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Perinatal Mental Health Service

The Perinatal Mental Health service for Ealing, Hounslow and Hammersmith & Fulham, provides specialist assessment, care and treatment for women who have a current or previous severe mental illness.

You will have heard that the UK Government has introduced a range of new stringent measures in an attempt to slow and reduce the spread of Covid-19.

This has had significant implications for all NHS services, including the West London Perinatal Mental Health Service. 

We are mindful that the situation is progressing rapidly and we advise you to check the West London NHS Trust main page for further updates

We appreciate that these are challenging times for the women we see and their families, and we will continue to do our best to offer support to all those within our care, but we have had to make changes to the way we deliver our services.

Changes we've made to the service since Covid-19

All non-urgent appointments will now be carried out via telephone. 

Our Trust is currently looking at secure videoing technology; we will let you know when and if this becomes available.

You may already have received appointment letters advising you to attend a clinic, please do not attend clinic on the date stated.

A member of our team will call you at the time of your appointment. If this is not suitable, please call our offices and we will arrange an alternative time to call you.

H&F: 0203 313 3033
Ealing: 0208 354 8180
Hounslow: 0208 483 1525


You can also email us 

During the hours of 9am-5pm, someone in the team will be available to take your call if you have any concerns about your mental health.

If you need to help in a mental health crisis or emergency please call the West London
24 hour Mental Health Support Line on 0300 1234 244.

If you would like further information on COVID-19 and pregnancy please speak to your midwife or obstetrician, or visit the Royal College of Obstetricians and Gynaecologists website www.rcog.org.uk.



Contact us

Ealing 

Tel: 0208 354 8180
Email us:
wlm-tr.PNMHEHHF@nhs.net

Hammersmith & Fulham 

Tel: 0203 313 3033
Email us:
wlm-tr.PNMHEHHF@nhs.net

Hounslow 

Tel: 0208 483 1525
Email us:
wlm-tr.PNMHEHHF@nhs.net


About the service

Most women who have mental health problems in pregnancy or after birth will get better with help from their GP and/or talking therapies services (IAPT) and support from voluntary sector services, friends and family. If you are not getting better despite this help, or if you have current or previous severe mental health problems, you might need to be referred to the perinatal mental health service.

Who we are

We are a team of nurses, psychiatrists, psychologists, social workers, occupational therapists and administrators. We offer specialist assessment, treatment, advice and support for women who:

  • Have a current or previous severe mental illness
  • Have a mental health problem which has not responded to treatments provided by a GP
  • Are planning a pregnancy, pregnant and up to one year after birth
  • Live in Ealing, Hounslow or Hammersmith & Fulham
  • Have a GP in Ealing, Hounslow or Hammersmith & Fulham

We work closely with midwives and obstetricians at the maternity services in West London. We also work together with GPs, health visitors, social workers, adult mental health teams and voluntary sector organisations who may be involved in supporting you and your family.We aim to help you to be as well as possible during pregnancy and after birth so that you can enjoy family life.


What do we offer?

The care and treatment we provide depends on what you and your family need. The sections below tell you what we offer at different stages:

I'm planning a pregnancy

We can offer a one off appointment if you have a current or previous severe mental health problem and are planning a pregnancy. This will help you to find out how pregnancy can affect your mental health and how to prevent relapse. We can help you to make decisions about using medication when you are trying to conceive, pregnant and breastfeeding. We can also tell you about the care you can access when you are pregnant and in the postnatal period.

You can bring your partner, a family member or friend to the appointment. It helps if they also have information and advice so they know how best to support you.

I'm pregnant

If you are currently unwell, or have had a severe mental illness in the past and want to make sure you stay as well as possible, we can offer:

  • Information about your mental health problems.
  • Advice about the risk of relapse in pregnancy and the postnatal period and how to prevent this
  • Advice about the risks and benefits of using psychiatric medication in pregnancy and breastfeeding.
  • Talking therapies
  • Support to help your developing relationship with your baby
  • Joint appointments and discussion with other professionals involved in your care to make sure everyone works together with you and your family
  • A pre-birth planning meeting with you, your partner or a family member and all the professionals involved in your care. This might include your midwife, health visitor and a psychiatrist or nurse from another mental health team. At the meeting everyone will agree a plan for your care during the rest of your pregnancy, when you come into hospital to have your baby and the first few weeks after birth.
  • A written perinatal mental health care plan, developed with you and your family and all the professionals involved, so that you know what care and treatment you will have during pregnancy, your maternity admission for the birth of your baby and the early postnatal period. This will also have contact details for all the professionals and information about how to access urgent help should you need to.
  • Information about local and national voluntary sector organisations you and your family may find helpful.
  • Advice and information about mental health problems for partners and other family members so they can understand your difficulties and how best to support you.

I've recently had a baby

If your baby is under one year old we can offer:

  • Advice and information about your mental health problem and treatment options.
  • Advice about the risks and benefits of using psychiatric medication if you are breastfeeding
  • Talking therapies
  • Specialist support to develop your relationship with your baby.
  • Joint appointments and discussion with other professionals involved in your care to make sure everyone works together with you and your family.
  • Information about local and national voluntary sector organisations you and your family may find helpful.
  • Advice and information for your partner and other family members so they can understand your difficulties and know how best to support you
  • Recommendations for your mental health care when you are discharged from the service and referral to other services if needed.

How can I access the service?

We accept referrals from any professionals. You can ask your GP, midwife, obstetrician, social worker, nurse, mental health worker or any other professional you work with to refer you. If they need more information, you could suggest they look at this website which has information about making a referral.

What if I’m already under the care of a mental health service?

Even if you are already under the care of a mental health service, it is important that you have specialist advice from the perinatal mental health service. We can work jointly with the team you are already seeing.

What happens after I have been referred?

We will read the written referral and decide if the perinatal mental health service is the right service for you. If we need more information we might phone you to ask a few questions. We may also contact your GP or other professionals. If we decide that you need to be under the care of the perinatal mental health service, we will contact you by letter, phone or email to arrange your assessment appointment. If we don’t think that this is the right service for you, we will write to you and the professionals who referred you. We will suggest other services and sources of support you may find helpful.

What will happen at my first appointment?

We see women in various places including antenatal clinics, children’s centres and at home. We will do our best to be flexible with appointment dates and times.

Your first appointment will last for about an hour. We will ask you about any current symptoms and difficulties. We will also ask questions about your past. We will give you information and advice about any risk you may have of becoming unwell and the treatments that can help you. We will agree a plan with you for your care and treatment in the short and long term.

Who should attend my appointment?

You are very welcome to bring your baby and other children with you to your appointment. Some women prefer to arrange for someone else to look after their children. You can bring your partner, or another family member or friend, with you if you want to.

What if I am not sure about what’s happening with my care?

You can contact the team at any stage of your care if you have any questions.

Confidentiality and Information Sharing

Everyone referred to West London Mental Health Trust has an electronic health record set up. This is confidential and can only be accessed by professionals employed by the trust who are involved in your care. Your health record contains basic details such as your address and date of birth. It also has contact details for your GP and other professionals involved in your care. Information about your appointments, care and treatment is recorded. Any letters we send or receive about you are also added to your health record. Doctors, nurses, therapists and other health professionals use this information to make sure that you receive the best possible care. You can find out more about your health record here

After your first appointment, and at other times during your care, the professional who sees you will usually write a letter. This will detail the discussion you have had including any advice and the plan you agree for your care.  Letter are usually shared with your GP and other mental health professionals. You will also be given copies of all letters written about you, unless you say that you don’t want these. Let the professional who sees you know if there is any information you don’t want to share.

It’s also important that some information is shared with the other professionals involved in your care, including your midwife, obstetrician and health visitor. Some women would prefer these professionals to have as much detail as possible so that these clinicians understand them well and so you don’t have to keep repeating information. Other women prefer only  a small amount of information to be shared – such as your diagnosis, the main concerns and the plan for your care. Talk to any of the professionals from the perinatal mental health service about the information you are happy to share.


Information for professionals

We accept referrals from any professional including GPs, midwives, health visitors, obstetricians and mental health professionals.

Referral guidance

  1. You can refer any women who are registered with a GP in Ealing, Hounslow or Hammersmith and Fulham and those having their maternity care at Queen Charlotte’s Maternity Hospital or West Middlesex University Hospital.
  1. Women can be referred from preconception until the end of the 12th postnatal month.
  1. Referrals are essential for women with current or previous:
    • Bipolar Affective Disorder
    • Schizophrenia / Schizoaffective disorder
    • Previous Postpartum Psychosis
    • Severe Depression
    • Other psychotic illness
    • Family History of Postpartum Psychosis

These women should be referred even if they are currently well

  1. Referrals are also accepted for women with other severe or complex mental illness. Such problems might include Post Traumatic Stress Disorder, Eating Disorders, Obsessive Compulsive Disorder and Personality Disorder.
  1. If a woman is prescribed a mood stabiliser, please state this in the referral so that these women can be prioritised and urgent advice given regarding medication.
  1. The service only works with women who cannot effectively be managed in primary care.
  1. If a woman is already under the care of a community mental health team, she should still be referred. We will work jointly with this team.
  1. If the woman is a psychiatric inpatient during pregnancy or the postnatal period, she should be referred so that the Perinatal Mental Health Service can see her during admission, ensure she has antenatal care if she is pregnant and that she is followed up on discharge from the inpatient unit.
  1. If substance misuse is the primary problem, please refer to specialist substance misuse services. We can work jointly with substance misuse services if the woman also has a severe mental illness.
  1. Women under 18 years old can be referred to Child and Adolescent Mental Health Services (CAMHS) and the Perinatal Mental Health Service will provide advice to CAMHS.

How can I refer to IAPT (talking therapies) services?

You can refer women for talking therapies to their local IAPT (Improving Access to Talking Therapies) service. For more information about IAPT services in West London click here


Helpful resources during COVID-19

Baby holding mothers hand

It is important to take care of your mind as well as your body, especially during COVID-19. This period of time might mean that you are unable to see people who would usually support you and this can have an impact on your emotional wellbeing. Below are some resources to support your mental health, connect you virtually with others and access some of the activities you might have planned to do in person with your baby.

Emotional wellbeing

Wellbeing First Aid

Remember, self-isolation does not have to mean complete isolation. Pick up the phone or use social media to keep in touch with friends and family.

Switch off from it- it is very easy and can be very tempting to keep the news on for the whole day. Checking in once or twice a day will ensure you are up to date. Any more, and you may not be able to think of anything else.

Manage your worries- it is normal to be more anxious given the circumstances. However, our worries can really run away with us. Write a list of your worries and divide these into ‘Things I can control’ and ‘Things I cannot control’.

Focus on the things within your control. These may be:

  • A positive attitude
  • Your own social distancing
  • Turning off the news
  • Following recommendations
  • Getting in touch with friends and family via phone or social media

Try and let go of the things that are not within your control. These may be:

  • If others follow the rules
  • Predicting what will happen
  • Other people’s motives
  • How others react
  • How long this will last

Here are some links with additional information:

Practical resources

Mutual Aid

COVID-19 Mutual Aid UK are a group of volunteers aiming to support the local community through the COVID-19 pandemic. They can support you with various things including getting shopping and a friendly phone call. You can find your local group here: https://covidmutualaid.org/

Alternatively, you can search ‘COVID-19 Mutual Aid Area’ (e.g. Hounslow) on Facebook to find your local group.

Virtual resources for you and your baby

  • Tinies classes are online baby massage classes suitable for mum and baby from 6 weeks
  • Virtual activities from your local Children’s Centre - https://www.family-support.org.uk/virtual-timetable
  • Family Support: Virtual Children’s Centre Program – a virtual children’s centre program with various videos, live streaming and advice.
  • Educational resources for older children

  • Twinkl have resources to support learning at home. They are offering a month of free access to parents in the event of school closures.
  • BBC Learning have resources for children of different ages.
  • Hungry Little Minds have fun activities aimed at 0-5 years old
  • Physical activities

    Staying active can be helpful for your mental health and provide some structure to your day.

    Talking to children about COVID-19

    Your children are likely to have questions about COVID-19, here is some information to help you answer their questions:


    Becoming a parent

    Becoming a parent is one of the biggest life changes you will ever experience. It is important to remember that there is no ‘perfect’ way to give birth or to be a parent. Every baby and every parent is different, so it can take time to work out what is best for you, your baby, and your family

    How might I feel?

    It is normal to have a mixture of emotions when you find out you are pregnant and when you have a baby. To name just a few, you might feel excitement and joy, or worry and anxiety about not feeling ‘ready’ to be a parent or about ‘getting it wrong’. You may or may not fall instantly in love with your baby. It often takes time to develop a close bond.

    You might feel sad about what it seems you have had to give up, for example: time on your own with your partner, work, time to exercise or see your friends. You may feel that you’ve lost your independence. You haven’t lost these things for ever – but there will be a lot of changes when you have a young baby.

    You might feel under pressure from yourself or others. There are many pictures of happy families on social media so it’s easy to assume that other people find parenting easy and can be “perfect parents”. The reality is that most people have a mix of happy and challenging times. Try to have realistic expectations and not to be too critical of yourself. Some days will be easier and more enjoyable than others. It’s normal to feel exhausted, stressed overwhelmed and frustrated at times.

    You may have memories from your own childhood and how your parents treated you. Depending on whether this was mostly positive or negative, this can bring up unexpected emotions. For example, you might even feel a bit jealous of your baby for the good life you and your partner intend to give him or her if you didn’t get a good start in life yourself.

    If you have a mental health problem, such as depression or anxiety, this can affect how you feel about your baby. You may also judge yourself more negatively as a parent than you would do when you are well.

    If you are worried about any feelings and thoughts you have about your baby or being a parent, talk to one the professionals you are seeing. This is particularly important if you think this affecting how you feel about your baby.

    What will I have to do to look after my baby well?

    There is a lot to get used to and a lot to learn when you have a baby. Your midwife, health visitor and the perinatal mental health team can give you advice and help. Don’t expect to feel confident straight away – it takes time to get to know your baby and how to look after him or her. You will need to feed, clean and dress your baby. You also need to learn how to comfort and soothe your baby when he/she is upset. Your baby will enjoy being held and cuddled and just spending time with you.  

    You can help your baby to feel secure and to develop close loving relationships. Talking, singing and playing all help your baby to develop.

    Have a look at some of the following resources to help you to understand what your baby needs and how you can enjoy everyday life as a parent:

    Unicef  - Baby Friendly This website has videos and information to help you build a close  relationship with your baby. 

    Best Beginnings Videos about many aspects of pregnancy and parenting. This includes a series of videos on caring for your baby and understanding your baby.  Also available on the Baby Buddy App. 

    Start4Life NHS advice and information about almost everything baby related during pregnancy, birth and parenthood. 

    Feeding

    You can decide whether to breastfeed or bottle feed your baby. Breastfeeding has many advantages, but not every new mother is able to breastfeed so don’t worry if you can’t.

    If you are taking medication for a physical or mental health problem talk to your psychiatrist or GP to help you weigh up the risks and benefits of breastfeeding when taking medication. It is possible to breastfeed when you are taking many of the medications used to treat mental health problems, but there are a few that are not safe.

    You may decide that it is best for you to bottle feed so that someone else can share the feeding with you, particularly night feeds. This may be helpful if sleep deprivation triggers relapse of your mental illness.

    There is lots of help and support if you do want to breastfeed. Remember that it takes time to get used to it. Ask your midwife or health visitor for support. They can also tell you about local breastfeeding cafes where you can get support in Ealing, Hounslow, Hammersmith & Fulham.

    Breastfeeding support

    National Breastfeeding Helpline Telephone and web chat support from trained breastfeeding volunteers. Tel: 0300 100 0212 9.30am to 9.30pm daily. 

    The Breastfeeding Network Breastfeeding information, including information about medication in breastfeeding. 

    Best Beginnings Videos about breastfeeding.  Also available on the Baby Buddy App. 

    The National Childbirth Trust Information, an infant feeding helpline and local face-to-face support . 

    The Association of Breastfeeding Mothers Breastfeeding information. 

    Will I need support?

    All new parents need help and support. If you have a mental health problem, or a risk of postnatal mental illness, this is particularly important.

    Accept offers of help from family and friends. This can include offers to cook, shop or take older children to nursery or school. Let others look after your baby for a while so you can sleep and rest. When you feel ready, it also helps if someone can look after your baby to give you time to yourself to do something you enjoy, spend some time with your partner or with friends. For some mental illnesses, such as Bipolar Disorder, sleep deprivation can sometimes lead to relapse. Having a partner or family member to help with at least some of the night feeds can be very helpful.

    Don’t worry if you don’t have family or friends nearby. There are lots of other ways to get support. The Children’s Centres in Ealing, Hounslow and Hammersmith & Fulham all have groups to support new parents. You will also be able to meet other parents there. There are many other groups for mothers and babies throughout the three boroughs.

    The following are links to Early Help and Family Support Services in Ealing, Hounslow and Hammersmith & Fulham:

    Hounslow

    Ealing

    Hammersmith& Fulham

    There is also support on line and through social media. Try some of the following:

    Netmums On line support and advice from the Netmums Parent Supporter Service – a trained team of parents as well as health visitors and experts from Women’s Aid and Citizen’s Advice Bureau to provide information and support. 

    Family Lives – Information and support for many aspects of parenting and family life.  A helpline for emotional support, information, advice and guidance on any aspect of parenting and family life.

    See also support linked to specific mental health conditions

    You will also have support from professionals. All new mums have a midwife, health visitor and GP. They can give you advice and support and tell you about, or refer you, to other services that you might find helpful.  If you are under the care of the perinatal mental health service the professionals in the team will also be able to advise you about what’s available locally.

    Many women with mental health problems can still look after their children well despite their illness. However, symptoms of mental illness can affect how you feel about your baby and your ability to safely care for your children in the way that you would when you are well. You may need extra help until you recover. Talk to any of the professionals you are seeing if your symptoms are getting worse or if you think they are affecting your care of your baby.


    I need help with

    Useful information about certain mental health conditions 

    Anxiety

    Anxiety in pregnancy and after birth

    Anxiety is a normal response to a difficult, stressful or threatening situation. Everyone feels anxious sometimes, for example when you have an interview or sit an exam. Most pregnant women and new parents feel anxious at times. There’s a lot that’s new or uncertain when you have a baby and this can be stressful. You may worry about what your scan will show, how you will cope with birth or whether your baby has a serious illness. This is normal.

    If you are anxious on most days for more than a couple of weeks and if this starts to affect your everyday life you may have an anxiety disorder. When this happens in pregnancy or the first year after birth it is sometimes called “perinatal anxiety”. If left untreated, anxiety can make it difficult to enjoy your pregnancy and your baby.

    What does it feel like to have perinatal anxiety?

    Anxiety symptoms include:

    • Feeling anxious, stressed, worried or nervous
    • Feeling tense, restless or on edge
    • Having anxious thoughts that keep coming into your mind and are difficult to control
    • Thinking that something terrible is going to happen e.g. you or baby will die
    • Physical symptoms such as tense muscles, a tight chest, a racing heart, feeling dizzy, breathless, sweaty, having headaches or stomach ache, numbness or tingling
    • Difficulty getting to sleep
    • Poor concentration
    • Avoiding things you are afraid of e.g. going out with your baby
    • Having to check things repeatedly – e.g. that your baby is breathing.

    What types of anxiety disorders can women have in pregnancy and after birth?

    What types of anxiety disorders can women have in pregnancy and after birth?

    Women can have many different types of anxiety disorders in pregnancy and after birth, just like at other times:

    • Generalised anxiety disorder - having anxiety symptoms most of the time.  
    • Panic Disorder  - sudden bursts of intense anxiety with physical symptoms, e.g. a racing heart, and thoughts that something terrible is going to happen, e.g. that you will “go crazy”, make a fool of yourself or die.
    • Phobia - a fear of a particular situation or thing.  Common phobias are fears of heights, spiders, blood and injections.
    • Social phobia  - a fear of being with other people.
    • Agoraphobia -  a fear of crowds or public places. This can mean you avoid going out.
    • Tokophobia  -  an intense fear of vaginal birth.
    • Obsessive-compulsive disorder  - having “obsessions”, “compulsions” and anxiety. Obsessions are thoughts or images that keep coming into your mind and make you anxious. Examples include fear of being contaminated by germs, worrying about something you’ve forgotten to do such as turning off a hot iron, or even an image of your or someone else harming your baby. Compulsions are actions which you feel the need to keep repeating to try to reduce your anxiety. Examples include repeatedly washing your hands or checking your baby is breathing.
    • Post-Traumatic Stress Disorder (PTSD) - is a response to experiencing a traumatic, or life threatening event. Symptoms include having flashbacks or nightmares, avoiding things which remind you of the traumatic event, being very watchful for signs of danger, jumpy and easily startled by noises as well as having other anxiety symptoms. When women have PTSD after birth it is sometimes called Birth Trauma.

    How common is anxiety?

    Most women have anxious thoughts at some point during pregnancy or when they have a new baby. Around 10 to 15 in every 100 women have an anxiety disorder in pregnancy or during the year after birth. You may have had an anxiety disorder before pregnancy or it may start for the first time when you are pregnant or after birth.

    Why is treatment important?

    An anxiety disorder can lead to avoidance of situations or places. It may mean that you don’t take your child to places where they can meet other children. You may not go to postnatal groups where you could get support and enjoy being with other mothers and babies. Without treatment, an anxiety disorder can get worse and start to have an impact on your ability to get on with everyday life.

    Where to get help?

    The help and treatment you need depends on how severe your anxiety is. Your GP, midwife and health visitor can help you decide what kind of help you need. Most people respond to treatment offered by their GP, including a talking therapy. If your anxiety is severe, you may be referred to the specialist Perinatal Mental Health Service.

    Which treatments are available?

    The treatment you need depends on how unwell you are. You should be told about all the likely benefits and risks of treatment so you can make the best choice for you.  

    There is good evidence that talking therapies, such as cognitive behaviour therapy, are effective for the treatment of anxiety disorders. Improving Access to Psychological Therapy (IAPT) services provide a range of talking therapies. You can contact your local service yourself or a professional can refer you. The Perinatal patient leaflet for London IAPT services has more information and contact details of IAPT services in your area. Local IAPT services will see you more quickly if you are pregnant or up to one year after birth. 

    If your symptoms are more severe, or if you don’t want a talking therapy, you may need medication. Your GP or psychiatrist can help you weigh up the risks and benefits of taking medication in pregnancy or if you are breastfeeding.

    Resources

    The following resources offer information and support for women who have anxiety disorders in pregnancy and after birth:

    Mind – Information about perinatal anxiety 

    Tommys – Information about anxiety and panic attacks in pregnancy. 

    PANDAS Foundation – Information and  support, including a helpline  and email support, for women experiencing anxiety and depression in pregnancy or the postnatal period. 

    Maternal OCD – Information and peer support for women with perinatal OCD. Peer support via phone, skype and email. 

    Royal College of Psychiatrists – Information about Perinatal OCD for women and carers 

    Birth Trauma Association – Information and support for women who have PTSD due to a traumatic birth 

    Netmums Information about anxiety and peer supporters offering advice and support on line. 

    Birth Trauma

    What is it?

    Women’s experiences of childbirth are very varied. Some women find aspects of their birth traumatic or frightening. It may be obvious that your birth was traumatic. Sometimes other people around you may not realise how afraid you were. Examples of traumatic births include: 

    • Forceps or emergency caesarean section
    • If you have complications e.g. postpartum haemorrhage (losing a lot of blood after birth)
    • Fear during labour that you and/or your baby will die or be seriously injured
    • If your baby has a serious injury or complication or if you baby dies

    Some mothers who have traumatic births develop symptoms of Post Traumatic Stress Disorder (PTSD). PTSD can happen after any very traumatic event. When it happens after childbirth it is sometimes called Birth Trauma.

    Symptoms of PTSD include

    • Flashbacks or nightmares about the birth - repeated distressing thoughts or images
    • Avoidance of things that remind you of the birth e.g. the hospital, other mothers and babies, sounds or smells that trigger memories.
    • Feeling “hypervigilant” - feeling jumpy or on ‘high alert’ or worrying that something bad will happen to your baby.
    • Feeling anxious, irritable or low
    • Feeling emotionally detached or numb
    • Difficulty sleeping
    • Poor concentration
    • Physical symptoms of panic such as a racing heart, feeling sweaty, breathless, tense or shaky.

    Experiencing PTSD symptoms after a traumatic birth is not your fault or a sign of weakness. Your mind is trying to make sense of an extremely scary experience.  

    For some mothers who have a traumatic birth, symptoms of PTSD resolve naturally within a month or two of birth. However, if the symptoms are not getting better you may need treatment.

    What helps?

    There is a lot of help and support so it’s important to ask for help if you have symptoms of PTSD. You can use

    Talk to family and friends about how you are feeling, so they can offer support and you don’t feel that you are having to cope on your own.

    Talk to your midwife, health visitor or GP. It can be helpful to have an appointment with your midwife or obstetrician to look through your medical records together. This can help you to understand what happened during your labour and delivery. It’s also an opportunity for you to ask questions about what happened and why.

    Self- help: You can learn effective grounding techniques to help you to manage flashbacks. You can also learn breathing exercises and other relaxation techniques.

    Do something you find relaxing, such as going for a walk or having a bath.

    Contact the Birth Trauma Association. This charity provides information and peer support for women and partners affected by birth trauma.  

    If you get pregnant again, tell your midwife about your previous traumatic birth. You may be offered a special appointment to discuss this and to help you make a birth plan.

    What treatments are available?

    There are two main treatments for PTSD: Trauma-focused cognitive behavioural therapy and eye movement desensitization and reprocessing (EMDR). These psychological treatments work by helping you to process the traumatic memories and reduce re-experiencing them. You will develop your coping skills through the use of’ self-soothing’ and ‘grounding’ techniques. These treatments are available in the Improving Access to Psychological Therapies services in Ealing, Hounslow and Hammersmith & Fulham. You can self-refer or ask your GP to refer you. 

    Most women with birth trauma do not need to be referred to the perinatal mental health service.

    Medication is not usually used to treat PTSD. However, as it is common to experience depression alongside PTSD, your GP may offer you medication to help with this.

    Depression

    What is depression?

    Depression is a common mental illness. If you have depression during pregnancy it is sometimes called Antenatal Depression. If you have it during the first year after your baby is born it is called Postnatal Depression. Perinatal Depression is the term sometimes used to describe depression that happens any time in pregnancy or up to one year after birth.

    The severity of depression varies. If you have mild depression you will still be able to do most things you usually do, such as work and look after your children. If you have severe depression this is likely to have an impact on how you manage things. You may need time off work and you will probably need help to look after your children. If your depression is very severe you may neglect yourself and you may have suicidal thoughts or even plan to harm yourself.

    Depression affects 10 to 15 in every 100 women in pregnancy or after birth. Treatments are very effective, but many women wait longer than they need to before seeking help. Some women feel ashamed or guilty for feeling low at what is thought of as a happy time. You shouldn’t feel like this. If you have depression it’s not your fault – it’s an illness and you need treatment, just like you would if you have any other illness. Tell your midwife, health visitor or GP if you think you have depression. They can make sure you get the right help and treatment so that you can enjoy your pregnancy and your baby.

    What are the symptoms of antenatal and postnatal depression?

    Symptoms of depression in pregnancy and after birth are similar to those at other times. Some of the changes that come with being pregnant, or a new parent, overlap with the symptoms of depression.  These include changes reduced energy, difficulty sleeping and poor appetite. This can sometimes make it hard for you or others to tell if you are unwell. It’s also a time when everything’s new and challenging. It can be hard to know whether your reactions and emotions are to be expected because life with a new baby can feel far from 'normal'! It’s always better to tell someone if you think you might have depression.

    For a diagnosis of depression you will have some or all of the following symptoms for at least 2 weeks:

    • low mood
    • feeling anxious or irritable (e.g. you may feel feeling irritated by your children or your partner and argue more than usual)
    • tearfulness or feeling close to tears
    • poor sleep – you may not be able to sleep even when your baby is asleep
    • poor appetite or overeating
    • poor concentration
    • lack of energy and motivation
    • loss of interest and enjoyment in things that you would normally enjoy
    • not wanting to see friends or family
    • feeling hopeless and negative about the future
    • loss of confidence- e.g. you may not feel able to look after your children on your own
    • thoughts that you are “not good enough” or “a failure” e.g. not thinking you’re a good mum
    • anxious thoughts – e.g. you may worry that something bad will happen to your baby or that your baby is unwell
    • feeling guilty for something you have or haven’t done
    • thoughts about harming yourself or your baby, ending your life, or wanting to escape or get away from everything.

    It’s common to have a lot of anxiety symptoms during an episode of depression. In very severe depression you can also have “psychotic symptoms” such as hearing voices (hallucinations).

    For more information about antenatal depression see the Tommy’s information 

    For more information about Postnatal Depression see the Royal College of Psychiatrist’s information leaflet

    What’s the difference between Postnatal Depression and the Baby Blues?

    At least half of all women have the Baby Blues between the third and tenth day after having a baby. Symptoms include feeling low, anxious and irritable. You may be tearful, over sensitive and you may feel overwhelmed. The symptoms of Baby Blues usually stop on their own after a few days, without treatment.

    For more information about the Baby Blues see the NCT website’s information and support

    How can I get help and treatment?

    Talk to your midwife, health visitor or GP if you think you have depression.  They can help you decide what kind of help you need. Most people are looked after by their GP and IAPT (talking therapies service). You can self refer to IAPT or your GP or another health professional can refer you.

    The  perinatal patient leaflet for London IAPT services has more information and contact details of IAPT services in your area. Local IAPT services  in Ealing, Hounslow and Hammersmith & Fulham will see you more quickly if you are pregnant or up to one year after birth. See here

    If your depression is severe, you can be referred to the specialist Perinatal Mental Health Service.

    Why is treatment important?

    Some women will get better without treatment. However, depression can go on for several months without treatment. This can mean a lot of suffering and can spoil the experience of motherhood. It can affect your relationship with your baby and partner. You may not look after your baby, or yourself, as well as you would when you are well. So the shorter it lasts, the better.

    Which treatments are available?

    The treatment you need depends on how unwell you are. These include talking therapies, such as Cognitive Behaviour Therapy (CBT) and medication. Your GP or psychiatrist can help you weigh up the risks and benefits of using medication in pregnancy or if you are breastfeeding. Many women take antidepressants in pregnancy and when breastfeeding. There’s also lots of help and support available. See the resources below for more information.

    Further information and resources

    Royal College of Psychiatrists – information about postnatal depression for women and information for partners, relatives and friends

    Tommys – information about antenatal depression . Telephone and email advice

    Netmums – information, peer support and an on line CBT helping with depression course

    APNI Information about postnatal depression. Peer support via phone and email 

    PANDAS  Information about antenatal and postnatal depression. Telephone and on line support 

    Best Beginnings   Videos of women describing their experience of antenatal and postnatal depression and about treatment. Also available on the Baby Buddy App 

    PND and Me Peer support for women who have depression in pregnancy and after birth – Twitter support  group - #PNDHour 

    Eating disorders

    What are eating disorders?

    Eating disorders are serious mental illnesses. They affect your attitude to eating and your body weight or shape. You may not eat enough, or you might over eat. You may over – exercise, use laxatives, make yourself vomit or use other ways to try to lose weight.

    Eating disorders can affect your health and your unborn baby’s health if you are pregnant. Severe eating disorders can be life-threatening. It’s really important to have help and treatment to make sure you have a healthy pregnancy.

    What are the different types of eating disorder?

    There are several types of eating disorder. The most well known are anorexia and bulimia nervosa:

    Anorexia Nervosa

    If you have anorexia you restrict the amount of food you eat and your weight is very low. You keep trying to lose weight even when you are very underweight. You may exercise excessively to try to lose weight and you may binge and vomit. You are likely to think that you are bigger than you are and to be very preoccupied by your weight and body shape. You may wear baggy clothes to hide your body. You have irregular periods or your periods may stop altogether.

    Bulimia Nervosa

    If you have bulimia you binge (eat large amounts of food at one time, often very quickly) and then make yourself vomit. You can feel very out of control when you do this and feel guilty, ashamed and low in mood afterwards. You may use laxatives or other means of controlling your weight. You are likely to be very preoccupied with your body weight and shape.

    Anorexia and Bulimia Nervosa are associated with physical health problems and other mental health problems such as depression.

    For more information about eating disorders:

    Royal College of Psychiatrists information leaflet about Anorexia and Bulimia 

    BEAT Eating Disorder charity’s information about types of eating disorders 

    Eating disorders and pregnancy

    You may have difficulty getting pregnant if you have an eating disorder. It’s common to have irregular periods if you have an eating disorder and so you may not realise you’re pregnant.

    Pregnancy can be hard when you have an eating disorder. For some women the normal changes in body shape and weight can be frightening. Pregnancy may bring up difficulty memories from your own childhood. However, sometimes being pregnant can make you very motivated to get better.

    It’s important that you see an obstetrician to make sure that the physical complications of your eating disorder don’t become too severe or affect your unborn baby. Depending on how severe your eating disorder is, you may be more likely to have some pregnancy related complications. Your pregnancy and your baby’s growth need to be monitored carefully.

    For information about health eating and managing eating disorder symptoms in pregnancy see the Eating Disorders and Pregnancy nutrition leaflets

    Eating disorders in the postnatal period

    Even if your eating disorder has improved during pregnancy, there is a risk of relapse after your baby is born. You may worry about the weight you have gained during pregnancy – it’s normal to take some time to lose this weight. Eating disorders are associated with an increased risk of Postnatal Depression. Talk to your GP or psychiatrist if your mood is low.  It’s important that you have treatment for depression.

    Some women with eating disorders find breastfeeding hard – midwives and health visitors will support you to feed your baby whether you choose breast or bottle feeding. You may also find feeding your baby challenging when he or she starts eating solid food. Your health visitor or the eating disorder service can help you with this.

    There is a lot of support for new mothers, so talk to your health visitor about what’s available near you. If you have not been referred to the Eating Disorder Service or perinatal mental health service during pregnancy but need treatment after your baby is born then your GP, midwife or health visitor can refer you.

    Treatment and support

    Treatments for eating disorders are the same in pregnancy and after birth as at other times.

    If your eating disorder is severe you may need to be under the care of the Eating Disorder Service. The perinatal mental health service can work jointly with this service if needed. This might be the case if you also have another mental health problem which you need treatment for during pregnancy.

    Further information and support

    BEAT Eating disorder charity offering information and support for people with eating disorders and their families, including email support, a telephone helplines and on line support groups Tel: 0808 801 0677 

    Anorexia Bulimia Care  National eating disorder charity providing information and peer support Telephone helpline Tel: 03000 11 12 13 

    Eating Disorders and Pregnancy -  Information about eating disorders for women and professionals 

    Bipolar Disorder and other Psychotic Illnesses

    What is it?

    Bipolar Disorder, Schizophrenia, Schizoaffective Disorder and other psychotic illnesses are serious mental health problems.

    If you have ever had a diagnosis of any of these mental health problems it’s very important that you tell your midwife or obstetrician about this. You should be referred to the perinatal mental health service even if you have been well for a long time. This is important so that you can get advice about:

    • The risks of becoming unwell in pregnancy and after birth - including the risk of Postpartum Psychosis.
    • Your medication in pregnancy. The perinatal psychiatrist can help you weigh up the risks and benefits of taking psychiatric medication in pregnancy and when breastfeeding. Don’t stop or change your medication without advice as you may become unwell.
    • The care and support available during pregnancy and when your baby is born. This will include how all the professionals will work together with you and your family so that you can stay as well as possible.

    You can even be referred to the perinatal mental health service when you’re planning a pregnancy. It can help to have this advice in advance. This will help you to be more prepared and give you time to make any changes to your medication before you start trying to get pregnant.

    [lg1]Link to the page about postpartum psychosis rather than repeating all the information here.

    Further information and resources

    Royal College of Psychiatrists – information leaflets about mental disorders including Schizophrenia, Schizoaffective Disorder and Bipolar Disorder

    Bipolar UK – national charity providing information and support for people with bipolar disorder and their families. Peer support by phone and on line.  Helpful information about Bipolar Disorder, pregnancy and childbirth 

    Rethink – National charity providing advice, information and support to people with mental health problems and their families 

    Mind – Information and support for people with mental health problems and their families. Peer support and a helpline. Tel 0300 123 3393

    Action on Postpartum Psychosis Information and support for women who have had, or are at risk of, Postpartum Psychosis and their families 

    Postpartum Psychosis

    What is Postpartum Psychosis?

    Postpartum psychosis (also known as puerperal psychosis) is a severe mental illness that affects a small number of women, usually in the first days or weeks after childbirth. It often comes on suddenly and you can become very unwell very quickly. Symptoms vary and can change rapidly. They include elated or depressed mood, confusion, hallucinations, delusions and changes in behaviour.  Postpartum psychosis is a psychiatric emergency. You should seek help as quickly as possible.

    How common is it?

    Postpartum psychosis affects 1 to 2 in every 1000 mothers. It can happen to any woman - even if you have good support and no obvious life stresses. In about half of cases it occurs ‘out of the blue’ to women who have not been ill before. However, some women have a much higher risk:

    • If you have bipolar disorder or schizoaffective disorder your risk is at least 1 in 5 (20%). You have this high risk even if you have been well for a long time.
    • If you have bipolar disorder or schizoaffective disorder and also have a mother or sister who has had postpartum psychosis your risk is 1 in 2 (50%).
    • If you have had postpartum psychosis before your risk of another episode is 1 in 2 (50%).
    •  If you have never had a mental health problem yourself but your mum or sister had postpartum psychosis your risk is around 3 in 100 (3%)

    If you are in one of these high risk groups, or if you have ever had a psychotic illness, you should be referred to the perinatal mental health team when you are planning a pregnancy or when you are pregnant. You can get advice and have care and treatment to reduce the risk that you will develop postpartum psychosis.

    What does it feel like to have Postpartum Psychosis

    There are many different symptoms and ways that postpartum psychosis can start. Symptoms can begin within a few hours of birth and usually start within the first two weeks. The onset can be later – up to three months after birth or sometimes after that. You can become very unwell within a day or two.

    Symptoms include:

    • Mood changes: feeling “high” or elated, low, anxious or irritable – often with rapid changes in mood
    • Confusion
    • Feeling energetic, overactive or restless
    • Changes in your speech: speaking fast – jumping from one subject to another, or not speaking much at all
    • Racing thoughts with lots of ideas
    • Finding it hard to sleep or not needing sleep
    • Feeling more confident, powerful or special than usual
    • Unusual behaviour
    • Paranoid or suspicious thoughts
    • Feeling that everyday events, or stories on the TV or radio, have special personal meaning
    • Strange beliefs that could not be true (delusions)
    • Hearing, seeing, feeling or smelling things that are not there (hallucinations)
    • Hopelessness, suicidal thoughts or making plans to harm yourself

    Postpartum psychosis is often extremely distressing for you and your family. Your symptoms may affect how you look after yourself and your baby. However, the good news is that with prompt treatment in hospital you will fully recover and be able to look after your baby.

    Can anything be done to prevent postpartum psychosis

    If you have never had a mental illness before, or a family history of postpartum psychosis, there is nothing that can identify whether you are likely to have postpartum psychosis or to prevent it.

    If you have ever had a psychotic illness (e.g. schizophrenia, schizoaffective disorder, psychotic depression), bipolar disorder, postpartum psychosis, or if you have a family history of bipolar disorder or postpartum psychosis you should be referred to the perinatal mental health service. If you are planning a pregnancy you can be referred for a one-off “preconception” appointment. It helps to have advice as early as possible, particularly if you need to make changes to your medication. Many pregnancies are unplanned, so don’t worry if this happens to you. In that case you can be referred to the perinatal mental health service in early pregnancy.

    Your GP or midwife can refer you. If you are already under the care of a mental health service you should still be referred as the perinatal mental health service can offer specialist advice and work alongside your general adult team. Ask your psychiatrist or care co-ordinator to refer you.

    The advice, care and treatment from the perinatal mental health service will include:

    • A review of your diagnosis and advice about your risk of postpartum psychosis and other mental health problems in pregnancy or after birth
    • Discussion about the risks and benefits of psychiatric medication in pregnancy and when breastfeeding. Decisions about medication are not straightforward, so the earlier you start thinking about this the better. The risk of postpartum psychosis may be higher if you stop medication in pregnancy and if you don’t take medication after birth.
    • Several professionals involved in your care. You will agree how often you are likely to see them and  be told how they will work together. You will usually have a perinatal psychiatrist and a perinatal mental health nurse working with your midwife, obstetrician, health visitor and any other professionals involved.
    • A pre-birth planning meeting at around 32 weeks of pregnancy. This involves you, your partner or family members, and all the professionals involved in your care. At the meeting everyone will agree a plan for your care during pregnancy and after birth, including all the care and support you and your family need and how you can access help. The aim will be to reduce your risk of postpartum psychosis, or otherwise to make sure it is recognised early so that you have prompt treatment.
    • When you come into hospital for the birth of your baby you can be seen by a perinatal mental health nurse or psychiatrist if needed.
    • When you go home from hospital with your baby your mental health will be closely monitored for the first 3 months after birth, when the risk of postpartum psychosis is highest. You will also have all the usual care from your midwives and health visitor that women have after having a new baby.
    • You and your family will be given emergency contact numbers for local crisis services. You can use West London NHS Trust’s 24 hour telephone helpline, see your GP or go to A&E if you, or your partner or family, think you are becoming unwell. If you think you are becoming unwell don’t wait. It is better to be seen quickly as symptoms can worsen rapidly.
    • Information about the Mother & Baby Unit. Most women with postpartum psychosis need to be treated in hospital. Ideally you should be offered a bed in a Mother & Baby Unit (MBU) if you need admission. This is a specialist psychiatric unit where mothers with mental illness are admitted with their babies. You will be supported in caring for your baby whilst you have the care and treatment you need. The nearest Mother & Baby Unit for women in West London is Coombe Wood Mother and Baby Unit at Central Middlesex Hospital www.cnwl.nhs.uk/coombe-wood/

    How is Postpartum Psychosis treated?

    Going through such a serious illness can have an impact on your sense of self, your relationship with your partner, and especially on your confidence as a mum. As you recover, you may want to talk to a psychologist or counsellor about your experience of postpartum psychosis. Action on Postpartum Psychosis is an excellent organisation that offers advice and support for women who have had postpartum psychosis and their families. 

    Their Peer Support Network includes an on-line support forum and one-to-one support 

    Where can I get more information?

    For more information see:

    Royal College of Psychiatrists information on Postpartum Psychosis  

    Royal College of Psychiatrists information on Postpartum Psychosis for carers

    Action on Postpartum Psychosis This is a charity which offers information, advice and peer support for women and families. The website has videos and descriptions of women’s personal experiences of postpartum psychosis.

    Personality Disorder

    What are personality disorders?

    Personality disorder is a mental health problem which happens when some of these ways you think, feel or behave cause suffering or distress to yourself or other people. The difficulties in personality disorder tend to be present most of the time, rather than being episodes of illness which come and go. There is a wide range of severity. If your personality disorder is more severe it is more likely to interfere with your everyday life, relationships with partners family and friends and ability to work.

    There are many different types of personality disorder. For more information about these see the following:

    Royal College of Psychiatrists information about personality disorders 

    Mind information about personality disorders 

    If I have a personality disorder can I have other mental health problems too?

    Depending on the type of personality disorder you have, you may be more likely to have depression, anxiety disorders, eating disorders, psychotic disorders or substance misuse problems. It’s important that you have treatment for these as well as for the personality disorder

    Personality Disorder, Pregnancy and Parenting

    Depending on the type of personality disorder you have and the severity, you may find pregnancy and/or parenting more difficult.

    Your own experience of growing up, and how your parents treated you, is an important factor contributing to the development of your personality and to personality disorder. For example, if you experienced abuse or neglect, witnessed domestic violence or if your parents were very critical or hostile this can have a lasting impact. Being pregnant and becoming a parent yourself can bring back difficult memories from your own childhood.

    If you find it hard to manage your own emotions it may be hard for you to cope with your baby crying and to help your child learn manage his or her emotions.

    If your personality affects your relationships you may find it difficult to have to meet and trust new professionals who are involved in your care in pregnancy and after birth. You may need help to develop your relationship with your baby.

    There are many other ways that personality disorder can affect you when you are pregnant or have a baby. Talk to your GP, midwife or health visitor. The good news is that there’s lots of help and support available.

    How can I get help with my personality disorder in pregnancy or after birth?

    If you think you have a personality disorder, or know you have one, then it’s really important to talk to your midwife or GP as soon as you can. They can make sure you have the right care and support during and after your pregnancy.

    If your partner or another close family member, can attend some of your appointments with you, it may help them to be able to support you.

    You may be referred to the perinatal mental health service. The professional who sees you can talk to you about treatment options. This will depend on what type of personality disorder you have, how it affects you and whether you also have another mental illness.  You might be offered a specialist individual or group therapy to treat your personality disorder or to support your developing relationship with your baby. You might also have a perinatal mental health nurse, or another member of the team to visit and support you at home. You can also be given advice about other services which can offer support.

    Further information and support

    For help in a crisis:

    West London NHS Trust 24 hour telephone support line  Tel: 0300 1234 244

    Samaritans – If you need to talk confidentially to someone if you’re not coping or if you have suicidal thoughts. Tel: 116 123

    For more information about personality disorders:

    Emergence An organisation offering information and support for people with personality disorder 

    Carers4PD  Information support and advocacy for carers of people with a personality disorder 


    Top Tips on staying well

    • Keep active This could be going for a walk with the pram, dancing to music at home or gentle yoga. Physical activity can boost your mood, and help you feel like you're getting to do some things just for yourself.
    • Sleep and rest Getting good sleep with a new baby might sound impossible, but finding time to rest can make a big difference to your mental health. Try sleeping or resting whenever your baby sleeps. If you can, ask your partner to help with night feeds.
    • Relax You might feel like you have no time for yourself, or that all you do is sit around at home, but actively taking time to relax can mean more than just watching TV. Think about what really helps you unwind, whether it's reading a book, gardening or doing crafts. Try to make a bit of time for this– even just five or ten minutes at a time.
    • Meditation and Mindfulness Try an app such as Headspace
    • Have realistic expectations Don’t expect to get as much done as you would have done before you had a baby. It’s easy to feel overwhelmed. Try setting yourself 20 minutes to do what you can of a task, whether that's doing the washing or sorting through paperwork. Notice what you have done instead of everything you still need to do.
    • Accept help from family and friends If your friends or family members offer to do the shopping, help cook meals or do some cleaning, say yes! Everyone needs some support, and your loved ones will probably want to do something practical to help you. Not everyone has family or friends nearby, so don’t worry if you don’t have anyone. There are often voluntary organisations that offer practical support if you need it.
    • Accept help from family and friends If your friends or family members offer to do the shopping, help cook meals or do some cleaning, say yes! Everyone needs some support, and your loved ones will probably want to do something practical to help you. Not everyone has family or friends nearby, so don’t worry if you don’t have anyone. There are often voluntary organisations that offer practical support if you need it.
    • Peer support It can help to talk to someone who has had similar mental health problems in pregnancy or after birth. APNI, PANDAS, Maternal OCD and Action on Postpartum Psychosis, all offer peer support either individually or in face-to-face groups or on line forums. See our resource page for contact details. 
    • Other support for families There are many organisations which offer support to mothers with mental health problems and their families. Examples include Family Nurse Partnership, Home Start and Family Action. See our resource page for contact details.  

    Relationship support

    Becoming parents brings many changes to your relationship. It can make you feel closer or it can lead to more arguments and conflict. It can be hard to find time to be together as a couple as you juggle work and family life. You may not understand each other’s experience when one of you goes to work and the other is at home all day with your baby. There can be changes in your sex life. You may feel jealous that your partner is giving your baby more attention than you. You may not agree about all aspects of parenting. It’s important to try to support each other and to get help for any relationship difficulties.

    What can help

  • Talk to and listen to each other - tell your partner how you’re feeling and ask whether he/she is worried about anything.
  • Try not to criticise your partner.
  • Try to understand your partner’s point of view.
  • Share the housework, shopping and washing
  • Give each other time to sleep and rest
  •  Make some time to do things together if you can

    Relationship counselling

    It can be helpful to have relationship counselling if you want to resolve difficulties in your relationship, understand each other’s perspectives and learn to communicate better with your partner. If you decide to separate, relationship counselling can make this less painful.

    The following organisations offer information, support and counselling for couples:

    Improving Access to Psychological Therapies (IAPT) You can self-refer for couples counselling or your GP, midwife or health visitor can refer you. Click here for details of local IAPT services.

    Netmums Provide evidence-based relationship support for new parents: This includes advice on ‘hidden issues’, ‘vicious cycles’ and ‘arguing better’. 

    Relate Specialises in relationship counselling for individuals and couples. Relate offers informal workshops and self-help guides with practical tips and videos to help you manage common relationship issues such as sex, separation and divorce, and parenting. Relationship counselling is offered face-to-face, by phone, email and Live Chat. 

    Family Lives Offers a helpline, online forums and relationship counselling

    Single parents

    Many new mums are not in a relationship when they have a baby. You may separate from your partner during pregnancy or soon after birth, which is an added stress. You might have lots of support from friends and family, or you may feel isolated. Talk to your midwife and health visitor so they can let you know about local support groups where you can meet other pregnant women and new mums in your area.

    Gingerbread – This is the leading national charity supporting single parents. Gingerbread offers advice and support about many aspects of family life as a single parent. They have a single parent group in West London (for women in Ealing, Hounslow and Hammersmith & Fulham) and an on-line forum. 

    Domestic abuse

    Domestic abuse is very common and affects 1 in 4 women at some time in their life. Women are at increased risk of domestic abuse in pregnancy.

    There are many different forms of domestic abuse. These include physical, emotional, sexual and financial abuse and coercive control. You may also need help and advice about honour’ based violence, forced marriage, FGM, human trafficking or modern slavery.

    It can be hard to tell someone if you’re being abused. You may feel frightened about what your partner will do if you tell anyone. You may have mixed feelings about your relationship and be unsure whether you want to leave. Some women feel ashamed and embarrassed – but you don’t need to feel that way. It’s important for you and your baby (and other children if you have any) that you get help and support.

    Talk to your midwife, health visitor, mental health nurse, GP, psychiatrist or any other professionals. If you are in immediate danger call the police (999).

    The National Domestic Violence Helpline is a 24 hour helpline run in partnership with Refuge and Women’s Aid: Tel 0808 2000 247 

    Other resources

    You can also get advice from the following local organisations:

    Woman’s Trust A counselling and advocacy service for women in Hammersmith & Fulham Tel: 0207 034 0303 

    Hounslow One Stop Shop Confidential advice and support for women in Hounslow. Weekly drop-in service. Tel: 07810 031 780 

    Hestia Advocacy, community-based support and refuges for women in Ealing.


    Talking to your children about parental mental illness

    Parents often tell us they find it difficult to talk to their children about their mental health difficulties.
    Some parents also worry about how their mental health might affect their children. However, we know that if children do not have the information they often fill in the blanks. Talking openly provides them with the facts and reduces the anxiety that comes with uncertainty.  It is important to bear in mind the age of your children when deciding how much information to give them about your mental health.

    There are a few things you can do to help your children understand your difficulties and reduce any impact your mental health might have on them:

    Honest communication

    Honest communication is one of the best ways to address any confusion your children may have about your mental health.

    • It can be helpful to talk to a professional and/or a trusted friend to decide what and how to tell your children.
    • Information about your mental health problem is best if it is clear and appropriate for the age of your children. If you have more than one child, this might mean talking to each of them separately.
    • Tell your children they can ask any questions they want to and wait until they feel ready to talk.

    Notice changes in mood or behaviour

    Children have lots of parts to their life including school, home, friends and hobbies. If you know how they are coping in each of these settings you will be able to deal with difficulties more quickly.

  • Notice changes in your child’s behaviour, such as withdrawing from activities they previously enjoyed. Also notice changes in mood, for example anger or anxiety. Acknowledge their feelings and the reason for any changes in behaviour.
  • Speak to a teacher at your child’s nursery or school to see how they think your child is coping.
  • Ask other adults you trust to let you know if they see something that concerns them.
  • Talk to your child about how they are coping.
  •  Make sure your child knows who they can talk to and that they are not alone

    Encouraging and supporting their experiences

    You might feel able to help and support your child but you might also find  it helpful to have someone else think about this with you.

    • Find a way of creating a safe and quiet place at home. This can be helpful for school work and relaxing

    • Talk to them about school and their work. Take an interest in what they enjoy and find more difficult

    Have a plan

    Consistency is important for children. If you don’t have a partner or another family member who knows your child and their routine well, it can be helpful for you to write a plan with your children for times when you might be unwell or absent. The plan could include the child’s weekly routine, likes and dislikes and who they can contact for help and support.

    Make sure your child knows who to talk to if they are worried about your mental health. This can reduce the need for your child to take on too much responsibility when you are unwell.

    Helpful resources

    My Mum’s got a Dodgy Brain In this short film, children talk about their experience of having a parent with a mental illness. Your children might find it useful to watch and talk with you about it.

    When a parent has a mental illness. This video shows young carers talking about their lives caring for a parent with a mental illness. 

    The Mind Guide to parenting with a mental health problem 

    Books for children:

    • Why Are You So Sad: A Child’s Book about Parental Depression by Beth Andrews
    • The Illustrated Mum by Jacqueline Wilson
    • The Wise Mouse by Virginia Ironside

    Help for new dads and partners

    Having a baby brings many changes and challenges not only for mothers, but for fathers and partners too. Supporting a new mum with a mental health problem can be worrying and stressful. Fathers and partners may also have their own mental health problems.  

    Help for dads and partners supporting a mum with mental health problems

    If you are concerned about your partner’s mental health in pregnancy or after birth, the most important thing you can do is to encourage her to talk to her GP, midwife, obstetrician, health visitor or mental health team as soon as possible. If she is already under the care of the perinatal mental health service and you think her mental health is much worse, do let the team know about your concerns.

    You can also help by:

    • Giving practical support e.g. help with housework, cooking and night time feeds.
    • Listen, allow her talk about how she feels and don’t judge
    • Tell your partner it’s not her fault – mental health problems can happen to anyone
    • Encourage her and tell her what’s going well
    • Read about her mental health problem so you understand it
    • Do things together that you both enjoy – e.g. go for a walk

    It can be stressful and exhausting looking after a mum with mental health problems as well as a baby and other children. Make sure you look after yourself too. You may find some of the following helpful:

    • Talk to friends, family or other dads
    • Ask family members for practical help
    • Ask for some time off work
    • Rest and sleep when you can
    • Exercise
    • Don’t use alcohol to cope with stress
    • Talk to the professionals involved and ask for more help if you need it.

    Resources for supporting women during and after pregnancy

    You may find the following resources for partners helpful:

    For general advice about supporting women during and after pregnancy:

    NHS Information  

    For information and advice about supporting women with specific mental health problems:

    Antenatal and Postnatal Depression

    Perinatal OCD

    Postpartum Psychosis

    Birth Trauma

    Can dads get Postnatal Depression?

    At least one in five men experience depression after becoming fathers. Symptoms are similar to depression at other times. These can include low mood, anxiety, feeling irritable or angry, difficulty sleeping, changes in appetite, not enjoying things, feeling inadequate or hopeless and difficulty bonding with your baby

    Why might new dads experience mental health problems?

    Many factors can affect dads and partners’ wellbeing and ability to cope. These include:

    Relationship difficulties – these may be longstanding or recent. Having a baby can be a stressful time for your relationship. You will have less time alone together.

    • Money worries
    • Less time for exercise, hobbies and relaxation
    • Lack of sleep
    • Increased domestic responsibility
    • Concern about your partner if she has a mental health problem
    • Previous depression or anxiety

    What can you do if you are a new dad feeling low, anxious, or struggling to bond with your baby?

    • Open up about your feelings to a trusted friend or family member.
    • Exercise – even if this is walking with your baby in a sling or a pram.
    • See friends and family regularly so you don’t feel alone.
    • Join a dads group so you can meet other new fathers
    • Spend time with your baby  - cuddle, change nappies, bath and play. Having a role in your baby’s care may help you feel closer to him or her. 
    • Try not to use negative coping strategies such as working too many hours, avoiding coming home or drinking too much.

    Getting professional help

    If you’ve tried these things and continue to have difficulties or if your symptoms worsen, it’s best to seek professional help. See your GP who can refer you for talking therapies and/or prescribe you medication if needed.

    Resources for fathers and partners

    You may find the following information and support helpful:

    National Childbirth Trust  - The NCT website offers information and support for dads including information on returning to work and family finances. 

    PANDAS Dads - has a Facebook page offering support for dads www.facebook.com/pg/pandasdads/posts/

    Family Lives – Information and support for many aspects of parenting and family life.  A helpline for emotional support, information, advice and guidance on any aspect of parenting and family life.

    The Institute for Health Visiting – leaflets on how new dads can get involved with caring for their baby and on fathers’ emotional wellbeing 

    The Fatherhood Institute Information and summaries of research and policy focussing on fathers 

    DaddiLife – A parenting website for dads 

    Dad Pad - An essential guide for new dads, developed with the NHS


    Additional resources 

    Other helpful links

    Action on Postpartum Psychosis. This is a charity which offers information, advice and peer support for women and families. The website has videos and descriptions of women’s personal experiences of postpartum psychosis.

    APNI Information about postnatal depression. Peer support via phone and email

    Best Beginnings   Videos of women describing their experience of antenatal and postnatal mental health and about treatment. Also available on the Baby Buddy App 

    Best Use of Medicines in Pregnancy  Information about medications in pregnancy 

    Birth Trauma Association – Information and support for women who have PTSD due to a traumatic birth 

    The Breastfeeding Network Breastfeeding information, including information about medication in breastfeeding. 

    Cry-sis Support for parents of babies with challenging behaviour, excessive crying and sleeplessness. Information and a helpline 

    Eating Disorders and Pregnancy -  Information about eating disorders for women and professionals 

    Family Lives Offers a helpline, online forums and relationship counselling

    Family Nurse Partnership Home visits from a trained family nurse to support young mums aged 19 years and under. From early pregnancy until your child is two years old

    Gingerbread – Advice and support about many aspects of family life as a single parent. They have a single parent group in West London (for women in Ealing, Hounslow and Hammersmith & Fulham) and an on-line forum.

    Headspace Meditation and Mindfulness information and guidance. 

    Home Start Home visiting support for families 

    Maternal OCD – Information and peer support for women with perinatal OCD. Peer support via phone, skype and email. 

    Miscarriage Association  Support for anyone affected by miscarriage. On line forum and telephone helpline. 

    The National Domestic Violence Helpline is a 24 hour helpline run in partnership with Refuge and Women’s Aid: Tel 0808 2000 247 

    Netmums Information about depression and anxiety  in pregnancy and after birth. Peer supporters offering advice and support on line and a free on line CBT for Postnatal Depression course. 

    PANDAS Foundation – Information and  support, including a helpline  and email support, for women experiencing anxiety and depression in pregnancy or the postnatal period.

    Relate Relationship counselling for individuals and couples.  Informal workshops and self-help guides with practical tips and videos to help you manage common relationship issues such as sex, separation and divorce, and parenting. Relationship counselling is offered face-to-face, by phone, email and Live Chat. 

    Royal College of Psychiatrists Information leaflets about mental health problems before, during and after pregnancy for women and families 

    SANDS Charity for families affected by the death of a baby. Helpline and online forum  and a support app. 

    Start4Life NHS advice and information about almost everything baby related during pregnancy, birth and parenthood. 

    Tommys – Information about emotional wellbeing and mental health problems in pregnancy and after birth. 

    Download a printable version of this section here


    Perinatal Positivity 


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