Mental health issues during pregnancy and after childbirth

Adjusting to a new baby in the house can be challenging. A new baby brings about significant, often unexpected, changes in your life, not only learning how to look after the baby, lack of sleep but also a change in what you are able to do in your life, particularly while your child is very young. All parents go through a period of adjustment and for most parents this is usually a temporary phase.

All babies are different and some are a lot easier to manage than others. For some parents adjusting to life with a baby is stressful and goes on for a long period of time. If this sounds like what you are experiencing with your new baby it can be helpful to talk to a health professional.³

Bonding issues with your new baby

While emotional bonding with your baby is important it doesn’t always happen instantly. This may leave parents feeling disappointed, guilty and stressed. With support and rest, the feeling of connection with your baby usually develops within a few days or weeks.

Parents who are not feeling bonded with their baby may be distant and withdrawn from their baby. If after a couple of weeks you still haven’t bonded with your baby it is important to talk with a health professional about how you are feeling because emotional bonding is important to your baby’s development.^2,3

Help and support

• Talk to your midwife, GP, obstetrician or child health nurse
• Phone the Pregnancy, Birth and Baby Helpline on 1800 882 436
• Phone Rural Link, a specialist after-hours mental health telephone service for rural communities in Western Australia, on 1800 552 002
  • 4:30pm – 8:30am Mon to Fri
  • 24 hours Sat, Sun & public holidays
• Call the Perinatal Anxiety and Depression Australia (PANDA) helpline
  • 1300 726 306
  •  9am to 7:30pm AEST Mon to Fri
• Phone the Ngala Parenting Line WA, open 7 days a week, 8am – 8pm
  • metro 08 93689368
  • on 1800 111 545 (free for STD callers)
• Call Healthdirect on 1800 022 222 for 24-hour health advice or visit https://www.healthdirect.gov.au/
• Phone the Mental Health Emergency Response Line, available 24 hours, 7 days a week
  • Perth metro 1300 555 788
  • Peel 1800 676 822

Contact Beyond Blue, 24/7 telephone service 1300 224 636 or online chat 3pm-12am (AEST) 7 days a week at www.beyondblue.org.au

The Baby Blues are considered very common. With up to 80% of new mothers experiencing a low mood, more commonly known as the Baby Blues, sometime in the first few weeks following childbirth.⁴

The symptoms occur when new mother’s feel quite sensitive and can include:

• Crying easily
• Feeling irritable
• Feeling tired
• Feeling anxious
• Experiencing mood swings.^2,5

Baby Blues are mainly caused by hormone changes following childbirth and settle within a few days without any need for treatment.^4,5

Family and friends can help by listening, understanding, providing support and help with learning how to take care of the baby.

If the symptoms go on for more than two weeks it is important to visit your GP or health professional as it could be the start of postnatal depression.

Help and support

• Talk to someone you trust about how you are feeling
• If you don’t want to talk to someone close to you call a support line
• See Mental Health Support Servcies for Couples, Parents and families

Talk to your GP, midwife or child health nurse.

Everyone experiences a little anxiety from time to time; it is a normal reaction to situations that are new and unfamiliar. Pregnancy, childbirth and then having a new baby to care for are a big life change and it is not surprising that parents would feel some anxiety during this time.⁶

However, too much anxiety can affect a mother’s ability to cope with pregnancy and looking after a new baby. For some women, during pregnancy or following childbirth may be the first time they have experienced anxiety. Whereas for other women, who have previously experienced anxiety, their symptoms may become worse during this period. 

Signs and symptoms

• Anxiety, worries or fear which:
  • interferes with daily tasks
  • interrupts your thinking
  • has you continually checking on your baby
  • stops you going out with your baby
  • are difficult to control
• Finding it difficult to get to sleep (even if baby is sleeping)
• Muscles feel tense or your chest feels tight
• You experience heart palpitations – feeling like your heart has skipped a beat or had an extra beat; your heart feels like it is racing, pounding or fluttering; or you may be more aware of your heartbeat then usual
• You experience panic attacks, feel on edge, restless or irritable.⁶

Help and support

Treatment options are available so if you are experiencing any of these symptoms.

• Talk to someone you trust about how you are feeling
• If you don’t want to talk to someone close to you call a support line
  • see Mental Health Support Services for Couples, Parents and Families
• Talk to your GP, midwife or child health nurse
• If it is an emergency call 000.

Support resources

• becoming a Parent: Emotional health and wellbeing booklet
• being a Mum pamphlet – A resource for Aboriginal mothers

Research conducted in Australia and around the world has found that up to one in ten women experience depression during pregnancy and one in seven women in the year following birth.⁷

Depression is different from the Baby Blues, it lasts for a longer period of time and may affect the mother herself, her child’s development and her relationships with her baby, partner and family.⁸ 

Depression usually develops slowly and can go on for many months. It can start before pregnancy, during pregnancy or it may develop following childbirth. Because the symptoms are frequently not recognised by others it is often not treated which may lead to a chronic condition or arise in a following pregnancy.⁶

There are effective treatments for depression and seeking help as early as possible will assist you in a quicker recovery by getting the treatment and support you need.

Signs and symptoms

The sign and symptoms of depression during pregnancy and following birth are the same as experienced at other times in life and can range from mild to severe.⁶

Not everyone will experience the same symptoms and some of the symptoms, such as feeling exhausted, could be due to the demands of caring for a new baby. It is important to seek the help of a health professional if you are experiencing some of the following symptoms for more than a few days, to assess whether you are experiencing depression:

• Low mood and often feeling tearful
• Feeling inadequate, worthless, hopeless, helpless, like a failure, guilty, ashamed, empty or sad
• Feeling resentful, angry or irritated (especially by those close to you)
• Fearful for the baby, of the baby, being alone with the baby, going out with the baby
• Sleeping too much or having difficulty sleeping
• Not eating or eating too much
• Difficulty coping with daily routine, not looking after yourself properly
• Lack of motivation, lack of energy or feeling exhausted
• Withdrawing from family and friends and activities you usually enjoy
• Poor concentration and memory
• Difficulty making decisions or thinking clearly
• Feeling overwhelmed, wanting to escape or get away from everything
• Thinking about harming yourself or taking your own life. 

If you are having thoughts about suicide and thinking your partner, baby and family would be better off without you it is time to seek help immediately. It is never too late to seek help.

Help and support

• Talk to someone you trust about how you are feeling
• If you don’t want to talk to someone close to you call a support line
• See Mental Health Support Services for Couples, Parents and Families
• talk to your GP, midwife or child health nurse
• If it is an emergency call 000.

Support resources:

• Becoming a Parent: Emotional health and wellbeing booklet
• Being a Mum pamphlet – A resource for Aboriginal mothers

Having a difficult labour and birth can be a traumatic experience. It can cause an acute stress reaction and in some instances it may result in Post-Traumatic Stress Disorder (PTSD). This can affect a woman’s adjustment to life with a new baby and usually happens when a mother believes her life or baby’s life was at risk.⁶ 

 Signs and symptoms

• Feeling intense fear, horror or helplessness during delivery
• Re-living her labour and delivery experience in her mind though flashbacks or nightmares
• Avoiding things that remind her of her labour or delivery such as:
  • not wanting to talk about the labour and delivery
  • unable to recall parts of her experience
  • avoiding the hospital where she gave birth
  • feeling of dread regarding another pregnancy
• Difficulty concentrating or sleeping
• Easily startled
• Feeling numb and just going through the motions of living day to day.²

Partners who have witnessed the labour and delivery are also often traumatised and often feel helpless and fearful that their baby or partner may die.

Help and support

Talking about what has happened can benefit both parents by helping them to understand their experience.

• Talk to your GP or child health nurse
• Call a support line
• See Mental Health Support Services for Couples, Parents and Families

Postpartum Psychosis is a serious but rare mental health condition that affects 1 in 1,000 mothers. It usually appears within a month following childbirth and can impair the mother’s ability to care for and bond with her baby and places her and her baby at risk of harm.² This condition requires urgent assessment, treatment and hospital admission.

Mothers who have previously experienced or have a family history of Bipolar Disorder or Schizophrenia are most at risk of developing Postpartum Psychosis. It is important that medical staff are told about this at antenatal check-ups.

Signs and symptoms

As this condition progresses, a variety of changeable symptoms that affect the mother’s behaviour, mood, energy and thought processes can develop such as:

• Increased energy, rapid speech and racing thoughts
• Intense feeling of wellbeing
• Needing very little sleep
• Appear confused or very argumentative
• Difficulty concentrating, rapid mood swings and erratic behaviour
• Hallucinations of seeing things that are not there or hearing voices that other people can’t
• Experience delusions – believe in things that are not based in reality
• Is very negative about herself and life
• Has little or no energy
• Feeling helpless, worthless or hopeless.
• Thoughts about suicide, harming the baby or herself.^2,9

Help and support

Marked changes in the mother’s behaviour following childbirth can be distressing to the mother, her partner and family, however this condition can be managed with the right treatment and usually recovery will take place over two to twelve weeks.⁹

Because the mother may be confused, her partner and families often need to help her to seek urgent medical attention from:

• A GP
• Mental Health Emergency Response Line (MHERL)
• Local community mental health service
• Hospital Emergency Department.
• Mental health professional

If you have an existing or past mental health issue it is important to speak to your doctor or a health professional before you become pregnant and ideally before you begin trying for a baby because you are at a higher risk of a relapse at this time.¹⁰ The good news is with the right treatment and care most women have healthy babies.¹¹

Before and during pregnancy it is important for all women to look after their mental and physical health by:

• Eating healthy meals which include fruit vegetables, whole grains and drinking plenty of water.¹² For more information on nutrition and pregnancy see:
• Getting plenty of sleep by establishing a good sleep pattern. For information see here:¹³
• Planning to engage in low to moderate physical activity.¹² For exercise suggestions see:
• Making time to slow down and relax
• Reducing stress by using muscle relaxation and deep breathing techniques¹⁴ see here for examples:

Health professionals recommend that women who are planning a pregnancy or are pregnant stop smoking¹² or using alcohol¹² or illicit drugs² to protect the baby and to maintain the wellbeing of the mother. For more support in achieving these changes talk to your GP, midwife or mental health professional.¹²

There a number of things to consider if you are planning to become pregnant and have a diagnosed mental health condition, such as schizophrenia, psychosis and psychotic disorders. There is a greater risk of having a sudden onset or relapse of symptoms during pregnancy or following childbirth (particularly in the first few weeks following childbirth) so it is important to talk to your doctor as early as possible. This way you can work with your doctor to have an appropriate plan put in place to support you should you experience an onset of symptoms.

It is also important to talk to your doctor if you are on medication for your condition. It is especially important to not go off or change your medication until you have spoken with your doctor because there are risks associated with stopping or changing medications for you and your baby at this time.

Some medications used to treat diagnosed mental health conditions can make it difficult to fall pregnant. Also, the dose of your medication may need to be adjusted or you may need to change to a medication that is suitable to use during pregnancy. There are also some medications that can affect your baby if used when breastfeeding.

 If you have a diagnosed mental illness, the Childbirth and Mental Illness (CAMI) Service at King Edward Memorial Hospital (KEMH) may be able to support you and your family on your journey to parenthood. You will need a referral from your GP, mental health service, or private psychiatrist.

For more information on things to consider please contact your GP, health professional or see here.