Having a baby is a big life event and impacts families in many different ways due to the multiple changes it brings about. You may experience a wide range of different feelings during pregnancy and after giving birth, but if you start to notice these feelings impacting on your day to day life, you might be experiencing a perinatal mental health problem.
The period of time from the moment of conception until the first year postnatally is known as the perinatal period, but you may also hear people referring to the antenatal period during pregnancy and the postnatal period, for the first year after baby is born. At anytime in the perinatal period (and also outside of this time!), you may notice your mental health changing and possibly deteriorating. Your Health Visiting team can support with this.
For women, 1 in 5 will experience a mental health condition in the perinatal period and up to 1 in 10 men will. This may include (but is not limited to) depression, anxiety, Obsessive Compulsive Disorder (OCD), intrusive thoughts or Post Traumatic Stress Disorder (PTSD). It is important to be aware of symptoms and where to seek help-your Health Visiting team can support you with this. At each of the key contacts with the Health Visiting service, we will discuss your mental health with you and we welcome you to discuss it with us at any time.
The Baby Blues
The Baby Blues is the most common and mildest form of depression, which usually occurs around 3-10 days after giving birth, and is thought to be due to the sudden changes in hormones and chemicals within your body generated by childbirth. Commonly symptoms include feeling emotional and tearful for no reason, feeling irritable or feeling anxious and restless. This usually only last for a few days and you should feel more yourself in terms of your emotional wellbeing.
If you experience depression when you are pregnant, or after giving birth, you may hear it called antenatal depression (when you are pregnant), postnatal depression (after you give birth) or perinatal depression (at any point from conception to around one year after giving birth). You may commonly hear people talk about postnatal depression, but may not have been aware of antenatal depression; sometimes people experience both. You may also experience anxiety as well as depression. It is also important to be aware that perinatal depression also effects men.
Common symptoms of depression include:
- Being tearful and low in mood;
- Being irritable and agitated;
- Not finding any pleasure in life or things you would usually enjoy;
- Withdrawing from people or activities;
- Feeling guilty or like you are letting people down;
- Being restless and finding it hard to sleep or relax;
- Reduced appetite or over eating;
- Difficulty bonding with your baby;
- Suicidal feelings or self harm.
The different between perinatal depression and baby blues, is that the symptoms for perinatal depression will often been enduring and persistent, rather than lasting for a few days.
If you find you are feeling like this, it is important to let a medical professional know so that you can be offered support and treatment and please be honest about how you are feeling so that the right interventions can be offered to you.
Becoming pregnant, thinking about childbirth or having a new baby, commonly cause people to have anxiety about a range of things, including preparing for your baby’s arrival, thinking about how you will give birth and caring for your baby when they arrive, but if you find that these worries and thoughts do not subside or get worse, you may have perinatal anxiety. A lot of people have heard of perinatal depression, but perinatal anxiety is just as common and may also occur alongside depression.
If you experience specific anxiety about giving birth, you may have Tokophobia. For further information on what Tokophobia is and what support can be put in place to help you with this, have a look at this useful information on the website Tommys.
Common symptoms of anxiety include:
- Feeling tense, nervous and on edge;
- Asking for reassurance more than usual or worrying that people are angry and upset with you;
- Thinking about things that have not even happened yet;
- Feeling your mind is really busy and ‘full up’ with thoughts;
- Dwelling on negative experiences, or thinking over a situation again and again (this is called rumination);
- Feeling restless and not being able to concentrate;
- Having panic attacks;
- Feeling numb which may impact your relationship with your baby.
If you find you are experiencing any of these symptoms, please get in touch with a medical professional to ensure you are reviewed and offered timely support and treatment.
Treatment for Perinatal Depression and Anxiety
Some things you can do to help improve your mental health, include:
- Ensuring you are eating a varied, healthy diet and keeping well hydrated.
- Trying to get regular sleep/rest-although this may be hard with a baby, so try to turn to those around you to support with this, your friends or family.
- Using techniques like meditation and mindfulness. You can find more information about mindfulness by clicking here. Apps likes Calm and Headspace might also be helpful, and there are also lots of videos on YouTube.
If you require talking therapy you can be referred or self refer to the Lewisham Talking Therapies service which is part of the Improving Access to Psychological Therapy (IAPT) service. The most common talking therapy to be offered for anxiety is Cognitive Behavioural Therapy (CBT), more information about CBT can be found here. This form of therapy could be offered to you with a therapist or via an online programme called Silver Cloud. SignHealth provide therapies for Deaf people using BSL; you can access more information about BSL by clicking here.
Medication should be discussed with and prescribed by your GP. Most medications to treat anxiety and depression are safe to take in pregnancy or when you are breastfeeding, but your GP, pharmacist or mental health team can advise you about this if you are concerned. It is important not to abruptly stop your medication if you are pregnant as this may cause you to relapse, instead talk to your GP, pharmacist or mental health team first.
Typically first line treatment for depression or anxiety is similar and would commonly be antidepressants. If you are prescribed medication by your GP, it is important to follow the advice regarding dosage and book in a follow up appointment to be reviewed around 4 weeks after starting your medication.
Sometimes a combination of medication and talking therapies will be suggested to you and you can make a decision about what you would like to do with advice from your GP or medical professional.
As a Health Visiting service we can also offer you extra support if you are experiencing mental health difficulties, so please do let us know if you feel you would benefit from this.
Postpartum Psychosis (PP) (sometimes also called Puerperal Psychosis or Postnatal Psychosis) is a severe, but treatable, mental illness which effects around 1-2 in 1000 women in the first days or weeks after giving birth (but is not limited to this time frame). It may occur ‘out of the blue’ to a woman who has no history of mental illness, but there are also some women who are at higher risk of developing PP due to their mental health history (including having PP before) or current diagnosis, including those with Bipolar or other severe mental illnesses, or those with a family history of PP.
If this applies to you, please make sure you discuss this with your Midwife at your antenatal contacts so that they can refer you to the Perinatal Mental Health Team for review.
It is not known exactly what causes PP, but there are likely to be many factors involved that lead to developing PP:
- Genetic factors are important; if you have a close relative like your mum or sister who have had it, you are more likely to experience it (your risk is around 3% of developing PP);
- Having a disturbed sleep pattern due to labour, delivery and having a new baby is likely to be a factor but it is not known how;
- Changes in your hormone levels after having a baby;
- There is not enough evidence to suggest that there is a link between experiencing birth trauma and developing PP.
Getting support for PP is considered a medical emergency as it can get worse quickly, so being aware of the symptoms is important. There are lots of different symptoms of PP and they may include:
- Being elated, excited or ‘high’
- Depressed, anxious or confused
- Excessively irritable or changeable in mood
- Delusions (strange beliefs that are untrue)
- Hallucinations (Seeing/hearing/feeling/smelling things that are not there)
- Mania (high mood, losing touch with reality)
- Severe Confusion
If you suspect Postpartum Psychosis, consult with a medical professional immediately. If there is any chance of risk to the person with PP, the baby they are caring for or those around them, please call 999 or attend A+E.
Most women will require treatment with medication and may need to be admitted to hospital. Sometimes women and their baby, are admitted to places called Mother and Baby Units (MBU) which provide specialist mental health support from a multidisciplinary team including Nursery Nurses, OT’s, Psychologists and Psychiatrists. With the right support and treatment, most women will make a full recovery.
For more information on Postpartum Psychosis, please visit Action on Postpartum Psychosis.
What to do in a crisis-please seek help!
- Speak to your Mental Health Team if you are under one (this information would be on your Care Plan/Crisis Plan), your GP or another medical professional, like a Health Visitor or a Midwife if you are working with them.
- Call 111.
- Call 0800 731 2864 to speak to the South London and Maudsley 24 hour crisis line. For more information, visit www.slam.nhs.uk/crisis
- Call the Samaritans for free on 116 123 (24 hours a day)
-Contact a Samaritan here
Further helpful information and links
- Lewisham Talking Therapies is a free and confidential NHS service that is part of the Improving Access to Psychological Therapies (IAPT) program. They offer a range of free and confidential talking therapies and specialist support, to adults 18 years and over, registered with a Lewisham GP. You can self refer or ask a medical professional to do this for you.
- Shout (text support) text ‘SHOUT’ to 85258 Text ‘DEAF’ to 85258 for support if you are Deaf or hearing impaired
- Mindful Mums, run by Bromley, Lewisham and Greenwich Mind, offers supportive five-week courses and drop-in sessions for pregnant women and new mums.
- Being Dads, run by Bromley, Lewisham and Greenwich Mind, help new and expectant dads or men with parenting responsibility for babies and young children up to two years old to learn more about looking after themselves, managing the changes and challenges of parenthood and supporting their partner.
- Papyrus is a charity for the prevention of young suicide and is aimed at people aged 35 years and under. They have a free 24 hour, 7 day a week telephone service called HOPELINE247 which can be reached on 0800 068 41 41. You can also text on 07860 039967 or email email@example.com.
- Pre and Postnatal Depression Advice and Support (PANDAS) Tel: 0843 28 98 401
- The Association for Post Natal Illness (APNI) Tel: 0207 386 0868
- Anxiety UK Tel: 08444 775774. Text service on 07537 416905 Email: firstname.lastname@example.org.
- The Motherhood Group is dedicated to share and support the black maternal experience through events, workshops, peer support, projects and advocacy.
- Menucha London is a registered charity in NW London who provides advice and support to empower Jewish Orthodox women experiencing Perinatal Mood Disorders (PMDs).
- Young Mums Support Network provides support, advice and training to young mums.