.
Where you can get help
The help and treatment you need depends on how severe your anxiety is.
Your GP, midwife and health visitor can help you decide what kind of help you need.
Most people respond to treatment offered by their GP, including a talking therapy.
If your anxiety is severe, you may be referred to the specialist perinatal mental health service.
The treatment you need depends on how unwell you are.
You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.
There is good evidence that talking therapies, such as cognitive behaviour therapy, are effective for the treatment of anxiety disorders.
Improving Access to Psychological Therapy (IAPT) services provide a range of talking therapies. You can contact your local service yourself or a professional can refer you.
You can download a leaflet (PDF) from IAPTs on how to get emotional support during pregnancy and your early baby days.
Local IAPT services will see you more quickly if you are pregnant or up to one year after birth.
If your symptoms are more severe, or if you don’t want a talking therapy, you may need medication. Your GP or psychiatrist can help you weigh up the risks and benefits of taking medication in pregnancy or if you are breastfeeding.
What is birth trauma?
Women’s experiences of childbirth are very varied. Some women find aspects of their birth traumatic or frightening. It may be obvious that your birth was traumatic. Sometimes other people around you may not realise how afraid you were.
Examples of traumatic births include:
- Forceps or emergency caesarean section
- If you have complications, for example, losing a lot of blood after birth (called a postpartum haemorrhage)
- Fear during labour that you and/or your baby will die or be seriously injured
- If your baby has a serious injury or complication or if you baby dies.
Some mothers who have traumatic births develop symptoms of post-traumatic stress disorder (PTSD). PTSD can happen after any very traumatic event. When it happens after childbirth, it can be referred to as birth trauma.
Symptoms of PTSD
- Flashbacks or nightmares about the birth – repeated distressing thoughts or images
- Avoidance of things that remind you of the birth, for example, the hospital, other mothers and babies, sounds or smells that trigger memories.
- Feeling ‘hypervigilant’ – feeling jumpy or on ‘high alert’ or worrying that something bad will happen to your baby
- Feeling anxious, irritable or low
- Feeling emotionally detached or numb
- Difficulty sleeping
- Poor concentration
- Physical symptoms of panic such as a racing heart, feeling sweaty, breathless, tense or shaky.
It’s not your fault
Experiencing PTSD symptoms after a traumatic birth is not your fault or a sign of weakness. Your mind is trying to make sense of an extremely scary experience.
When you need treatment
For some mothers who have a traumatic birth, symptoms of PTSD get better on their own within a month or two of birth. However, if the symptoms are not getting better you may need treatment.
It’s important to ask for help if you’ve got symptoms of PTSD. There is a lot of help and support.
- Talk to family and friends about how you are feeling, so they can offer support and you don’t feel that you are having to cope on your own
- Talk to your midwife, health visitor or GP
- It can help to have an appointment with your midwife or the doctor who looked after your pregnancy (obstetrician) to look through your medical records together. This can help you understand what happened during your labour and delivery an allow let you to ask what happened, and why.
If you get pregnant again, tell your midwife about your previous traumatic birth. You may be offered a special appointment to discuss this and to help you make a birth plan.
Keep doing things that you find relaxing, such as going for a walk or having a bath.
You can also learn ways to help you to manage flashbacks, these include
- Grounding techniques
- Breathing exercises and other relaxation techniques.
Find out more about self-help techniques on the Get Self Help website
Treatments for PTSD
There are two main treatments for PTSD:
- Trauma-focused cognitive behavioural therapy
- Eye movement desensitisation and reprocessing (EMDR).
These psychological treatments work by helping you to process the traumatic memories and reduce the amount you re-experience them.
You will develop your coping skills through the use of ‘self-soothing’ and ‘grounding’ techniques.
IAPT services in Ealing, Hammersmith and Fulham, and Hounslow offer these services.
You can self-refer or ask your GP to refer you. Find your local service and more about the therapies offered on our IAPTs pages.
Most women with birth trauma do not need to be referred to the perinatal mental health service.
Medication is not usually used to treat PTSD. However, as it is common to experience depression alongside PTSD, your GP may offer you medication to help with this.
Get information and peer support to help you and your partner from the Birth Trauma Association
Depression is a common mental illness.
Perinatal depression is the term sometimes used to describe depression that happens any time in your pregnancy or up to one year after birth.
- If you have depression during your pregnancy, it is sometimes called antenatal depression.
- If you have it during the first year after your baby is born, it is called postnatal depression.
The severity of depression varies.
- If you have mild depression, you will still be able to do most things you usually do, like work and look after your children
- If you have severe depression, this is likely to have an impact on how you manage things. You may need time off work and you may need help to look after your children
- If your depression is very severe, you may neglect yourself and you may have suicidal thoughts or even plan to harm yourself.
Depression affects 10 to 15 in every 100 women in pregnancy or after birth. That’s between 10% and 15%.
It’s not your fault
Though treatments are very effective, many women wait longer than they need to before seeking help.
Some women feel ashamed or guilty for feeling low at what is thought of as a happy time.
You shouldn’t feel like this. If you’ve got depression, it’s not your fault – it’s an illness and you need treatment, just like you would if you’d got any other illness.
If you think you’ve got depression, tell your midwife, health visitor or GP. They can make sure you get the right help and treatment so that you can enjoy your pregnancy and your baby.
Symptoms of antenatal and postnatal depression
Symptoms of depression in pregnancy and after birth are similar to those at other times. Some of the changes that come with being pregnant, or a new parent, overlap with the symptoms of depression.
- Reduced energy
- Difficulty sleeping
- Poor appetite.
This can sometimes make it hard for you or others to tell if you are unwell.
Hard to spot
It’s also a time when everything’s new and challenging. It can be hard to know whether your reactions and emotions are to be expected because life with a new baby can feel far from 'normal'.
It’s always better to tell someone if you think you might have depression.
To have a diagnosis of depression, you will have some or all of the following symptoms for at least 2 weeks:
- Low mood Feeling anxious or irritable (for example, you may feel irritated by your children or your partner and argue more than usual)
- Tearfulness or feeling close to tears
- Poor sleep – you may not be able to sleep even when your baby is asleep
- Poor appetite or overeating
- Poor concentration
- Lack of energy and motivation
- Loss of interest and enjoyment in things that you would normally enjoy
- Not wanting to see friends or family
- Feeling hopeless and negative about the future
- Loss of confidence, for example, you may not feel able to look after your children on your own
- Thoughts that you are not good enough or a failure, for example, not thinking you’re a good mum
- Anxious thoughts – for example, you may worry that something bad will happen to your baby or that your baby is unwell
- Feeling guilty for something you have or haven’t done
- Thoughts about harming yourself or your baby, ending your life, or wanting to escape or get away from everything.
It’s common to have a lot of anxiety symptoms during an episode of depression. In very severe depression you can also have ‘psychotic symptoms’ such as hearing voices (hallucinations).
How to get help and treatment
If you think you have depression, talk to your midwife, health visitor or GP. They can help you decide what kind of help you need.
Most people are looked after by their GP and IAPT (Talking therapies service).
You can refer yourself to IAPT or your GP or another health professional can refer you.
IAPT services in Ealing, Hammersmith and Fulham, and Hounslow will see you more quickly if you are pregnant or up to one year after birth.
Find your local IAPTs service
If your depression is severe, you can be referred to the specialist perinatal mental health service.
Why treatment is important
Some women will get better without treatment. However, depression can go on for several months without treatment.
- This can mean a lot of suffering and can spoil the experience of motherhood
- It can affect your relationship with your baby and partner
- You may not be able to look after your baby, or yourself, as well as you would when you are well.
So the shorter it lasts, the better.
The treatment you need depends on how unwell you are.
- Talking therapies, such as cognitive behavioural therapy (CBT) and
Your GP or psychiatrist can help you weigh up the risks and benefits of using medication in pregnancy or if you are breastfeeding. Many women take antidepressants in pregnancy and when breastfeeding. There’s also lots of help and support available. See the resources below.
The difference between postnatal depression and the ‘baby blues’
The ‘baby blues’ affect at least half of all women after they’ve had a baby. They usually happen between 3 and 10 days after the birth. You might feel:
• Low, anxious and irritable
• Oversensitive and overwhelmed.
The symptoms of ‘baby blues’ usually stop on their own after a few days, without treatment.
See the Tommy’s website for more information about antenatal depression
Visit the Royal College of Psychiatrists website for more information about postnatal depression and specifically for information and support for partners, relatives and friends
Where to find support online
Eating disorders are serious mental illnesses.
• They affect your attitude to eating and your body weight or shape.
• You may not eat enough, or you might over eat.
• You may over-exercise, use laxatives, make yourself vomit or use other ways to try to lose weight.
Eating disorders can affect your health and your unborn baby’s health if you are pregnant.
Severe eating disorders can be life-threatening.
So, it’s really important to have help and treatment to make sure you have a healthy pregnancy.
Different types of eating disorder
There are several types of eating disorder. The most well-known are anorexia and bulimia nervosa.
If you have anorexia you:
- Restrict the amount of food you eat and your weight is very low
- Keep trying to lose weight even when you are very underweight
- May exercise excessively to try to lose weight and you may binge and vomit
- Are likely to think that you are bigger than you are and to be very preoccupied by your weight and body shape
- May wear baggy clothes to hide your body
- Have irregular periods or your periods may stop altogether.
If you have bulimia you:
- Binge (eat large amounts of food at one time, often very quickly) and then make yourself vomit
- Can feel very out of control when you do this and feel guilty, ashamed and low in mood afterwards
- May use laxatives or other means of controlling your weight
- Are likely to be very preoccupied with your body weight and shape.
Anorexia and bulimia nervosa are associated with physical health problems and other mental health problems such as depression.
Eating disorders and pregnancy
You may have difficulty getting pregnant if you’ve got an eating disorder. It’s common to have irregular periods and so you may not realise you’re pregnant.
Pregnancy can be hard when you have an eating disorder. For some women, the normal changes in body shape and weight can be frightening. Pregnancy may bring up difficult memories from your own childhood. However, sometimes being pregnant can make you very motivated to get better.
It’s important that you see an obstetrician to make sure that the physical complications of your eating disorder don’t become too severe or affect your unborn baby.
Depending on how severe your eating disorder is, you may be more likely to have some complications related to your pregnancy.
Your pregnancy and your baby’s growth need to be monitored carefully.
The Eating Disorders and Pregnancy website has a range of useful leaflets about pregnancy and nutrition.
Eating disorders in the postnatal period
Even if your eating disorder has improved during pregnancy, there is a risk of relapse after your baby is born.
- You may worry about the weight you have gained during pregnancy – it’s normal to take some time to lose this weight.
- You might have an increased risk of postnatal depression.
If your mood is low, talk to your GP or psychiatrist. It’s important you get treatment for depression.
Feeding your baby
- Breastfeeding might be hard if you have an eating disorder. Your midwife and health visitors will help you to feed your baby, whether you choose breast or bottle feeding.
- Feeding your baby might be challenging when he or she starts eating solid food. Your health visitor or the eating disorder service can help you with this.
There is a lot of support for new mothers, so talk to your health visitor about what’s available near you.
If you need treatment after your baby is born, ask them or you GP to refer you to the eating disorder service or perinatal mental health service.
Eating disorder treatments are the same in pregnancy and after birth as at other times.
If your eating disorder is severe, you may need to be under the care of the specialist eating disorder service. The perinatal mental health service works jointly with this service if needed.
This might be the case if you also have another mental health problem which you need treatment for during pregnancy.
Where to find support online
Anorexia Bulimia Care
BEAT (eating disorder charity)
Eating Disorders and Pregnancy
Royal College of Psychiatrists Anorexia and Bulimia
About psychotic illnesses
Bipolar disorder, schizophrenia, schizoaffective disorder and other psychotic illnesses are serious mental health problems.
- If you’ve had a diagnosis of these mental health problems, it’s very important that you tell your midwife or the doctor looking after your pregnancy (obstetrician) about this
- You should be referred to the perinatal mental health service, even if you have been well for a long time.
Telling your health care team is important because you need to get advice about:
- The risks of becoming unwell in pregnancy and after birth. This includes the risk of postpartum psychosis
- Your medication in pregnancy. The perinatal psychiatrist can help you weigh up the risks and benefits of taking psychiatric medication in pregnancy and when breastfeeding. Don’t stop or change your medication without advice, as you may become unwell
- The care and support available during pregnancy and when your baby is born. This will include how all the professionals will work together with you and your family so that you can stay as well as possible.
Ask to be referred to the perinatal mental health service if you are planning a pregnancy.
Getting advice in advance will give you time to:
- Be more prepared
- Make any changes to your medication before you start trying to get pregnant.
Where to find support online
About postpartum psychosis
Postpartum psychosis is a psychiatric emergency. You should seek help as quickly as possible.
Postpartum psychosis (also known as puerperal psychosis) is a severe mental illness.
It affects a small number of women, usually in the first days or weeks after childbirth. It often comes on suddenly and you can become very unwell very quickly.
Symptoms vary and can change rapidly. They include:
- Elated or depressed mood
- Delusions and changes in behaviour.
Who postpartum psychosis affects
About 1 to 2 in every 1000 mothers are affected by postpartum psychosis. That’s about 0.1%
It can happen to any woman – even if you have good support and no obvious life stresses. In about half of cases it occurs out of the blue to women who have not been ill before.
However, some women have a much higher risk:
- If you have bipolar disorder or schizoaffective disorder your risk is at least 1 in 5 (20%)
- You have this high risk even if you have been well for a long time.
- If you have bipolar disorder or schizoaffective disorder and also have a mother or sister who has had postpartum psychosis your risk is 1 in 2 (50%).
- If you have had postpartum psychosis before, your risk of another episode is 1 in 2 (50%).
- If you have never had a mental health problem yourself but your mum or sister had postpartum psychosis your risk is around 3 in 100 (3%).
If you are in a high risk group, or if you have ever had a psychotic illness, you should be referred to the perinatal mental health team when you are planning a pregnancy or when you are pregnant.
You can get advice and have care and treatment to reduce the risk that you will develop postpartum psychosis.
How it feels to have postpartum psychosis
Postpartum psychosis can start in many ways, with lots of different symptoms. You can become very unwell within a day or two.
Symptoms can begin:
- Within a few hours of birth and usually start within the first 2 weeks
- Up to 3 months after birth or sometimes after that.
- Mood changes: feeling ‘high’ or elated, low, anxious or irritable – often with rapid changes in mood
- Feeling energetic, overactive or restless
- Changes in your speech: speaking fast – jumping from one subject to another, or not speaking much at all
- Racing thoughts, with lots of ideas
- Finding it hard to sleep or not needing sleep
- Feeling more confident, powerful or special than usual
- Exhibiting unusual behaviour
- Having paranoid or suspicious thoughts
- Feeling that everyday events or stories on the TV or radio, have special personal meaning
- Forming strange beliefs that could not be true (delusions)
- Hearing, seeing, feeling or smelling things that are not there (hallucinations)
- Having a sense of hopelessness, suicidal thoughts or making plans to harm yourself.
Postpartum psychosis is often extremely distressing for you and your family. Your symptoms may affect how you look after yourself and your baby.
However, the good news is that with prompt treatment in hospital, you will fully recover and be able to look after your baby.
How to prevent postpartum psychosis
It’s impossible to predict or prevent postpartum psychosis if you’ve never had a mental illness before, or don’t have a family history.
If you have ever had a psychotic illness (for example, schizophrenia, schizoaffective disorder, psychotic depression), bipolar disorder, postpartum psychosis, or if you have a family history of bipolar disorder or postpartum psychosis, you should be referred to the perinatal mental health service.
If you are planning a pregnancy you can be referred for a one-off preconception appointment. It helps to have advice as early as possible, particularly if you need to make changes to your medication. Many pregnancies are unplanned, so don’t worry if this happens to you. In that case, you can be referred to the perinatal mental health service in early pregnancy.
Your GP or midwife can refer you. If you are already under the care of a mental health service, you should still be referred, as the perinatal mental health service can offer specialist advice and work alongside your general adult team. Ask your psychiatrist or care co-ordinator to refer you.
Advice, care and treatment from the perinatal mental health service includes:
Review and discussion
- A review of your diagnosis and advice about your risk of postpartum psychosis and other mental health problems in pregnancy or after birth.
- Discussion about the risks and benefits of psychiatric medication in pregnancy and when breastfeeding. Decisions about medication are not straightforward, so the earlier you start thinking about this the better. The risk of postpartum psychosis may be higher if you stop medication in pregnancy and if you don’t take medication after birth.
- Several professionals will be involved in your care. You will agree how often you are likely to see them, with an explanation of how they will work together. You will usually have a perinatal psychiatrist and a perinatal mental health nurse working with your midwife, obstetrician, health visitor and any other professionals involved.
Pre-birth planning meeting
A pre-birth planning meeting at around 32 weeks of pregnancy. This involves you, your partner or family members, and all the professionals involved in your care. At this meeting, everyone will agree a plan for your care during pregnancy and after birth, including all the care and support you and your family need and how you can access help. The aim will be to reduce your risk of postpartum psychosis, or otherwise to make sure it is recognised early so that you have prompt treatment.
Support at hospital
When you come into hospital for the birth of your baby, you can be seen by a perinatal mental health nurse or psychiatrist, if needed.
Support at home
- When you go home from hospital with your baby, your mental health will be closely monitored for the first 3 months after birth, when the risk of postpartum psychosis is highest. You will also have all the usual care from your midwives and health visitor that women have after having a new baby
- You and your family will be given emergency contact numbers for local crisis services
- You can use West London NHS Trust’s 24 hour telephone helpline 0800 328 4444, see your GP or go to the Emergency department if you, or your partner or family, think you are becoming unwell
- If you think you are becoming unwell, don’t wait. It is better to be seen quickly as symptoms can worsen rapidly.
Mother and Baby Unit (MBU)
Most women with postpartum psychosis need to be treated in hospital in a Mother and Baby Unit (MBU). This is a specialist psychiatric unit where mothers with mental illness are admitted with their babies. You should be offered a bed in a Mother (MBU) if you need admission.
You will be supported in caring for your baby while you have the care and treatment you need.
The nearest MBU for women in West London is Coombe Wood Mother and Baby Unit at Central Middlesex Hospital.
Going through such a serious illness can have an impact on your sense of self, your relationship with your partner, and especially on your confidence as a mum.
As you recover, you may want to talk to a psychologist or counsellor about your experience of postpartum psychosis.
Action on Postpartum Psychosis
Action on Postpartum Psychosis is an excellent organisation that offers advice and support for women who have had postpartum psychosis and their families.
We recommend their peer support network, which includes an online support forum and one-to-one support. Go to the Action on Postpartum Psychosis website to find out more.
Find more support online
A personality disorder is a mental health problem that happens when some of the ways you think, feel or behave cause suffering or distress to yourself or other people.
Difficulties in personality disorder tend to be there most of the time, rather than coming and going, but stress can make things worse.
There is a wide range of severity. A more severe personality disorder is more likely to interfere with your everyday life, relationships with partners, family and friends and ability to work.
There are many different types of personality disorder.
There is a lot of great information available online about personality disorders, from trusted sources, including:
Personality disorder, pregnancy and parenting
You may find pregnancy and parenting more difficult if you have a personality disorder.
It depends on:
- The type of personality disorder you have
- How severe or serious it is.
Your experience of growing up is important. How your parents or carers treated you is part of how your personality developed and why you have a personality disorder.
For example, long term problems can be caused if:
- You were abused or neglected
- You saw domestic violence – your mum being hit, for example
- Your parents were very critical or hostile – nasty and mean.
Being pregnant and becoming a parent can bring back difficult memories from your childhood.
- If it’s hard for you to manage your own emotions, it might be hard for you to cope with your baby crying. And it could be hard to help your child learn to manage their own emotions.
- If it’s hard for you to cope with relationships, you might struggle to trust the professionals who are looking after you during your pregnancy and after birth. And you may need help to develop your relationship with your baby.
There are many other ways that personality disorder can affect you when you are pregnant or have a baby.
The good news is there’s lots of help and support available. Talk to your GP, midwife or health visitor.
How to get help with your personality disorder in pregnancy or after birth
If you think you have a personality disorder, or know you have one, then it’s really important to talk to your midwife or GP as soon as you can.
They can make sure you have the right care and support during and after your pregnancy.
If your partner or another close family member can attend some of your appointments with you, it may help them to be able to support you.
You may be referred to the perinatal mental health service.
The professional who sees you can talk to you about treatment options.
This will depend on:
- What type of personality disorder you have
- How it affects you
- Whether you also have another mental illness.
You might be offered:
- A specialist individual or group therapy to treat your personality disorder or to support your developing relationship with your baby
- A perinatal mental health nurse, or another member of the team to visit and support you at home
- Advice about other services which can offer support.