Pregnancy and post-birth mental health conditions


Dr Chi-Chi Obuaya, consultant psychiatrist at Nightingale Hospital, London, on the mental health conditions that can develop during pregnancy or post-birth, and how they can be treated

For many women, pregnancy and motherhood are positive experiences, albeit not without challenges or conflicting emotions. During the post-birth period, sleep deprivation, hormonal changes and adjusting to new family roles involve great emotional upheaval. For this reason, it is unsurprising that 10-13% of women will develop a mental health condition during pregnancy or post-birth.

Up to 50% of women experience the ‘baby blues’ in the days and weeks following the delivery, during which they may feel tearful and emotionally fragile. This is incredibly common, and many women will get through this phase spontaneously and without medical treatment. It does, however, require understanding and support from loved ones.

Post-natal depression
About one in every 10 women experience either post-natal depression or anxiety in the weeks and months following birth and this is quite distinct from the common baby blues. The symptoms of depression can include a low mood, fatigue, difficulty enjoying yourself, feelings of guilt, hopelessness or worthlessness and suicidal thoughts.

There may additionally be physical symptoms of anxiety such as a racing heart, shortness of breath, sweating or a dry mouth, as well as psychological symptoms of anxiety—for example, nervousness, or the feeling that one might even die. There may be also repetitive thoughts or urges to carry out particular actions. 

For a secure attachment to develop, it is essential for mothers to bond with their babies. For this reason, recognising and treating mental health difficulties in mothers is vitally important. Babies often exhibit signs of distress, which the mother needs to be able to respond to in order to create a safe and nurturing environment. Untreated maternal mental health problems can affect women’s ability to provide the protection and emotional support their babies need.

Women with pre-existing mental health conditions are more likely to experience difficulties during their pregnancy and post-birth, although these can also arise out of the blue.

Post-partum psychosis
The most serious mental health condition seen in the post-natal period is postpartum psychosis, which affects approximately one in every 500 women. Symptoms usually start suddenly, commonly within the first two weeks of giving birth. The characteristic symptoms include rapid fluctuations in mood, agitation, social withdrawal, paranoid thoughts and hearing voices. Post-partum psychosis should be treated as a medical emergency.

Post-natal depression treatment
Women who experience post-natal depression and are breastfeeding are often concerned about taking antidepressant medication and the impact this may have on their breastmilk. However, there is overwhelming evidence that the most important consideration is to proactively address the mother’s mental health. Also, treatment does not always mean medication. In some cases, practical support or talking therapy may be sufficient. What is essential, is that women access help when they need it, without fear of judgement or shame.

For specific discussions around the suitability of different types of drugs, such as antidepressants and mood stabilising medication, women should speak to a mental health specialist.

Having a healthy pregnancy
It is also important that women try to eat as healthily as possible during pregnancy and take any necessary supplements. It is advised that women avoid alcohol, drugs and smoking. Additionally, all new mothers should consider attending antenatal classes.

During pregnancy it is important that expectant mothers feel able to speak openly to partners, family, friends and health care professionals about any mental health difficulties.

Combating isolation after birth
It is very common for expectant mothers and their partners to focus almost exclusively on the birth of the child, without considering the multitude of emotions and life adjustments that will follow. Joining a group of fellow new parents can be a great way to become part of a supportive community and build your confidence.