After giving birth

Postnatal depression and other postpartum mental health problems

11 min read

Many new mothers are affected by mental health issues like postnatal depression and birth trauma – we go through the symptoms to look out for and where to get help.

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Becoming a parent is always a challenge, but the early days with a new baby are even harder if you also suffer from postnatal depression, post-traumatic stress disorder or another mental health problem. And it can be very difficult to know what’s normal and when you should seek help while you’re in a situation that is already new and unfamiliar. 

Here we explain the most common mental health issues women experience after giving birth, tell you what help and treatments are available and how to find the support you need. It’s important to remember that if you’re worried or anxious about the way you’re feeling in any way, it’s always best to seek help as early as possible.

What is postnatal depression?

Postnatal depression (PND) is one of the most common and well-known mental health problems after birth, affecting more than one-in-ten new mothers in the first year of motherhood. PND can either start suddenly, or develop gradually over time, so it can be tricky to notice the signs at first.

While every woman’s experience of postnatal depression is unique, these are some of the main symptoms you may notice:

  • feeling low, tearful or sad most of the time
  • feeling irritable, agitated or apathetic towards your partner or child(ren)
  • lack of energy and trouble sleeping
  • loss of interest in the world around you and the things you usually enjoy
  • finding it difficult to concentrate and make decisions
  • loss of appetite, or comfort eating
  • lack of interest in sex
  • feeling like you’re unable to look after your baby or like you may want to harm them
  • difficulty bonding with your baby and not enjoying spending time with them.

Any new mother can develop postnatal depression, but you’re more likely to be diagnosed with it if you:

  • had mental ill health before you got pregnant
  • suffered from antenatal depression during your pregnancy
  • don’t have support from family or friends
  • have experienced other stressful events recently – such as the loss of a family member, redundancy or your relationship ending.

Treatments for PND

Postnatal depression can get better on its own, but it can also continue for years if you don’t receive the help you need. So if you think you may have PND, it’s very important that you seek help from your midwife, GP or health visitor.

They can assess you, usually using a questionnaire, and suggest a course of action or treatment to help you get better, tailored to your circumstances and how severe your depression is. The main treatment options are:

  • Self-helpIf you have mild PND, your health provider might suggest self-help methods as a first step to see if that helps improve your condition, for example through you getting more sleep, regular exercise, resting when your baby sleeps and eating nutritious food.
  • Talking therapyCounselling, like cognitive behaviour therapy, is often an effective treatment for PND. Your counsellor may help you explore any relevant issues, including from the past, as well as how you’re feeling and thinking at the moment, to help you get better.
  • MedicationAnti-depressants can be very helpful in improving PND. If you’re prescribed medication, you’ll probably have to take it for three to four weeks in order to feel the full effect, and initially you may even feel a bit worse. There are anti-depressants that are safe for breastfeeding mothers, take a look at this leaflet from The Breastfeeding Network for more information.

What is postnatal anxiety?

Anxiety after birth is as common as postnatal depression, affecting more than one-in-ten new mothers. Many women also experience postnatal depression and anxiety at the same time. Postnatal anxiety is a  broad term, covering everything from generalised anxiety disorder (GAD) and obsessive compulsive disorder (OCD) to phobias, health anxiety and post-traumatic stress disorder (PTSD), and they can all affect you in different ways.

However, what all different anxiety disorders have in common is that they cause a higher than normal level of anxiety in your body, and possibly in situations where you wouldn’t expect to feel anxious. The high state of anxiety makes you experience physical symptoms, for example you may notice some of the following:

  • finding it difficult to relax
  • feeling shaky or faint
  • heart palpitations (your heart beating quickly)
  • finding it difficult to breathe
  • excess sweating or blushing
  • needing to go to the toilet more often
  • worrying thoughts that seem out of proportion
  • feelings of fear
  • panic attacks.

Treatments for postnatal anxiety

If you seek help for anxiety symptoms after giving birth, the type of treatment you’ll be offered will depend on which type of anxiety disorder you’re diagnosed with and how severe your symptoms are. Generally speaking, there are two approaches.

  • Facilitated self-help: You’ll be given self‑help materials based on cognitive behaviour therapy (CBT) to work on over two to three months with support either face-to-face or by phone. Your progress should be evaluated to see if the treatment is helping.
  • Talking therapy: For certain disorders, for example social anxiety or PTSD, you should be recommended more intense treatment without first trying self-help, for example cognitive behaviour therapy (CBT). This is a treatment where you have counselling sessions face-to-face with a therapist, either alone or in a group setting.

What are birth trauma and post-traumatic stress disorder?

Giving birth can be an exciting and empowering experience, but for a lot of women the opposite is true, and they come away from their baby’s birth feeling traumatised by the event.

Up to one-in-three new mothers are estimated to be suffering from birth trauma, and a tenth of those develop post-traumatic stress disorder (PTSD). Birth trauma is when you have some symptoms of PTSD, but not enough for a full diagnosis.

If you have birth trauma or PTSD, these are some of the things you may experience:

  • Re-experiencing the traumatic event through flashbacks, nightmares or intrusive thoughts.
  • Avoiding anything that reminds you of the birth.
  • Being hypervigilant about your baby’s well-being.
  • Feeling guilty and blaming yourself for the way the birth went.
  • Having difficulty remembering parts of your birth experience.

You’re more likely to suffer from birth trauma if you have complications like an instrumental birth or emergency c-section, especially if you felt that yours or your baby’s life was under threat at any point, but it’s important to know that any woman can experience birth trauma – even if you have a textbook birth on paper.

Rather than just being about what happened when you gave birth, birth trauma is a result of how you experienced the event and what kind of support you received from the people looking after you. For example, you’re likely to develop birth trauma if, during or after the birth, you felt:

  • powerless or not listened to
  • fearful or confused
  • isolated or abandoned
  • that you weren’t asked to give consent to medical procedures.

Birth debrief

After a traumatic birth, you may have a lot of questions about what happened when your baby was born. In some areas, the NHS runs a Birth Afterthoughts or debrief service which offers the opportunity to go through your experience of birth with a midwife or consultant.

At the appointment, you’ll be able to ask any questions you have about what happened and anything you don’t understand about your maternity records. Many women find this a useful first step in working through their feelings.

There usually isn’t a time limit on a birth debrief, so even if your birth was years ago, you can still request one. Your local Patient Advice and Liaison Service (PALS) should be able to tell you whether a Birth Afterthoughts scheme operates in your area.

Read more about your rights during birth, how to request your maternity records and how to make a complaint against your hospital or NHS trust.

Treatments for PTSD

There are currently two evidence-based treatments for women suffering from birth-related PTSD that are recommended by NICE, and that you may be referred to if you seek help from your health provider.

  • Cognitive behavioural therapy (CBT)This is a birth-specific talking treatment which focuses on how your thoughts, beliefs and attitudes around the birth affect your feelings and behaviour, and teaches you coping skills for dealing with problems.
  • Eye movement desensitisation and reprocessing (EMDR)You’ll be guided by a therapist to make rhythmic eye movements while recalling the birth in your mind, to help you process the event and speed up recovery. EMDR can be especially useful if you’re finding it difficult to talk out loud about what happened during the birth as the treatment doesn’t require you to speak about your experience.
  • Other options: While CBT and EMDR are the only treatments that are recommended by NICE, many women find that there are other treatments and coping mechanisms that they find helpful when overcoming PTSD or birth trauma, for example the rewind technique. Have a look under Private treatment and support organisations to find a practitioner that provides alternative techniques.

What is postpartum psychosis?

Postpartum psychosis is a rare mental health illness that usually starts suddenly within two weeks of the birth of your baby, although it can develop up to several weeks later. Fewer than 2 in 1,000 new mothers experience this serious condition.

Symptoms of postpartum psychosis can include:

  • hallucinations or delusions
  • talking and thinking too much or too quickly
  • feeling “high” or “on top of the world”
  • signs of depression
  • feeling suspicious, fearful or very confused
  • restlessness or loss of inhibitions.

If you think that you, your partner, or someone close to you is experiencing postpartum psychosis, it’s important to seek help immediately by contacting your GP, calling 111 or going to A&E.

Treatments for postpartum psychosis

Most women make a full recovery from postpartum psychosis if they receive the right treatment, usually in a hospital setting to start with. These are the main treatment options:

  • Medication: You may be prescribed antidepressants, antipsychotics (to help with delusions or hallucinations), or mood stabilisers.
  • Talking therapy: As you’re recovering, you may be referred to cognitive behavioural therapy (CBT).
  • Electrovulsion therapy: Electric shocks are rarely used, but may be recommended if your symptoms are particularly severe.

Mother and baby unit (MBU)

If you’re experiencing postpartum psychosis and need to be admitted for treatment, you will often be able to stay in a mother and baby unit (MBU).

Here, your baby will be able to stay with you while you’re receiving treatment in a safe environment that has been specifically prepared for mothers and their babies.

How can I get help?

Seeking help for mental health problems is often difficult, and after birth it can be even more so because you have a new baby to take care of and you may think that society expects you to cope and even be happy at this time.

But try to remember that you’re never to blame for having mental health problems. No matter how bad you’re feeling, it’s not your fault and you deserve to get help to feel better.

If you find the prospect of seeking help daunting, which is not at all strange, you may find it helpful to talk to someone close to you first, for example your partner, a good friend or a family member. They can help you book an appointment, come with you for support and help you talk to a health professional.

Seeking help from your midwife, health visitor or GP

If you’re still having postnatal appointments with your midwife, talking to them about the way you’re feeling is often be the best first port of call.

Your midwife will have a lot of experience of helping women who have postnatal depression, anxiety or suffer from a traumatising birth experience, and should be able to find you the help you need – for example by referring you to a counselor or the perinatal mental health team in your area.

If you’re having trouble getting help through your midwife or have been signed off from midwifery care, you can turn to your health visitor – they’re there to look after your health as well as that of your baby. You can also talk to your GP, either at a dedicated appointment or when you go for your six-week postnatal check-up.

If you have a bad experience opening up to a professional, don’t give up – try to speak to someone else. There is support and help out there for you.

The perinatal mental health team

If you have severe or moderate mental ill health, you may be referred to the  perinatal mental health team in your area.  This consists of different health professionals like psychiatrists, specialist nurses, psychologists, psychotherapists, occupational therapists and social workers who specialise in looking after women’s mental health in pregnancy and after birth.

Around half of the NHS trusts in the UK have a perinatal mental health team. Look up your local hospital to find out if they have one you can get help from.

Private treatment and support organisations

As well as seeking help from your health provider and those close to you, there are organisations specialising in maternal mental health who often run helplines and support groups, as well as private counsellors who offer treatment for a fee.

  • Make Birth Better has advice and a map of NHS and private practitioners who work with women and their partners after a difficult birth.
  • The Birth Trauma Association has online support groups for people affected by birth trauma and post-traumatic stress disorder.
  • PANDAS has a helpline and peer support groups for parents with antenatal and postnatal depression.
  • Mind has a helpline providing help and support about mental health conditions and treatments.
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