Perinatal mental health

What is perinatal mental health?

The perinatal period spans from conception through to around one year after birth. It is a time of enormous physical, emotional and psychological change. While it is often portrayed as a time of joy, the reality for many parents is far more complex. Up to one in five women and one in ten men experience a mental health difficulty during the perinatal period.

Perinatal mental health difficulties include antenatal and postnatal depression, anxiety disorders, post-traumatic stress disorder following birth, obsessive-compulsive disorder, and in rare cases, postpartum psychosis. These are not caused by a lack of love for your baby or a failure of character. They are genuine psychological difficulties influenced by hormonal changes, sleep deprivation, life adjustment and, in many cases, earlier life experiences.

Tokophobia, the extreme fear of pregnancy and childbirth, is another recognised perinatal difficulty that can affect people before, during or after pregnancy.

The perinatal period can also resurface psychological difficulties that you may have experienced before or thought you had moved past. Previous experiences of anxiety, depression, trauma, or loss can be reactivated by the physical and emotional demands of pregnancy and new parenthood. This does not mean you have failed to deal with those issues. It means that the perinatal period places unique pressures on your psychological resources, and sometimes additional support is needed.

It is also important to recognise that perinatal mental health is not only a mother’s issue. Partners, including fathers and co-parents, can experience significant psychological difficulties during this time, including depression, anxiety and adjustment difficulties. Yet they often receive less recognition and less support.

Signs of perinatal mental health difficulties

Symptoms can vary widely but may include:

• Emotional: persistent low mood, tearfulness, anxiety, irritability, feelings of guilt or inadequacy, emotional numbness, difficulty bonding with your baby
• Cognitive: intrusive or frightening thoughts about harm coming to your baby, difficulty concentrating, indecisiveness, negative thoughts about yourself as a parent
• Physical: severe fatigue beyond normal new-parent tiredness, changes in appetite, sleep difficulties even when the baby is sleeping, panic symptoms
• Behavioural: withdrawing from your partner, family or friends, avoiding being alone with the baby, excessive checking behaviours, loss of interest in things you used to enjoy

Many people do not recognise these experiences as a mental health difficulty. They assume it is just part of being a new parent. But if these feelings are persistent or significantly affecting your daily life, professional support can help.

Some specific presentations worth noting include perinatal OCD, which often involves intrusive, unwanted thoughts about harming your baby. These thoughts are distressing precisely because they go against what you want, and they are not an indication that you are a danger to your child. They are a symptom of anxiety, and they respond well to treatment. Birth trauma is another common difficulty, where the experience of labour and delivery, or events during pregnancy, leads to symptoms similar to PTSD, including flashbacks, nightmares, hypervigilance and avoidance of reminders of the birth.

How therapy can help

Therapy during the perinatal period is tailored to the specific challenges of this life stage. Our clinical psychologists may use:

• Cognitive behavioural therapy (CBT): effective for perinatal depression and anxiety, helping you address unhelpful thoughts about yourself as a parent and manage overwhelming feelings
• EMDR: helps process traumatic birth experiences or earlier traumas that have resurfaced during the perinatal period, reducing the intensity of distressing memories
• Compassion-focused therapy (CFT): addresses the intense self-criticism and shame that many new parents experience, supporting the development of self-compassion at a time when you need it most
• Acceptance and commitment therapy (ACT): helps you navigate the gap between expectations and reality, and engage with parenthood in line with your values rather than being driven by fear or guilt
• Parent-infant therapy: focuses on supporting the developing relationship between you and your baby, particularly where bonding has been affected by mental health difficulties

Therapy can also provide a space to process the complex emotions that the transition to parenthood brings, including grief for your previous identity and lifestyle, ambivalence about parenthood, relationship changes, and the pressure to meet unrealistic standards. These feelings are more common than you might think, and talking about them in a non-judgemental space can be profoundly relieving.

Online therapy can be particularly valuable during the perinatal period, as it removes barriers such as travel, childcare and the physical demands of getting to an appointment with a young baby.

Our approach

At The Online Psychologists, we have a deep understanding of the psychological complexities of the perinatal period. Our HCPC-registered clinical psychologists include specialists with experience in perinatal mental health, birth trauma, adjustment to parenthood and parent-infant relationships.

We begin with a comprehensive assessment to understand your specific difficulties in context. This includes exploring how you are feeling, the circumstances of your pregnancy or birth, your relationship with your baby, your support network, and any relevant history, such as previous mental health difficulties, pregnancy loss, or fertility treatment. This allows us to develop a treatment plan that addresses your individual needs rather than offering a generic response.

Our personalised matching process pairs you with a psychologist who has relevant perinatal experience. This matters because perinatal mental health involves specific clinical knowledge, including an understanding of the interaction between hormonal and psychological factors, the particular nature of perinatal intrusive thoughts, and the dynamics of the parent-infant relationship.

Online delivery is ideally suited to perinatal therapy. Getting to a face-to-face appointment with a newborn can feel impossible, particularly when you are sleep-deprived, recovering physically, or experiencing anxiety about leaving the house. Being able to access therapy from your own home, at a time that works around feeds and naps, removes a major barrier to getting help. It also means you can access specialist perinatal support regardless of where you live, which is important given that specialist perinatal services are not available everywhere.

We draw on evidence-based approaches including CBT, EMDR, CFT, ACT and parent-infant therapy, selecting the right approach based on your presentation and preferences.

What does perinatal therapy involve?

Therapy begins with an initial assessment session, lasting around 50 minutes, where your psychologist will take the time to understand your experience in full. This includes how you are feeling emotionally, the circumstances of your pregnancy and birth, your relationship with your baby, and what you are hoping to get from therapy. It is a collaborative conversation, not an interrogation, and it is designed to help your psychologist tailor the therapy to you.

Sessions are held weekly, each lasting 50 minutes, via secure video call. We understand that life with a baby is unpredictable, and we try to be flexible around the realities of this. If your baby is present during sessions, that is absolutely fine. Some psychologists use these moments as an opportunity to observe and support the parent-infant relationship in real time.

The content of sessions depends on your needs. Common areas of focus include:

• Managing anxiety, low mood or intrusive thoughts
• Processing a traumatic birth experience
• Rebuilding confidence as a parent
• Working through difficulties in bonding with your baby
• Navigating relationship changes with your partner
• Addressing the gap between expectations and reality of parenthood
• Processing grief related to fertility, pregnancy loss or the loss of your pre-baby identity

Between sessions, your psychologist may suggest gentle exercises to practise at home. These could include mindfulness techniques, thought records to track and challenge negative thinking, self-compassion practices, or small steps to re-engage with activities you have been avoiding. These are always sensitive to your energy levels and the demands of caring for a baby.

The length of therapy varies. Some people find that a focused course of 8 to 12 sessions provides the support they need. Others, particularly those dealing with birth trauma or long-standing difficulties that have been reactivated by the perinatal period, benefit from longer-term work.

When to seek help

If you are struggling emotionally during pregnancy or after birth, you deserve support. Early intervention leads to better outcomes for both parents and babies. You do not need to wait until things feel unmanageable. Reaching out is an act of care for yourself and your family.

Frequently asked questions

Is it normal to have scary thoughts about my baby?

Intrusive thoughts about harm coming to your baby are a very common feature of perinatal anxiety and perinatal OCD. They are distressing precisely because they go against your wishes, which is actually a reassuring sign. These thoughts do not mean you are a danger to your child. They are a symptom of anxiety, and they respond very well to treatment with CBT and other evidence-based approaches. If you are experiencing these thoughts, please know that you are not alone, and a psychologist can help.

Can partners or fathers access perinatal therapy too?

Absolutely. Perinatal mental health difficulties are not limited to the person who has given birth. Partners and fathers can experience depression, anxiety, adjustment difficulties and relationship strain during the perinatal period. Our psychologists support all parents, regardless of gender or role, and can help with the psychological challenges that this major life transition brings.

Will therapy affect my relationship with my health visitor or midwife?

No. Therapy with a clinical psychologist is confidential. Your psychologist will not share information with your health visitor, midwife or GP without your consent, except in the rare circumstances where there is a serious risk to safety. Many people find that therapy actually improves their confidence in engaging with other healthcare professionals.

Is online therapy safe and effective during the perinatal period?

Yes. Research supports the effectiveness of online therapy for perinatal mental health difficulties, including depression, anxiety and birth trauma. Online delivery is often the most practical option for new parents, and many people find that being in a familiar environment helps them feel more comfortable and open during sessions. All our sessions use a secure, encrypted video platform.