A doctor's view on mental wellbeing in pregnancy

Mental health problems in pregnancy are really common. We think they affect at least one in ten women, but it’s probably more than that because women are less likely to be diagnosed during pregnancy.   

There is some overlap with the symptoms of depression and of pregnancy. For example not being able to sleep, feeling very tired, feeling anxious about the future or even feeling quite negative about the future. These feelings are not unusual during pregnancy. It’s very common to feel tired and it’s common to have a level of anxiety.  It’s also common to have sleep problems. The key is realising when you’re moving beyond the bounds of normal emotional upheaval.

It’s very difficult for other people who haven’t experienced depression or anxiety to understand how it can feel.

Family members may say ‘You’re bound to be anxious, you’re bound to be a bit depressed if you’re not sleeping’. There can be an element of telling them to pull themselves together.

But when the symptoms last for two weeks or more, women need to come and see a doctor. We need to discuss these symptoms and see how we can organise the best support and help.

However, there is a still a stigma with mental illness and depression so people are worried about admitting it. I find a lot of women come and see me about something else with their pregnancy, some physical ailment, and I’ll explore their feelings, especially if I have a sense that something has gone on or if they’ve had some problems before.

Then I get comments like: ‘I feel terrible. Is this normal?’ 

As a GP the most important thing for me is to try and diagnose any depression or anxiety and also try and understand the scale of it. The management and treatment depends on the level of severity. So it’s not just a one step process. If I feel that extra support is needed from someone who is more experienced then there are services and support groups that they can be referred to.

Sometimes we recommend talking treatments and some people need medication.  Many women don’t want to come to a doctor with symptoms of depression or anxiety in pregnancy because they think they will be given medication that might affect the baby or breastfeeding. Nothing is given though without a consultation and a clear conversation about the risks and benefits with the mother. We consider the possible risks to the baby, and also the risks to mum and baby of not having treatment.

It’s also important for women to be able to talk to someone at home.

Often, when someone comes with anxiety or depression I print off a leaflet for them to read but also to give to their families, because it’s often a lot easier for them to show people the leaflet rather than trying to explain it themselves or talk about ‘having depression’.  

Some women who have experienced previous postnatal depression come and see me thinking about having a second child but very nervous about getting it again. They may not get it but they are at increased risk so it’s important that we have a plan if it happens. The key is recognising the early signs. If they’re picked up, we can treat it. So if we can arrange a plan, a regular review, it can often make a big difference.

Women who have existing mental health problems, or have had a history of it, need to be monitored a lot more closely during pregnancy because there is an increased risk of it recurring. 

Many women come to see me who have pre-existing mental illness, such as bipolar disorder or depression.

Those women may have been on medication for a long time. But when they decide to become pregnant or have a subsequent pregnancy, they worry about the effect of the medication. It’s very important that they do not stop taking it without any consultation. Being able to plan is very important. The medication might need to be changed or reviewed but the way to do it is in consultation with a doctor or healthcare team. 

Women need to feel able to talk to someone, whether it’s a midwife, GP or health visitor. I always say, ‘If it’s not normal for you, it’s very important to come and talk to us.’