Perinatal Mental Health Disorders
The perinatal period is defined as the time during pregnancy and the first 12 months after birth.
Perinatal Depression (PND)
During the perinatal period, 10-15% of women develop significant symptoms of depression or anxiety.
PND usually develops within the first few weeks after giving birth, but may also begin earlier (during pregnancy), or later (up to a year after birth).
Postpartum Obsessive Compulsive Disorder (pOCD)
Postpartum OCD (pOCD) is a type of anxiety disorder, affecting approximately 3-5% of women after giving birth.
Many women don’t come forward about their pOCD symptoms because they fear that they will lose their baby if they speak up.
Most new mothers experience postpartum ‘baby blues’ after childbirth, but when is it actually PND?
Paternal Postpartum Depression (PPD) can have the same negative effect on partner relationships/child development as PND in mothers.
New fathers can also exhibit signs of postpartum OCD.
Postpartum Psychosis
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth.
Presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery, and in the majority of women, within the first two postpartum weeks.
Diagnosing Perinatal MH Disorders
N.B. a positive screen on the EPDS is not the same as a diagnosis of depression, but forms part of a full assessment.
For further assessment or suspected other PNMH disorders:
pOCD → see Obsessive Compulsive Disorder (OCD) and/or Anxiety Disorders
Postpartum Psychosis → see Psychosis
Penrose Health Action Plan
⚠️ Safety netting
Assess risk status, taking into account:
- stage of pregnancy
- breast-feeding status
- medication status (risk of teratogenic effects)
If there is a need for commencement/change in medication → discuss with GP or strongly consider advice from secondary MH service.
If a woman with a psychotic disorder is pregnant/planning a pregnancy, and being managed solely in primary care → refer to secondary MH service.
Secondary and External services may be better placed to help/support patients than we are.
- Secondary services offer psychological treatments (e.g., interpersonal/psychodynamic therapies, CBT)
- External services in the community offer many options for social and psychological help through relationships with the wider service network (e.g. Social Prescriber, Befriender, Care Coordinator, Therapist, Lifestyle Coach, etc.)
We do not provide any form of psychotherapy within our surgeries.
Patient Journey - Determining Schedule of Reviews
If patient has history of SMI (active or not; including Bipolar Disorder) and is considering pregnancy, is pregnant, or has given birth within a year → refer to secondary MH service.
If patient with no history of SMI is pregnant/has given birth within the last year, and has recently developed symptoms of depression, anxiety, psychosis or OCD → discuss with GP, and consider referral to Perinatal Mental Health Team (see Perinatal Mental Health Teams).
- If a patient is actively managed by another mental health provider → liaise with services as required and conclude routine MHN appointments.
- If rejected by secondary services and patient is at high risk → review again in <1-2 weeks.
All follow-up reviews → book appointment with GP.
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.
- Postpartum Psychiatric Disorders - MGH Center for Women's Mental Health (womensmentalhealth.org)
- Postpartum depression - Symptoms and causes - Mayo Clinic
- Postpartum Depression in Men - PMC (nih.gov)
- The Signs of Postnatal Depression (tommys.org)
- Postpartum Obsessive Compulsive Disorder (OCD) - PostpartumDepression.org