Pregnancy & mental health before birth

Body changes, tiredness, sickness and big life changes can all affect mood. Feeling worried or unsure at times does not mean you won’t be a loving parent.

What matters is how long feelings last and how much they get in the way. Low or anxious mood most of the day for two weeks or more is worth raising with your care team.

Many people have moments of doubt about becoming a parent, even with a planned pregnancy. Saying “I’m not sure how I feel” to someone safe can ease the pressure to feel only happy.

Unplanned or unwanted pregnancy is one of the risk factors for depression in pregnancy listed by the U.S. Preventive Services Task Force. Support from a trusted provider or counsellor can help you think things through without pressure.

Family, friends and even strangers may share opinions about your body, birth or parenting. It’s okay to say, “Thanks, I’ll talk that over with my midwife,” and move on.

It can feel like

• A sad, anxious or “empty” mood most of the day
• Losing interest in things you usually enjoy
• Feeling hopeless, guilty or worthless
• Feeling very tired, beyond normal pregnancy tiredness
• Changes in sleep or appetite that worry you

Some of these overlap with normal pregnancy, which is why depression is easy to miss. If you’re unsure, ask your care team to check in with you.

A review of 102 studies found anxiety symptoms in about 18% of women in the first trimester, rising to about 25% in the third.

It can feel like

• Constant worry that something bad will happen
• Racing thoughts and trouble relaxing
• Feeling restless or on edge
• Trouble sleeping even when tired
• Panic attacks, with a pounding heart or shortness of breath

Some people have sudden, upsetting thoughts about harm coming to the baby. These are covered in “Pregnancy & after birth” (section: Anxiety, scary thoughts and perinatal OCD) and in “Harm & intrusive-thoughts OCD”.

Mental health conditions were the most common underlying cause of pregnancy-related deaths in the U.S. in 2020, and more than 80% of all pregnancy-related deaths were judged preventable. Getting support early really matters.

• A personal or family history of depression or anxiety
• A history of physical or sexual abuse
• Current stressful life events, or money worries
• Little support from a partner, family or friends
• An unplanned or unwanted pregnancy
• Pregnancy complications, or diabetes before or during pregnancy
• Being a teen parent or a single parent

Postpartum Support International lists groups who face higher stress, including LGBTQ+ families, military families, teen parents, single parents, parents of color and parents expecting multiples.

Postpartum Support International lists thyroid imbalance and a history of PMDD among risk factors. Your provider can check your thyroid if your mood changes.

The “Periods, PMDD & hormones” guide has more on hormone-related mood changes.

Counselling for people at higher risk lowered the chance of perinatal depression by 39%, the U.S. Preventive Services Task Force found. Social support, rest and early help all count.

Being honest about how you really feel helps your care team support you. Many areas have specialist perinatal mental health services for people with long-term conditions.

Things to share

• What you have been diagnosed with, and when
• What has helped you before
• Early warning signs that you’re becoming unwell
• Who supports you

If you are already getting treatment, talk with your clinical provider as soon as you know you are pregnant, or before trying, and don’t stop or change anything without speaking to them first.

The NHS lists bipolar disorder among the long-term conditions where you should be referred to a specialist perinatal mental health service in pregnancy. A plan made with your care team is important. The “Bipolar in women” guide has more.

Weight checks and a changing body can stir up old patterns. You can ask not to be told your weight, or to stand facing away from the scale. Tell your care team what would help. See “Eating disorders”.

• Your warning signs
• What helps when you start to slip
• Who to call, and their numbers
• What you want your partner or family to do
• Your care team’s contact details

Use the “My pregnancy mental health plan” worksheet.

• A previous hard or frightening birth, or a pregnancy loss
• A history of abuse or sexual violence
• Feeling pressured to have a certain kind of birth
• Not knowing how uncommon serious complications are
• Fear of pain or losing control

If a past birth was hard, the “Hard or frightening births” guide has a section on thinking about another baby.

Cleveland Clinic says prenatal visits are a good time to talk about your worries about childbirth. Raising it early gives more time for support before the birth.

You might say: “I’m really frightened of giving birth, and it’s affecting me.”

• Cognitive behavioural therapy (CBT), the usual first option, to work through what is fuelling the fear
• Prenatal classes that explain what to expect
• A tour of the hospital or birth centre, with time for questions
• Calming practices like gentle yoga or meditation
• Support groups and positive people around you

Things to include

• What you are most afraid of
• What helps you feel calm and in control
• How you’d like staff to explain things or ask consent
• Who you want with you
• Your preferences if plans need to change

Use the “My birth worries and what helps” worksheet to prepare.

Some people love their pregnant body. Others find the changes hard, especially with a history of body image struggles. Both are okay. Focusing on what your body is doing, rather than how it looks, helps some people.

You may worry about losing parts of yourself: your career, hobbies, freedom or friendships. Holding on to one or two things that feel like “you” during pregnancy can help.

Things to talk about before baby

• How you’ll share night feeds, chores and leave
• What each of you is worried about
• How you’ll ask for help when tired
• How you’ll make time for each other

Relationship stress is one of the risk factors Postpartum Support International lists.

Recent partner violence is one of the things the U.S. Preventive Services Task Force lists as raising the risk of perinatal depression. If you don’t feel safe, you deserve help.

Call the National Domestic Violence Hotline at 1-800-799-7233. You can also tell your midwife or doctor privately. See “Domestic violence: the basics”.

Financial strain is a known risk factor. The “Pregnancy & after birth” guide covers work needs, and “Your rights at work” explains workplace protections.

Many people only start to relax after a certain week or scan, and anxiety may spike before appointments. Planning something kind for yourself on those days can help.

The “Miscarriage & pregnancy loss” guide has a section on the next pregnancy.

You may grieve a baby who died while loving the one you are carrying. Both can be true. Some families find ways to honour the baby they lost during the new pregnancy.

After a long time trying, people sometimes feel they “should” only feel grateful. Worry, numbness or mixed feelings are still valid. See “Living with infertility”.

Tell your care team about past losses or treatment, and ask whether extra appointments or emotional support are available. Postpartum Support International offers more than 50 online support groups led by trained facilitators, including support for loss and grief in pregnancy.

Partners may worry about money, the birth, or being a good parent, and feel they must stay strong. Their feelings deserve support too. See “Dads’ mental health”.

Postpartum Support International says perinatal mental health conditions affect other family members too, including dads and partners.

• Seeming sad, flat or tearful most days
• Constant worry or panic
• Withdrawing from people or things they enjoy
• Saying they feel hopeless or like a burden

• Ask “How are you really feeling?” and listen without fixing
• Encourage a check-in with the midwife or doctor, and offer to go
• Take on chores so they can rest
• Learn about pregnancy mental health together
• Look after your own wellbeing too

Most programs studied used CBT or interpersonal therapy, often in groups, and many started in the second trimester. Sessions ranged from 4 to 20 meetings.

Examples include “Mothers and Babies”, with weekly group sessions in pregnancy and boosters after birth, and “ROSE”, with a few prenatal group sessions and one after birth.

Ask your midwife, OB-GYN or doctor to check on your mood and anxiety during pregnancy. If no one asks, you can bring it up yourself.

• Join a pregnancy or parent group, in person or online
• Ask friends and family who can bring meals or help after birth
• Plan who will help at night in the early weeks
• Save helpline numbers in your phone

Postpartum Support International offers more than 50 online support groups led by trained facilitators.

• Rest when you can, and say no to extras
• Gentle movement your care team says is safe
• Time outside in daylight
• Regular meals and snacks
• Some time each week that is just for you

Sleep, personal time, mindfulness and support groups are among the self-care steps Postpartum Support International recommends.