Understanding your symptoms and identifying support
What does Maternal Mental Health Mean?
Maternal mental health refers to the psychological wellbeing of people who are pregnant, trying to get pregnant or have just given birth.
Some people may have already experienced mental health problems before pregnancy that can then become more intense whilst pregnant or, people can develop mental health problems for the first time during/after pregnancy.
Some examples of the mental health difficulties people can face are; prenatal and postnatal anxiety, birth trauma and adjustment to parenthood. These difficulties can present themselves in mild, moderate or severe ways.
Within this leaflet we will guide you through some common maternal mental health difficulties and any support and/or treatment that is available.
1 in 5 people who are pregnant or have recently given birth experience maternal mental health problems (Bauer et al., 2014).
Overview of maternal mental health difficulties
Adjustment to parenthood
It is common for people to have mixed emotions about their pregnancy, some people may feel; happy, excited, shocked, angry, sad, confused and/or scared. These feelings are normal and are often connected to a range of things such as; missing an old life, previous fertility and pregnancy experiences, financial situations, current family dynamics, and not feeling ready to transition in to parenthood.
These feelings are also impacted by the increase in progesterone and oestrogen the body produces during pregnancy, these hormones are needed to maintain healthy pregnancies but can result in mood swings, irritability and tearfulness that may add to an already overwhelming experience.
Transitioning in to parenthood is a particularly vulnerable time for some people and may leave them at risk of depression, anxiety, low self-esteem and low confidence. Speaking openly about these problems and seeking peer support can help people to navigate this complicated period.
Birth trauma
There are many reasons why someone may experience a traumatic birth such as; emergency c-sections, still births, premature births, difficult forceps births, feeling uncared for during labour and/or being left in pain.
Every year in the UK 30,000 people who give birth develop Post-Traumatic Stress Disorder (PTSD) however, not everyone’s symptoms receive this formal diagnosis. Therefore, the term birth trauma is used to cover anyone who feels negatively affected by a traumatic birth experience.
Some symptoms of birth trauma can include: flashbacks of the traumatic experience, intrusive thoughts, nightmares, distress when reminded of the trauma, sweating, pain, nausea, panicking, irritability, feeling numb or cut off from feelings, avoiding thinking about the traumatic event, feeling guilty and/or feeling unsafe.
Postpartum psychosis
Postpartum Psychosis is a serious, but rare, mental health condition that can affect someone after giving birth.
Many people experience changes in their mood after giving birth, this is known as the ‘baby blues’ and may include feeling: sad, tearful and/or anxious however, these symptoms are normal and should only last a few days.
Postpartum psychosis is very different to the ‘baby blues’ and is considered a serious medical emergency.
Symptoms can include: hallucinations (seeing, hearing, feeling or smelling things that are not there), delusions (thinking or believing things that are unlikely to be true), manic mood (feeling on top of the world, thinking and talking too quickly), low mood (withdrawn, tearful, lacking energy, anxiety, trouble sleeping, agitation).
Prenatal anxiety
Prenatal anxiety (also known as antenatal anxiety) is a common experience and refers to persistent and intense feelings of anxiety during pregnancy.
It is normal to feel a little anxiety during pregnancy as it can be difficult navigating this new phase of life. However, for some people this anxiety can begin to interfere with everyday life.
Some physical symptoms of prenatal anxiety include; headaches, grinding teeth, sweating, panic attacks, feeling restless, fast breathing and/or raised heart rate.
Emotional symptoms include; feeling tense, nervous, unable to relax, repeatedly thinking over bad experiences, being overly concerned about your babies welfare, feeling disconnected from the world and/or feeling disconnected from yourself.
Postnatal anxiety
Postnatal anxiety refers to persistent and intense feelings of anxiety after a baby has been born.
After giving birth it is normal to feel worried about looking after a new born baby, you may have anxious thoughts about something bad happening to the baby or be worried about doing something wrong. However, these feelings and thoughts tend to go away after a few months. Postnatal anxiety differs from normal worrying as it begins to take over a person’s everyday life.
Some symptoms of postnatal anxiety include; panic attacks, avoiding certain places, avoiding doing certain things, being overly careful, constantly asking reassurance from loved ones or healthcare professionals, feeling restless, irritable, on edge, uncontrollably worried and feeling a sense of dread.
Postnatal depression
Postnatal depression is a common mental health condition and type of depression that can occur any time after a year of giving birth.
It is normal for many people to feel tearful and down after giving birth however, this shouldn’t last longer than 2 weeks. If you are persistently experiencing low mood after giving birth then you may be experiencing postnatal depression.
Parents can be made to feel like they should be happy all of the time because they have a new baby however, it does not make you a bad parent if you are experiencing postnatal depression – it is not your fault and it can happen to anyone.
Some symptoms include; feelings of sadness, lack of interest in hobbies, lack of energy, difficulty sleeping, finding it hard to look after yourself and your baby, withdrawing from loved ones, intrusive scary thoughts.
Birth related OCD
Birth Related Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder that is experienced during pregnancy or a year after giving birth.
OCD can be understood in three main parts: obsessions (uncontrollable thoughts, images and worries that appear in your mind), emotions (usually distress caused by the obsessions) and compulsions (repetitive actions that you do to reduce the feelings of distress caused by the obsessions).
Some common birth related obsessions include; intrusive thoughts about hurting or sexually abusing your baby, fear of making a child seriously ill, fear of death when giving birth.
Some common birth related compulsions include; excessive washing and cleaning of toys and clothes, constantly checking the baby, repeatedly seeking reassurance your baby is okay.
Tokophobia
Tokophobia is a mental health difficulty that refers to a severe fear of giving birth.
It is very common and normal to feel anxious or scared about giving birth. However, when someone has Tokophobia this fear is so extreme that it makes them not want to go through with having a baby.
Some people may experience Tokophobia due to a history of sexual abuse, fear of medical care, hearing stories about traumatic births or previously experiencing a traumatic birth.
Some symptoms of Tokophobia include; problems sleeping, nightmares, panic attacks, extreme fear around childbirth (including fear of birth defects, still births and maternal deaths) and/or severe feelings of dread when thinking about pregnancy and giving birth.
Almost three quarters of pregnant people have some degree of fear around pregnancy or childbirth (National Childbirth Trust).
Eating disorders
An eating disorder means a person has an unhealthy relationship with food and/or their body image.
Some common eating disorders include; Anorexia (restricting food intake), Bulimia (eating and then deliberately being sick or taking laxatives) and Binge Eating Disorder (over eating).
During pregnancy a person’s body grows and changes, this can lead to an increase in anxiety around weight gain and body shape. Having an eating disorder whilst pregnant can increase the risk of; miscarriage, slowing or stopping a baby’s growth, complications during labour and/or the baby being born before it is fully developed.
Symptoms can include; having an overly strict relationship with food, avoiding social situations where food is involved, deliberately making yourself sick, over exercising, over eating or under eating.
Bipolar
Bipolar disorder is a mental health condition that severely affects your mood.
If you have bipolar disorder and you are pregnant then you are at a greater risk of developing postpartum psychosis, postnatal depression or experiencing a relapse. Some medication for bipolar disorder can also carry risks when you are pregnant or breastfeeding so it’s important to speak to your doctor. Do not stop taking any medication before you have spoken to a medical professional as this can lead to withdrawal, or make symptoms worse.
Symptoms of Bipolar disorder can include; depressive episodes (feeling very low, suicidal thoughts, lacking energy, loss of interest in everyday activities, feeling irritable), and manic episodes (feeling very high, overactive, easily distracted, hallucinating, engaging in risky behaviour) – between these episodes you may also have a period of stable mood.
Loss
Loss is common during fertility and pregnancy journeys and can occur at any point. People may experience loss in different ways through; miscarriages (when a baby dies before 24 weeks), stillbirths (when a baby dies at or after 24 weeks), termination (medically ending a pregnancy) or neonatal deaths (where the baby dies within 28 days of being born).
Some symptoms of a miscarriage include; vaginal bleeding, cramping and pain in abdomen. Unfortunately with stillbirth’s there are not always clear symptoms however, it is important to contact your midwife if you feel your baby’s movements have slowed down, stopped or changed.
There is no right or wrong way to feel after a pregnancy loss but it is very common to go through feelings of grief – this includes a whole mixture of emotions such as; anger, sadness, shock, jealousy, fear and guilt.
Grief can also cause physical symptoms such as; nightmares, flashbacks, lack of energy, heart palpitations, shaking and hyper-sensitivity.
Every person’s recovery time after experiencing loss is different and this process is not always straight forward – for some people loss can cause mental health problems or make existing conditions worse, if this is the case for you it is important to find the right help to support you.
General NHS Support Services
Midwives are healthcare professionals that a specially trained to care for pregnant people and babies. During your pregnancy you will be assigned a midwife, their name can be found in your pregnancy notes. This midwife will be responsible for taking care of you throughout your pregnancy journey, including during and after labour.
Midwives
Midwives can provide a range of support, such as: checking the health of you and your baby, providing tips on how to help you have a healthy pregnancy, discuss birthing and care options and provide information on antenatal classes.
Midwives are also trained to understand the psychological processes around pregnancy, loss and birth and will be able to support you with any concerns you may have.
GPs
General Practitioners (GPs) are healthcare professionals that treat common medical conditions and are responsible for referring patients to other health services for specialist care.
Your GP can help to identify any mental health problems you may be experiencing during your pregnancy journey, they can then answer any questions you may have and signpost you to the correct support and care. Your 6 week check is an opportunity to discuss your health and wellbeing needs with your GP.
Specialist NHS Support Services
Maternal Mental Health Service
The Maternal Mental Health Service (MMHS) is designed to provide support for people’s mental and emotional wellbeing throughout their pregnancy journey.
The service can help people who are pregnant, people who have experienced difficult births and/or people who have lost a baby.
The MMHS provides talking therapies such as; Compassion Focused Therapy (CFT) and Eye Movement Desensitisation Reprocessing (EMDR).
Anyone from your maternity care team can refer you to the MMHS.
Contact via telephone: 01768 245954 or
email: mmhs@ncic.nhs.uk
North Cumbria Talking Therapies
North Cumbria Talking Therapies is a free service that provides talking therapies for those over the age of 18 experiencing mental health difficulties such as; Post-Traumatic Stress Disorder (PTSD), Anxiety and Depression. The trained practitioners will work with you to understand your needs and help to decide what support will be best. The talking therapies offered are designed to help you understand and change your ways of thinking, some therapies include: Cognitive Behavioural Therapy (CBT) and Counselling.
You can refer through your GP or you can self-refer via paper form or online: bhttps://gateway.mayden.co.uk/referral-v2/ea77c8a7-44e4-4b74-a504-7ea7bef8d4f1
Community Perinatal Mental Health Team
The Community Perinatal Mental Health Team (CPMHT) specialise in assessing, diagnosing and treating people with mental health difficulties who are pregnant, trying to get pregnant or have just given birth.
The team work with pregnant people who have a pre-existing mental health problem or people who are experiencing mental health problems for the first time during their pregnancy journey.
A range of support is on offer, such as: evidence based psychological interventions, a care plan to support the needs of yourself and your baby, advice and information to answer your queries.
Anyone from your maternity care team can refer you to the CPMHT, such as your midwife or GP.
Social Services
Social Workers
Social workers work with a range of people to support them in finding solutions to the problems in their everyday lives.
Social workers can help pregnant people and people who have just given birth through providing support and information about; how to care for and raise children, financial worries, relationship issues, family problems and maternal mental health concerns.
You can self-refer to social services if you feel you need extra support or a healthcare professional can refer you if they are concerned about yours and your baby’s needs.
Family Action (Carlisle, Copeland and Allerdale)
Family Action is a national organisation that provides practical, emotional and financial support to families experiencing a range of struggles including mental health difficulties, domestic abuse, poverty, disadvantages and/or social isolation.
Family Action can offer support to families across Carlisle, Copeland and Allerdale - this includes: grants for those facing financial hardship, specialist mental health and wellbeing services and food programmes.
To get in touch with Family Action call:
020 7254 6251 (general queries) or
080 8802 6666 (parenting help).
Alternatively, visit their website: https://www.family-action.org.uk/
For local information search for Family Action in your area on Facebook
Barnardo's (Eden)
Barnardo's is a children's charity set up to support and protect children and young people in the UK.
They provide a range of services to support families across the Eden Valley who are experiencing difficult situations.
Barnardo's also run local children's centres for expectant families and parents with young children where they can access support for; parenting advice, antenatal and postnatal classes, parent/child bonding and children's sensory play.
For more information visit: https://www.barnardos.org.uk/https://www.barnardos.org.uk/what-we-do/services/eden-0-19-child-and-family-support-service
For local information search for Barnardo's in your area on Facebook
Local Services
West & North Cumbria Maternity Voices
Maternity Voices is a team of parent representatives that work alongside healthcare professionals to ensure that the voices, opinions and needs of pregnant people and their partners/coparents are recognised and heard.
Maternity Voices work with service users to develop and improve the maternal and neonatal care that is provided through their local NHS.
It is important that every person has the opportunity to share their experience of the care they have received throughout their pregnancy journey.
For more information visit: www.wnecumbriamvp.co.uk
The Happy Mums Foundation
The Happy Mums Foundation is a local social enterprise that offers a range of weekly peer support groups to mums who are experiencing maternal mental health problems.
All of the volunteers and employees at Happy Mums have either directly experienced maternal mental health problems or have supported friends and/or family members going through similar issues.
Call: 01228 592301
Email: info@happymums.org.uk
Visit: www.happymums.org.uk
Safety Net
Safety Net is a local charity that specialises in supporting adults and children who have experienced rape, exploitation and domestic and sexual abuse.
Safety Net can offer a range of services from psychological therapies to advice and support for immediate needs.
Some therapies include: one on one counselling or groups sessions to improve confidence and resilience.
Services can be provided face-to-face, online or over the phone to suit your needs.
Call: 01228 515859
Email: office@safetynetuk.org
Visit: www.safetynetuk.org
Write: 1 Fisher Street, Carlisle, Cumbria, CA3 8RR
Birth Afterthoughts/Postnatal Listening
Birth Afterthoughts/Postnatal Listening is an NHS service that offers a one off appointment to provide answers to questions that people may have about their birth.
Sometimes labour and birth can go differently than expected and you may have needed interventions that led to lapses in your memory and traumatic feelings.
The service is confidential and gives you the opportunity to discuss your birth experience with a qualified midwife.
The aim of Birth Afterthoughts/Postnatal Listening is to talk through the events that happened during your labour and birth and answer any questions you may have, whilst providing some clarity to your experience.
Together We
Together We is a local organisation that provides interventions to support people with their mental and physical health.
The organisation is made up of four connected services that offer a range of support:
1) ‘Carry’ – wellbeing support for expecting and new families.
2) ‘Talk’ – talking therapies.
3) ‘Fitness’ – exercise sessions.
4) ‘Recovery’ – support for people recovering from mental health difficulties.
For more information visit: www.togetherwe.uk
Cumbria Family Support
Cumbria Family Support is a charity that helps families with children in Cumbria get through difficult times.
Qualified and experienced staff and volunteers can provide a range of tailored support to suit the needs of each individual family.
Some family issues the team can help support with include:
- Behavioural issues
- Mental health problems
- Addiction
- Abuse
- Neglect
For more information visit: https://www.cumbriafamilysupport.org.uk/
Offload
Offload is a local organisation that aims to support the mental health and wellbeing of men.
Offload offer peer support groups for men to share their stores and work through common issues together. They also arrange away days to areas like the Lake District and collaborate with other local services to provide free activities like walking groups.
For more information visit: www.offloadcumbria.co.uk
Treatment options
Peer support
Peer support is a term used to describe a range of intervention options where people share their similar experiences in an attempt to support each other.
Peer support can create a safe place, both in person and online, for people to feel included, valued and heard by others who understand their difficulties from first-hand experience.
Some examples of peer support treatments and interventions include: group discussions to talk through particular topics or, shared activities like walking, gardening or arts & crafts. Peer support can take place in groups or can also be offered on a one-to-one level and in this case can be referred to as mentoring or befriending.
Medication
Some mental health conditions can be treated using psychiatric medication.
The four main types of psychiatric medication are: antidepressants, antipsychotics, sleeping pills and mood stabilisers.
Before taking any medication for your mental health it is important to fully understand what the drug is and its ingredients, how to take and store the drug, why you are taking it, alternative treatments that are available, how to safely stop using the drug and any potential short-term and long-term side effects. Your medication should be reviewed regularly by your doctor or psychiatrist.
If you are pregnant or breastfeeding always bring this to your doctors attention to ensure the safety of you and your baby.
Social prescribing
Social prescribing is when healthcare professionals refer patients to a range of local community services to support their overall wellbeing.
Social prescribing recognises that people’s physical and mental health is affected by a range of social, economic and environmental factors.
For example; if you are experiencing financial difficulties and cannot afford food then the stress and lack of nutrition this can cause may have a negative impact on your health and wellbeing.
Social prescribing then allows healthcare professionals to link up with community organisations that can provide practical support, for example through foodbanks, community groups and/or social housing services.
Psychological therapies
There are a range of one-to-one and/or group talking therapies available to support people with various maternal mental health issues, some include:
Cognitive Behavioural Therapy (CBT)
In CBT problems are broken down in to four areas:
1) Thoughts (how we make sense of what is happening)
2) Emotions (how we feel about a situation)
3) Behaviour (what we do to feel safe, or take our mind off our problems)
4) Physical sensations (how our body reacts to a situation).
CBT helps you to recognise the relationship between these four areas, and to learn different ways of responding to each.
Eye Movement Desensitisation Reprocessing (EMDR)
EMDR is a therapy where traumatic memories are accessed by using sets of side-to-side eye movements, sounds, or taps. The eye movements can replicate the rapid eye movement (REM) that takes place when we dream.
Your EMDR therapist will then guide you to reprocess these traumatic memories so they are less distressing and help to reduce the difficult physical and emotion
Compassion Focused Therapy (CFT)
CFT is an approach that helps you to manage high levels of self-criticism and shame and develop a new relationship with the difficult feelings you are experiencing.
This is achieved through using guided exercises that help to foster methods of giving and receiving compassion.
Acceptance and Commitment Therapy (ACT)
ACT focuses on recognising and accepting aspects of life that are out of your control and then setting goals to help you learn how to cope with this.
Mindfulness practices are used within ACT to help bring you in to the here and now instead of over thinking about past experiences or future worries.
These therapies may be accessed through the NHS Specialist Support Services mentioned in this leaflet.
If you are feeling uncertain about how to access a mental health service then your GP may be able to refer you and also provide advice on which service can support you the best.
Some services can be accessed without talking to your GP and this is known as a 'self-referral'.
Practical Support
Maternity Service
The NHS Maternity Service provides online antenatal classes that discuss practical topics such as; how to breastfeed, nappy changing, sleep safety and bathing.
For more information visit: www.ncic.nhs.uk/services/maternity
Step Forward
Step Forward provides tailored support to adults who have experienced mental health difficulties and would like help accessing opportunities to volunteer or rejoin the workforce.
For more information visit:
https://cumbriacvs.org.uk/about-us/step-forward/
Health Visitor
Your Health Visitor can provide a range of information and resources to further support you and your baby practically. For example, Health Visitors can help to advise on; nutrition, growth/development and support groups.
For more information visit:
https://www.ncic.nhs.uk/services/healthy-child-hub-0-19/health-visiting-1
Healthy Start
If you’re more than 10 weeks pregnant or have a child under 4, you may be entitled to get help to buy healthy food and milk. Such as; fresh, frozen and tinned fruit and vegetables, cow's milk and infant formula milk.
For more information visit:
https://www.healthystart.nhs.uk/
Baby Basics
Baby Basics provide much needed baby care essentials and equipment to mothers and families in need, this can be accessed through referrals from health professionals likes NHS midwives and health visitors.
Baby Basics provide services within Carlisle, West Cumbria and South Lakes.
For more information visit:
Crisis support
If you are experiencing a mental health crisis and need urgent support, you can contact your local NHS Crisis Resolution and Home Treatment Service (CRHT).
The CRHT team are made up of experienced mental health staff, including nurses, social workers, psychiatrists and pharmacy staff. They offer assessment and home treatment for people aged 16+ experiencing a mental health crisis, as an alternative to hospital admission.
The team operates 24 hours a day, 7 days a week. However, the crisis team does not provide an ‘emergency’ service such as a 999 response.
North Cumbria: 0800 652 2865
South Cumbria: 0800 952 0110
Those who are deaf/hard of hearing can text 07795 656 226
OR contact the Access and Liaison Integration Service on 0300 123 9015 available for people experiencing acute mental health distress and their carer’s.
Wellbeing Helpline & Texting Services staffed by volunteers also available Mon-Fri 7pm-11pm and Sat-Sun 12pm-Midnight on 0800 915 4640 or by texting ‘Hello’ to 07860 022846).
Urgent help
If you feel like harming or hurting yourself or other people:
- Call 999
- Go to your nearest Accident and Emergency department (A&E)
Non-urgent situations
- Visit your GP
- Call NHS 111 – open 24 hours a day, all year. Trained nurses can provide advice, information about your local crisis support services and/or your nearest A&E department.
- Call Samaritans on 116 123 – to access confidential support for people experiencing feelings of distress.
Glossary of key terms
- Antenatal Care: Care provided by healthcare professionals whilst a person is pregnant.
- Antenatal Classes: These are classes that help you to prepare for your baby’s birth and how to care for your baby.
- Maternal Mental Health: The psychological wellbeing of people who are pregnant, trying to get pregnant or have just given birth.
- Miscarriage: When a baby dies before 24 weeks.
- Neonatal death: Where a baby dies within 28 days of being born.
- Prenatal/Antenatal: The period of time before birth.
- Perinatal: The period of time when you become pregnant and up to a year after giving birth.
- Postnatal/Postpartum: The period of time after birth.
- Termination: Also known as an abortion, this means to medically end a pregnancy.
- Stillbirth: When a baby dies at or after 24 weeks.
Confidentiality
‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.
For further information on confidentiality contact the Information Governance Team:
Information.Governance@ncic.nhs.uk | 01228 603961
Feedback
We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:
pals@ncic.nhs.uk | 01228 814008 or 01946 523818
If you would like to raise a complaint regarding your care, please contact the Complaints Department:
complaints@ncic.nhs.uk | 01228 936302