Perinatal Mental Health

Perinatal mental health concerns a woman’s emotional and psychiatric well-being during pregnancy and after childbirth, commonly including the first year postpartum. It covers new disorders, recurrence or worsening of pre-existing illness, and the psychological effects of pregnancy loss, childbirth and early caregiving.

Conditions across the perinatal continuum

Symptoms may begin during pregnancy, continue after delivery or first appear postpartum. The spectrum extends from common depression and anxiety to less common but severe psychiatric illness.

• During pregnancy, important conditions include antenatal depression, anxiety, severe fear of childbirth, substance-use problems and relapse of pre-existing disorders.
• After birth, postpartum depression may involve persistent sadness, loss of interest, guilt, impaired functioning and difficulty caring for oneself or the infant.
• Anxiety disorders, obsessive-compulsive symptoms and post-traumatic stress symptoms may follow pregnancy, pregnancy loss or a traumatic birth.
• Postpartum psychosis, marked by severe confusion, delusions, hallucinations or marked mood disturbance, is a psychiatric emergency requiring urgent specialist care.
• Short-lived emotional lability called the postpartum blues is distinct from a disorder, but persistent or severe symptoms require assessment.

What comprehensive care includes

Perinatal mental health care is a continuum rather than treatment of postpartum depression alone. It combines mental health support with routine antenatal, obstetric, postnatal and child-care services.

• Care includes prevention, sensitive enquiry, screening, clinical assessment, diagnosis, treatment, referral and follow-up.
• Assessment considers biological factors as well as violence, poverty, stigma, inadequate support, unintended pregnancy, loss and stressful childbirth.
• Treatment may include psychosocial support, psychological therapies and, where indicated, medication chosen through an individual risk-benefit assessment during pregnancy or breastfeeding.
• Urgent action is required where there is risk of suicide, self-harm, harm to the infant, psychosis or inability to provide essential care.
• Support for partners, family relationships and mother-infant bonding can strengthen recovery and caregiving.