Perinatal mental health

What is perinatal mental health?

Perinatal mental health difficulties are the anxiety, depression, distressing thoughts and mood changes that can develop during pregnancy and in the first year after a baby is born. They can affect sleep, appetite, concentration and the ability to feel connected to a baby, and they respond well to talking therapy delivered online.

The term covers a range of experiences: antenatal depression and anxiety during pregnancy, postnatal depression after birth, birth trauma, distressing intrusive thoughts about a baby’s safety and low mood that lasts beyond the first couple of weeks, sometimes called the baby blues when it does not settle. Some people notice one clear episode, others find symptoms build gradually over several months. None of it reflects a person’s ability as a parent, and it is common enough that most psychologists working with adults will have supported clients through some version of it. This page offers clinical psychology support for Greenwich and south east London, working online with adults, including Blackheath, Charlton, Deptford, Lewisham, New Cross and Maze Hill.

Signs of perinatal mental health difficulties

Symptoms differ from person to person and can appear at any point from early pregnancy through to a baby’s first birthday. They are not always obvious to the person experiencing them, particularly when exhaustion and a new routine make it hard to tell what is ordinary and what is not.

During pregnancy

Common signs include persistent worry about the pregnancy or birth, low mood that does not lift, tearfulness, appetite changes beyond what pregnancy itself explains, difficulty sleeping even when the chance to rest is there and a sense of dread about becoming a parent. Some people develop specific fears around scans, labour or medical procedures that go beyond ordinary nerves and start to dominate daily thinking.

After birth

After birth, signs can include flat mood or a loss of interest in things that used to matter, exhaustion that rest does not touch, irritability, tearfulness, withdrawing from family and friends, difficulty feeling close to the baby, panic or racing thoughts and intrusive images or thoughts about harm coming to the baby. These thoughts are usually a sign of anxiety rather than any real risk, though they can be frightening to have and hard to mention out loud. Anyone experiencing thoughts of harming themselves or their baby should treat this as urgent and contact a GP, midwife, health visitor or NHS 111 straight away.

How therapy can help

Therapy gives a structured space to work through what is happening rather than managing it alone between appointments and midwife visits. A psychologist can help separate ordinary new-parent tiredness from a mental health difficulty that needs treatment, work through the specific worries or intrusive thoughts a person is having and build practical strategies for the weeks and months ahead. For birth trauma, therapy can help process what happened during labour or delivery in a way that reduces its hold on daily life and on decisions about future pregnancies. For depression and anxiety, therapy addresses both the immediate symptoms and the patterns of thinking that keep them going, so change tends to hold beyond the end of treatment rather than depending on constant effort to manage symptoms day to day.

Our approach

Sessions draw on approaches with evidence for perinatal depression and anxiety, particularly cognitive behavioural therapy and interpersonal therapy, in line with NICE guidance on mental health in pregnancy and the postnatal period. Cognitive behavioural therapy looks at the connection between thoughts, feelings and behaviour, and gives practical tools for managing anxiety, low mood and intrusive thoughts. Interpersonal therapy focuses on relationships and life changes, which fits naturally with a period defined by exactly that: shifting roles, changed sleep and a different relationship with a partner, family or friends. The specific approach used is agreed between client and psychologist based on what the person is dealing with and what has helped or not helped before, rather than applied as a fixed programme every client works through in the same order.

What does perinatal therapy involve?

An initial appointment covers what has been happening, how long it has been going on, and what support, if any, is already in place through a GP, midwife or health visitor. From there, sessions are booked at a pace that suits the person, often weekly to begin with, moving to fortnightly as things settle and new patterns take hold. Sessions take place by video call, which means no travel, no waiting room and no need to arrange childcare, though plenty of people do have a baby with them and that is entirely workable. Everything discussed is confidential in the way any psychological therapy is, with the usual exceptions around risk of serious harm to a client or to someone else.

Working around a baby’s routine

Perinatal therapy has to fit around feeds, naps and the unpredictability of early parenthood, so sessions are scheduled with some flexibility built in rather than treated as fixed slots that cannot move. A session cut short by a crying baby or rearranged at short notice is a normal, expected part of this work.

When to seek help

There is no threshold of severity someone needs to reach before getting support. Persistent low mood, anxiety that does not settle, intrusive thoughts, or a sense of not coping are all reasons to reach out, whatever point in pregnancy or the first year they started. Symptoms that last more than two weeks, or that are getting in the way of daily life, sleep or bonding with a baby, are worth raising with a GP or health visitor alongside seeking therapy. For anyone with thoughts of self-harm or of harming their baby, or any symptom that feels frightening or out of control, this counts as urgent and should go to a GP, midwife, health visitor or NHS 111 without delay, rather than waiting for a first therapy appointment. We will update this site as the practice develops, and in the meantime online psychology support is available to adults across Greenwich, SE10 and the western edge of SE3.