Perinatal mental health support

What is perinatal mental health?

Perinatal mental health covers the emotional and psychological wellbeing of a parent during pregnancy and in the year or so after birth. Difficulties in this period can include depression, anxiety, obsessive thoughts, and the effects of a frightening birth experience.

The term covers a range of presentations rather than a single condition. Antenatal depression and anxiety develop during pregnancy. Postnatal depression and anxiety develop after birth, sometimes in the early weeks and sometimes months later. Some parents experience intrusive, unwanted thoughts about their baby being harmed, which is a recognised feature of perinatal obsessive difficulties rather than evidence of any real danger. Others are left struggling with the psychological aftermath of a difficult or traumatic birth, or with the scale of adjustment a new baby brings to daily life, sleep and identity.

We offer online clinical psychology for adults in Bromley and the surrounding towns of south east London, including Beckenham, Chislehurst, Shortlands, Bickley, Hayes and Petts Wood, working by video call rather than in a clinic room.

Signs of perinatal mental health difficulties

Every pregnancy and every recovery from birth looks different, so it helps to know the range of what can show up rather than a single checklist.

During pregnancy

• Persistent low mood, tearfulness or numbness
• Constant worry about the pregnancy, birth or the baby’s health
• Panic symptoms such as a racing heart, breathlessness or a sense of dread
• Difficulty sleeping beyond the usual discomforts of pregnancy
• Withdrawing from friends, family or usual activities

After birth

• Ongoing sadness, guilt or a flat, disconnected feeling towards the baby
• Repeated frightening or intrusive thoughts, often followed by checking or avoidance
• Flashbacks, nightmares or a strong urge to avoid anything that recalls the birth
• Irritability or anger that feels out of proportion or hard to control
• Loss of appetite, or eating and sleeping patterns that go beyond what a newborn’s routine would explain
• Difficulty concentrating or making everyday decisions

Any one of these on its own does not point to a particular diagnosis. What matters is whether the difficulty is persistent, is getting in the way of daily life, or feels different from how you expected to feel.

How therapy can help

Cognitive behavioural therapy, recommended by NICE for depression and anxiety, is often used in perinatal work because it gives structured, practical ways to interrupt cycles of worry, low mood and avoidance. Sessions look at the specific thoughts and behaviours keeping a difficulty going, such as checking rituals linked to intrusive thoughts, or avoidance of situations that recall a traumatic birth, and build alternatives step by step.

Where a difficult birth has left someone with symptoms of post-traumatic stress, trauma-focused approaches including trauma-focused CBT and EMDR, both recommended by NICE for PTSD, can help the mind process what happened so that memories of the birth stop intruding into the present. Therapy can also draw on compassion-focused techniques for the guilt and shame that frequently accompany perinatal difficulties, since many parents judge themselves harshly for feelings they did not choose and cannot simply reason away.

Alongside symptom-focused work, sessions give space to talk plainly about the exhaustion, identity change and loss of independence that come with early parenthood, without those conversations being rushed past in a ten-minute appointment elsewhere.

Our approach

Work begins with time to understand your history, current symptoms and what you want from therapy, before agreeing a plan tailored to your situation rather than a fixed programme applied to everyone. Sessions are collaborative: you set the pace, and the focus shifts if a new difficulty, such as a setback in feeding or a change in sleep, becomes more pressing than the original reason you got in touch.

Because everything happens online, sessions can be arranged around feeding schedules, naps and the unpredictability of life with a baby, without the added strain of travel. This suits parents across Bromley and the wider area who need appointments to fit around a routine that changes week to week. Where it is helpful, a partner can be included in part of a session, though the work always stays centred on what you need. At the moment all our sessions are online by secure video.

What does perinatal therapy involve?

A first session focuses on understanding what has been happening, when it started, and how it is affecting your mood, sleep, relationships and daily functioning. From there, a small number of clear goals are agreed, whether that is reducing panic, processing a traumatic birth, or managing intrusive thoughts that currently feel unmanageable.

Subsequent sessions, usually weekly or fortnightly by video call, use specific techniques matched to the goals: behavioural strategies to rebuild activity and routine where mood has dropped, cognitive work to examine and shift unhelpful thought patterns, grounding and processing techniques for trauma symptoms, and practical planning around sleep, feeding routines and support at home. Progress is reviewed regularly, and the number of sessions is guided by how things are changing rather than a fixed course length decided in advance.

Between sessions, you might be asked to try small, specific tasks, such as noting patterns in low mood or practising a grounding technique when intrusive thoughts appear, so that the work extends beyond the session itself.

When to seek help

There is no threshold of severity you need to reach before contacting a psychologist. If low mood, anxiety, intrusive thoughts or the effects of a difficult birth are shaping your days, whether that started in pregnancy or months after your baby arrived, that is reason enough to seek support.

A smaller number of perinatal presentations need urgent attention rather than a course of talking therapy. Postpartum psychosis is rare but serious, and can include confusion, hallucinations or behaviour that feels completely out of character. If you or someone else is worried about your safety or your baby’s safety, or if symptoms are severe and appearing suddenly, contact your GP, midwife or NHS 111 straight away, or call 999 in an emergency. Talking therapy is appropriate once any immediate safety concern has been addressed, not as a substitute for it.