Mental Health During Pregnancy: Understanding the Signs and Finding Support

Pregnancy is often described as a joyful and exciting time, but the reality can be far more complicated.

Alongside happiness and anticipation, pregnancy can bring fear, uncertainty, physical discomfort, relationship changes and worries about the future. Some people feel emotionally well throughout pregnancy, while others experience anxiety, depression, intrusive thoughts or a return of previous mental health difficulties.

Experiencing poor mental health during pregnancy does not mean you are ungrateful, weak or going to be a bad parent. Mental health problems can affect anyone during pregnancy, including people who have never struggled before.

The NHS advises speaking to your midwife, maternity team or GP when you are worried about your mental health. Support is available, and seeking help early can make a significant difference.

What Is Perinatal Mental Health?

Perinatal mental health refers to emotional and psychological wellbeing during pregnancy and after the baby is born.

The perinatal period is generally understood within NHS services as pregnancy through to the first year after childbirth. Mental health difficulties may begin during pregnancy, return after a period of recovery or continue from an existing condition.

Mental health problems during pregnancy may include:

• Antenatal depression.
• Anxiety disorders.
• Panic attacks.
• Obsessive-compulsive disorder.
• Post-traumatic stress disorder.
• Eating disorders.
• Severe fear of childbirth.
• Bipolar disorder.
• Psychosis.
• Problems involving alcohol or drugs.

Depression and anxiety are among the most common mental health difficulties experienced during pregnancy. The Royal College of Psychiatrists estimates that they affect around 10 to 15 in every 100 pregnant women.

Why Can Pregnancy Affect Mental Health?

Pregnancy involves major physical, hormonal, emotional and practical changes.

Even when a pregnancy is planned, someone may worry about the baby’s health, childbirth, finances, housing, work or whether they will cope as a parent.

Common pressures can include:

• Previous miscarriage, stillbirth or traumatic birth.
• Pregnancy complications.
• Severe pregnancy sickness or ongoing pain.
• Fertility treatment.
• An unplanned pregnancy.
• Relationship difficulties.
• Financial pressure.
• Limited family support.
• Domestic abuse.
• Previous trauma.
• Existing physical or mental health conditions.
• Fear of childbirth.
• Worries about body changes.
• Pressure to appear happy.

People who have previously experienced anxiety, depression or another mental health condition may notice that symptoms return during pregnancy. Others may experience mental health difficulties for the first time.

Anxiety During Pregnancy

Some worry during pregnancy is understandable. However, anxiety may become a problem when it is persistent, difficult to control or begins to interfere with daily life.

Pregnancy anxiety may involve constant fears about the baby, repeated checking, panic symptoms or an overwhelming need for reassurance.

Signs can include:

• Racing thoughts.
• Feeling constantly on edge.
• Difficulty relaxing.
• A racing heartbeat.
• Shortness of breath.
• Dizziness or trembling.
• Difficulty sleeping.
• Repeatedly searching for reassurance.
• Avoiding appointments or certain situations.
• Constantly expecting something to go wrong.

Some people develop an intense fear of pregnancy or childbirth known as tokophobia. Maternity services can offer support when fear of childbirth becomes severe or overwhelming.

Depression During Pregnancy

Depression that develops during pregnancy is sometimes called antenatal or prenatal depression.

It is more than having an occasional difficult day. Symptoms may continue for weeks and affect someone’s ability to function, connect with others or care for themselves.

Possible signs of antenatal depression include:

• Persistent sadness or low mood.
• Feeling tearful.
• Irritability or anger.
• Loss of interest in people or activities.
• Changes in appetite.
• Feeling guilty or hopeless.
• Difficulty concentrating.
• Negative thoughts about becoming a parent.
• Feeling unable to cope.
• Withdrawing from other people.

Some symptoms, such as tiredness or changes in sleep, can also be connected to pregnancy itself. This can make depression harder to recognise. The important issue is how severe the symptoms are, how long they continue and how much they affect everyday life.

Intrusive Thoughts During Pregnancy

Intrusive thoughts are unwanted thoughts, images or urges that appear suddenly.

During pregnancy, someone may experience frightening thoughts about illness, accidents, childbirth or something happening to the baby.

These thoughts can feel upsetting because they often involve the things the person cares about most. Experiencing an unwanted thought does not automatically mean someone wants it to happen or intends to act on it.

However, intrusive thoughts may require professional support when they become frequent, cause intense distress or lead to repeated checking, avoidance or compulsive behaviour.

Speaking honestly to a midwife, GP or mental health professional can help someone receive the right assessment without judgement.

The Pressure to Feel Happy

Pregnant people are often expected to feel excited and grateful.

This can make it difficult to admit that pregnancy feels frightening, lonely or overwhelming.

Someone may compare themselves with carefully selected images on social media and wonder why they are not enjoying every moment. They may feel guilty for struggling, especially when the pregnancy was planned or long awaited.

There is no single correct emotional response to pregnancy.

It is possible to love and want a baby while also feeling anxious, uncertain or emotionally exhausted. Difficult emotions do not make someone a bad parent.

Pregnancy After Loss or Trauma

Pregnancy following miscarriage, stillbirth, neonatal loss or a traumatic birth can bring intense and conflicting emotions.

Hope may exist alongside grief and fear. Appointments, scans, hospitals or physical sensations may trigger painful memories.

Someone may find it difficult to trust reassuring news or become highly alert to changes in their body.

Trauma-informed support can help people talk about these fears safely. NICE guidance covers mental health care following traumatic birth, miscarriage and stillbirth as part of antenatal and postnatal mental health support.

Existing Mental Health Conditions and Pregnancy

People who already live with a mental health condition may need additional support during pregnancy.

It is important to tell your midwife and GP about:

• Previous depression or anxiety.
• Bipolar disorder.
• Psychosis.
• Previous postnatal depression.
• Previous postpartum psychosis.
• Eating disorders.
• PTSD or complex trauma.
• Previous psychiatric treatment.
• Current mental health medication.

This information allows healthcare professionals to plan appropriate support during pregnancy and after birth.

Do not suddenly stop prescribed mental health medication after discovering you are pregnant. The risks and benefits should be discussed with a qualified healthcare professional so that an individual treatment plan can be agreed. NICE recommends considering the person’s condition, previous response to treatment and the potential benefits and risks of available options.

Practical Ways to Support Your Mental Health

Self-care cannot replace professional treatment, but small steps may support emotional wellbeing.

Helpful approaches can include:

• Talking honestly to your midwife or GP.
• Keeping regular antenatal appointments.
• Sharing your feelings with someone you trust.
• Resting when your body needs it.
• Eating regularly.
• Taking gentle exercise when medically appropriate.
• Spending time outdoors.
• Reducing pressure and unnecessary commitments.
• Limiting upsetting social media content.
• Using breathing or grounding exercises.
• Keeping a journal.
• Joining an antenatal or peer-support group.
• Asking for practical help.

The NHS also advises avoiding alcohol, smoking and non-prescribed drugs during pregnancy and discussing any concerns about substance use with a healthcare professional.

How Partners, Friends and Family Can Help

Supportive relationships can make pregnancy feel less isolating.

Partners, relatives and friends can help by:

• Listening without judgement.
• Taking concerns seriously.
• Helping with household tasks.
• Attending appointments when invited.
• Encouraging rest.
• Learning about perinatal mental health.
• Avoiding pressure to appear happy.
• Helping the person contact professional support.

Statements such as “you should be enjoying this” or “try not to worry” may unintentionally make someone feel dismissed.

A more helpful response might be:

“I can see that this is difficult.”

“You do not have to manage this alone.”

“How can I support you today?”

Professional Mental Health Support During Pregnancy

Support may include conversations with a midwife or GP, counselling, psychological therapy, medication or referral to a specialist perinatal mental health service.

NICE guidance covers recognising, assessing and treating mental health problems during pregnancy and the first year after childbirth. Treatment should be based on individual needs, preferences, symptoms and medical history.

Specialist perinatal mental health teams support people with moderate, severe or complex mental health needs. NHS England states that specialist teams are available across England.

When to Ask for Help

Speak to your midwife, maternity team or GP when:

• Anxiety or low mood continues.
• You are struggling to sleep because of your thoughts.
• You are withdrawing from other people.
• You are experiencing panic attacks.
• You feel unable to cope.
• Intrusive thoughts are causing significant distress.
• A previous mental health condition is returning.
• You are using alcohol or drugs to cope.
• Your mental health is affecting everyday life.

You do not need to wait until symptoms become severe. The NHS advises contacting a midwife, health visitor or GP when mental health support is needed.

Seek urgent help when someone is at immediate risk, feels unable to keep themselves safe, is experiencing severe confusion, unusual beliefs or hallucinations, or has thoughts of harming themselves or another person. Call 999 or attend A&E when there is an immediate danger.

You Deserve Support During Pregnancy

Mental health is an important part of pregnancy care.

Struggling emotionally does not mean you are failing. Pregnancy can bring enormous changes, and asking for support is a responsible step for both you and your baby.

At Anxious Minds, we understand how anxiety, depression, trauma and major life changes can affect mental wellbeing.

Our counselling and mental health support services provide a safe and confidential place to talk about difficult feelings, understand what is happening and develop healthier coping strategies.

You do not have to pretend that everything is fine. With compassionate support and appropriate professional care, mental health difficulties during pregnancy can be treated and managed.