Mental health in pregnancy

You can talk to your midwife or doctor if you feel low, frightened or always on edge during pregnancy. Depression and anxiety can start for the first time in pregnancy, and past problems can come back. Support is available during pregnancy as well as after the birth.

Talk about how you feel day to day

Depression during pregnancy is often called antenatal depression. Signs can include feeling low or tearful most of the time, losing interest in things, guilt or hopelessness, changes in eating, and trouble concentrating. If this is how you feel, talk to a GP or midwife.

Anxiety can mean worry that’s hard to control and affects daily life. You may feel tense, struggle to sleep because you’re worrying, or find it hard to concentrate. Some people have panic attacks. A clinician can ask what’s happening and whether anxiety has affected you before.

You can use everyday words: “I keep waking up worrying,” or “I don’t enjoy things any more and I’m struggling at work.” Note what has changed, how often it happens and what feels hardest. Start with how you feel. You don’t need a medical name for it.

When the fear centres on giving birth

An extreme fear of giving birth is called tokophobia. NICE recommends that you get the chance to talk about these fears with someone experienced in mental health support around pregnancy and birth. If fear of the birth is taking over your thoughts, ask your midwife or doctor for that conversation.

Try writing down the parts that frighten you, such as pain, examinations or feeling out of control. You can ask to talk about these one at a time, at a pace you can manage. Bring questions about the support you’d have during labour and how your wishes can be written down.

Treatment can fit your circumstances

Talking therapies, including cognitive behavioural therapy (CBT), can help with depression and anxiety in pregnancy. You may also be offered medicine. You and your clinician can talk about therapy, medicine or both, based on your symptoms and what you prefer.

Tell the clinician which treatments have helped before and which haven’t. Talk about any worries you have about treatment. You can talk about the effects of leaving the illness untreated, as well as the benefits and risks of treatment.

If you take prescribed medicine, tell your doctor or specialist you’re pregnant as soon as you can. Don’t stop it without talking to them. Ask who will review your treatment and how to get advice if your symptoms change.

Planning care for an existing condition

The NHS recommends a referral to a perinatal mental health service (for mental health in pregnancy and after birth) for people with long-term conditions. These include bipolar disorder, schizophrenia, obsessive compulsive disorder or an eating disorder. These services give specialist support during and after pregnancy.

For people with a current or past severe mental illness, NICE recommends a written care plan that covers pregnancy, birth and the weeks after. Ask for a copy of the plan, including the names and contact details of the people involved. A partner, relative or carer can be involved if you agree.

Get the right help now

Call 999 now in the UK, 911 in the US, or your local emergency number if there’s immediate danger of harm or you can’t keep yourself or someone else safe. Emergency care comes before waiting for a routine appointment.

If you have thoughts of suicide or harming yourself, get urgent mental health help now, even if you don’t feel in immediate danger. In England, call NHS 111 and choose the mental health option. Elsewhere in the UK, contact your local urgent mental health service. In the US, call or text 988. Elsewhere, contact your local crisis service.

If you start hearing or seeing things others don’t, or have strong beliefs others don’t share, contact a GP or urgent mental health service straight away. In the US, contact your doctor or a crisis service. Elsewhere, use local urgent care. For urgent mental health help in England, call NHS 111 and choose the mental health option.

In the UK, Samaritans will listen for free on 116 123, day or night. In the US, call or text 988 for the Suicide & Crisis Lifeline. These services can support you when you’re struggling. Call emergency services if there’s immediate danger.

For low mood or anxiety that carries on, without these urgent warning signs, contact your GP or midwife in the UK, your obstetric or primary care clinician in the US, or your local doctor or midwife. Ask what support is available and who to contact if things get worse while you wait.