What if my mental health gets worse in pregnancy?

This information is for you if you have or had a severe mental illness and if you are planning to have a baby within the next 5 years. If you have a mental health issue that is less severe this information may be more helpful.

There is a higher chance that mental illness will come back or get worse at this time than at other times of your life.

On this page

Mental illness in pregnancy 

How likely is it that my mental illness will get worse?

Spotting early warning signs

How to plan in case you become ill

Advance care planning

Mental illness in pregnancy

Many people with a severe mental illness have no issues in pregnancy. There is a higher chance that your mental illness will come back or get worse at this time than at other times in your life, though.

Symptoms of severe mental illness can appear all of a sudden during pregnancy and soon after the birth. So, you and others around you need to know what the signs are, and how to look out for them.  

When you feel well, it’s easy to think nothing will go wrong, but it’s good to have some plans in place in case your mental health gets worse. It can help you get the care and support you need before and after the birth.

How likely is it that my mental illness will get worse?

For all sorts of reasons, you’re more likely to have issues with your mental health during pregnancy than at other times in your life. There is a chance that your mental illness could come back, or that you could get new symptoms.  

This can happen to all pregnant people, but it may be more likely if:

• you stop taking your mental health medication (but it can also happen if you keep taking your medication)
• you have bipolar disorder – your symptoms may come back after the birth, and there is a higher risk of postpartum psychosis, which is a severe illness that needs treating straight away
• you have had postpartum psychosis in the past
• you have schizophrenia or a different psychotic illness.

Spotting early warning signs

Keeping a mood diary can help you spot any changes in your mood. Bipolar UK has a mood diary that you can print out, or there are lots of free apps on offer.

Your family and friends can help you spot any changes to your mental health if you let them know what symptoms to look out for.

If you notice any changes in your mood or mental health, speak to your GP or perinatal mental health team. It’s vital to get treatment quickly to reduce the risk of harm to you and your baby.

The health professionals looking after you will ask how you’re feeling at every appointment. Always be honest about your symptoms so they can give you the best support.

Healthcare professionals are there to help, not to judge you. They may offer you treatment, or change the treatment you’re currently taking.

How to plan in case you become ill

It’s important to plan ahead, because symptoms of some mental illnesses such as postpartum psychosis, can come on quickly.

‘The perinatal psychiatrist talked us through all the possibilities and the worries. That reassured us and gave us an idea of what we needed to do and which way to go.’

‘We did a care plan, and I was very happy... In the care plan we made sure that if something happens we all know what to do’.    

Your perinatal mental health team, midwife or health visitor can help you make a plan for what will happen if your mental health worsens. They can tell you what support there could be for you.  

If there’s a chance of your mental illness coming back after the birth, you may be offered a pre-birth planning meeting at 30-32 weeks of pregnancy.

This will help you and the health professionals looking after you plan what care you may need before and after the birth. It’s also a chance to make sure you have the support you need at home. You can take your partner, a family member, or a friend to the meeting if you would like to.

Advance care planning

While you’re well, you can say what treatment and care you would or wouldn’t like to receive during pregnancy and childbirth. This can be useful if your mental illness means you can’t make choices at the time.  

You can also say whether you want your partner or family to make decisions for you if you’re not able to.  

There are two ways of doing this – with an advance decision, and an advance statement. 

Advance care planning can help you feel in control of what happens to you if you become unwell. It can also help your loved ones know that they are following your wishes while you recover.

‘We now have a care plan, and I’m really grateful for the perinatal psychiatrist’s summary, which is very clear. I’ve been able to give that to the midwife, a copy’s gone to my GP and a copy’s gone to the community mental health team. So, I now feel like everybody’s singing from the same hymn sheet.’

Advance decision

An advance decision lists any treatments you don’t want to have. This could include procedures, such as c-sections. It must be written down and signed by yourself and a witness, such as your doctor.

Health professionals must take your wishes into account by law. However, they may be able to give you treatment you don’t want if it is an emergency. 

An advance decision is a document to state any treatments you want to refuse in the future.

An advanced decision is sometimes known as an ‘advance directive’ or a ‘living will’.

An advance decision is legally binding.

You need to be over the age of 18 to make an advance decision.

Advance statement

An advance statement allows you to say what care you would like to receive. This can also include the care your baby gets. For example, if you need treatment and cannot stay in a mother and baby unit, an advance statement can say who you want to look after your baby in that case.  

An advance statement is not legally binding, but health professionals should take it into account.

You can make an advance decision or statement at any time before or during pregnancy, as long as you have the mental capacity.

You may not even need your advance decision or statement if you keep feeling well. But knowing that your wishes will be taken into account can help put your mind at rest.

If you want to, you can ask your doctor to sign the document. You can then keep it and give copies to members of your healthcare team.

You can use an advance statement to say who you would like to manage your affairs, such as paying bills, or looking after children if you are unable to.

Doctors should follow your advance statement, but they are not required to by law.

Bipolar UK has a video showing a couple Jenny and Henry talking about their experience of bipolar disorder. Towards the end of the video, they explain why they made an advance statement.