Mental health in pregnancy

You can talk to your midwife or doctor if you feel low, frightened or constantly on edge during pregnancy. Depression and anxiety can appear for the first time during pregnancy, and earlier problems can return. Support is available during pregnancy as well as after birth.

Talk about how you feel day to day

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

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

You can use ordinary words: “I keep waking up worrying,” or “I no longer enjoy things 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 label.

When the fear centres on giving birth

An extreme fear of childbirth is called tokophobia. NICE recommends that you have a chance to discuss these fears with someone experienced in perinatal mental health support. Ask your midwife or doctor for that conversation if fear of the birth is dominating your thoughts.

Try writing down the particular parts that frighten you, such as pain, examinations or feeling out of control. You can ask to discuss these separately, at a pace you can manage. Bring questions about what support would be available during labour and how your preferences can be recorded.

Treatment can fit your circumstances

Talking therapies, including cognitive behavioural therapy or CBT, can help with depression and anxiety in pregnancy. Medicine may also be offered. You and your clinician can discuss therapy, medicine or both, based on your symptoms and preferences.

Tell the clinician which treatments have helped before and which haven’t. Talk about any worries you have about treatment. The discussion can include the effects of untreated illness as well as the benefits and risks of available treatments.

If you take prescribed medicine, tell your doctor or specialist about the pregnancy as soon as possible. Do not stop it without talking to them. Ask who will review the treatment and how to get advice if your symptoms change.

Planning care for an existing condition

The NHS recommends referral to a perinatal mental health service for people with long-term conditions such as bipolar disorder, schizophrenia, obsessive compulsive disorder or an eating disorder. These services offer specialist support during and after pregnancy.

For people with current or past severe mental illness, NICE recommends a written care plan covering pregnancy, birth and the postnatal period. 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 is immediate danger of harm or you cannot keep yourself or someone else safe. Emergency care takes priority over waiting for a routine appointment.

Seek urgent mental health help now if you have thoughts of suicide or harming yourself, even if you do not feel in immediate danger. In England, call NHS 111 and select 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.

Contact a GP or urgent mental health service immediately if you start hearing or seeing things others do not, or develop strong beliefs others do not share. In the US, contact your doctor or crisis service; elsewhere, use local urgent care. For urgent mental health help in England, call NHS 111 and select the mental health option.

In the UK, Samaritans offers a free listening service on 116 123, day or night. In the US, call or text 988 for the Suicide & Crisis Lifeline. These contacts can support you in distress; call emergency services for immediate danger.

For ongoing low mood or anxiety 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 worsen while you wait.