Perinatal mental illness is the umbrella term for a range of issues that may occur during pregnancy or after the birth of a child.

 

These issues can range from mild to severe and depending on the level of severity, different treatment options are available.

 

Click on the topics below for more detailed information on each of the perinatal mental health issues.

Depression (Antenatal & Postnatal)

Antenatal and postnatal depression is a mood disorder that occurs in pregnancy or in the first year after giving birth. 1 in 5 women will experience depression and 1 in 10 men.

Many women experience ‘baby blues’ in the first ten days after giving birth which is very normal. However, having feelings of low mood, tearfulness, numbness or lack of interest in things that usually bring pleasure that last for longer than two weeks can be a sign of depression.

Perinatal depression is a treatable condition with the right help and support. It is important to note that like all mental health conditions, this is an illness and it is not your fault. Getting help and support early will help you to recover more quickly and get back to feeling like yourself again.

There are different theories on what causes antenatal and postnatal depression. It is most likely a combination of several of the below:

Emotional

Becoming a parent is one of the biggest transitions a person can go through in their lifetime. Every pregnancy, birth and baby are different and each comes with its own set of challenges whether this is your first baby or your tenth.

Problems within  relationships may be magnified, you may have other children at home who will need to adapt to a new sibling or you may be concerned about your job or financial situation. All of these stresses can be contributing factors in depression.

If you have suffered a miscarriage or still birth, this can bring up feelings of grief and sadness as well as fear for the current pregnancy.

While in most cases antenatal depression will resolve before the birth of the baby, it is estimated that up to a third will continue and evolve into postnatal depression. It is important to recognise both conditions early in order for speedy diagnosis and  treatment.

It is important to note that perinatal depression is 100% treatable and in most cases can be resolved quickly with early intervention.

Physical

Hormonal changes

Pregnancy, childbirth and breastfeeding are times of great hormonal change in a woman as the body grows, nourishes and births a baby. This can cause changes in mood as well as physical changes in the body that may be uncomfortable or unsettling.

Nausea

In pregnancy, nausea can cause a lot of mental distress, especially if it persists for the length of the pregnancy or is severe (a condition known as hyperemesis gravidarum)

Iron and zinc deficiencies

These have been linked to depression in pregnancy as the body may become deficient. Eating plenty of iron and zinc rich foods is very important as well as Vitamin C to help the body absorb the iron.

Changes in appearance

Pregnancy and motherhood take a natural toll on how our bodies look. We may gain weight, lose weight, lose hair after pregnancy and our skin can change. All of this can make us lose some of our confidence. specially in today’s society where a great emphasis is placed on a woman’s appearance, the process of becoming a mother and finding yourself with a body that feels different from usual can be very upsetting.

Sleep

Discomfort during pregnancy, and the normal frequent night wakings of a baby mean that sleep is often interrupted or you wake feeling unrested. Sleep is a crucial process that allows our bodies to heal and our brains to process the events of the day. When this is disturbed, the effect can be extremely detrimental.

Sufferers will often describe perinatal depression as rather than being a time of joy and excitement, pregnancy and the postnatal period become a time despair, hopelessness and anxiety.

Symptoms

  • Crying for no apparent reason
  • Feelings of guilt or worthlessness
  • Hopeless about the future
  • Lack of energy, finding it difficult to get of bed and face the day
  • Relationship worries (e.g. worrying their partner may leave before or shortly after the baby is born)
  • Becoming withdrawn or hostile to those closest to you
  • Feelings of hostility or indifference towards your pregnancy/baby
  • Conflict with parents: pregnancy can often stir up emotions about their own upbringing
  • Isolation
  • Feelings of despair or distress outside the normal ‘lows’
  • Difficulty sleeping
  • Fear of seeking help
  • Irritable and angry
  • Reduced appetite or increased appetite (comfort eating)
  • Loss of concentration
  • Intrusive thoughts, thoughts about death or thoughts of suicide

Antenatal and postnatal depression is a treatable illness with the right help and support. Treatment options include:

Self-help

There are a number of effective self-help techniques you can use to feel better. These can include peer support, online cognitive behavioural therapy, self-care such as managing stress, exercising regularly and eating well. Click on Our Services to find out ways that We Are Pangs may be able to support you.

Psychological Therapies

Psychological therapies are a range of talk therapies and courses that challenge the way your brain thinks and reacts in certain situations. They can help you explore difficult circumstances or events and find a way to move forward. Services are available on the NHS and you can be referred by your GP. There are also community mental health teams available in most trusts that you can be referred to.

If services aren’t available in your area, you can also access counselling services provided by charities such as New Life (see our list of partner organisations for a full list). You can also pay to see a private therapist but be sure to do your research and only see someone with the appropriate qualifications and experience.

Medication

There are a range of medications available to treat depression including antidepressants, beta blockers and mood stabilisers. Speak to your GP for further information, especially if you are pregnant or breastfeeding.

There are a number of medications suitable in these circumstances. If you are concerned about breastfeeding while on medication you can seek advice from Wendy Jones at Breastfeeding and Medication.

Anxiety (Antenatal & Postnatal)

While anxiety is often lumped into the symptoms of depression, anxiety disorders can and do exist on their own without depressive symptoms. It is often only when anxiety reaches a point of crisis that depressive symptoms appear.

When we talk about anxiety, we are not talking about the normal every day worries and concerns. While anxiety plays a role in our daily lives (preventing us from stepping out in front or buses or running with scissors), the fight-or-flight response can become hyper-vigilant, always on the alert for danger. When this happens, seemingly innocuous events can trigger anxiety or panic attacks as the brain perceives threats all around.

When faced with danger such as an aggressive dog, our brain prepares our bodies to react in one of four ways.

  • Flight: run away from the danger
  • Fight: fend off the attack
  • Freeze: stay still in hope that the danger will pass by
  • Flop: faint, giving the impression of death so that the animal will leave us alone. This is also triggered if the brain suspects that you cannot survive the attack, thereby preparing for a painless death through unconsciousness.

The brain assesses the situation and reacts in a fraction of a second, flooding your body with stress hormones (cortisol and adrenaline), sending blood coursing to your major muscles groups to prepare to fight or run away, dilating your pupils, amongst many
other symptoms. This is the feeling of panic.

The problem with an anxiety disorder is that the brain can’t tell the difference between a real threat and a perceived threat.

With anxiety disorders, the smallest thing can trigger a panic. It could be a smell that reminds them of a time they felt unsafe or intrusive thoughts of danger such as hospital smells after a difficult birth.

It’s important to remember that anxiety is the brain’s way of trying to keep us safe and it is a vital function of living. However, there are ways to manage anxiety so that you can return to a state of calm.

Anxiety disorders can be caused by a number of factors, most commonly trauma where a person feels under threat or unsafe from a real or perceived danger. Birth trauma is a common cause of postnatal anxiety.

Whilst a certain level of anxiety is expected in pregnancy, anxiety disorder is much more than the usual pregnancy worries. It can be all-consuming and make life very difficult.

Fluctuating hormones in pregnancy, after birth and during breatfeeding can also impact on anxiety levels. Stress and other circumstances in a parent’s life can also add to anxiety making it feel very difficult to manage.

It is important to remember that there are a range of very successful treatments for anxiety.

Physical Symptoms

  • Racing pulse
  • Sweating
  • Clenching or grinding teeth
  • Feeling breathless or unable to breathe deeply
  • Feeling tight-chested
  • Feeling light-headed
  • Stomach upset or frequent bowel movements
  • Feeling hot or flushed
    • Lump in the throat
    • Muscle tension
    • Dry mouth
    • Nausea
    • Muscle weakness
    • Fatigue
    • Headache
    • Loss of appetite

Emotional Symtoms

  • Feeling anxious, nervous, or afraid most of the time
  • Feeling like something awful is about to happen
  • Feeling tense, uptight, unable to relax and on edge
  • Feelings of panic or terror
  • Constant obsessive worrying
  • Racing thoughts
    • Dwelling on worst case scenarios/catastrophising
    • Finding it difficult to carry out simple tasks
    • Pacing, unable to sit still
    • Talking more quickly than usual
    • Snappy, irritable or angry behaviour
    • Drinking or smoking more regularly
    • Negative self-talk (I’m making an idiot out of myself)

Anxiety is a treatable illness with the right help and support. Treatment options include:

Self-help

There are a number of effective self-help techniques you can use to feel better. These can include peer support, online cognitive behavioural therapy, self-care such as managing stress, exercising regularly and eating well. Click on Our Services to find out ways that We Are Pangs may be able to support you.

Psychological Therapies

Psychological therapies are a range of talk therapies and courses that challenge the way your brain thinks and reacts in certain situations. They can help you explore difficult circumstances or events and find a way to move forward. Services are available on the NHS and you can be referred by your GP. There are also community mental health teams available in most trusts that you can be referred to.

If services aren’t available in your area, you can also access counselling services provided by charities such as New Life (see our list of partner organisations for a full list). You can also pay to see a private therapist but be sure to do your research and only see someone with the appropriate qualifications and experience.

Medication

There are a range of medications available to treat anxiety including antidepressants, anxiolytics, beta blockers and mood stabilisers. Speak to your GP for further information, especially if you are pregnant or breastfeeding.

There are a number of medications suitable in these circumstances. If you are concerned about breastfeeding while on medication you can seek advice from Wendy Jones at Breastfeeding and Medication.

Obsessive-Compulsive Disorder (OCD)

People who suffer with OCD will experience unwelcome thoughts and urges, often followed by repetitive actions.

The obsessive nature of the illness focuses on persistent and uncontrollable thoughts, worries, fears or impulses which are very difficult to ignore.

The compulsive nature of the illness causes the person to carry out repetitive and persistent physical activities such as flicking light switches, checking and double checking locks on doors and can include mental thought rituals such as counting to a certain number before being able to fall asleep.

With postnatal depression and anxiety, intrusive or obsessive thoughts on their own aren’t a symptom of OCD. It is only when the person believes that something bad might happen, and that they will be responsible for this if they don’t carry out certain rituals that OCD may be present.

In more severe cases, OCD can result in self-harm, often unnoticed by the sufferer until afterwards (such as skin picking or scratching until they bleed).

OCD is seen as an anxiety disorder and many of the treatment methods will be similar.

Much like anxiety disorders, OCD can be caused by a number of factors, most commonly trauma where a person feels under threat or unsafe from a real or perceived danger.

It is important to remember that there are a range of very successful treatments for OCD.

OCD is split into two main parts:

  • obsessions – having intrusive thoughts, ideas or urges that repeatedly appear in your mind. For example, worrying about germs everywhere or thoughts of hurting your child.
  • compulsions – these are repetitive activities that you feel you must do. This could be something like repeatedly flicking light switches, or counting in your head to prevent harm from coming to a loved one.

The aim of a compulsion is to relieve the intense anxiety caused by obsessive thoughts. However, the process of repeating these compulsions is often distressing in itself, and any relief you feel is often short-lived.

It is important to remember that having these intrusive thoughts doesn’t mean you will act on them. They are distressing and frightening and it is important that you talk to someone who can help and support you.

The main treatment for OCD is cognitive behavioural therapy (CBT), particularly a CBT method called Exposure and Response Prevention (ERP). This is a talking therapy with a practical element to help you train your brain to respond differently to your OCD triggers.

There are also medications that can be used and which work effectively alongside talk therapy. If waiting lists are long for CBT in your area, your GP may suggest medication until the support becomes available to help you manage your symptoms.

If you are pregnant or breastfeeding, there are a number of medications suitable in these circumstances. If you are concerned about breastfeeding while on medication you can seek advice from Wendy Jones at Breastfeeding and Medication.

Self-help

There are a number of effective self-help techniques you can use to feel better. These can include peer support, online cognitive behavioural therapy, self-care such as managing stress, exercising regularly and eating well. Click on Our Services to find out ways that We Are Pangs may be able to support you.

 

Birth Trauma & Post-traumatic Stress Disorder (PTSD)

Birth trauma occurs when a woman or her partner feels a severe threat to their lives or the lives or others (their baby or partner). This threat may be real, caused by actual events in the delivery room, or may be perceived threats, i.e. lives weren’t actually in
danger but the sufferer felt sufficiently frightened enough to perceive they were in danger.

Birth trauma can occur even when a birth has been straightforward and uncomplicated. It can also be caused by a long or difficult labour and delivery, an unplanned caesarean section, emergency treatment or other unexpected events in the delivery room that led to the person feeling unsafe or vulnerable.

PTSD occurs when this trauma has a lasting and detrimental effect on the sufferer and can impede the person’s ability to cope with every day tasks and impact their relationship with others, including the baby.

You may develop post-traumatic stress disorder (PTSD) if you experience:

  • a difficult labour with a long and painful delivery
  • an unplanned caesarean section
  • emergency treatment
  • other shocking, unexpected and traumatic experiences during birth
  • traumatic breastfeeding experience

PTSD is a very intense and distressing illness and yet is very treatable.

  • Flashbacks of the event
  • Obsessively revisiting the event, playing it over and over, unable to move forward
  • Intrusive thoughts and images
  • Panic (usually triggered by some aspect of the event e.g. the smell of a hospital)
  • Nightmares and disrupted sleep
  • Intense distress at reminders of the trauma (real or perceived)
  • Sweating, nausea, pain, numbness, trembling
  • Outbursts of anger or irritability
  • Hyper-alert for danger
    • Lack of concentration
    • Jumpiness or being easily startled
    • Self-destructive behaviour or high-risk behaviour
    • Avoiding situations that remind you of the event
    • Numbing with alcohol or drugs
    • Feelings of detachment, emotional numbness, not being able to connect with others
    • Repressing memories
    • Difficulty expressing affection or being vulnerable
    • Unable to sit still, needing to be busy or distracted

The treatments for PTSD are primarily talking therapies, in particular:

  • Trauma-focused cognitive behavioural therapy (CBT) which is specifically designed to treat PTSD.
  • Eye movement desensitisation and reprocessing (EMDR). In this treatment you are guided by a therapist to make rhythmic eye movements while recalling the traumatic event. The eye movements are designed to stimulate the information-processing system in the brain. The aim of the treatment is to help you process the traumatic events, and speed up re-adjustment and recovery.
  • Rewind Method. In this treatment you are taken through a guided meditation by a trained practitioner which allows you to explore and process the traumatic memory in a safe space. You can find our list of trained Rewind Practitioners here.

Medication is not normally offered to treat PTSD but, as it is common to also experience anxiety and depression alongside PTSD, your doctor might offer you medication to treat this. Your doctor might also offer you medication to support you to feel more stable and able to care for your baby, or if there’s a long wait for talking treatments in your area.

Postnatal Psychosis

In contrast to the other mental illnesses postnatal psychosis is very rare, only occurring in around 1 in 1000 women after birth. It is a very serious condition that requires emergency medical treatment.

Symptoms usually begin quite suddenly a few weeks after birth.

Women who are diagnosed with psychosis often experience hallucinations, mania and delusions.

Its important to note the difference between delusions and hallucinations.

Hallucinations are when you see or hear things that aren’t there. They can also appear as tastes, smells or sensations that you experience that others around you don’t. You may hear voices or see people who aren’t there. Usually the sufferer is unaware that
they are experiencing anything unusual and don’t realise they are ill until it is picked up by someone else.

Delusions are when you hold ideas or beliefs that others don’t, such as having the ability to talk to God or control events such as the weather. They can include paranoia, thinking that someone is trying to harm you or your baby and it can be very distressing and intense.

No one really knows what causes postnatal psychosis but the the risks are raised if:

  • You have bipolar disorder (this increases the risk of psychosis to one in four births)
  • There is a history of mental illness in your family, particularly postnatal psychosis
  • You have had a traumatic pregnancy or birth experience

Postnatal psychosis is a frighten and intense experience. If you or your partner experience any of the following symptoms it is important to seek immediate medical attention.

  • Feeling excited or elated
  • Feeling severely depressed
  • Rapid mood changes
  • Feeling confused or disorientated
  • Feeling restless
  • Unable to sleep
  • Unable to concentrate
  • Experiencing psychotic symptoms such as hallucinations or delusions

Treatment for postnatal psychosis will vary depending on the woman. In most cases you will be offered anti-psychotic medication and support from a mental health team. In more severe cases, you may need to be hospitalised, ideally in a mother and baby unit so that you are not separated from your baby. Unfortunately in Northern Ireland, we don’t have access to a mother and baby unit but it is possible to access a unit in Scotland or England if you are able to travel.

Very severe cases may require electroconvulsive therapy (ECT).

If you relate to any of the above, it is important to speak to your GP, health visitor or midwife and seek support. There are also a range of self-help techniques that you can use to help yourself feel better.

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