Perinatal mental health

Perinatal mental health difficulties, including anxiety, depression, birth-related trauma or distressing intrusive thoughts, during pregnancy or the first year after birth are common and treatable, though they often go unspoken. A clinical psychologist with perinatal experience can help you make sense of what you’re feeling and find a way through it.

What perinatal difficulties are and how they show up

The perinatal period, pregnancy through to around a year after birth, brings significant hormonal, physical and identity changes, and it’s also a period of higher risk for anxiety and depression. Perinatal depression can involve persistent low mood, loss of interest, exhaustion beyond ordinary new-parent tiredness, and difficulty bonding, though bonding difficulties are common and don’t mean something has gone permanently wrong. Perinatal anxiety often centres on the baby’s safety and wellbeing, sometimes escalating into constant checking or reassurance-seeking.

Some parents experience intrusive, unwanted thoughts about harm coming to their baby, sometimes from their own actions, which can be a feature of perinatal anxiety or perinatal OCD. These thoughts are distressing precisely because they conflict so sharply with how much the parent cares, and they don’t reflect any real intention or risk, though they can feel frightening and are often kept secret out of shame. Birth trauma is another distinct presentation, where a difficult or frightening birth experience leaves lasting symptoms similar to PTSD, and is covered in more detail on our PTSD and trauma page.

Perinatal difficulties are also shaped by factors that go beyond the individual: disrupted sleep, the physical recovery from pregnancy and birth, hormonal shifts, and a sudden loss of independence and routine. Previous mental health difficulties, a difficult birth, limited support at home, or a baby with complex feeding or sleep needs can all increase the likelihood of anxiety or depression developing. None of these factors mean a parent has done anything wrong, and none of them make the difficulty any less real or worth addressing.

When to seek help

If low mood, anxiety or intrusive thoughts have lasted more than two weeks during pregnancy or after birth, or are affecting your ability to function, bond or feel safe, it’s worth speaking to a specialist. This applies regardless of how “together” things look from the outside, and regardless of whether this is a first baby or not. If you are having thoughts of harming yourself or your baby, please see the crisis support information below before anything else.

How a clinical psychologist assesses and treats perinatal difficulties

Assessment takes into account the specific demands of the perinatal period alongside your symptoms, since treatment needs to be adapted to pregnancy, feeding, sleep deprivation and the practical realities of life with a young baby. NICE guidance on antenatal and postnatal mental health recommends CBT as a first-line psychological treatment for perinatal anxiety and depression, often adapted in structure and pacing to fit around a baby’s needs.

Where intrusive thoughts are a significant feature, treatment draws on the same exposure-based principles used for OCD, helping you build a different relationship with the thoughts rather than trying to suppress or avoid them. Where shame around perceived failure to bond, cope or feel “how you’re supposed to feel” is prominent, compassion-focused therapy (CFT) can also be a helpful addition, since perinatal difficulties are so often accompanied by guilt.

Assessment will also ask, sensitively, about your birth experience and any complications, since a difficult birth can sit underneath anxiety or low mood without being immediately obvious as the cause. Where a partner or wider family is involved and supportive, your psychologist may suggest ways they can help with specific tasks between sessions, though the therapy itself remains focused on you.

What online sessions look like

Sessions run over secure video call, usually fifty minutes, and can be arranged flexibly around feeding schedules and unpredictable nap times, including shorter or rescheduled sessions where needed. It’s entirely normal to have your baby in the room, and your psychologist will not expect childcare to be arranged for every appointment. Between sessions, tasks are kept realistic given how little uninterrupted time new parents typically have.

Talking about how you actually feel

Many parents describe feeling they should be grateful, happy or coping better than they are, and that expectation can make it harder to admit when things feel difficult. A specialist perinatal psychologist will not be surprised by ambivalence, exhaustion, resentment or fear alongside love for a baby, all of these can coexist, and naming them honestly is usually a relief rather than something to be ashamed of. Assessment and treatment proceed at your pace, and there is no requirement to present things in a more positive light than they actually feel.

Perinatal mental health and life in Islington and north London

Islington’s N1 postcodes take in Upper Street, Angel, Highbury, Canonbury and Barnsbury, with the Victoria and Northern lines running through the area. For new parents in this part of north London, getting to an in-person appointment with a baby in tow, on the Victoria or Northern line or otherwise, can be one more barrier on top of everything else. Online sessions remove that barrier, meaning support fits around nap times and feeds rather than a trip across town.

Getting started

Sessions are online, so there is nothing to wait for before starting. Our get started page is the quickest way in, and we will match you with a psychologist experienced in perinatal work, whatever stage of pregnancy or early parenthood you’re at.

If you need support right now

If you are in crisis, having thoughts of harming yourself or your baby, or thinking about ending your life, please don’t wait for an appointment. Call 999 in an emergency, contact NHS 111 and select option 2 for a mental health crisis, or call the Samaritans on 116 123, free, at any time, day or night.