Some women are lucky and find labour easy and empowering but, for many, it’s difficult, exhausting and not what they were expecting.
Common emotions afterwards include exhaustion, joy and relief. No matter how it goes you should feel a sense of achievement and pride – after all, you will have just brought a tiny baby into the world.
But if the birth is different to how you’d hoped or imagined – harder, longer or more painful, for example – you may end up feeling distressed or disappointed.
How can I prepare for childbirth?
Your perinatal mental health team may offer you a pre-birth planning meeting at 30-32 weeks of pregnancy. This meeting is a chance to talk to your healthcare team about what support you will need before and after your baby is born. It also helps everyone know what to do and who to contact if you or those around you are worried about your mental health.
Your perinatal mental health team will give you information in advance about what will happen at the meeting and who will be there.
At the meeting, you and your healthcare team will talk about your past mental health and any worries you may have. You will also talk about what support you will have at home after your baby is born.
‘We did a care plan and I was very happy with it. In the care plan we made sure that if something happens we all know what to do.’
Woman talking about her 32-week meeting
You can take your partner, a family member or friend to the meeting if you would like to. You can also have an independent advocate, who will help you express what you want to say. Ask your doctor or midwife if you would like this. After the meeting, you will be sent a written summary of what you talked about and agreed.
You can also talk to your midwife or perinatal mental health team at any time during your pregnancy.
What happens during labour and childbirth?
You can have a partner, friend or family member with you during labour and birth to support you and speak for you, if you need them to. This person is usually called a birth partner. You can have more than one person with you, but there may be a limit on numbers in a hospital or birth centre, or if you’re having a caesarean.
Every labour and birth is different but there are three main stages of labour. Before the first stage, you will start getting contractions but they won’t be regular. This is called the latent phase. It’s a good idea to phone your midwife at this point so they can assess you. They will let you know when to go to hospital or the birth centre, if you’re not having your baby at home.
There are things you can do at home to help you feel more comfortable during the latent phase, such as:
- having a warm bath
- asking someone to give you a back massage
- taking paracetamol
- using a transcutaneous electrical nerve stimulation (TENS) machine
- moving around.
You may want to think about what type of pain relief you will want during labour. You could include this in your birth plan but don’t worry if you change your mind once you go into labour. Your midwife can talk through your options with you, which may include:
- breathing and relaxation
- complementary therapies
- using a birthing ball
- having a water birth
- using a TENS machine
- gas and air (Entonox)
- medication, such as diamorphine or pethidine
- having an epidural.
‘I had an epidural, which was a huge relief and made the whole experience much more stress-free because I’m quite prone to anxiety.’
Mum with bipolar disorder
First stage of labour
In the first stage of labour, your contractions become stronger and more regular. Your midwife will talk you through what’s happening and will monitor you and the baby. They will offer you regular vaginal examinations to see how your labour is progressing. They will explain what they’re doing and why, but you don’t have to have these examinations if you don’t want them.
Towards the end of the first stage, when the cervix is nearly open, contractions get stronger. This is known as 'transition'. You may not notice when you’re moving from the first to the second stage.
Second stage of labour
In the second stage, your cervix is fully open (dilated) and the muscles of your womb are tightening and loosening to push the baby down and out. Your midwife will monitor you and the baby closely and support you as you push.
Third stage of labour
You’re in the third stage of labour when you’ve had your baby but need to deliver the placenta. Your midwife will speak to you during your pregnancy about the 2 options for delivering the placenta and the pros and cons of each.
Coping with labour if you have bipolar disorder
Some women with bipolar disorder worry that a long labour, with a lack of sleep, may trigger their symptoms. If you’re worried about this, your midwife or perinatal mental health team can talk through your options with you.
A c-section is an operation where a doctor makes a cut in your abdomen (just below your bikini line) and womb and lifts your baby out through it. If you feel you want a c-section, speak to your midwife about the advantages and disadvantages. It’s a major operation but if you’re still sure you want a c-section after talking it through with your healthcare team, you should be able to have one. Get more information about c-sections here.
After the birth
The healthcare team will monitor your baby to check for any effects of your mental health medication. If your baby shows signs of withdrawal from the medication, they may need to spend some time in the newborn (neonatal) care unit.
More information and support
Family nurse Partnership
Home visiting programme for first-time young mums and families.
Provides pregnant women and new mums with specialist counselling for emotional or mental health difficulties.
Symptoms and management of ADHD or autism (ASD) when planning a pregnancy
Healthy food and regular activity can improve mental wellbeing as well as being very important for the development of a future baby.
Having a baby is a positive and exciting experience for many women. But if you have had a traumatic experience in the past, you may find some of the difficult feelings come back when you’re planning a pregnancy or become pregnant.
When you have a serious mental illness the earlier you start planning your pregnancy the better
There is a higher chance that your mental illness will come back or get worse at this time than at other times of your life.
When you are managing a serious mental illness there’s lots of support to help you through pregnancy and beyond. Find out about the people and teams that help you here.
Your support network is very important when you are planning a pregnancy with a serious mental illness. The people around and close to you can support you and this can have a big effect on how you manage pregnancy and after.
The 5 most important things you could do before you get pregnant if you are managing a serious mental illness and are planning a pregnancy
Information for you about different types of treatment for mental health illness if you have a serious mental illness and are planning to become pregnant.
Information about when to try for a baby and fertility when you have a serious mental illness
If you have bipolar disorder and want to get pregnant it’s important to talk to your doctor before you start trying.
If you take drugs regularly it can be really tough to stop, but now that you are planning a pregnancy you have a big chance to stop safely.
It’s safest to not drink at all while you’re planning a pregnancy but if you’re finding this hard, there’s lots of help available.
Information about giving up smoking while on mental health medication
Other organisations and resources who can give support if you are planning a pregnancy with a serious mental illness
You can plan ahead for the early days with a newborn by thinking about what help you might need to keep well and to look after your baby. With the right support, women with mental illness can look after their children just as well as any other parent.
Life becomes busier and more chaotic when there is a baby involved. Returning to work is a challenge for most new parents, but it can be harder if you have a mental illness. Being prepared and having support can help.
- Pan-London Perinatal Mental Health Networks (2019) Pre-birth planning: Best Practice Toolkit for Perinatal Mental Health Services.
- NHS (2017) What happens during labour and birth. www.nhs.uk/conditions/pregnancy-and-baby/what-happens-during-labour-and-birth/
- Dolman C, Jones IR, Howard L. (2016) Women with bipolar disorder and pregnancy: factors influencing their decision-making. BJPsych Open 2: 294–300. doi: 10.1192/bjpo.bp.116.003079
- National Institute for Health and Care Excellence (2014, updated 2020) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192].