Mental health problems during pregnancy and after birth
In brief
Postnatal depression and other perinatal mental health problems (during pregnancy and in the year after birth) are common, and they can be treated. The baby blues are short-lived and last a few days; sadness or anxiety that lasts more than two weeks may be depression and needs a consultation. Postpartum psychosis is rare and is an emergency. In France, suicide is the leading cause of maternal death in the year after birth: if you have dark thoughts, call the national suicide prevention line 3114 in France.
Why does mental health matter during pregnancy?
Pregnancy and the arrival of a baby turn your body, sleep, relationship and sense of identity upside down. These changes can reveal or worsen an underlying mental health vulnerability. According to a review published in The Lancet, mental health problems are among the most common complications of pregnancy and the postnatal period, with possible consequences for the mother, the child and the family.
In France, the 2016-2018 National Confidential Enquiry into Maternal Deaths shows that suicide and other psychiatric causes are the leading cause of maternal death up to one year after birth (17% of these deaths). Identifying and treating these problems is therefore part of pregnancy care, just like blood pressure checks or scans, up to giving birth in Paris and beyond.
In France, the early antenatal interview, offered to all pregnant women, and the early postnatal interview, held between the 4th and 8th week after birth, are ideal opportunities to talk about it.
What increases the risk of mental health problems in pregnancy?
- a personal history of depression, anxiety disorder, bipolar disorder or psychosis;
- a depressive episode during a previous pregnancy or postnatal period;
- a family history of mental illness, particularly bipolar disorder or postpartum psychosis;
- suddenly stopping psychiatric medication on learning of the pregnancy;
- a difficult obstetric history: miscarriage, pregnancy loss, premature birth, traumatic delivery;
- isolation, financial hardship, relationship conflict, recent bereavement;
- domestic violence, current or past.
If you take psychiatric medication, do not stop it on your own when you find out you are pregnant. Several medicines can be continued; the decision is made with your psychiatrist and your obstetrician, weighing the risks of the illness against those of the treatment. Our article on medicines during pregnancy explains these principles.
How can you tell baby blues from postnatal depression or postpartum psychosis?
The table below summarises the main situations. It helps you find your bearings, but only a professional can make a diagnosis.
| Situation | When? | Main signs | What to do? |
|---|---|---|---|
| Baby blues | Between day 3 and day 10, lasts a few days | Tearfulness, oversensitivity, irritability, feeling overwhelmed | Rest, support from those around you; see a professional if it lasts more than two weeks |
| Antenatal depression | During pregnancy | Sadness, loss of interest, fatigue, guilt, sleep problems not explained by pregnancy | See a professional: psychological support, sometimes treatment |
| Postnatal depression | In the weeks or months after birth, up to one year | Persistent sadness, loss of pleasure, feeling like a bad mother, severe anxiety, dark thoughts | Seek help promptly; talking therapy, medication if needed, sometimes mother-and-baby admission |
| Postpartum psychosis | Suddenly, usually in the first few weeks | Confusion, total sleeplessness, agitation or elation, delusional ideas about the baby, unusual behaviour | Emergency: in France, call 15 or go to psychiatric emergency services |
Anxiety disorders (panic attacks, overwhelming worry, intrusive thoughts of harming the baby that the mother finds horrifying and does not act on) and post-traumatic stress after a difficult birth are also common. They deserve proper care.
Postpartum psychosis in practice
It is rare: a first episode occurs in about 0.25 to 0.6 per 1,000 births. It often starts suddenly, sometimes within hours, in a woman who seemed well. The risk is higher with personal bipolar disorder or a family history of postpartum psychosis. A medical cause (infection, thyroid disorder, neurological problem) is always looked for. Treatment involves hospital admission, ideally in a mother-and-baby unit, and appropriate medication. The episode usually resolves, but follow-up is needed: after an isolated postpartum psychosis, the risk of recurrence in a later pregnancy is about one in three, and prevention can be planned.
What are the signs of depression during or after pregnancy?
Talk promptly to your gynaecologist, your midwife, your GP or your baby's paediatrician if, for more than two weeks:
- you feel sad, empty or hopeless most of the time;
- you no longer enjoy anything, including time with your baby;
- you feel unable to look after your baby, or constantly guilty;
- you have repeated panic attacks or overwhelming anxiety;
- you cannot sleep, even when the baby is asleep;
- you avoid your baby or, on the contrary, cannot take your eyes off them for fear something bad will happen.
Your partner and those close to you play a key role: they are often the first to notice a change. They can also contact a professional themselves.
What treatment and support are available?
- Listening and support: appointments with a midwife, psychologist or psychiatrist, the early postnatal interview, and in France home visits from the PMI (maternal and child health service).
- Talking therapy: cognitive behavioural therapy and interpersonal therapy have proven effective for perinatal depression.
- Medication: some antidepressants and other treatments are compatible with pregnancy and breastfeeding. The choice is individual and made in consultation.
- Mother-and-baby units: these allow the mother to be admitted with her baby, full time or as a day patient, to receive care without separation.
- Perinatal psychiatry: for women with bipolar disorder or a history of postpartum psychosis, a prevention plan is drawn up during pregnancy with the psychiatrist and the maternity unit.
If needed, the practice refers you to a perinatal psychiatry team or another suitable professional.
When is it a mental health emergency after birth?
In France, call 15 (SAMU) or 112, or your local emergency number, or go to the maternity or psychiatric emergency department, if you or someone close to you notices:
- thoughts of suicide, wanting to disappear or to end your life;
- thoughts of harming the baby together with an urge to act on them;
- confusion, incoherent speech, the conviction that the baby is not yours or has been swapped;
- agitation, unusual elation, several nights without any sleep;
- hallucinations (seeing or hearing things others do not).
In France, the national suicide prevention line 3114 is free and available 24 hours a day, 7 days a week, for you and for those close to you. During pregnancy, associated physical symptoms (bleeding, pain, reduced baby movements) also mean you should go to the maternity emergency department.
How can I look after my mental health day to day?
- Protect your sleep: share night feeds, nap when the baby sleeps.
- Accept practical help from those around you with meals, housework or older children.
- Break the isolation: parent groups, support associations, the PMI.
- Limit alcohol and avoid other substances, which worsen anxiety and depression.
- Do not aim for perfection: it is normal not to feel an overwhelming bond with your baby straight away.
Postnatal check-ups, covered in our article on breastfeeding, are also an opportunity to talk about how you are feeling.
Frequently asked questions
Are the baby blues the same as depression?
No. The baby blues are common, short-lived and go away within a few days without treatment. If symptoms last more than two weeks or get worse, see a professional to check for postnatal depression.
Can fathers get depression after a birth too?
Yes. Fathers and co-parents can develop depression in the year after birth. The same signs should prompt them to see their doctor.
Can I breastfeed while taking an antidepressant?
Often yes: several antidepressants are compatible with breastfeeding. The choice of treatment takes your wish to breastfeed into account and is made with your doctor.
Do frightening thoughts of harming my baby mean I am dangerous?
These intrusive thoughts are common, especially with anxiety, and mothers find them horrifying. They do not mean you will act on them, but telling a professional can bring relief.
References
- Howard LM, et al. Non-psychotic mental disorders in the perinatal period. Lancet, 2014. doi:10.1016/S0140-6736(14)61276-9 — PMID 25455248
- Bergink V, et al. Postpartum Psychosis: Madness, Mania, and Melancholia in Motherhood. Am J Psychiatry, 2016. doi:10.1176/appi.ajp.2016.16040454 — PMID 27609245
- Saucedo M, et al. [Maternal mortality in France, 2016-2018, frequency, causes and women's profile]. Gynecol Obstet Fertil Senol, 2024. doi:10.1016/j.gofs.2024.02.020 — PMID 38373492
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
A question about your situation?Appointments at the practice or by video consultation, usually within one week to 10 days.
Book an appointmentGeneral information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.