Perinatal Mental Health

Stories, signs to notice and what to do

The Tablet She Wanted to Throw Away

Anjali was twenty-nine and thirty weeks pregnant when she told her husband, Rohit, that she had put her antidepressant tablets in the bin. She had taken them for two years after a bad spell at work. A cousin's WhatsApp forward said any medicine would harm the baby, and she could not stop thinking about it.

For three nights she slept badly. By the fourth day the old heaviness was creeping back: no appetite, no interest in the nursery they had painted together, and a tight, frightened feeling every time the baby kicked. She did not tell anyone because she felt she was already failing as a mother.

Rohit noticed she had stopped humming in the kitchen. He did not scold her. He sat down and said he was worried, and that they did not have to decide anything alone. He found the tablets, kept them aside, and rang the clinic that very morning.

At the visit, the psychiatrist and the obstetrician spoke to Anjali together. They explained that some medicines are safer than others in pregnancy, that severe untreated depression also carries risks for mother and baby, and that the choice would be made jointly, with a plan, not by a forum or by stopping suddenly at home. Anjali cried with relief. She left with a follow-up date for both doctors and a short list of warning signs to watch for after the birth.

How to recognise it

• Fear of medicine in pregnancy leads to a sudden stop without a plan.
• Low mood, loss of interest, poor sleep and worry return within days or weeks of stopping.
• Shame about being a 'bad mother' keeps the problem hidden.
• Advice from relatives or online forums is treated as more reliable than the treating doctors.
• The low mood is affecting eating, sleeping and enjoyment of the pregnancy.

What this story explains

This story shows that decisions about psychiatric medicine in pregnancy belong jointly to the psychiatrist and the obstetrician, and that stopping a needed medicine out of fear can be riskier than a carefully chosen one.

Probable root causes

• Misinformation and fear about medicine and the baby's safety.
• Hormonal changes of pregnancy on top of a past depressive illness.
• Guilt and perfectionism about being a 'good' mother.
• A family or community that gossips about medicines instead of asking the doctor.
• Disturbed sleep, which itself worsens mood.

What to do

1. Tell the doctor about any plan to stop, or any stop already made, as soon as possible.
2. Ask for the psychiatrist and obstetrician to talk to each other and to you together.
3. Ask clearly about benefits and risks of treating and of not treating.
4. Agree a follow-up schedule for mood during pregnancy and after birth.
5. Add non-medicine supports: counselling, rest, regular meals, a trusted person to talk to.
6. Write down early warning signs and who to call if mood drops.

Whom to consult

• Psychiatrist and obstetrician or gynaecologist together, as early as pregnancy is confirmed or at once if medicine has been stopped.
• Family doctor if you cannot reach specialists quickly.
• Clinical psychologist or counsellor for talking therapy alongside any medicine decision.
• Emergency service or nearest hospital if there are thoughts of self-harm.

Do and don’t

How to behave and communicate

• Partner: 'I am worried about you, and we do not have to decide this alone.'
• Listen first without correcting her fears, then offer to find the right doctor together.
• Avoid 'just be positive for the baby'; say 'your health matters too.'
• Relatives: 'Let us hear what her doctors say before we advise.'
• Use a calm, steady voice and offer to sit through the appointment.

Not Just Tired Tears

Zainab brought her daughter home from the hospital in Lahore on a Tuesday. By the fourth day she was crying over nothing: a cold cup of tea, a song on the radio. Her mother-in-law shrugged and said it was normal. It was. By the end of the first week the tears eased, and Zainab laughed again when the baby yawned.

Her friend Maryam, in Leeds, had a different path. Her son was nine weeks old when she admitted to her sister that she felt nothing when he smiled. She lay awake even when he slept, certain she was a terrible mother, and dreaded the evenings. She had stopped answering friends' messages.

Her husband said, 'You should be grateful. Look how healthy he is.' That sentence made her feel worse and more alone. Her sister did something different. She took the baby for two hours so Maryam could sleep, fed her a proper meal, and said gently, 'This is lasting too long to be just tiredness. I think you are ill, not failing.'

They saw the family doctor together. Maryam answered the questions honestly, including the one about the baby feeling far away. She was told it was postpartum depression, that it is common and treatable, and that it was not a moral failure to bond. A plan with talking support and a review date followed, and Maryam started to believe she would feel like herself again.

How to recognise it

• Baby blues: tearfulness and mood waves in roughly the first week, with the mother still able to be with the baby, and it passes.
• Postpartum depression: low mood stays beyond the first weeks, interest drops, sleep is broken even when the baby sleeps.
• Growing guilt and feeling the baby is far away.
• Withdrawing from friends and family.
• Any voices, thoughts of harming the baby or self, or loss of touch with reality is an emergency.

What this story explains

This story shows the chapter's difference between baby blues, which pass, and postpartum depression, which is an illness that needs professional attention and is not a failure.

Probable root causes

• Sharp hormonal change after the placenta leaves.
• Severe sleep loss and the physical strain of birth.
• Past depression or anxiety, or thyroid trouble.
• Little practical help, isolation, or money and relationship stress.
• Pressure to feel only joy, which makes honest feelings seem shameful.

What to do

1. Note how long the low mood has lasted and whether it is getting better or worse.
2. Arrange sleep protection: someone else takes the baby for a block of hours.
3. Feed the adult too: regular meals and water.
4. Book the family doctor or maternal health clinic, and go with her if she wishes.
5. Ask directly about thoughts of harming herself or the baby.
6. Follow the treatment plan and keep the review visit.

Whom to consult

• Family doctor, health visitor or maternity clinic if low mood lasts beyond about two weeks after birth.
• Psychiatrist if mood is severe, if she cannot function, or if there is any past mental illness.
• Clinical psychologist or counsellor for talking therapy.
• Emergency service or hospital at once for voices, thoughts of harm, or confusion.

Do and don’t

How to behave and communicate

• Say 'You are not a bad mother. This can happen to anyone, and help works.'
• Listen without fixing, and let silences be.
• Ask, 'How are you really, apart from the baby?'
• Avoid advice about how to feel; offer concrete help instead.
• Use a warm, unhurried tone and repeat reassurance often.

The Birth That Went Well on Paper

Priya's daughter was born by emergency caesarean after a night of frightening alarms. The baby was healthy, the doctors smiled, and relatives sent cheerful photos. Everyone said, 'All is well that ends well.'

Six weeks later Priya still woke with her heart pounding, replaying the moment the room filled with people and nobody would tell her anything. She avoided the hospital road. When her sister mentioned a friend's birth, Priya went cold and quiet. She felt guilty for not being happier.

Her husband, Karan, had been in the corridor that night, hearing only fragments. He had not spoken of it since. He was snapping at small things, sleeping badly, and drinking more tea and coffee to get through the days. He felt he had no right to be upset when mother and baby were safe.

One evening Karan said, 'I keep seeing that door. Do you?' Priya burst into tears and said yes. They realised neither had been alone in it. They asked the family doctor for a talk, and were told that a birth can be a trauma for the person who lived it, and for the partner, even when the baby is well. Priya was referred for therapy, Karan was offered a check-in for himself, and both of them breathed out for the first time in weeks.

How to recognise it

• Flashbacks, nightmares or sudden fear linked to the birth.
• Avoiding reminders such as hospital, news, or other people's birth stories.
• Feeling numb, jumpy, or guilty that 'it should have been fine.'
• A partner who is irritable, sleepless, or quietly overworking, also affected by what they saw.
• Symptoms lasting weeks, and affecting care of self, baby, or the relationship.

What this story explains

This story shows the chapter's point that a medically successful birth can still be a trauma for the person who lived it, and that partners can also become depressed or frightened.

Probable root causes

• Fear for life or loss of control during an emergency.
• Lack of explanation or communication during the birth.
• Previous anxiety, trauma, or a difficult earlier pregnancy.
• Silence afterwards because everyone focuses on the baby.
• Exhaustion, which lowers the ability to cope with distressing memories.

What to do

1. Name it gently: 'That was frightening, and it makes sense you are still shaken.'
2. Let each person tell their version of the birth if they wish.
3. Ask the maternity team for a debrief to understand what happened.
4. See a doctor if flashbacks, avoidance or low mood last beyond a few weeks.
5. Look after the partner too: sleep, food, someone to talk to.
6. Keep everyday routines steady and ask for help with baby care.

Whom to consult

• Family doctor or obstetrician for a birth debrief and a referral.
• Clinical psychologist or trained trauma therapist for persistent flashbacks.
• Psychiatrist if sleep, mood, or anxiety are severe.
• Emergency service or hospital if there is danger to self or others.

Do and don’t

How to behave and communicate

• Say 'Tell me as much or as little as you want. I am here.'
• Listen without interrupting or correcting memory.
• Avoid comparing births; say 'Your experience matters.'
• Partner to partner: 'I was scared too. Can we get help together?'
• Keep a slow, steady voice and allow tears.

A Quiet Room After the Scan

Sunita was ten weeks pregnant when a routine scan in Pune showed no heartbeat. The doctor spoke kindly, but the words blurred. By evening she was home, and the first thing her aunt said was, 'It is good it happened early. You can try again.'

Sunita nodded, but inside she felt as if someone had turned the lights off. She had already imagined the child's room. She went back to work after three days because she did not want to seem weak. Her husband, Vikram, buried himself in his phone. He did not know whether to mention it, so he said nothing.

Weeks later she was still crying in the bathroom, avoiding friends with babies, and lying awake at night. She felt ashamed for grieving a baby 'who was never born.'

One evening Vikram found her sitting with the scan picture. He sat beside her and said, 'I am sad too. I did not know how to say it.' They talked for the first time. The next week they asked the family doctor about counselling. They were told that loss in this season, whether miscarriage, stillbirth, or a baby in intensive care, is grief, and grief has no timetable. Sunita took leave, joined a small support circle, and made a quiet ritual of lighting a lamp on the due date.

How to recognise it

• Deep sadness, tears, or numbness after a pregnancy loss, lasting weeks or longer.
• Avoiding pregnant women, babies, or baby shops.
• Shame or guilt, and thoughts such as 'I did something wrong.'
• Partners grieving silently, or in a different pattern.
• Low mood that stops her sleeping, eating or working over a long time.

What this story explains

This story shows the chapter's teaching that miscarriage, stillbirth and a baby in intensive care are real grief, and that grief is not on a timetable.

Probable root causes

• The loss of hopes, plans and an imagined future.
• Hormonal shifts after pregnancy ends.
• Silence and stigma around early loss.
• Self-blame and unhelpful remarks from others.
• Past depression or anxiety that makes grief heavier.

What to do

1. Name the loss: 'You lost a baby, and it is all right to grieve.'
2. Give time off and avoid pressure to be 'back to normal.'
3. Let both partners share feelings in their own way.
4. Allow a ritual such as lighting a lamp, a name, or a quiet moment.
5. Check gently for how sleep, eating and mood are after a few weeks.
6. Seek help if grief turns into constant low mood or thoughts of ending life.

Whom to consult

• Obstetrician or gynaecologist for the medical follow-up and any questions about cause.
• Family doctor if sleep, appetite or mood stay very low.
• Counsellor or clinical psychologist for grief support.
• Emergency service or hospital if there are thoughts of self-harm.

Do and don’t

How to behave and communicate

• Say 'I am so sorry. I am here whenever you want to talk.'
• Sit with silence and tears without fixing.
• Avoid silver linings; say 'This is a real loss.'
• To a partner: 'You are allowed to hurt too.'
• Use a soft voice and check in again after weeks.

The Night Rosa Stopped Making Sense

Rosa, thirty-one, had delivered her first baby in Lisbon five days earlier. On the first two nights she barely slept, which her husband, Miguel, put down to excitement. By the fourth day she was talking very fast, laughing and then weeping, and saying she had been chosen for a special mission.

On the fifth night she told Miguel that the baby was in danger and that she could hear someone telling her what she must do. She was frightened, but she was also sure. She did not seem to know that this was not real. She paced the flat, refusing to put the baby down.

Miguel remembered what the midwife had mentioned at discharge: voices, a wish to harm the baby or herself, or a break with reality is an emergency. He did not wait for morning. He did not leave Rosa alone with the baby. He rang her mother to come over at once and then called the emergency number.

Rosa was taken to hospital, where the psychiatric team looked after her with care and the baby was kept safe with family. It was an illness, they were told, not a character flaw, and it responds to treatment. Miguel was exhausted but certain he had done the right thing. In the weeks after, Rosa recovered in steps, with her family close and plenty of follow-up.

How to recognise it

• Sudden change within days or weeks of birth: very little sleep without feeling tired, racing speech, restlessness.
• Hearing voices or having beliefs that are clearly out of touch with reality.
• Fear or suspicion about the baby, or a wish to harm the baby or self.
• Confusion, wildly changing mood, or strange behaviour not typical of her.
• The mother may not realise she is unwell.

What this story explains

This story shows the chapter's emergency rule: voices, thoughts of harming the baby or self, or a break with reality after birth need a psychiatrist the same day, not reassurance that it will pass.

Probable root causes

• Rapid hormonal change after birth.
• Severe sleep loss.
• Personal or family history of bipolar illness or earlier psychosis.
• Physical stress of delivery or illness.
• Little support or a stressful home situation, adding pressure.

What to do

1. Treat it as an emergency at once and do not wait for morning.
2. Never leave the mother alone with the baby, and keep both safe.
3. Call the local emergency number or take her to the nearest hospital.
4. Bring any medicines and the maternity notes if available.
5. Stay calm and speak simply; do not argue with what she believes.
6. Arrange family support for the baby and for the partner.

Whom to consult

• Emergency service or nearest hospital immediately.
• Psychiatrist, same day, for assessment and treatment planning.
• Obstetrician or midwife to be told what is happening.
• Family doctor and counsellor later for follow-up and recovery support.

Do and don’t

How to behave and communicate

• Use a quiet, slow voice: 'I am here. You are safe. We are getting help.'
• Do not argue; say 'I can see you are frightened.'
• Keep sentences short and simple.
• Avoid shouting or crowding her with many people.
• Afterwards: 'This was an illness. It was not your fault.'

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.