Almost 1 in 5 women experience a mental health condition during pregnancy or in the first year after birth. Poor mental health in the mother is associated with higher risks of obstetric complications such as pre-eclampsia, premature delivery, and stillbirth, among others, including suicide.

Studies have also shown that untreated maternal mental health problems can result in poorer birth outcomes, including low birth weights and risks of difficulties bonding between parents and baby (Voit et al, 2022).

Mothers with poor mental health are more likely to miss perinatal appointments with health care providers, making detection and treatment difficult as well impacting on the overall monitoring of perinatal health, both for mother and baby.

Common Perinatal Mental Health Conditions

• Depression
• Anxiety
• Obsessive-Compulsive Disorder (OCD)
• Postpartum Psychosis
• Postpartum Post-Traumatic Stress Disorder (PTSD)

Risk Factors

Fertility issues

For 48% of women and 15% of men infertility can be the worst crisis of their lives (Freeman et al, 1985). Where IVF and other fertility treatments are pursued, both men and women in most cases found treatment to take a severe emotional strain, with phases of optimistic anticipation and hope, followed by periods of disappointment if treatment does not work (Boivin et al, 2012).

Miscarriage and pregnancy loss

Friedman & Gath (1989) were among the first to investigate the psychiatric implications of miscarriage and they found 48% of women reported depressive disorders – four times more than women from community samples.  Lok & Neugebauer (2007) found similar results with 20-55% of women developed depressive symptoms as a result of miscarriage.

20-40% of women report anxiety symptoms after miscarriage, with anxiety appearing to develop immediately after miscarriage and decreasing over the following six months, returning to its initial level one year later (Carter et al, 2007).

Geller et al (2001) found that, six months after miscarriage, women were significantly more likely to develop OCD. Instances of panic attack or phobic disorder were not significantly different between women who had miscarried and the community sample, but clinically it is not uncommon to observe women developing panic attacks after miscarriage (Carter et al, 2007).

Engelhard et al (2001) assessed PTSD among 113 women who experienced pregnancy loss. One month after the loss, the prevalence of PTSD was 25% and the severity of symptoms was similar to the one observed in other trauma populations.

Traumatic birth experiences

1 in 3 women experience a birth as traumatic (Alcorn et al, 2010). Beck (2011) found that PTSD after traumatic births can have a detrimental impact on breastfeeding, and on mother-child interaction, with some women suffered uncontrollable flashbacks when breastfeeding for example or felt a disturbing detachment from infants while feeding.

Mothers with PTSD tended to distance themselves from infants who might trigger post-traumatic stress symptoms. At the yearly anniversary of their birth trauma, some mothers reported that an emotional bond with their infants was missing (Beck, 2006b). Mothers reported that their child’s birthdays could cause flare-ups in PTSD symptoms with increased distress in anticipation. 

Other risk factors

Other risk factors for perinatal and postnatal mental health issues include adolescent pregnancies, poverty, having little or no support at home or in the community, physical health conditions, among others.

Conclusions

Identification of mental health issues should be a high priority with perinatal health care providers, with evidence-based interventions being made available and promoted. While randomised controlled trials are not yet available, Cognitive Behavioural Therapy and Trauma-Focused CBT for PTSD, and specialised CBT for OCD are indicated in this client group (Beck, 2020), and at our clinics we have specialised training and experience providing CBT around perinatal and postnatal issues.

For more information on how CBT can help, please feel free to get in touch directly at sian.thrasher@cbtnetworks.com or call to arrange a free initial discussion with Dr Thrasher on 01608 737614. We are an independent treatment service and are registered with major health insurers.

Further reading

Handbook of Perinatal Clinical Psychology

Edited by Rosa Maria Quatraro & Pietro Grusso (2020)