Very few people come to me for help with their mental health during pregnancy. Despite the fact, I am a pregnancy specialist, run a busy perinatal mental health service, research pregnancy and basically talk about it all the time. For years I thought this was because I was not doing a good enough marketing job. Maybe all the pregnant clients were going to another Clinical Psychologist with a better website or directory site profile? But as I have become more experienced (and more confident in my website) I have realised that my marketing is not the issue. People do not come forward for help during pregnancy because they feel shame about needing help with their mental health at a time that should be “joyful”.
In fact, this mirrors my own experience. When I was struck down with Hyperemesis Gravidarum in my first, much longed for, pregnancy I didn’t even contemplate looking for help. Partially this was because the depths of despair swallowed me up pretty quickly once I lost the ability to drink water. It is very hard to think of a plan when all you can think about is where to be sick next! But I also remember an odd but very powerful sense of guilt about how sad I felt. Part of me thought it was ungrateful to be depressed when I knew how lucky I was to be pregnant with a healthy baby.
When I look back I wish I had been able to view my situation with more compassion. Knowing what I do now it seems obvious that my mental health would be vulnerable during pregnancy, even without the emotional and physical onslaught that is HG. Like a sturdy wall, mental well-being is built upon interconnected blocks, each supporting the others. When these blocks are absent or weakened we are likely to struggle with our mental health and pregnancy can be a very wobbly time for the wall indeed.
PERMA™: The Building Blocks of Mental Health
Seligman's (2011) PERMA™ model offers a clear picture of the essential building blocks of mental well-being. Here is a quick recap of the foundations he defines as vital for good mental well-being (you can read more about this in my previous blog):
Positive Emotions: The experience of joy, love, comfort, and happiness. Knowing how to access these states is crucial, especially during challenging times.
Engagement: The ability to immerse yourself fully in activities, finding "flow" and a sense of achievement even amidst the demands of pregnancy and parenting.
Relationships: The deep connections with loved ones that provide understanding, support, and a sense of belonging.
Meaning: The belief that your actions and choices matter, whether it's in your family, community, or a larger purpose.
Achievement: The sense of progress and accomplishment that fuels motivation and a sense of self-worth.
The Paradox of Pregnancy and Parenthood
When we celebrate an impending birth, we often focus on the PERMA™ elements we expect to flourish. Laughter, love, bonding, and a newfound sense of purpose seem inevitable. However, experienced parents know that reality can be more complex.Pregnancy and parenthood can challenge every aspect of PERMA™:
Positive Emotions: Hormonal fluctuations, physical discomfort, and sleep deprivation can dampen joy. Socializing and self-care may become elusive.
Engagement: Exhaustion, sickness, and the constant demands of a newborn can make it hard to find time for flow and meaningful activities.
Relationships: Sleep deprivation, changing family dynamics, and financial stress can strain even the strongest bonds.
Meaning: Work and valued roles may be disrupted, and the intangible nature of early parenting can obscure a sense of purpose.
Achievement: The lack of immediate feedback and societal pressures can leave new parents feeling unaccomplished and devalued.
Therapy in Pregnancy and Parenthood: Rebuilding mental health
People often wait for a magical moment when they will “bounce back” after birth or “feel like me again.” This is understandable as there is so much pressure to resume the life, career and identity that you held before you became a parent. However, the reality is most of us need to reconstruct ourselves as our families grow. Every aspect of PERMA is challenged when a baby arrives and we need to adopt new roles, identities and behaviours in order to find that sense of contentment again. Therapy offers a safe and supportive space to begin this reconstructive journey and can be particularly helpful if you are feeling anxious, depressed or traumatised during pregnancy or parenthood.
These are some common aims of therapy in pregnancy and early parenthood:
Identify and address unmet needs.
Develop coping mechanisms for emotional and physical challenges.
Strengthen communication and relationships.
Reclaim a sense of meaning and purpose.
Set achievable goals and celebrate progress.
Explore underlying traumas or anxieties with tools like EMDR therapy.
Cognitive Behavioural Therapies
There are lots of therapeutic approaches that can help with perinatal mental health. I think it is important that therapy addresses every aspect of PERMA, including those that are outside your control such as physical health, biology and unhelpful beliefs about pregnancy, parenting and the role of women in our society. For this reason, I typically use Compassion Focussed Therapy (CFT) and Acceptance and Commitment Therapy (ACT) with my clients.
CFT and ACT are both types of Cognitive Behavioural Therapy that focus on understanding why you are struggling, developing an empowered relationship with your mind and body and taking action to improve your situation. Therapy often involves learning new skills such as mindfulness, boundary setting and self-advocay and making lifestyle changes that support your mental health.
In some cases however, there is something deeper making it hard to restore PERMA. Maybe pregnancy or birth activated memories of bad past experiences or you’ve been through something during pregnancy or birth that changed how you view the world. This is when I am most likely to recommend EMDR.
EMDR Therapy: Unlocking Healing and Resilience
Eye Movement Desensitization and Reprocessing (EMDR) is a powerful therapeutic approach that can be particularly helpful for perinatal mental health challenges. By targeting distressing memories and negative beliefs, EMDR helps reprocess them in a healthier way. This can lead to reduced anxiety, improved self-esteem, and a greater sense of control.
When I first trained in EMDR therapy we were warned not to use it with pregnant clients. This is because, for ethical reasons, we have not been able to test the safety of EMDR in pregnancy and there were concerns that the process of therapy may cause the mother and baby undue stress. However, this conclusion failed to consider the stress that is caused (to mother and baby) by untreated trauma symptoms. For example, if you are pregnant with your second child but had a traumatic birth the first time you may find yourself struggling to attend your antenatal appointments, or feeling incredibly stressed and anxious if you do. EMDR can quickly and effectively reduce the intensity of anxiety so that you can access the best care for you and your baby and you are not regularly experiencing high levels of stress. For this reason, if you are experiencing high levels of stress or anxiety already, or you are struggling to do important things because of your anxiety or PTSD I am very happy that we have EMDR in our toolkit to help you.
Let's explore how EMDR works its magic:
Identifying the Target:
The therapist helps you identify specific distressing memories or negative beliefs that contribute to your current emotional difficulties. These targets can include past traumas, experiences that relate to childbirth, or memories related to parenting. It is not always obvious at the beginning what will come up during EMDR so don’t worry if you don’t already know what will be your “target”, that is something a skilled therapist can help you to work out.
Bilateral Stimulation:
While focusing on the target memory or belief, you engage in bilateral stimulation, which involves following the therapist's finger or other visual cues with your eyes, or experiencing alternating taps or tones in each ear.
This bilateral stimulation is believed to facilitate the processing of distressing memories and emotions, allowing your brain to naturally heal and make sense of yoru experiences. Many people describe this as “updating old memories with new knowledge.”
Desensitization and Reprocessing:
As you engage in bilateral stimulation and focus on the target, the distressing emotions and sensations associated with the memory begin to decrease in intensity.
At the same time most people find themselves thinking more positive thoughts about themselves and taking new learning from the experiences. This promotes a sense of healing an empowerment.
Benefits of EMDR for Perinatal Mental Health:
Reduces anxiety and depression symptoms.
Decreases the intensity of traumatic memories.
Improves self-esteem and confidence.
Promotes emotional regulation and resilience.
Creates a sense of empowerment and control.
EMDR is a powerful tool but it isn’t the right path for everyone. A skilled therapist will help you work out the best way to re-build your wellbeing by spending time understanding the problems you are dealing with now and you will agree your therapy plan together.
Seek support if you are struggling
Remember, you are not alone. If you are struggling with your mental health during pregnancy, seeking help is a sign of strength and self-care. If you are struggling in pregnancy or after teh birth of your child you should tell your GP, midwife or health visitor as they can refer you to an NHS perinatal mental health service.
If you would prefer to access therapy privately you can book a free therapy consultation now to see how our team of specialist psychologists can support you.
Want to support the mental health of parents in your workplace? Book a call with our founder here to talk about the workplace training and support we offer.
Need urgent support?
We do not provide emergency services. If you or someone you care about requires urgent support with their mental health you should contact the NHS urgent support service here.
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