Your pregnancy

Mental health in pregnancy

10 min read

Depression and anxiety affect many pregnant women but there is help and support available – we go through how to cope if you’re struggling emotionally during your pregnancy.

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Pregnancy is often perceived to be a time when you should be glowing with joy – but in reality, the period between finding out you’re pregnant and giving birth to your baby can be filled with conflicting emotions. It’s during this time that many women develop mental health conditions like depression or anxiety.

Why am I feeling down?

It’s completely normal to feel a bit anxious about birth, worried about becoming a parent and generally low from time to time when you’re pregnant. These are very natural reactions to the big changes your body and mind are going through.

Suddenly, your body isn’t just your own anymore and you may be experiencing difficult pregnancy symptoms or health problems. As if that’s not enough, you have the upcoming birth to think about and plans to make for a newborn baby. It’s natural to have fears and worries about what’s happening and what’s to come.

There are a number of factors which can make pregnancy an especially difficult time emotionally:

  • Hormonal changes which affect your mood
  • Physical changes to your body
  • Pregnancy pains and discomfort
  • Concern for how your baby is doing
  • Worries about what giving birth will be like
  • Previous problems with your mental health
  • Lack of support from a partner, family or friends
  • Going through a hard time in your relationship
  • Recent experience of bereavement
  • Having suffered abuse in the past.

How do I know if what I’m feeling is normal?

While you should expect to experience some low moods and anxious thoughts when pregnant, many women go on to develop specific mental health conditions that need treatment.

There isn’t a hard and fast line between what’s normal emotional changes and what could be symptoms of something more serious, so the best thing to do is to ask yourself how you’re feeling and how your emotions are affecting you, and let that be your guide.

For example, you may want to seek help if you find that:

  • your feelings are having a severe impact on your day-to-day life
  • your anxiety is affecting your quality of life
  • thoughts of giving birth are filling you with dread, or
  • the way you’re feeling affects your relationship with those close to you.

It’s important to note that these are just examples. If you feel worried or anxious about the way you’re feeling, it’s always best to mention it to your midwife, who can assess you and find the help you need.

Mental health conditions in pregnancy

Below is a brief introduction to some of the most common mental health conditions experienced during pregnancy.

Prenatal or antenatal depression

Depression can start at any point in your pregnancy and it’s far more common than most people realise: more than one-in-ten expectant mothers are thought to suffer from it.

If you have antenatal depression, you may find that you’re:

  • always anxious
  • feeling guilty
  • crying a lot
  • lacking energy
  • feeling isolated
  • worrying about your relationship, or
  • having very strong emotions around your own childhood.

If you experience some of the symptoms above or your partner has noticed that you seem more down than usual, it can be a good idea to talk to your midwife about how you’re feeling.

If you’re diagnosed with antenatal depression, it’s likely to go away when your baby’s born. However, one-in-three women with depression in pregnancy go on to develop postnatal depression, so it’s important that you’re supported after the birth as well so you can get help if this happens to you.

Antenatal anxiety

Most pregnant women will feel a bit worried, as pregnancy and birth are times of intense change. But if anxious feelings have a severe impact on your day-to-day life, you may be suffering from antenatal anxiety.

Anxiety during pregnancy is almost as common as depression, affecting one-in-ten pregnant women, but there is less awareness around it. Episodes of anxiety are very individual, but common symptoms you may experience include:

  • difficulty relaxing
  • feeling shaky
  • heart palpitations (your heart beating quickly)
  • difficulty breathing
  • feeling faint
  • muscles tensing up.

If you suffer from anxiety, you may be frightened of your symptoms and worry that you’ll have a heart attack or faint, but it can be reassuring to know that this is very unlikely to happen.

Anxiety is your body’s way of telling you that it’s on high alert for danger, and stress hormones are released to help you get ready to get away from the threat causing symptoms like heart palpitations. While it can be very unsettling, the reaction in your body is not dangerous.

If you seek help, you can be given tools to use – for example, relaxation techniques, to cope with your anxiety in different situations.

Tokophobia: fear of childbirth

Feeling apprehensive about the prospect of giving birth is completely normal, but in some cases the worry can turn into something more serious.

Somewhere between two and 20 per cent of pregnant women have tokophobia – a significant fear of childbirth. The estimated numbers vary wildly depending on how broad a definition is used.

The fear can be debilitating and affect the choices you make in pregnancy and birth. Often, but far from always, these feelings stem from having had a previous traumatic birth. Various aspects of birth can be triggering for different women, but some common symptoms of tokophobia include:

  • feeling scared about being injured during the birth
  • worrying that you won’t be listened to during birth, or;
  • being scared of something happening to your baby.

If you’re very worried about giving birth, seek help from your midwife as soon as possible. What help you need depends on what your fears are based around, so it’s important to have a discussion that considers your own experiences and fears.

Some options for dealing with tokophobia that you might like to consider include:

  • having counselling to overcome a previous traumatic birth
  • going to relaxation classes and learning relaxation techniques
  • talking to a senior midwife to come up with a detailed birth plan which helps you feel in control
  • booking a planned c-section if you’re very anxious about having a vaginal birth.

Whatever the solution is for you, the important thing is that you get the help you need to have the best chances of having a positive birth experience.

Other mental health conditions

While the conditions above are the most common ones in pregnant women, there are many other problems you may be affected by. For example, pregnancy can be a trigger for obsessive-compulsive disorder (OCD), and eating disorders can also surface in pregnancy.

It’s always a good idea to talk to your healthcare provider if you feel that you may need help or advice with any aspect of your mental or physical health.

If you’ve had mental ill health in the past

If you’ve had severe mental illness in the past (for example bipolar affective disorder, severe depression or psychosis), you’re more likely to become ill during pregnancy or in the year after giving birth than at other times in your life.

That doesn’t mean that you definitely will experience mental health issues now, just that it makes sense for you to keep a closer eye on how you’re feeling, so you can quickly seek help if you need it.

Where can I get help?

Seeking help for mental health problems can often feel difficult, and in pregnancy this can be exacerbated because you’re constantly bombarded with the idea that you should be feeling positive about the whole experience.

You may hesitate to seek help because you feel as though you’re not coping as well with pregnancy as other women appear to be, that it means you won’t be as good a parent, or that healthcare professionals will judge you if you open up.

However, this couldn’t be further from the truth.

Whatever thoughts and emotions you’re struggling with, it’s never your fault, it doesn’t have any bearing on the parent you’ll be and you won’t be judged.

Health professionals would much rather you to tell them about any problems or worries you’re having so you can get help as soon as possible, rather than waiting until mental health issues become more severe.

Support from your family or friends

You may find it helpful to talk to someone close to you about the way you’re feeling before you approach a health professional – for example, your partner, a good friend or a family member. They can help you book an appointment with your midwife or doctor and come with you for support if you would like that.

You may also find it useful to bring this checklist when you go to your appointment, to make sure you get to say everything you need to.

Seeking help from your midwife or GP

The best way to get help is often through your midwife, either at one of your antenatal appointments if you have one scheduled soon, or by calling them (the phone number should be at the front of your maternity notes).

Your midwife will be used to pregnant women experiencing mental health problems and can ensure that you get the help you need, for example by referring you to a counsellor or a specialist perinatal mental health team.

If you’re having difficulty getting help through your midwife, you can turn to your GP instead, or the health visiting team if you also have an older child.

If you have a bad experience opening up to a health 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 team consists of a range of health professionals who specialise in mental health in pregnancy and after birth, and who can support you.

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.

Coming off or changing medication

If you’re on medication for a mental health condition before you got pregnant, you may have to come off it during pregnancy so the medicine doesn’t pass through the placenta to your baby. However, it’s important that you don’t stop any medication before you get advice from your doctor.

Speak to your doctor or your community mental health team (CMHT) as soon as possible when you’re planning to start a family, or find out that you are pregnant, so you can discuss how to manage your treatment during pregnancy and while you’re breastfeeding.

Support organisations and helplines

As well as looking for support from health professionals and those closest to you, there are organisations specialising in mental health who run helplines where you can talk directly to someone understanding.

  • PANDAS has a helpline and peer support groups for parents with antenatal depression.
  • Anxiety UK has a helpline giving information and support to people experiencing anxiety.
  • Mind has a helpline providing support and advice about mental health conditions and treatments.

More from Which?

  • Your rights during pregnancy and birth: Understand your legal rights to receive the maternity care and choose the birth that you want..
  • Your antenatal appointments: Understand what will happen at your appointments and how to make the most of your maternity care.
  • Beyond baby blues: The first few weeks after birth are often filled with conflicting emotions – find out what to expect and where to find support.

References

These are the sources of information used in this article:

Antenatal and postnatal mental health: clinical management and service guidance, NICE Clinical Guideline 192, London: National Institute for Health and Clinical Excellence (2018)

Hofberg K, Ward MR, Fear of pregnancy and childbirth, Postgraduate Medical Journal (2003)

Howard LM et al, The accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy, British Journal of Psychiatry (2018)

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