Perinatal Mental Health

What is perinatal mental health?

It refers to a person’s emotional and psychological wellbeing during pregnancy and up to roughly one year after. While the perinatal period can be a positive and exciting time, it also brings major physical, hormonal and life changes that can affect mental health. Almost a third of individuals who are pregnant or have recently given birth will experience some form of mental health difficulty.

What are the different types of perinatal mental health difficulties?

Different types of perinatal mental health difficulties include:

• Perinatal depression (depression during or after pregnancy)
• Perinatal anxiety (including generalised anxiety, panic, or health anxiety)
• Perinatal OCD (intrusive thoughts and compulsive behaviours)
• Birth trauma and PTSD (experiencing or witnessing a frightening and/or distressing event related to labour and delivery)
• Tokophobia (intense fear of childbirth)
• Postpartum psychosis – (there is another page on this topic)

What are the signs of perinatal mental health difficulties?

Perinatal mental health difficulties can show up in many ways, often beginning with changes in how a person feels, thinks, or behaves during pregnancy or after birth. Someone may notice their mood shifting suddenly or staying low all the time, feeling unusually sad, tearful, irritable, or overwhelmed. They might find themselves struggling with guilt, shame, or a sense of hopelessness. For some, intrusive thoughts (unwanted, distressing images or ideas) may appear, including fears about something bad happening to the baby or worries that feel scary and out of character. These intrusive thoughts are more common than many people realise and can be very upsetting. In the perinatal period these thoughts can be particularly distressing and if they are impacting on your daily life you might need to reach out for support.

For people experiencing perinatal mental health difficulties bonding may feel difficult or delayed, or they may worry that they are not a “good enough” parent. In some cases, they may feel down or emotionally numb, even at a time when they expected to feel joy.

Alongside this, simple everyday tasks may start to feel unmanageable, and someone may feel overwhelmed by responsibilities that previously felt routine. Fatigue is common in early parenthood, but extreme exhaustion—combined with inability to sleep or relax even when the baby is sleeping—can be a sign that mental health is under strain.

Anxiety can appear as constant worry, racing thoughts, or physical symptoms such as a racing heart or restlessness. A person may feel tense, unable to switch off, or preoccupied with fears that something is wrong with their baby or with themselves. This anxiety might centre on feeding, health, body image, or the birth experience. In more severe cases, someone may begin to see, hear, or believe things that others do not, which are signs of a potentially serious condition needing urgent support. These experiences can be frightening and confusing and may develop rapidly in the days or weeks after birth.

Another sign that someone may be struggling is when they express feeling incompetent, out of character, or unlike themselves. They may withdraw from loved ones, feel unable to ask for help, or worry excessively about being judged. Sometimes, the people around them – partners, family, or friends – are the first to spot these changes and notice that the person seems unusually confused, distressed, overwhelmed, or unlike their usual self. Health professionals consider sudden or unusual changes in mental state, persistent negative thoughts about oneself as a parent, or any thoughts of self-harm as important “red flags” that require prompt attention. [ghc.nhs.uk]

Across all of these experiences, the most important message is that not feeling right matters. For many, these signs emerge gradually; for others, they appear suddenly. In every case, they are valid, real, and deserving of timely support.

What causes perinatal mental health difficulties?

Perinatal mental health challenges usually arise from a combination of physical, psychological, social, and environmental factors.

1. Physical Factors

• Hormonal changes during and after pregnancy.
• Sleep deprivation
• Chronic pain (e.g., pelvic pain, severe morning sickness)
• Complications in pregnancy or birth, such as pre-eclampsia, emergency C‑section, haemorrhage
• Fertility treatment stress or physically taxing processes
• Underlying health conditions, e.g., diabetes, thyroid disorders
• Previous mental health history, as pregnancy can trigger relapse

2. Psychological Factors

• Anxiety about pregnancy, birth, or parenting
• Perfectionism or high self‑expectations
• Low self-esteem or feelings of inadequacy
• Unresolved grief or past losses (miscarriage, stillbirth, neonatal loss)
• Previous episodes of depression, anxiety, OCD, or trauma-related difficulties
• Difficulties adjusting to parenthood or identity changes

3. Trauma-Related Factors

• Past trauma, including childhood abuse or neglect
• Birth trauma – a frightening, painful, or overwhelming birth experience
• Traumatic medical interventions, e.g., emergency procedures
• Perceived lack of control, consent, or dignity during birth
• Postnatal events, such as neonatal intensive care admissions
• Domestic abuse (sexual, physical, emotional, coercive control)

4. Social / Environmental Factors

• Lack of social support, isolation or loneliness
• Relationship problems with partner or family
• Financial worries, housing instability, or poverty
• Work pressures, including maternity discrimination
• Cultural expectations or stigma around pregnancy and parenting
• Migration, asylum-seeking, or being far from family networks
• Parenting additional children without support
• Caring for a baby with health or developmental complications

5. Lifestyle and Practical Factors

• Sleep disruption common in pregnancy/postnatal period
• Overwhelm due to caring responsibilities
• Poor nutrition, low exercise, fatigue
• Substance use (alcohol, drugs, prescribed medication challenges)
• Changes in routine or reduced self-care time

6. Interpersonal and Relational Factors

• Conflict with co-parent or separation
• Role changes within the partnership
• Stress from differing parenting views
• Lack of support with childcare or household responsibilities

What can help? 

There are lots of ways someone can get support during pregnancy or after having a baby, and nobody has to cope alone.

Talking to a GP, midwife, or health visitor is one of the best first steps. They can listen, give advice, and help the person get the right support, including referring them to specialist perinatal mental health teams if needed.

Support from charities or local parent groups can also make a big difference. These organisations offer advice, emotional support, and sometimes helplines or online communities.

Talking therapies (like counselling or CBT) can help people understand their feelings, learn coping skills, and feel more in control. They’re available before, during, and after pregnancy.

Specialist perinatal mental health services can offer extra help if someone is really struggling. These teams include nurses, doctors, and therapists who understand mental health problems during pregnancy and after birth. They can help with things like checking medication, planning for the birth, and building confidence as a new parent.

It also helps when the person has people they trust to talk to, like a partner, family member, or friend. Feeling listened to can make things feel less scary.

After the birth, everyone checked in on the baby, but inside I was falling apart. I didn’t feel like myself anymore, I felt empty and just couldn’t relax or enjoy anything. I kept thinking I should be coping better than I was. It took me a long time to realise that asking for help didn’t make me a bad mother.

What can I do to support someone experiencing perinatal mental health difficulties?

1. Encourage Them to Speak to Healthcare Professionals

Gently encourage them to talk to a GP, midwife, or health visitor. These professionals can offer advice, check how they’re coping, and refer them to the right services.  If they are nervous about being judged, remind them that healthcare staff expect to hear about worries, low mood, or anxiety and want to help.

You could offer to go with them to appointments, help them keep track of advice or medication, reassure them if they feel worried about starting therapy or provide practical help, like watching the baby during appointments or collecting prescriptions.

2. Signpost to Helpful Charities and Community Support

Charities and local parent groups offer guidance, helplines, peer support, and information for people struggling before or after birth. These can feel less formal and easier to approach. You could offer to attend a support group with them if they want company, watch older children while they attend a mother and baby group or help them find online communities.

3. Listen Without Judgement

One of the most important forms of support is simply being there. People experiencing perinatal mental health difficulties may worry about being seen as a “bad parent,” which can make it hard to open up. Listening calmly and acknowledging their feelings can help them feel understood and less alone. Avoid giving too much advice and let them set the pace of the conversation. If it is relevant you could share what you or others you are close to, found difficult during the perinatal period, to reassure that they are not alone in feeling this way.

4. Offer Everyday Help

Practical help can make a big difference, especially if someone is tired, overwhelmed, or anxious. Even small things can help them cope better. You could offer to help with cooking, shopping, watching the baby or their other children so they can rest or housework tasks.

5. Look After Yourself Too

Supporting someone can be emotionally demanding. Make sure you also reach out to friends, family, or professionals if you need support yourself. The stronger you feel, the better you can support them.

Know When to Seek Urgent Help

If the person talks about harming themselves or their baby, or shows signs of severe confusion, hallucinations, or behaviour that is very out of character, it may indicate a condition like postpartum psychosis, and they need urgent help.

The Perinatal State of Mind

“Social media, films and television can make us think that having a new baby is something that most people “just handle.” But the truth is that many people struggle with mental-health in one way or another during or after pregnancy and we can often blame ourselves or feel like the only one struggling.” – Perinatal State of Mind.

Personal Experiences

“After my daughter was born, my mind never seemed to slow down, even when everything was quiet. I was constantly checking, worrying, and replaying worst-case scenarios, convinced something bad was about to happen. People told me it was “normal-new-mum nerves,” but inside it felt much bigger and harder to manage. I loved my baby so much, but the anxiety made me doubt every decision I made. I felt worn out from being on edge all the time, but too ashamed to admit how frightened I really was. Getting support helped me realise I wasn’t broken — I was dealing with postnatal anxiety, and I wasn’t alone.”

“The birth of my son Jacob didn’t go how I expected at all, and at the time I felt scared and totally out of my depth. Even after it was over and we were home, my mind kept going back to it, especially at night when things were quiet. I felt on edge and stressed all the time, even though people kept saying, “At least you and the baby are okay now.” Then came the guilt — guilt for not just being happy, guilt for still feeling shaken when I thought I should have moved on. I kept telling myself I was being ungrateful or overreacting, especially when others seemed to cope fine. It took a long time to accept that the birth had been traumatic for me, and that feeling stressed afterwards didn’t mean I was failing — it meant it had been a lot to process.”

“When I think back to when my baby was born it’s all a bit of a blur, I was in survival mode, and I was just managing day to day. The midwife referred me into the team. I was a bit anxious about it, but once id met one of the team, I felt listened to and I knew I would get support from nice people, and it all fell into place from there. The perinatal team always felt really friendly and comfortable, and everyone was so welcoming. I felt like the team were on my side right from the start they advocated for me to help me get help that I needed.

So many people think having a baby is happiest time and although it is, it can be such a big shock especially with the first one because there is a lot to adjust to and learn. I worried lots and was having thoughts that other people might think I’m a bad mam for struggling with my mental health. I put a lot of pressure on myself to be the best at being a new mam and this led to me feeling overwhelmed.

I was also really scared I wouldn’t be able to bond with my baby, but when she arrived it sort of went the other way, and I couldn’t let her out of my sight we were really bonded, but this sort of affected dads’ bond with baby.

Having a baby can bring up stuff from childhood which wasn’t expecting. So at times I felt like I was looking after ‘little me’ and a little baby which was difficult to navigate at times. Therapy helped me see this and work through it.

The team offered lots of support it wasn’t just mental health related, there was so many options. I did a craft group, first aid with nursery nurse, baby massage, a care after trauma group, a mindfulness group, and 1:1 schema therapy. These things got me through the difficult time, and I don’t think I’d be in the place I am today if it wasn’t for the team. I didn’t have any family or social support, so I felt a bit isolated and overwhelmed, but the team were always there to support me when I needed them.

The groups available were really varied. I was nervous to go at first but quickly felt safe and understood, everyone was lovely. It helped with the feelings of isolation because while we all had different things going on, we all knew we were in a place where we wouldn’t feel judged, and I also got to spend quality time with baby and do fun things with her which I wouldn’t have been able to do at home. I also learned loads from the groups such as understanding why I was feeling the way I was and got coping skills to help me. We even went to a walking group with other mums, that was so nice and relaxed.

The therapy has changed how I think and feel about things; it sticks with you because now I think back to what my therapist would say in that situation and just think about that. I now have a better ability to catch myself when I have difficult thoughts and feelings, sometimes it’s still really hard but I have a lot more awareness of what’s happening now. It helped me to look at things from what I’d been through and why I was struggling with the things I was now it was really eye opening. I’d tried other therapies before, but this was the most helpful I felt like we were on the same side working together.

I had support from the team for over a year, so the ending felt a bit difficult, but the team really helped me through this, giving me plenty of advance information for how this would happen and what would be available after perinatal. I feel lucky to have had the support I had.

Lots of people don’t know about the perinatal team and I wish that more people knew that the support is out there. I feel like a lot of mental health for mums is still quite quiet and not spoken about and not many people knowing what it is and how it can be supported.

I would say to any new mam who is struggling, don’t worry what other people are thinking because getting help for you is more important and it is so worth asking for the help.”

“I wanted to share my story so that if someone else who is going through a difficult time before or after having their baby, they might know they’re not alone, and that it’s more common than people think to struggle with their mental health. I had a difficult birth and pregnancy, and afterwards I became very anxious and panicked, I was struggling with my sleep and had scary worrying thoughts and difficult emotions. I remember being so terrified as I didn’t understand why my mental health was not good and I was afraid that I wasn’t going to be okay, but I want to reassure people that there is help out there and some lovely people who can help you.

I’ve noticed there is a still a bit of stigma when it comes to perinatal mental health because it isn’t talked about enough. Sometimes people don’t know what to say or do to help and this can feel isolating. I recall feeling caught up in between loss of who I was before the pregnancy, and the new changes and growth. I was excited, but it is a massive change of identity. There was a feeling that I had to keep putting on a brave face and keep going, but underneath I was really struggling.

I felt a bit nervous in getting help, but I am so glad that I did. It helped break the cycle of my mental health difficulties and allowed me to understand what was happening and why, rather than thinking there was something ‘wrong’ with me. I felt so validated by the team, they were so relaxed, helpful, and kind, really approachable and friendly. They also offered support for my mam as well because she was my main support at the time, so it seemed like we had someone on our side. The team offered help with my mental health, but also practical things like feeding, first aid, and medication, so it felt like all areas were being covered.

I went to a group with the perinatal team. I was nervous beforehand but quickly realised I didn’t need to be! Being a new mum can be isolating but I came to find that I started looking forward to the group each week. I learned a lot about myself, my anxiety, and how to cope and manage. I can see progress in all areas of my life now because of what I took away from the group. I made new friends there and we keep in touch still. It was great because we would see each other every week, have a routine with it, and it got us out the house and offered support and structure. It was a safe place to ask questions and feel validated, which helped normalise the experiences we were having. I didn’t feel as alone because we were all finding things tough and we helped each other too in this sense. The support has helped me to change the way I think about things, and I feel more confident. We also took our babies to the group if we wanted to which was helpful, the team are adaptable and do everything possible to make accessing support as easy as it can be. They understand the time juggling, demands and issues new mams have!

If I could go back in time and speak to myself when I was going through it after the birth, I would say to remember what you’ve been through, with all those hormones and changes, it’s no wonder you feel overwhelmed. It’s not your fault, and what you’re going through right now will end with the right help and support. There will be ups and downs but take each day as it comes and stick with it.

Advice I would give to a new mam who is struggling would be to go and get help because it is out there, don’t be scared to reach out you are not alone. And most importantly be kind to yourself and accept yourself where you are it will get better.”

In April 2024, following a miscarriage in 2023, I found out I was pregnant with my little boy.

My initial feelings were excitement and relief — we were finally going to have a baby. It felt different this time. My partner and I were so excited and hopeful about the future.

 After a few weeks of living on the high of being pregnant, I began to experience intrusive and unwanted thoughts about harming my baby once he was born. At first, these thoughts were fleeting and would come and go, and I was often able to push them to the back of my mind. As the weeks passed, however, they intensified. I struggled to sleep or concentrate, became increasingly agitated, and my mood dropped significantly. Eventually, this led to very dark thoughts about ending my life once my baby was born.

At the time I found out I was pregnant; I was under the care of adult mental health services and was transferred to the perinatal mental health team. Through this, I built a trusting relationship with my community psychiatric nurse and psychologist, which became an essential source of support.

The thoughts I was experiencing were of a sexual nature — fears that I would sexually abuse my baby. This is an incredibly taboo subject and something I found extremely difficult and shameful to talk about. It took a great deal of courage to admit these thoughts were there at all. Instead of being judged or dismissed, I was met with understanding, reassurance, and care. I felt listened to and supported and was reassured that these thoughts were a symptom of distress and anxiety, not a reflection of who I am or an indication that I was a bad or dangerous person.

 Despite the support I was receiving, my mental health continued to deteriorate. By 33 weeks pregnant, I felt completely overwhelmed. I wasn’t sleeping, I was terrified of my own thoughts, and I no longer trusted myself to stay safe. Together with the perinatal team, the decision was made for me to be admitted to the Mother and Baby Unit. Being admitted while still pregnant felt surreal and frightening. Part of me felt as though I had already failed as a mother before my baby had even arrived, but another part of me knew I needed help to keep both of us safe.

The weeks leading up to the birth were distressing and full of worry. However, the support I received on the Mother and Baby Unit was exceptional. It gave me the space to breathe, to feel contained, and to begin processing what was happening.

My baby boy was born via caesarean section, and although I was surrounded by professionals who understood what I had been going through, I was still terrified. I feared that the moment he arrived, all my worst thoughts would come true — that I would somehow become the dangerous person my mind had convinced me I was.

I remained in the Mother and Baby Unit with baby until he was almost six months old. Those months were some of the hardest, but also the most healing, of my life. The intrusive thoughts did not disappear overnight, but through therapy, support, and learning to understand intrusive thoughts as a symptom rather than an intention, I slowly began to trust myself again. The staff supported me to bond with my baby and to understand my triggers. The unit did everything possible to make our stay comfortable, and the staff were consistently supportive, friendly, knowledgeable, and compassionate in the care they provided.

I had regular catchups with my key nurse, including one-to-one time to discuss any concerns as well as what was going well. Nursery nurses were always available to offer advice and support around caring for my baby, which helped build my confidence as a mother.

My partner was able to visit as often as he wished and could stay overnight on the ward, allowing him to bond with our baby and support us as a family.

While on the ward, we held weekly meetings to review my progress and identify areas to focus on in the coming week. The community perinatal mental health team attended these meetings to stay involved and to maintain the strong relationship we had built prior to my admission.

Towards the end of my stay on the Mother and Baby Unit, while on leave, I began attending appointments with the perinatal team in the community. During this time, I worked closely with my psychologist, who helped me develop a stronger sense of self and explore my values — what is important to me as a mother and as an individual. This work enabled me to challenge the intrusive thoughts more effectively; over time, they became smaller, less frequent, and had less impact on my daily life and my ability to care for my baby.

In therapy, we also gently touched on my personal history and the trauma I experienced growing up. For the first time in my life, I felt I was in a safe enough environment to begin discussing this. Having that space has given me the foundations I need to process my trauma and to “package it up” in a way that allows me to deal with it safely, at my own pace.

Following discharge from the perinatal team I have been able to reflect on my involvement with them and have come to realise I am a mum who fought through something terrifying, and I’m still growing and healing. My bond with my baby boy is strong, loving, and real. I no longer see myself as the danger but as a mum who is simply trying her best. 

Reaching out for help was the hardest thing I’ve ever done, but it saved me and my baby boy. And with thanks to the perinatal team and Mother and baby Unit this has all been possible. 

If you’re reading this and are struggling, I hope my story shows that recovery is possible, even when things feel impossible.