PLANNING A PREGNANCY
Advice for women with mental health
About this leaflet
This leaflet is for:
- women who have a mental health problem and
want to have a baby
- women who have had a mental health problem in
the past and want to have a baby
- women planning a first pregnancy and those
who have children and want to get pregnant again
- partners and family members who want to find
out more about how pregnancy can affect, or be affected by, mental
The leaflet describes:
- what you can do to have a healthy pregnancy
- how pregnancy can affect your mental health
- support and advice available for women with mental health
problems who are planning a pregnancy
- how to get advice about medication in pregnancy and
Why does it help to plan a pregnancy?
Deciding to have a baby is one of the most
important choices a woman will make. For women with mental health
problems there are many issues to consider. You need to have good
information, advice and support.
It may be hard to know when it's the
best time for you to have a baby. You can talk to your GP or
psychiatrist even if you are just thinking about having a baby in
the future. They may be able to give you the information you need
to make decisions about your care. If not, they may be able to
refer you to a perinatal psychiatrist.
It is best for your baby if you can improve
your health before you get pregnant.
Planning a pregnancy will give you time
- find out about how pregnancy may affect
your mental health
- get information about medication in
- decide whether you want to change your
treatment before you try to get pregnant
- decide which maternity unit you want to go
- find out about mental health services for
pregnant women in your area
- consider what support you will need,
especially after birth (e.g. you may need help with night
- make sure you get help for any physical
- get help to stop smoking, drinking or
using illegal drugs before you get pregnant
- make sure you are as well as possible
before you get pregnant.
Hopefully this will help you enjoy your
Who can I talk to for advice when I am planning a
All women can ask their GP for information and
advice when they are planning a pregnancy. If you are under the
care of a mental health service you should talk to a
In some areas there are perinatal mental
health services. These are specialist services for pregnant women
and women with a baby up to one year old. Ask your GP or
psychiatrist if they can refer you to a perinatal mental health
service for advice when you are planning a pregnancy. This is
particularly important if you have had Bipolar Disorder, Schizophrenia, Postpartum Psychosis or any other
psychotic illness. It may also be helpful if you have had other
severe mental health problems (e.g. Depression or Obsessive Compulsive Disorder).
You may also find it helpful to talk to other
women who have had mental health problems and who now have
children. The organisations listed at the end of this leaflet offer
advice and support.
How can I make sure that I have a healthy
You need to think about your physical health
as well as your mental health.
You will have a more healthy pregnancy if
- Stop smoking
- Cut down or stop drinking alcohol
- Stop using cannabis and other illegal drugs
- Lose weight if you are overweight – healthy eating and exercise
- Increase your weight if you are underweight
- Take folic acid (400mcg daily) for 3 months before you get
pregnant and for the first 12 weeks of pregnancy – this can reduce
the chance of your baby having a birth defect called spina
- Take a higher dose of folic acid (5mg daily) if you are on some
medications e.g. Valproate (Depakote) or Carbamazepine
- Have a check-up with your dentist – gum disease is associated
with premature birth
- Have a “well-woman” check-up e.g. a smear test and
screening for sexually transmitted diseases
- Get advice about any physical health problems e.g. diabetes or
- Make sure your vaccinations are up to date e.g. Rubella (German
Measles) - a virus which can be dangerous for your baby in early
- Get advice about how to eat healthily and foods you should
Your GP or psychiatrist can tell you where you
can get help and advice in your area. For example, you may want to
go to a smoking cessation service to help you stop smoking. If you
have a physical health problem, e.g. diabetes, your GP may need to
refer you for specialist advice.
Should I stop my medication?
Many women worry about taking medication in
pregnancy. You need to think carefully about what the risks and
benefits of medication are for you and your baby. For many
women it may be safer to take medication in pregnancy than to stop.
This is more likely if you have had a more severe illness. Deciding
whether or not to continue or change your medication is not
If you want to get pregnant you should discuss
your medication with your psychiatrist or GP. They can give
you up to date information about medications in pregnancy. They can
help you to decide what is best for you and your baby. Don’t stop
your medication or reduce the dose suddenly. You are more likely to
relapse if you do this without advice.
Always check whether herbal or over the
counter medicines are safe to use in pregnancy.
It is best to use contraception until you have
seen your doctor to discuss your medication. Unplanned pregnancies
are common. If you find you are pregnant you should see your doctor
as soon as possible.
In order to decide about using medication in pregnancy, you will
need to think about:
- How unwell you have been in the past
- How quickly you become unwell when you stop
- Medications you have taken:
- which treatments have helped you most?
- have some medicines caused side-effect?
- Up-to-date information about the safety of certain medications
- What might happen if you are unwell during pregnancy. This
- you may not take good care of yourself.
- you might not attend appointments with your midwife. This means
you may not get the care you need.
- people who use drugs and alcohol may use more when unwell. This
can be harmful for your unborn baby.
- you may need a higher dose of medication if you become ill.
Sometimes you may need two or more medications to treat a relapse.
This might be more risky for your unborn baby than if you take a
standard dose of medication throughout pregnancy.
- you may need in-patient treatment.
- you may still be unwell when your baby is
born. You may then find it more difficult to care for your baby. It
may also affect your relationship with your baby.
- if your illness is not treated, this may be
more harmful for your baby than using medication. Untreated mental
illness may cause a number of problems. For example, some research
studies have found babies are more likely to have low birth weight
if their mother has depression in pregnancy. Untreated mental
illness can also affect a baby’s development later on.
- Unfortunately 2-3 in every 100 babies
are born with an abnormality, even when the mother has not taken
Your doctor should support you whether you
decide to continue, stop or change your medication.
Will I be able to breastfeed if I am on
Breastfeeding has many health benefits for
mother and baby. Women can breastfeed whilst taking many types of
psychiatric medication. You need to talk to your doctor about the
medication you are taking. If your baby is unwell or premature the
advice may change. You can talk to the doctor looking after your
baby about this.
Fully breastfeeding a baby can be very
tiring. Some women find it easier to combine breast and bottle
feeding. If a partner, friend or family member can do some of the
feeds you will be able to get more rest.
Sometimes women feel guilty if they can’t
breastfeed. If you are unable to breastfeed you should not worry.
It is more important for your baby that you are well. You will
still develop a close bond with your baby if you bottle feed.
How may my mental health be affected by
For some women pregnancy may be difficult.
Others enjoy pregnancy. Many factors can affect how you feel in
pregnancy. These include physical symptoms (e.g. morning sickness),
the support you have, and stressful events in your life.
Pregnancy does not protect you from having
mental health problems. Most mental health problems are just as
common in pregnancy as at other times.
For some mental illnesses (e.g. Bipolar
Affective Disorder or previous Postpartum Psychosis) there is
a particularly high risk of becoming unwell after having a baby.
This can happen even if you have been well for many years.
If you plan to get pregnant it is important
to tell your GP if you have ever had a mental illness. Your GP or
psychiatrist can give you advice about your risk of becoming unwell
in pregnancy or after birth. They can tell you what support is
available and what will help to keep you well.
For more information see our leaflets on
Postnatal Depression and Postpartum Psychosis.
What support and help will be available for me in
All pregnant women have care from a midwife
during pregnancy. When you first see your midwife she will ask
about your mental and physical health. You should let your midwife
know if you have ever had a mental health problem. She can tell you
about the support available where you live.
In some areas there are perinatal mental
health services. These are specialist mental health services for
pregnant women and women with a baby under one year old. They will
work with you, your family, your midwife and health visitor and any
other professionals involved.
After birth all women see a health visitor
to get advice about caring for their baby. Children’s Centres have
postnatal groups where you can get help, advice and support and
meet other new mums in your area.
What if I can’t get pregnant?
It usually takes several months to get pregnant. About 85% (85
in every 100) women will get pregnant in a year if they do not use
contraception and have sex regularly. Half of the rest will get
pregnant in the second year.
Some antipsychotic medications can make it more difficult to get
pregnant. This is because they affect a hormone called prolactin.
If your prolactin levels are too high you may not be able to get
pregnant. If you are finding it difficult to get pregnant your GP
can check your prolactin levels. If your medication means you have
raised prolactin you may need to change to another drug. Don’t stop
medication suddenly without advice. Discuss this with your
Some physical health problems can make it more difficult to get
pregnant. You may find it more difficult to get pregnant if you are
obese or if your weight is very low. Talk to your GP for
What is it like to become a parent?
Having children is often rewarding and
satisfying. Many parents also find it stressful and exhausting at
times. Newborn babies are dependent for all their care on
their parents. You need to make sure you have practical and
emotional support to help you to manage. If you have mental health
problems you may need extra support to make sure your child has the
care she or he needs. For example, if you often have admissions to
hospital, you need to plan for their father, grandparents or
friends to provide consistent and loving care for your child if you
What about Children’s Social Care?
Most women with mental health problems look
after their children very well. Some families struggle to look
after their children. This may mean they put their children at
risk, usually without meaning to.
Some women are worried about seeking support
from Children’s Social Care. Social workers aim to support
parents to provide the best care for their children. They work with
families to identify any difficulties. They can help make
plans with you so all family members are supported and children are
safe if there are problems.
If the professionals caring for you during
pregnancy think it would be helpful for Children’s Social Care to
be involved with your family they will discuss the reasons for this
Where can I get further information?
Association: Tel: 0845 122 8690
Information, advice and support about sexual
health, contraception and pregnancy. Confidential helpline.
Trust: Tel: 0300 330 0700
Support and information on all aspects of
pregnancy, birth and early parenthood. Local groups and telephone
0800 0147 800
Funds research into pregnancy problems and
provides information to parents.
College of Obstetricians and Gynaecologists
Information leaflets about pregnancy and
Information and support for people with
Including an information leaflet about Bipolar
Disorder, pregnancy and childbirth.
Information and support for women with OCD,
including support group and skype support.
Action on Postpartum
Psychosis: Tel: 020 3322
Postpartum Psychosis information, advice,
research and support. On-line forum and peer support network.
Foundation: Tel: 0843 2898401
Pre- and post-natal depression advice and
Association for Postnatal
Illness: Tel: 020 7386
Information about postnatal depression and
support from a network of volunteers who have experienced postnatal
Action: Tel: 020 7254 6251
Support and practical help for families
affected by mental illness, including 'Newpin' services - offering
support to parents of children under-5 whose mental health is
affecting their ability to provide safe parenting.
Start: Tel: 0800 068 6368
Support and practical help for families with
at least one child under-5. Help offered to parents finding it hard
to cope for many reasons. These include mental illness, isolation,
bereavement, illness of parent or child.
Check the facts about alcohol and pregnancy.
- Antenatal and postnatal mental health:
clinical management and service guidance. NICE Clinical Guideline
45 (2007) National Institute for Clinical Excellence: London
- Antenatal Care: Nice Clinical Guideline 62
(2010) National Institute for Clinical Excellence: London
- Management of perinatal mood disorders
(2012). Scottish Intercollegiate Guidelines Network (SIGN)
Edinburgh: SIGN; 2012.
Written by: Alison Puffett, Olivia Protti, Maddalena
Miele-Norton and Lucinda Green on behalf of the London and South
Consultant Perinatal Psychiatrists Association
Service User Involvement: Maternal Mental Health Alliance
This leaflet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series editor: Dr Philip Timms.
© March 2014. Due for review: March 2016. Royal
College of Psychiatrists. This leaflet may be downloaded, printed
out, photocopied and distributed free of charge as long as the
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For a catalogue of public education materials or copies of our
Royal College of Psychiatrists, 21 Prescot
Street, London E1 8BB. Telephone: 020 3701
Charity registration number (England and Wales) 228636
and in Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our
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