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Hormone changes in pregnancy means that your symptoms can come back or get worse even if your illness was very well managed before you became pregnant. That’s why it is important to get help quickly if your mental illness symptoms come back or get worse during this time.
If your symptoms come back or get worse it isn’t your fault and health professionals want to make sure you get the support and treatment you need to help you stay well or get better.
Your GP's role
You can talk to your GP about your plans for pregnancy and your experience of mental health illness. You could also talk to a doctor in a local family planning clinic.
Your doctor is there to help you, not judge you in any way.
You could try asking the following questions:
- How might pregnancy and childbirth affect me?
- What is the risk of my mental illness coming back or getting worse?
- What are the risks and benefits of taking my usual mental health medication?
- How might my mental illness and its treatment affect me during pregnancy and childbirth?
- How might my mental illness and its treatment affect my ability to care for and enjoy my baby?
- How could my symptoms be controlled if I stop medication?
- What mental health services are available for pregnant women in my area?
- What support is available after my baby is born?
Specialist perinatal mental health teams
Specialist perinatal mental health teams are experts in caring for women who have, or had, moderate to severe mental illness before, during and after pregnancy. Perinatal means the time from when you get pregnant to a year after the birth.
The mental health team may include:
- doctors who diagnose and treat mental illness (perinatal psychiatrists)
- perinatal mental health nurses
- health professionals who specialise in talking therapies (perinatal psychologists)
- other specialist professionals, such as occupational therapists, nursery nurses, social workers and pharmacists.
- The team works together with the other professionals listed on this page to make sure you and your family have the care you need. They will work with you, and your partner or family if you agree, to put together a plan for your care during and after pregnancy. A member of the team will give you a copy of your care plan and let you know who you can contact if you need support or urgent help.
Where you see your perinatal mental health team will depend on what happens in your area. For example, you may have your appointments at an antenatal clinic, children’s centre or at home.
Your GP or other health professionals can refer you to a perinatal mental health team if you’re planning a pregnancy or if you’re already pregnant. You may see them at a pre-conception counselling appointment if you’re planning a pregnancy. You may also see one or more members of the team if you are referred during pregnancy or after the birth.
Community mental health team (CMHT)
If you’re already under the care of a community mental health team (CMHT), you should tell your care co-ordinator and/or psychiatrist if you’re planning a pregnancy or if you’re pregnant. You can continue to see your usual care co-ordinator and/or consultant.
Psychological therapy services
There are many different types of psychological (talking) therapies. You may be offered individual or group therapy. Mother-infant therapy can help you build a strong relationship with your baby, cognitive behavioural therapy can help anxiety or depressive illnesses and couple therapy can help with any problems in your relationship with your partner.
If you think psychological therapies can help you, your GP, midwife or health visitor can refer you to your local psychological therapy service.If you’re in England, you can ask for details of your local Improving Access to Psychological Therapies (IAPT) service, or find these on the NHS website, so you can refer yourself.
IAPT services vary across the country but many offer self-help and cognitive behavioural therapy for individuals, groups and couples. In some areas there are groups for pregnant women or new mums.
If you are under the care of a perinatal mental health service, you can have psychological therapy with the perinatal community mental health team. There are also other psychological therapies services which your GP or the perinatal mental health team can refer you to, depending on the type of therapy you need.
Midwifery team and antenatal care
Midwives ask all women at their first appointment about any physical and mental health problems. Telling your midwife about any past or current mental illness means they can recommend sources of help and support in your area. They can refer you to your local psychological therapy service or to the perinatal mental health service if needed.
Your mental illness means that you can sometimes have extra care in pregnancy. Ask at your booking appointment if they can offer ‘continuity of care’. This means you can see the same named midwife or small group of midwives through your whole pregnancy. This builds trust and has been shown to benefit mothers and babies.
Health professionals should ask you about your mental health and any symptoms at each of your antenatal (during pregnancy) appointments. Being honest about your symptoms will allow them to give you any support you may need.
Some hospitals have a specialist mental health midwife, who you may see during your pregnancy. All hospitals have a doctor who specialises in pregnancy and childbirth (obstetrician). You may see an obstetrician during pregnancy and in the days after you give birth. Midwives and obstetricians work closely with perinatal mental health teams.
All women remain under the care of a midwife until 10 days after the birth. If you have a serious mental illness or a risk of severe mental illness after birth, the midwives may continue to see you for up to 28 days after your baby is born.
Health visiting team
Your health visitor will give you advice on caring for your baby and may offer listening or counselling services, where you can talk about any worries you may have. They will work closely with your GP and any mental health professionals you are seeing to make sure you have the care and support you need.
Some women will meet their health visitor before birth towards the end of pregnancy. This is more likely if you have a severe mental health problem. All women will see their health visitor at home 10 to 14 days after the birth. You will then continue to see them either at home or in a clinic.
If you are a young parent you may also have support from a family nurse.
Mother and baby unit (MBU)
Mother and Baby Units are specialist inpatient psychiatric units. They are a safe place for you to stay with your baby if you need inpatient treatment for severe mental illness. They look after women who are in the late stages of pregnancy or in the first year after birth.
If you’re not sure if you want to stay in the MBU, you can usually visit the unit first to find out what it’s like to stay there and to ask any questions you may have. Some NHS Trust mother and baby units have made video tours for the trust website that may be helpful.
This is an example from Yorkshire and Humber Mother and Baby Unit: