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Pre-conception Planning

Pre-conception counselling is available for women who have previously experienced a severe mental illness such as bipolar effective disorder or other psychosis and would like to plan a pregnancy.

Postnatal Depression

Postnatal Depression (PND) can affect 10-15% of women having a baby. The symptoms are similar to those in depression at other times. PND often starts within one or two months after having a baby. About a third of women with PND have symptoms which started in pregnancy and continue after birth.  

Sometimes there is an obvious reason for PND, but not always.  You may feel distressed, or guilty for feeling like this, as you expected to be happy about having a baby. However, PND can happen to anyone and it is not your fault. It's never too late to seek help. Even if you have been depressed for a while, you can get better. The help you need will depend on how severe your condition is.

Interventions / How we use them to help: 

Cognitive Behavioural Therapy (CBT) is an effective and evidence-based way to treat PND. It works firstly by looking at how making very small changes to how you are spending your time could have a small impact on improving your mood. It can also help to challenge the overwhelming barrage of negative thoughts that PND creates and start to identify some small positives.

Working with a therapist can help to gradually rebuild confidence and self-esteem in yourself as a mum. CBT is affective as a solo treatment or can be complimented by medication.   

Anxiety

Becoming pregnant and being a new parent can be an anxious and unknown time. Anxiety is something we all experience from time to time and is a completely normal way for our bodies and brains to respond to a threat. Anxiety becomes problematic when the feeling is there a lot of the time; is too strong or when it carries on even when it is not needed.  If you feel like the thoughts and physical symptoms of anxiety are interfering with being able to enjoy this period in your life or being the kind of mum (or parent) you would like to be, then it could be an indicator to seek some help. 

Interventions / How we use them to help : 

As with all conditions, the severity, symptoms and the approach used to manage your anxiety will differ. Upon referral to the service and after assessment, the approaches used to support you can include:

Cognitive Behavioural Therapy (CBT)  – This is a common and effective method used to treat anxiety. It works by helping you understand the ‘vicious cycle’ of anxiety and how avoiding the things/situations you find difficult ultimately maintains your fear of them. It is a supportive and gradual way of facing fears and being able to manage the worries and physical symptoms this creates in order to lead a less restricted life.

Maternal OCD

Obsessive Compulsive Disorder (OCD) is a common mental health condition that can affect anyone. If a woman has OCD during pregnancy or after birth it is known as Perinatal or Maternal OCD.  

It affects 2 in 100 women in pregnancy and 2 -3 in every 100 women in the year after giving birth. 

OCD has three main parts: 

1. Thoughts or images that keep coming into your mind. These are called obsessions. 
2. Anxiety - as a result of these thoughts. 
3. Thoughts or actions you keep repeating to try to reduce your anxiety. These are called compulsions. 

Interventions / How we use them to help :  

A range of interventions are available to be used to support you, and these can include Cognitive Behavioural Therapy (CBT). 

CBT is a really effective evidenced-based way of tackling OCD. It works by helping you identify how your compulsions are not really providing a long-term solution to the problem. CBT can offer you other strategies to gradually start to face up to your OCD fears and disprove them. This will mean that you are able to take back control of your life and enjoy it much more. Within the service we are able to provide 1:1 CBT or the option of working in a supportive group with other mums experiencing similar things. CBT can work as a solo treatment, or be complimented by medication. 

Bonding and Attachment

Some parents may not feel a connection with their baby during pregnancy or establish an immediate affectionate bond with baby early on, and some parents do. This is normal.

The process of bonding with your new-born can feel very different for each parent and their baby, and has no time limit. Bonds that are meant to last a lifetime don’t bind overnight; rather, they form gradually over the days, weeks and months following the arrival of your baby. The more time you spend with your baby, cuddling, feeding, massaging, singing and talking to your baby, the closer you will feel to them. 

Forming that bond can take time to adjust to.  If however you find that you are continuing to have difficulties bonding with your baby after weeks or months and feeling sad, low or depressed, it could be a sign of post natal depression.

What you might notice: 

You may notice that you avoid caring for your baby or avoid being left on your own with them. Some mums notice that they are easily frustrated with their babies being unsettled and irritable. You may feel like you don’t know what your baby needs or how to comfort them.  

You may notice that you don’t feel a love for your baby like you thought you would. Some mums describe a ‘disconnect’ from their baby. 

Forming that bond can take time to adjust to.  If however you find that you are continuing to have difficulties bonding with your baby after weeks or months and feeling sad, low or depressed, it could be a sign of post natal depression.

Interventions / How we use them to help : 

Developing the bond between you and your baby can have an invaluable impact on your mental health wellbeing and upon referral to the service, the approaches used to help support you and your bonding to your baby can include:

Baby Massage:  The benefits of massage can be invaluable in maintaining and strengthening bonds between parents and their baby. Massaging your baby may help you and your baby relax, it can reduce crying, and encourage interactions between you and your baby. It can also positively affect baby’s hormones that control stress.  

Video Interaction Guidance (VIG): video interaction guidance is an intervention in which a practitioner uses video clips of you and your baby to enhance your communication and your relationship. 

Kristina in the video below provides more details on some of the interventions we offer.

Bipolar Disorder and Postpartum Psychosis

Understanding Bipolar disorder and pregnancy:

Women with bipolar disorder are at a particularly higher risk of relapse particularly in the first days/weeks following childbirth. Women with bipolar disorder can experience both postnatal depression and postpartum psychosis. Episodes of postpartum psychosis occur in approximately 25% of births to women with bipolar disorder. Episodes of depression also occurs in 25% with Bipolar disorder meaning that 50% of women with Bipolar disorder will experience a post partum episode. The risk can be further increased where a woman has previously experienced a post partum episode. All postpartum episodes in women with bipolar disorder must be taken seriously.

Understanding Postpartum psychosis and pregnancy:

Postpartum psychosis can affect 1 in 500 women after birth. It is a severe mental health condition that can appear quickly. Women are usually mentally well during pregnancy but immediately after delivery or in the first few days / weeks, they rapidly becomes very unwell and this is usually very obvious to those that know her well. Symptoms may include thinking, speaking and acting very differently with bizarre beliefs and experiences related to self, others or the baby. This should be considered an emergency that requires immediate medical treatment.

There are many ways a postpartum episode can start. Women often have symptoms of depression or mania or a mixture of these. Symptoms can change very quickly from hour to hour and from one day to the next. Most commonly postpartum psychosis begins in the first few weeks after birth. Often, symptoms begin in the first few days after having a baby. Getting the right help ensures that this can be managed and women can enjoy their experience of being a mother.

What to do: During pregnancy let people know as soon as possible. If you are taking medication, do not stop taking these suddenly before getting advice. It is important to let all those involved with your pregnancy know that you have bipolar disorder or psychosis, and that there is a risk of becoming unwell again following delivery.

Interventions / How we use them to help: 

Medication: Most women that have postpartum psychosis will be treated with a medication. This usually helps the person to feel well again quickly. You may stay on this type of medication for a while even when you feel well and then reduce it gradually.

Mother and Baby Units (MBUs): These are special wards where a mother can be admitted for help with her mental health and the baby can stay with her on the ward. We know keeping mother and baby together is really important for bonding and wellbeing and MBUs have staff that look after mother and baby. Partners and family can visit. Most mothers with postpartum psychosis will spend some time in an MBU.

Psychological therapy: Women with postpartum psychosis may benefit from seeing a psychologist when they are recovering from postpartum psychosis. This is to make sense of what happened and to cope with any remaining symptoms such as trauma, low mood or anxiety. 

Peer support: Often one of the most helpful things to women who have had postpartum psychosis is meeting someone else who has had this and recovered. A perinatal mental health team or an MBU may have peer support workers to meet with or charities such as APP have people with lived experience who volunteer for them.

About you - Mum and Baby

The journey from pregnancy to motherhood take you through a range of physical and psychological changes. Effectively managing the physical and routine aspects of these new change will go a long way to improving your mental health wellbeing.

Sleep management

In the same way sleep is very important for baby’s development, it is also vital for your physical and mental well-being. It enables the brain to process the day’s activities, retain and store information for future use and allows you to feel alert and responsive to your everyday life events and caring for your baby.

Lack of sleep can have a major impact on the your physical and mental health; or make worse any existing mental health conditions, which can in turn affect yours and baby’s overall wellbeing. For this reason sleep management is very important.

What we can do to help

Our Occupational Therapists and Nursery Nurses can help you identify your sleep issues and explore your current evening routines and habits in supporting you to discover a better bedtime routine that will suit you personally. They will also advise you on your baby’s sleeping patterns as well as understanding safer sleep for babies.

By simply tweaking a few of your night time habits, looking at your environment, learning helpful tips and other suggestions will enable you to prepare your mind and body for a better quality night sleep.

Find out more about sleep hygiene on our children's resource page.

Bonding and attachment

Developing the bond between you and your baby can have an invaluable impact on your mental health wellbeing. More information on this can be found within Bonding and Attachment in our core services section. Kristina dispels in the video below dispels some myths around bonding with your baby.

About you - Dads and Partners 

Perinatal mental health and You

Becoming a parent can be an overwhelming time, whether it is your first child or not. It is important to know that looking after your own mental health is equally as important as getting support for your partner.

Your primary focus is likely to be on your partner and the baby, and if their mental health is suffering, it can be difficult to know how to help and support them during this time.  They may find it difficult to seek support on their own. A key step you can take is to listen to them even if you don’t understand and encourage and support them in contacting their midwife, health visitor or GP, who can then refer them to the SPMHS if required.

Dad’s own mental health 

Research has shown that up to 10% of new dads can experience mental health conditions. You may experience a mixture of emotions such as having low moods, sudden change in your moods, feeling irritated or angry, having intrusive thoughts, feeling indifferent to the baby, lacking motivation, avoiding baby and your partner or even having the feeling of not being good enough.

Up to 50% of new dads where their partners are suffering from depression are also likely to be affected by depression. Taking the first step in talking about how you are feeling is the start of any road to recovery. We do not provided one-one therapy for Dads and Partners, but do encourage their involvement in the friends and family group interventions that we offer if their partner is open to the service (delete). We can make referrals to teams and services who do provide direct support to Dads or Partners going through these challenges.

Information for Dad’s and Partners 

If your partner/wife is under the care of the Specialist Perinatal Mental Health Service and you would like more information on how you can provide support to them, the Perinatal Service provides a Friends & Family group. This group has been developed with the support of women and their families who have lived experienced of perinatal mental health conditions.  It provides information and support to anyone with a friend or relative open to the service and gives the opportunity to ask questions and discuss relevant issues.

Support for you 

• Dadpad is an essential guide for new dadds which has been developed with the NHS
• Pink Parents  provide support and advice to gay and lesbian parents 
• Postpartum Men  provides support and advice to dads who feel they may be experiencing depression 

About you - Family and Friends 

Understanding Perinatal Mental Health: 

Perinatal mental health refers to mental health conditions which occur during pregnancy and after having a baby.

There are several perinatal mental health conditions that can occur with different symptoms. These can include; depression, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, postpartum psychosis and post-traumatic stress disorder (PTSD).

Supporting Mothers and Babies 

Mental health conditions during this time may impact on a mother’s relationship with her baby. It can reduce confidence and belief in their ability to be a good mother.

Studies show that more than 75% of mothers state that having emotional support positively impacts their mental wellbeing. It is important not to underestimate the importance of a listening ear.  Sometimes having someone there to listen can make the biggest difference. You don’t have to understand, you just have to want to understand.

Seeking additional support 

Mothers are often embarrassed about asking for help due to fears of being judged. Studies have found that up to half of women identified as depressed initially had not spoken to anyone about their conditions. Of those who had, the majority (63-88%) did not talk to a health professional.

83% of women* who had been referred to the Specialist Perinatal Mental Health service confirmed a significant improvement in their mental health after discharge from the service.

Family members can find it difficult to offer support or encourage the mother to seek help due to a lack of understanding about pregnancy and mental health conditions. Getting support early is key in the prevention of mental health conditions developing.

If your family member is struggling during pregnancy or after having a baby, encourage them to seek support from their Midwife, Health Visitor or GP. They can make a referral to the SPMH service.

For family members currently under the Service, you can speak to a duty worker on 01604 657735, Monday-Friday 9am-5pm or register for the Friends and Family group to get more information and advice on perinatal mental health conditions. (This bit has been amended)

For 24/7 mental health support, you can call the Integrated Mental Health Hub on 0800 448 0828. 

*Apr 2020 – Mar 2021 – percentage of mothers who showed a maintained or improved level of outcome on completion of care

About You - Supporting Differences in Perinatal Health

Our understanding of having a baby and what a family looks like is shaped by our own experiences, cultural backgrounds and the diverse types of relationships that we have.

As a service we understand the importance of providing personalised support and actively work with those accessing the service to understand their diverse family structures, how they may self-identify, and their beliefs and cultural practices around pregnancy and after having a baby.

Research shows that the number of mothers from Black, Asian and Minority Ethnic backgrounds experiencing mental health conditions is around 13% higher than other backgrounds because of additional factors related to their culture and ethnicity.

Language, cultural differences, sexuality, gender identity or the fear of approaching mental health services shouldn’t be a barrier to accessing services.

Accessing Support

Recognising the symptoms of a mental health condition is the starting point to getting the right support. If you or someone close to you is struggling with their mental health, please talk to your GP, Midwife or Health Visitor and they will provide advice and support, including a referral to the perinatal mental health team if required. 

83% of women who have been through the service confirmed a significant improvement in their mental health wellbeing.

We can arrange translators where required and will work with family and friends to ensure the right support is made available by the most appropriate service.

Understanding fear of child birth

Fear of childbirth or pregnancy is also known as tokophobia. It is a severe fear that can emerge even if a woman or birthing parent desires to have a baby. The fear can be present even where a woman or birthing parent has never given birth before or as is more common, where they have previously given birth, but had a previous traumatic experience of childbirth. This fear can significantly impact the overall pregnancy experience.

Dr Kirsty Harris discusses tokophobia (fear of child birth)

How we can help

There are many possible causes as to why this fear has developed and a number of different ways we can support you with this. Where a referral has been accepted by the service, following a assessment, an appropriate type of care will be taken and this can include:

• Online webinars 
• Individual therapy
• A meeting with you, a psychologist or therapist and a specialist midwife to explain the full carre plan and make a plan tailored to your needs.
• Organising a visit to the labour ward and/or meet the matron, if this would help alleviate your anxiety.
• Education group about tokophobia. This will help you understand your fear of childbirth, develop helpful methods and meet other people with similar fears or experiences to you.

Understanding birth trauma

Birth trauma is a short phrase for post-traumatic stress disorder (PTSD) after childbirth. It can also affect people who have some symptoms of PTSD, but not enough for a full diagnosis.

33% of people describe their perinatal experience as traumatic. About 1-3% of women develop symptoms birth-related PTSD.  Some partners may also suffer PTSD from a traumatic birth.

Trauma is individual and for this reason, the same situation can affect people differently.

The Maternal Mental Health service talk about birth trauma and the impact this can have:

What you may be experiencing

If you’ve had a traumatic birth you may have felt scared, helplessness, out of control, or powerless at the time. Following the birth, you may experience the following:

• Re-experiencing the traumatic event- through flashbacks, nightmares or intrusive memories. This can feel very distressing.
• Avoidance- efforts to avoid anything that reminds you of the trauma. This can mean refusing to walk past the hospital where you gave birth, or avoiding meeting other people with new babies. You might also avoid things like talking about birth, TV shows about birth, hospitals or medical visits
• Feeling on edge- constantly feeling alert and jumpy. You may also have difficulty focusing on things or getting to sleep.
• Difficult feelings and beliefs- feeling low, unsafe, anger, shame or guilt. You may feel guilty and blame yourself for your traumatic birth. You may also have feelings of shock and disbelief, failure, fear of something happening to you or baby, extreme exhaustion, depression, rage, suicidal thoughts, feelings of detachment, or emptiness.

How we can help

Birth trauma may resolve on its own or you may need some help with this. Psychological therapy can help with this. Once the referral is accepted by the service, an assessment will be completed. The clinician will then work with you to build a plan that suits your needs.

Types of therapy you may be offered include:

• Trauma-focused CBT (Cognitive behavioural therapy) and/or EMDR (Eye Movement Desensitisation and Reprocessing)- these are one-to-one therapy to help you to understand your experience, help you to feel safe and then help with processing the memories of the birth so that it can be thought about without causing distress.
• A ‘Family and Friends’ session - often a partner or family member may have witnessed or also experienced your birth experience and its impact. They may find it hard to understand and need help with theirs and your distress.
• Peer support work- this will involve getting support and simply talking to someone who may have had a similar experience to you in the past.
• Trauma Stabilisation Group - this is a group therapy offering a range of methods, psychoeducation, and the opportunity to meet other women with similar needs and experiences to you.