Mental healthcare before, during and after pregnancy

Over the last few years mental health services for women who are pregnant or postnatal (post-birth) have increased significantly.

Why is it necessary?

10-20% of women experience mental illness in the perinatal period. A range of services is available.

There are specialist mental health teams all over the country to help women who:

  • develop a mental illness in pregnancy or postnatally (such as depression, anxiety or obsessive compulsive disorder), or
  • have a pre-existing mental illness and are in the perinatal period.
What help is available?

If you have a serious mental illness such as schizophrenia, Bipolar Affective Disorder or a serious depressive or anxiety disorder and are considering trying for a baby in the near future, perinatal mental health teams offer pre-conception counselling.

This involves an appointment where the doctor will discuss the medication you are taking and explain the risks and benefits of continuing the medication as well as risks of relapse, and will help you plan for a safe pregnancy for you and your baby.

You will be able to find out what support you are likely to be offered if you do become pregnant. If you already have a mental health team you can ask to be referred – and if not, your GP can refer you.

If you find out you are unexpectedly pregnant and are taking medication for your mental health, perinatal mental health teams offer urgent medication advice, either to your GP or will offer you an appointment, usually within two weeks. It is not advisable to stop medication suddenly. Most mental health medications can be taken during pregnancy, and stopping suddenly may cause a relapse.

For women who are mentally unwell or at high risk of becoming unwell, perinatal mental health teams can offer a wide range of support, including medication reviews, nurse input, occupational health input, psychological therapy and nursery nurse support. They also offer birth planning, working alongside the obstetric and midwifery team. This may be important for women who have experienced previous trauma.

As part of perinatal mental health teams, maternal mental health services are being developed to help women who have experienced trauma or loss related to the maternity experience.

What about after I have a baby?

Postnatally, perinatal mental health teams can offer help with mental illness, interventions to help with bonding and psychological interventions. GPs are often able to treat mild to moderate postnatal illness with medication, and may suggest a self referral to IAPT for talking therapy (you can google IAPT services in your area – pregnant and postnatal women are usually prioritised). However you can also ask your GP, midwife or health visitor for a referral to the perinatal mental health team in your area if needed.

They can also offer signposting to appropriate mental health services for fathers and partners.

What about emergency help?

If you or your family feel feel that you need urgent help with your mental health out of hours, you should call 111 or 999. Alternatively you should go to A&E where you can access help from mental health staff, and ask to be referred to the perinatal mental health team the next day.

Will my baby be taken away from me if I admit I am struggling?

This is unusual, especially as mental illness is so common in the perinatal period. Many women worry about disclosing mental health difficulties for fear of their children being removed. Remember –  mental illness doesn’t make someone a bad parent.

Perinatal mental health services are there to support mothers to be the parent they want to be. Children’s services are sometimes involved to offer further support to families who need it, but these cases are rare.

Summary

We have described mental healthcare before, during and after pregnancy. We hope it is helpful.