Perinatal mental health support?

[MyCatDrinksFlatWhites]

Has anyone here asked for or received perinatal mental health support during pregnancy? If so, what was on offer for you and did you find it helpful? I have really bad anxiety as well as depression, and previous birth was traumatic (and being pregnant again is stirring that up) so am feeling like I need some support but also questioning what that support might look like and what they can actually offer/do? Happy to chat via PM if you'd rather not post but would be really grateful for any responses as feeling a bit overwhelmed.

Hey, I’m also experiencing anxiety. I’m 19 weeks pregnant, I’m having counselling for it. I don’t think the hormones help either.
Im having counselling privately but I’m sure they can refer you for CBT on NHS- I’m not sure what the waiting times would be. Also they may discuss medication options with you?!
Anxiety is horrible, you’re not alone 💜

I've seen a nurse and a consultant (I have depression and anxiety plus ptsd) during this pregnancy. I see a psychiatrist privately so I don't have much involvement with them as they're happy for my psych to take the lead but there is definitely a lot of support available if needed both in terms of medication and talking therapy. I've also had a planning session with the perinatal psych, my midwife and my HV to discuss the birth and aftercare. Sorry to not be more help at all but from what I've seen they are very proactive at getting involved and there are lots of options for help out there. I'm sorry you're suffering, wishing you all the best

Thank you - that's good to know. I don't want medication as I've had Sertraline before and it didn't work for me at all, and I think that is the one they're most likely to prescribe in pregnancy.

None of this is new for me and it wasn't being managed before I got pregnant but because a lot of my issues flared up after a bad birth, this pregnancy has set them off again.

I feel like I need support when pregnant and around the birth, as that is where my anxieties are focused and I'm having lots of nightmares and intrusive thoughts again. Also have a lot of problems with nausea which is starting to really get me down now. And because I'm not sleeping well, I'm just exhausted (not my first DC so can't rest as much as I'd like either).

Have 16 week appointment this week and hoping to explore options.

I spoke deeply about my poor mental health during my booking in appointment (basically sobbed the entire appointment). Wasn't referred to PNMH until mid second trimester... Didn't see the anyone until 26 weeks. I'm 33 weeks and only had one session with a PNMH midwife, and they think that being referred to my county's well-being service is enough for me (which i don't agree with).
Even though every midwife appointment I've had I've broken down in tears, been to MDAU multiple times and broken down, admitted to being suicidal but not willing to take action because of my daughter, telling them that the medication I'm on isn't working and i feel i need some sort of addition therapy as well as a medication change (I am working with my GP to find one that works), etc.
I know they're a fantastic service and am very grateful for them (i guess mainly in theory), but I can't help but feel let down by the care I've received as i believe i need more support as a soon to be single parent with previous (and current) mental health issues.
And that being said, i am quite simply terrified for after the birth and trying to avoid PPD essentially on my own (if what I've experienced so far is anything to go on). It's been atrocious trying to handle my antenatal depression, and i imagine it's going to be worse once I'm sleep deprived and in the fourth trimester.

I hope you have a better experience than I've had.

Hi. Sorry to hear you’re struggling - I am too. I have to say the support I have received has been woeful, huge waits for Talking Therapies (haven’t spoken to anyone yet), lots of gps and midwives saying how seriously they take the mental health of the mother but not actually doing anything...I know, overstretched NHS etc.

If you’ve got the money I’d go privately. Sorry not much help! X

Oh dear. I was really hoping someone would have positive stories and I'm sorry that's not the case for either of you! You are basically echoing my concerns that unless you pay privately, there is no actual support available and definitely not in a timely manner. I get it, I get the NHS is massively stretched and has no money, but I do wish that midwives/GPs/healthcare professionals wouldn't keep promoting "support" options that, in reality, are not necessarily available.

I have seen a counsellor through my employer but essentially my issues are too complex for her, and she is happy to try to help re anxiety in general but thinks I need more specialist support in relation to the birth. The question is where to find it....

Update: midwife has now referred me to perinatal mental health team. I will let you know what kind of support is available in case it's useful to anyone else. Apparently, unlike the wellbeing team, this means I will be assessed in person...

@MyCatDrinksFlatWhites

Good luck, i really hope they're helpful and supportive for you. It's heartbreaking for me, because like you, my community midwife always speaks about how important maternal mental health is, but i don't feel supported at all in the slightest. I wish i had the funds to go private.
If you don't mind me asking, what county are you in? I'm in Suffolk and an wondering if it really does differ that much based on counties....

Sadly the availability of treatment on the NHS really varies depending on where you live. In my area pregnant women are given priority access to mental health treatment (counselling/CBT etc) on the NHS. There is also a specialist mental health midwife who is lovely and extremely supportive, she was a great help in my current pregnancy. Have you spoken to your midwife or GP to see what might be available near you?

I had very similar issues to you (PTSD and anxiety related to a traumatic birth), but had extensive treatment, privately, before I got pregnant again to try and deal with it. I had counselling and the 'three step rewind technique' which made a huge difference for me. I have still struggled in this pregnancy, but have found support from my midwife and others has helped me through it.

You may find some helpful resources here www.makebirthbetter.org/

Thank you, that's helpful - will take a look at the link. It's a bit frustrating because the midwife (who is lovely) keeps muttering about support but, when pushed, doesn't seem able to elaborate on what form this might take beyond medication, which I'm not willing to take.

I had counselling around three years ago, which helped massively with the actual "symptoms". But of course, being pregnant again has caused it all to flare up. Clearly, there are other factors which contributed to the PTSD but I'd rather not go into those here.

I am willing to pay to get the right help but am finding it difficult to identify someone with the right skill set. Having seen a couple of other counsellors in recent years who turned out to be fairly ineffective (and in both cases, exacerbated things), I am very hesitant about starting more therapy with anyone unless I feel confident they have the skills to help me.

Frustratingly, I haven't found anyone local to me who focuses on birth trauma or trauma specifically, although I have found one who focuses on birth-related issues who may be worth a try. I suspect what I need is some combination of trauma-focused CBT, EMDR and more traditional person-centred/compassion-focused therapy. Nice and easy, then.

I did try looking at London-based trauma therapists that I found through the Birth Trauma Association, but the promising one I found charges £200 for an assessment and £140 per session, which we just can't afford.

If I’m honest, I found them useless. They just wanted to dole out drugs or send me to somewhere else for counselling or CBT so I was no longer under them.

I’d expect them to be equally useless about birth trauma. My baby died shortly after birth and they were quite surprised it upset me.

In my area, we have multiple teams focused on different things. Theres a specialist perinatal team but thats more for things like bipolar etc, and most mums end up with the regular mental health team or the primary counselling service.

Certainly in my area theres a massive promotion of stability for pregnant ladies, thus for its not deemed as the right time for potentially destablising therapy work so its usually more practical advice etc thats offered.

@AllFourOfThem, that's terrible - I'm so sorry for your loss.

@Fallofrain, thank you - that's kind of what I would expect. I'm just keen not to end up in a worse or similar place after this birth than last time.

I'd also welcome any practical suggestions for things that might help - I'm keen to do a hospital tour so I know what to expect on the day/when I go in, but would welcome any other suggestions for finding it all a bit less scary!

Thank you.

From a practical suggestion point of view, have you had a debrief about what happened last time? Your hospital might also have a mental health midwife team or obstetrician. I’m not sure if you are under a consultant but it’s perfectly reasonable to ask to be referred to one to support you with your concerns. Do you want a vaginal birth or do you think an elective section might be better for you?

I totally know where you are coming from. I had CBT shortly after my birth trauma which was horrendously retraumatizing, and really set back by recovery. You are aboslutely right to find someone with particular expertise in this area.

I initially paid for private counselling with a birth trauma expert via skype. She charges £65 per session. I would recommend her very highly lorifitzgerald.co.uk/support/natal-fertility-birth-counselling/

I also cannot emphasis who transformational i found the 3 step technique. I was hugely skeptical as it sounded too good to be true, but i felt a massive shift in my trauma after just one session and only needed 3 sessions in total. www.traumaticbirthrecovery.com/what-is-the-3-step-treatment/

I've just been referred to a step 3 service, currently waiting to hear back. Apparently they aim to see people within 3 months. Compared to many services I know that is
quick, but it doesn't feel like it right now.

I've found staff to be fairly useless so far. At the booking-in appointment the midwife wrote things in my notes which are categorically untrue, didn't ask questions which she marked that she had, didn't give me information which she said that she had.

Everyone I've spoken to in the health service since I became pregnant has, at some point, put their head on one side, asked me "And is this your first baby?" and then proceeded to treat me like a fucking idiot. (Shout out to one doctor who asked if I'd considered trying Gaviscon, and another who told me that I didn't have thrush, and the midwife who told me that I should go to a 'Requires Improvement' maternity unit to give birth, not the 'Outstanding' one that is slightly closer).

Talking Therapies services (step 2) local to me prioritise pregnant women, so you can expect to be seen within a week or so. However, they don't have any specialisation/specific training for working with pregnant women, and I feel that my current difficulties are 99% pregnancy related. I don't want to have a script read out loud to me by a 21 year old psychology graduate. Also, I work in a service rather similar to Talking Therapies and have already tried all the strategies I am aware of, so was able to tell the GP that I thought I probably needed something different. I was a bit that she tried to persuade me to take meds with zero discussion of what difference that might make during pregnancy and breastfeeding. She also didn't do any kind of risk assessment.

Peri-natal Mental Health Team (step 3/4) in my area accept referrals re: women with bpd, bi-polar, schizophrenia, drug/alcohol issues, social care involvement, ptsd, which (so far) I don't meet.

Anyway, I've been referred now to this obstetric/gynae psychology service (step 3) that is run by a clin psychologist, so hoping to hear from them fairly soon, and hoping they will be a bit more knowledgeable, and slightly less patronising.

Sorry you're having a tough time.
I'm with the perinatal midwife team and they've been great for me. I've asked for as minimal contact as possible so they've agreed that I contact them when I feel I need them.

They can get you therapy, review medications, are there whenever you need to talk and set up a care plan for pregnancy and post birth so that you get as much support as possible.

@peamad, thanks for those links - will take a look.

@Tableclothing, this is my concern exactly. Midwife originally wanted to refer me to the Wellbeing service until she heard I was having nightmares, at which point she announced that the Wellbeing service was "a bit naff" and they would just phone me once a month to see how I was doing. No offence, but I have friends who do that - seemed a bit pointless if you're not going to take it further.

I'm not willing to take medication as a) I didn't get on with Sertraline at all and it didn't help, b) I'm naturally concerned about side-effects to the baby, c) I'm not keen on the medication merry-go-round of trying it, upping the dose, managing side effects, working out at what point to call it quits if not improving, etc, and d) I see no point in taking medication without therapy in tandem.

And to the poster above, I will probably end up going down the ELCS route, partly as I'm very concerned for my MH if I try to psych myself up for a vaginal birth and then either don't go into labour (like last time) or don't progress and end up with an EMCS - I think it would really add to my feelings of failure (which I know are unjustified but it is what it is). If I go into labour naturally before my section date, there may be a conversation to be had.

I'm 19 weeks and been referred to perinatal. I suffer depression, BPD and anxiety and PTSD, the latter two which were brought on by a traumatic birth experience with my son nearly 17 years ago! I'm finding my anxiety is worsening as I'm terrified about the birth after last time and how poorly I was for a long time afterwards, I'm worried I'm going to have the same problems this time, or worse.
I'm also reluctant to go onto any medication until the baby is born. I was on an antidepressant for 26 years and stopped it when I found out I was pregnant. My midwife has been very supportive and arranged an appointment with a consultant but she just wanted to put me on medication, she said Sertraline is the main one they prescribe to pregnant women.
Waiting to hear back from perinatal and a mental health midwife. I have lots of health anxiety as well that stem from the traumatic birth of my son x

An update for anyone who might have similar questions to me: the perinatal team in our area are limited in what they can offer. They seem more at ease with post-birth issues than ante-natal issues.

They want to refer me down to the wellbeing team for EMDR or anxiety-focused CBT but there is a waiting list and no idea when I'd be seen. They also may refer me to a perinatal psychiatrist to discuss medication (which I am reluctant to discuss as I'm not willing to take it - I can't see it will make me feel less fearful about birth). Due to an administrative quirk as my hospital is out of area, they can't engage with the hospital in relation to pre-birth stuff or feelings around birth. And there has been no mention of mental health midwives or similar.

So I'm now 22 weeks pregnant and would be pleasantly surprised to be offered any help this side of the birth, to be honest. Looking into private options - although it's taken about eight weeks to find a private therapist with the right skill set and availability who I may be able to see for an assessment at some stage this month.

I’ve been given an appointment with a perinatal psychiatrist even though I really don’t need it. They’re basing this on a severe reaction that I had to the Mirena coil which was resolved over a year ago with no problems since. It caused me to slip in and out of psychosis for the year that I had it fitted.
At my booking appointment the midwife said she would note it down but also send an email to say everything’s fine and I don’t need any support. Clearly they don’t believe me
When the receptionist called to get me booked in she insisted that the psychiatrist himself wants to see me