A First Steps guide to

Emotional health
and pregnancy

First Steps, Version 2, September 2013 -1- Emotional health and pregnancy
Using self-help tools and what to expect from this booklet….

The strategies/tools suggested in this booklet are evidence based methods of managing
emotions and reducing the effects the way that we feel has on our everyday life. We are all
individuals and respond to situations in different ways therefore not every tool will work with
everyone. Pregnancy can be an exciting time but as it involves so many changes it can be
overwhelming. This booklet is designed to offer you advice and strategies on how to keep
yourself emotionally well during pregnancy.

The booklet also offers some tips on how to cope and stay emotionally well in the few weeks
following giving birth. It is important to note that whilst self-help strategies can help with how
you feel overall, whilst you are pregnant and in the few weeks following birth you are likely to
feel hormonal and experience fluctuating moods which is completely normal. This booklet
may help to reduce the impact your moods have on you and your baby but if self-help isn’t
enough and you feel that you need more support, it is important to discuss this with your GP.
In addition there are a number of helpful resources at the back of this booklet or you could
call our phone line/email us for more information/advice.
801 0325 or visit

Here at Virgin Care we are keen that this information is shared as widely as possible to help support
anyone who might benefit from it. However, can we remind you that it is subject to Copyright
Legislation so please do let us know if you plan to reuse or reproduce any of the content

First Steps -2- Emotional health and pregnancy

What is in this booklet?

Pages

What is emotional health? 4

Emotional health and mental health 4

Depression, low mood and pre-partum blues during pregnancy 5

Achieving everyday emotional health 8

Anxiety during pregnancy 9

What to expect during pregnancy 12

Lifestyle during pregnancy 13

Foods to avoid 14

Body image and self-esteem 15

Taking care of yourself during pregnancy and after giving birth 19

Baby blues 24

Postnatal depression (PND) 24

Additional support and information 26

First Steps -3- Emotional health and pregnancy

What is emotional health?

Throughout our lives we all experience a wide range of emotions and moods such as
happiness, stress, anxiety, frustration and sadness. This is a normal, healthy emotional
reaction to events and our thoughts about these events. During pregnancy your hormone
levels will be changing and you may find your moods are different or more extreme than they
were before pregnancy. This is completely normal however it can be useful to try to work out
if your mood changes are linked to your pregnancy hormones or if you could be experiencing
low mood or depression. The terms depression and low mood are often used
interchangeably however depression is a diagnosable mental illness; whereas low mood
describes an emotional state.

For many people feelings of sadness usually pass in a few days or when circumstances
change. However, when these feelings last more than a few days, come back frequently or
start to affect your work, interests and / or feelings towards your family and friends, then it
could be a sign of depression. Mild depression can be improved through the use of some
simple self-help techniques which are described throughout this booklet. It is important to talk
to your GP about the way that you are feeling, especially if you feel that you are depressed
or your mood is not improving through the use of self-help.

Low mood and depression in its mildest form does not stop you from leading your normal life,
but it makes everything seem harder and less worthwhile. In its most severe form depression
can seriously affect your ability to function on a daily basis. Some people find themselves
feeling that life is not worth living or that other people would be better off without you. Whilst
these thoughts can feel very frightening it is important to remember that sadly they are quite
common. However, it is very important that you seek help from your GP or if you feel that you
are in imminent danger, the emergency services. The following services may also be helpful.

NHS Out of Hours Crisis Helpline: 0300 456 83 42. Text phone 07717 989 024
Samaritans: 08457 90 90 90 www.samaritans.org jo@samaritans.org

Emotional health and mental health

Emotional well being has been defined as:

A state of well-being in which the individual realises his or her own abilities,
can work productively and fruitfully, and is able to make a contribution
to his/her community (World Health Organisation)

Emotional distress is related to the way you feel whereas a mental illness is a diagnosable
condition. A person may have a severe mental illness such as schizophrenia, but is living a
fulfilled and happy life, therefore has high emotional health. Likewise a person may have no
diagnosable mental illness, but is feeling stressed and struggling with everyday tasks and
therefore has a low emotional health. Achieving a sense of emotional health can be more
challenging when you are pregnant or have just given birth as both stages involve a lot of
change and hormone levels are increased making your moods more difficult to cope with.

First Steps -4- Emotional health and pregnancy

Mental health continuum

Complete Severe
well-being psychological distress

Having more risk factors can cause us to have more psychological distress

Having more protective factors can improve our mental well-being

Mental health is fluid and we can all move up and down the mental health continuum
throughout our lives. How much we move up and down the continuum can be exaggerated
during times of significant change such as pregnancy.

Depression, low mood and pre-partum blues during pregnancy

What is depression and low mood?

 Depression is a diagnosable mental illness

 Low mood describes an emotional state

Depression is diagnosed by the following:

If you have experienced 1 of the following symptoms, most of the time,

for over 2 weeks

Low mood or sadness Loss of interest or pleasure

And at least 4 of the following symptoms:

 Sleep disturbance - either falling asleep or early morning wakening

 Either a loss or increase in appetite
 Difficulty concentrating
 Slowed functioning (either thinking, talking or acting slower than
usual) or agitation
 Lower sex drive
 Less energy
 Loss of self-confidence or self-esteem
 Thoughts of death or suicide
 Feelings of guilt

First Steps -5- Emotional health and pregnancy

Symptoms of depression

Depression and low mood affects us in four ways:

The way we think

 Difficulty in making decisions  Feeling inadequate
 Difficulties in concentration and  Self criticism
memory  Negative thoughts
 Feeling worthless
 Self doubt

The way we feel emotionally

 Sad  Angry
 Hopeless  Numb
 Irritated  Guilt

The way we feel physically

 Weight gain  Loss of energy/always feeling tired
 Weight loss  Restlessness and agitation
 Sleep disturbances  Tearful
 Aches and pains
 Decreased or increased appetite

The things that we do

 Losing interest and enjoyment in  Frequent crying
activities you previously enjoyed  Irritation/aggression
 Difficulty doing everyday tasks

Pregnancy can be a very emotional time and feelings of depression and low mood can set in
for a variety of reasons. Pre-partum blues or mild depression during pregnancy is generally
related to the huge social and physical changes that are taking place for the expectant
mother. Change is a part of life and can be a good thing however it usually involves loss of
some sort. This can lead to mixed feelings during pregnancy. Mild depression, low mood and
pre-partum blues can be improved through the use of some self-help techniques which are
described throughout this booklet. It is important to talk to your GP and/or midwife about the
way that you are feeling if you feel that you are depressed or that your mood is not improving
through the use of self-help. Getting professional help can make the difference between a
very negative pregnancy experience and a much more balanced, positive one.

First Steps -6- Emotional health and pregnancy

The cycle of low mood

We already know that when a person feels low in their mood they are likely to have
decreased energy, lack of motivation and decreased interest in previously pleasurable
activities. However imagine a time when you were generally feeling happy and healthy. How
would you have felt if you were unable to spend time with friends/family, exercise or spend
time doing your hobbies or interests? For most people, being unable to do the things that
they enjoy, leads them to feeling low and unhappy. Therefore, depression and low mood can
become self-fulfilling. We often feel that we will do what we enjoy when we feel better.
However the reality is we will not feel better until we do the things that we enjoy.

 “I will do what I enjoy when I feel better”

 “I will feel better when I do what I enjoy”

Our thoughts, feelings (physical and emotional) and behaviours also feed in to each other.
The following model is a useful way of looking at the different aspects of your low mood.

Life event

Thoughts

Emotional Physical
symptoms symptoms

Behaviours

First Steps -7- Emotional health and pregnancy

Achieving every day emotional health

Just as achieving physical fitness takes time, practice and commitment, so too does
achieving mental fitness. There are three basic principles in obtaining emotional health: the
first is to maximise the things that make you feel good, and minimise the things that make
you feel bad; second is valuing yourself; and third is to recognise that you can change.

Maximise the things that make you feel good, and minimise (as far as practical) the
things that make you feel bad. This is important both during and after your pregnancy.

Some feel good factors include:

 Making time for relaxation
 Being able to express your feelings
 Having achievable goals to aim for
 Making time for the things you enjoy
 Maintaining a healthy diet
 Exercise
 Work you find rewarding
 A comfortable balance between work and leisure
 Time to yourself, to do the things that interest you
 Time for friends and family

Some things to minimise:

 Unnecessary stress, at home or at work
 Feelings of rage or frustration
 Expecting too much of yourself and negative thoughts and feelings

Valuing yourself

Valuing yourself will help you to recognise the things in your life that you value and deserve
and help you to build your life on a secure foundation. Everyone deserves to have a life
where you feel happy and secure. If you value yourself enough, you will know when to take
action and make changes in your life and when to let go of problems that you cannot change
or are not yours.

Recognising that you can change

Change is part of life. We are all products of our environment and experience, but are never
fated to live or feel the same way forever. There are 3 conditions for long-lasting change:

a. Understand the present: Do not hide from reality, but see the present clearly.

b. Do not be burdened by the past: The past cannot be changed. Do not allow it to weigh
you down. Choosing to let go of the past does not mean that you accept or agree with
what has happened; just that you recognise that thinking about it is not helpful to you.

c. Accept the uncertainty of the future: Much of the future is not under our control. It is in our
best interest to accept uncertainty and learn how to face the future with confidence.

First Steps -8- Emotional health and pregnancy

Anxiety during pregnancy

No matter how much your pregnancy was wanted and planned for, and no matter how much
you are looking forward to the birth of your baby, you may have moments of anxiety and fear.
Sometimes, severe anxiety can cause physical symptoms, including increased heart rate,
headaches, nausea, diarrhoea and rashes.

Common reasons for anxiety during pregnancy:

 Anxiety about the baby – concerns about the health of your baby and normal
development
 Concerns about the upcoming labour – pain, losing control etc
 Worry that you will not connect with your baby, especially if the circumstances in
which she or he was conceived were not as hoped
 Anxiety about becoming a parent and other people’s judgement of how you will be as
a parent
 Anxiety about being fully prepared for your baby’s arrival

These are frightening but entirely normal fears.

Anxiety presents itself in four different ways….

Cognitive symptoms Emotional symptoms

 Indecisiveness
 Inability to concentrate/poor memory
 Overestimation of danger
 Underestimation in ability to cope
 Trouble thinking clearly
 Seeing only the negative
 Anxious or racing thoughts
 Constant worrying
 Fearful anticipation
 Anxious
 Panic
 Worry
 Restlessness/agitation
 Irritability or impatience
 Inability to relax
 Feeling tense and “on edge”
 Feeling overwhelmed
 Sense of loneliness and isolation
 Depression or general unhappiness

Physical symptoms Behavioural symptoms

 Headaches/muscle tension/stiffness  Avoiding situations

 Weak legs/shaking/ trembling  Leaving situations
 Feeling flushed  Perfectionism
 Sweating  Trying to control situations
 Diarrhoea/constipation  Eating more or eating less
 Nausea/dizziness  Isolating yourself from others
 Chest pain/rapid heartbeat  Nervous habits (eg. nail biting, pacing)
 Weight gain/weight loss  Teeth grinding or jaw clenching
 Blurred vision  Overreacting to unexpected problems
 Loss of sex drive

First Steps -9- Emotional health and pregnancy

Cycle of anxiety

Case study example

You are trying to choose a pram for your baby and become anxious that you are making the
wrong decision about which type of pram is best for you and your baby.

Unhelpful thoughts

“I’m going to mess this up”

“I can’t make a simple
decision, there’s no
chance I’ll be able to raise
a child”
“I can’t cope with this”
“I need to get out of here”

Avoidance behaviours Physical reactions

 Heart rate increases

Leave shop, try to ignore
the need to get a pram  Clammy or sweaty

 Feels sick

Moods/feelings

 Anxious

 Guilty

 Scared

First Steps - 10 - Emotional health and pregnancy

Breaking the vicious circle
In order to break the vicious circle, we need to tackle parts of it. We can change our physical
reactions by practicing relaxation techniques and we can change our behaviours by tackling
avoidance. By doing all of these things, we should start to notice changes in our mood and in
time feel less anxious.

Challenging thoughts - things to think about…

 What is the evidence?

What evidence do I have to support my thoughts?
What evidence do I have that does not support them?

 What alternative views are there?

How would someone else view this situation?
How would I have viewed this situation in the past?

 What is the effect of thinking the way I do?

Does it help me, or keep me from getting what I want? How?

We will look in more detail at challenging unhelpful thoughts later on in the booklet

Other ways to manage anxiety during pregnancy…

Here are a few practical tips to help you manage your stress and reduce anxiety at work and
at home:

 Know your limits – don’t push yourself to do more than feels comfortable

 Practice saying "no". Now may be a good time to acknowledge that you can’t do it all,
all the time. Make slowing down a priority and get used to the idea of asking others for
help

 Try deep-breathing exercises, yoga, or stretching

 Get regular exercise such as swimming or walking

 Try to eat a healthy, well-balanced diet so you have the physical and emotional
energy you need

 Get enough rest. You need extra sleep to help your body nourish your growing baby

 Join, or create a support group / online support group. If you're coping with a difficult
situation, speaking to others in the same boat can help

First Steps - 11 - Emotional health and pregnancy

What to expect during pregnancy

Part of being able to cope emotionally with changes that occur during pregnancy is
preparation. If you are prepared for what may be coming you might find that it’s easier to
cope with emotionally. It can also be helpful to know that what you’re experiencing is normal.
It is advisable to educate yourself as much as you can about the different stages of
pregnancy. In the meantime here are a few things you can expect to experience during
pregnancy:

First trimester (weeks 1 to 12):

 Morning sickness/general nausea (for some women this may last throughout
pregnancy)
 Fatigue
 Food cravings or aversion
 Forgetfulness or ‘baby brain’
 Vivid dreams

Second trimester (weeks 13 to 26):

 Growing stomach
 Shortness of breath
 Bladder and kidney infections

Third trimester (weeks 27 to 42):

 Backaches
 Gum problems
 Frequent urination
 Clumsiness

Throughout all three stages of pregnancy you are more likely to experience mood swings.
This is as a result of the high level of hormones in your body. In order to help you re-balance
yourself you can use the self-help strategies in the booklet to identify things you could
change or challenge which may help you feel a bit more in control.

Preparing for labour and birth

There can be a build up of anxiety around labour and giving birth. This anxiety can be helped
by preparing as much as you can and educating yourself about the process. Planning can
reduce the amount of unknown events on the day which can help reduce stress. There are
several things you can do to help make it a smooth and stress free process:

 Birth plans

 Plan your journey

 Pack your bag in advance

First Steps - 12 - Emotional health and pregnancy

Lifestyle during pregnancy

Nutrition

Eating a healthy, balanced diet is important throughout your life and it can have a big impact
on how you feel emotionally. Eating healthily during pregnancy will help your baby to develop
and grow healthily, and will keep you fit and well. If you don’t get enough of the nutrients you
need it can affect various things such as your energy levels, concentration and sleep. Overall
it is hard to feel emotionally well if you don’t feel physically well.

Calories during pregnancy…

For the first and second trimesters you won't need to have any more calories than you would
have consumed before becoming pregnant - about 2,000 calories a day. If you're aged
between 15 and 18 you may still be growing and will need 2,110 calories a day.

During the last trimester you will need an extra 200 calories each day - a total of 2,200 a day.

To help you get your calorie increase right in your third trimester, each of these healthy
choices is about 200 calories:
 A small pitta bread, toasted and filled with a
tablespoon of reduced-fat hummus and a handful of
grated carrot, plus three dried apricots
 30g of muesli, with a quarter of a pint of semi-
skimmed milk and an apple
 Two slices of wholegrain bread with a tablespoon of
cottage cheese
 Low-fat yoghurt with six almonds

You may find being pregnant makes you very hungry for fatty or sugary foods. You shouldn't
go hungry, but try to get the balance right. Having the odd chocolate bar or packet of crisps is
fine but try to have healthier snacks the rest of the time.

Here are some tips to help you feel full:

 Eat breakfast every day

 Eat high-fibre foods, drink plenty of water and take exercise. This can help you control
your appetite
 Keep healthy foods to hand. A filled fruit bowl makes it easy to grab a healthy snack
 Try snacking on smoothies and handfuls of dried fruit
 Have a small amount of protein with each meal. Balanced meals help you to feel fuller
for longer

It's important to eat a variety of different foods every day to get the right balance of nutrients
that you and your baby need. Have a healthy breakfast every day because this can help you
to avoid snacking on foods that are high in fat and sugar. You will probably find that you are

First Steps - 13 - Emotional health and pregnancy

more hungry than usual, but you don't need to eat anymore than usual - assuming you were
eating well and consuming a healthy amount of calories before becoming pregnant.

Foods to avoid

There are some foods you should avoid when you're pregnant because they might make you
ill or harm your baby. Here are some of the foods that you are advised to avoid during
pregnancy1:

 Pâté
 Raw or partially cooked eggs
 Liver
 Raw or undercooked meat
 Supplements containing vitamin A
 Some types of fish
 Sushi
 Raw shellfish
 Cold cured meats
 Peanuts
 Unpasteurised milk
 Caffeine
 Alcohol
 Vitamin A

1
NHS Choices
First Steps - 14 - Emotional health and pregnancy
Body image and self-esteem

Pregnancy is a time of great change and many of these changes are

linked to your changing body. As your shape changes you will be re-
working your relationship with your body. This can be especially difficult
if you had a more complicated self body image before pregnancy. In this
instance you may find that your self-esteem is affected by your
pregnancy and post-pregnancy body which can have a knock on effect
to other areas of your life such as motivation and relationships. If you were conscious about
keeping your weight low before pregnancy then it may be difficult to accept that you are likely
to gain around 25 to 40 lbs during your pregnancy. Old body issues can re-surface or new
insecurities can form which can be difficult to deal with.

One issue that is central to your changing body is the lack of control you may feel you now
have over how you look. Although you can control how your body looks to a certain extent,
by keeping active and ensuring you eat well (See Nutrition and Exercise sections), you will
not be able to control certain aspects such as the development of your baby bump. You may
have found that you are embracing and enjoying your changing shape however many
women find this difficult to do.

Tips for coping with your changing body:

 Focus on the purpose of the changes: Try to focus on the reason for your bodily
changes. Big changes have to happen in order for your baby to develop healthily.
Remind yourself that your body is changing to help your baby grow and develop. It’s a
natural process and can be an amazing experience.

 Educate yourself: Learning about the processes of pregnancy can help you
understand and appreciate it more easily. Educating yourself about your experiences
and reading about the experiences other people have had can help you embrace the
changes.

 Maintain a positive attitude: Being positive about your body image before pregnancy
usually makes it easier to cope with the physical and emotional changes that are
about to take place. If you know you suffer from low self-esteem because of your
appearance, you might find it even harder to accept your newly pregnant shape.
Finding ways to come to terms with your new figure will help you enjoy your
pregnancy much more overall. Having talking therapy can help with sorting through
some of these issues.

 Stay active: Light exercise during uncomplicated pregnancies, like going for regular
walks can help you to feel positive and healthy. Swimming is also good exercise, and
is often preferred by women in advanced stages of pregnancy because of the feeling
of weightlessness produced by the water. Yoga is another popular option, for its low-
intensity benefits. Exercising regularly can help to alleviate feelings of helplessness,
and allow you to still feel healthy and fit and more in control of your body.

 Ask for support: Having a good support network around you is essential during
pregnancy and immediately after birth. Draw on your partner, family members and
close friends or support services and be open about how you feel. Bottling up your
fears or negative feelings is likely to make you feel worse.

First Steps - 15 - Emotional health and pregnancy

Body image after giving birth

After you have given birth your body will have undergone a lot of change and although you
will have had your baby your body will not look like it did before you were pregnant. This may
bring with it issues of low self-esteem which can have a damaging effect on your overall well-
being and can make meeting the needs of your baby harder to do. Issues with self-esteem
often become a vicious cycle of negative thoughts, beliefs, behaviours and feelings. The
chart below demonstrates how this can happen:

Situation
After having your baby you are asked to go
swimming with some other Mums and
babies

Negative core belief

My worth is linked to my appearance

Thoughts

“I can’t be in a bikini at the moment”

“It will be embarrassing for people to
see my body”
“If I don’t go I’m letting people down”

Behaviours Physical reactions

 Don’t go swimming  Tense

 Avoid contacting the  Headache
women in case they  Energy levels lower
ask you swimming
again
 Isolated

Moods

 Depressed
 Sad
 Guilty
 Lonely

First Steps - 16 - Emotional health and pregnancy

It’s important to try to challenge your unhelpful thoughts. Balancing your thoughts
can have a big impact on other areas. To help you with identifying unhelpful thoughts
here is a list of some common thinking errors that people can find themselves
repeating. Have a look and see if any of them apply to you at certain times…

 Mind-reading
After you have a baby, it's easy to think that everyone you encounter is judging how
you look and how much weight you’ve lost. Try to challenge the thoughts that you may
have that others are judging you and your body shape.

 Catastrophizing
Catastrophizing is where you take an event and multiply its severity or importance
until things become out of perspective and unmanageable. “I look awful now and will
never lose any weight. There’s no point in trying, I may as well give up.”

 Discounting positives
Focusing on negatives and not praising yourself for the positive things you do can
have a big impact on your emotional health. A good approach to things includes some
positive element, “Ok, so I can’t get into my favourite jeans yet, but I will be able to
and I’ve done well to lose the weight I have already”.

 “Should” statements
Trying to motivate yourself with ‘should’, ‘must’ and ‘ought’ statements places
unnecessary pressure and expectations on yourself. These pressures are unhelpful
and can lead to feelings of failure. “I should be able to cope with all of the tasks I have
to do; I used to be able to manage anything that I had to”.

Challenging unhelpful thoughts

Once we learn to recognise our unhelpful thinking styles, we can then start to look at
alternative ways of thinking. It can be useful to consider:

 What is the evidence?

What evidence do I have to support my thoughts?
What evidence do I have that tells me that the thought is not true?

 What alternative views are there?

How would someone else view this situation?
What would I say to my friend if they were in same situation?

 What is the effect of thinking the way I do?

Does it help me, or does it keep me from getting what I want? How?

The chart has been filled in again below with the same situation but with alternative thoughts
to show the impact this can have…

First Steps - 17 - Emotional health and pregnancy

Alternative thoughts

Negative core belief

My worth is linked to my appearance

Thoughts

“I might not look how I would like to but I

have just had a baby”
“The other new Mums are in the same
position as me”

Behaviours Physical reactions

 Go swimming.  Good energy levels

 Make some new
friends with other
Mums

Moods

 Contented
 Positive

First Steps - 18 - Emotional health and pregnancy

Taking care of yourself during pregnancy and after giving birth

Exercise

Exercising has the following benefits in terms of your emotional

health. It can;

 Boost your mood by increasing the levels of feel-good chemicals (endorphins) in your
brain
 Help you to lose weight and regain your pre-baby figure which can help with body
image issues
 Protect you from aches and pains.
 Give you more energy, if you are feeling tired.
 Improve your strength and stamina, which will make looking after your newborn
easier.

Exercise during pregnancy

Exercise is not dangerous for your baby. The more active and fit you are during pregnancy,
the easier it will be for you to adapt to your changing shape and weight gain. It will also help
you to cope with labour and get back into shape after the birth.

Keep up the normal daily physical activity or exercise you did before pregnancy for as long
as you feel comfortable. If you were sedentary before you became pregnant it's important to
review your exercise plan with your healthcare provider before you begin. You shouldn’t be
trying to start a new vigorous exercise routine when pregnant, but if you aren't in any of the
high-risk categories you can begin a mild to moderate exercise regime.

Exercise tips

 Always warm up before exercising, and cool down afterwards

 Try to keep active on a daily basis: half an hour of walking each day can be enough,
but if you can't manage that, any amount is better than nothing
 Avoid any strenuous exercise in hot weather
 If you go to exercise classes, make sure your teacher is properly qualified, and knows
that you’re pregnant as well as how many weeks pregnant you are

Exercises to avoid during pregnancy

 Don't lie flat on your back, particularly after 16 weeks, because the weight of your
bump presses on the main blood vessel bringing blood back to your heart which can
make you feel faint
 Don't take part in contact sports where there's a risk of being hit, such as kickboxing,
judo or squash
 Don't take part in horse-riding, downhill skiing, ice hockey, gymnastics or cycling,
because there's a risk of falling
 Don't go scuba-diving, as your baby has no protection against decompression
sickness

First Steps - 19 - Emotional health and pregnancy

Exercise after giving birth

It is recommended that you do gentle exercise immediately following birth and after 6 weeks
you can start increasing your exercise if you wish. The most important exercises in the first
few days after birth are pelvic floor exercises.2

Exercise after a caesarean

 A caesarean is a major operation. Listen to your body and don’t push yourself too
much especially in the 6 weeks following the birth
 Once you feel ready you can work on your lower tummy muscles

Lie on your back with your knees bent, squeeze in your pelvic floor muscles as you breathe
out rather than as you breathe in, pull in your belly button in and up at the same time, try to
hold the squeeze for 10 seconds without holding your breath.3

Daily routine

A key part of feeling emotionally well is making sure your daily routine is balanced with
activities that you have to do with things that you want to do. If your days are largely filled
with completing tasks that you have to do, with little time spent doing things you get pleasure
from it is likely that your mood will be affected over time. Getting a balanced routine can be
difficult when you are pregnant or have a newborn baby. Completing an Activity Diary can
help you to do this however and it offers you a way of working out what your current daily
activities are and what changes you may be able to make:

2
Babycentre
3
Babycentre
First Steps - 20 - Emotional health and pregnancy
Activity diary

Step 1: Keeping an activity diary

The first step is to look at how you currently spend your time and to consider how satisfying
you find your daily activities and routine. If you have had your baby the way you spend your
time is likely to be greatly impacted by your baby and the duties involved in caring for your
baby, however trying to incorporate a balanced variety of activities into your weekly routine
that includes things that you enjoy can help improve emotional health.
Try to record daily activities along with ratings of how satisfying you find each activity (sense
of pleasure or sense of achievement).
It is important that there is a good balance between the things that you have to do and the
things that you want to do.

Step 2: What would you like to change?

Once you have kept a diary for a week or so, it is time to reflect on how you spend your time
and consider what you would like to change. The following questions may help with this:
What was satisfying and what wasn’t? How can you make your daily activities more
satisfying?

Are you striking a balance between enjoyable activities and relaxation, and things you have
to do?

First Steps - 21 - Emotional health and pregnancy

Activity diary

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Baby swimming Meet friend and

her baby for
Morning coffee

Lunch, nap

Afternoon

Dinner at home

Evening

What was the

best part of the
day?

First Steps - 22 - Emotional health and pregnancy

Sleep

You may find it difficult to get comfortable when sleeping during pregnancy and you may find
that various things begin to affect your sleep. Getting a good amount and good quality of
sleep is a very important part of feeling emotionally well. Here are some things that can
commonly disturb women’s sleep during pregnancy;

 Leg cramps
 Strange dreams
 Heartburn and indigestion
 You baby moving during the night
 Needing the toilet regularly

Sleep tips during pregnancy

Here are a few things to bear in mind if you are struggling

with sleep…

 Lying on your back after around 16 weeks can be uncomfortable, and can also mean
that the weight of your bump presses on the big blood vessels and can make you feel
faint

 Sleeping on your left side is advised and might be

more comfortable. You can try supporting your bump
with pillows, and put a pillow between your knees

 Towards the end of pregnancy, as your bump becomes heavy, you might find it more
comfortable to prop yourself up with pillows so that you’re almost in a sitting position.
Sleeping propped up like this can sometimes help with pregnancy heartburn too

 Try to relax before bedtime. You may find having a bath or reading before bed helps.
Relaxation techniques may help (please see our website)

 Exercise can help you feel more energetic during the day and can help you sleep
better at night

There are some medications that are considered safe to take during pregnancy and that
might help you sleep better. Always talk to your doctor before taking any kinds of medication
during pregnancy. This includes over-the-counter drugs, herbs, and dietary supplements.

First Steps - 23 - Emotional health and pregnancy

Baby blues

There is often an expectation that having a baby is going to be a source of happiness but as
a new mother you may be a long way from feeling this straight away and this can bring with it
huge anxiety. You may go through a short period of feeling emotional and tearful which may
be brief and manageable – known as the “baby blues” – which is completely normal.
Although experiencing baby blues is distressing it’s important to know that it doesn’t last long
– usually only a few days and no treatment is necessary.

You may however develop deeper more long term depression known as postnatal
depression. A very small amount of new mothers may also experience an extremely severe
form of depression known as puerperal psychosis - about one in every 1,000 women who
have no history of mental ill health will develop puerperal psychosis.4

Postnatal depression (PND)

Postnatal or postpartum depression is very common. Around one in ten women suffer from
postnatal depression.

Signs and symptoms of postnatal depression

You may experience one or more of the following (it’s unlikely that you will experience all of
them at the same time):
 Tearful, anxious, angry or guilty feelings
 Severe anxiety
 Excessive worry about your baby’s health and well-being
 Feeling disconnected from your baby and/or others around you
 Be troubled by intrusive thoughts about harming your baby
 Struggle to feel positive feelings or to enjoy your new baby

Postnatal depression usually sets in soon after childbirth and develops gradually over a
period of several months. However, it can come on suddenly and in some women the first
signs don’t appear until up to a year after they’ve given birth. Because of the possibility of
delayed onset, if you have a depressive episode within six months of having a baby,
postnatal depression should be considered.

Here are some possible causes and factors in postnatal depression;

 Difficulty adjusting to the shock of becoming a mother and the sudden

responsibility of looking after a baby
 Regularly finding yourself alone in the house with no adults to talk to
 Exhaustion
 The losses involved in becoming a mother such as the loss of your previous
identity and independence

4
www.mentalhealthcare.org.uk
First Steps - 24 - Emotional health and pregnancy
  Changing relationships - the relationship between you and your partner is likely to
alter
 Difficult labour - if you have a difficult labour with a long and painful delivery, an
unplanned caesarean section or emergency treatment you may be suffering from a
form of post-traumatic stress disorder rather than PND. This can affect your
relationship with your baby and partner
 Hormonal upheaval - the hormones involved during and pregnancy and following
child birth can be difficult to cope with and can contribute to difficulty with your mood
which can contribute to depression
 Childhood experiences - long buried emotional issues can re-surface with the shock
of giving birth, particularly if you were separated from own mother for any length of
time during your early childhood

If you’re suffering from postnatal depression there is no reason to feel guilty, the symptoms
are outside your control. However choosing to seek support with your PND is within your
control and it is important to seek help straight away to make recovery as successful and
quick as possible.

Treatment and help for postnatal depression

There are various treatment options for postnatal depression. If you feel you are suffering
with PND it’s important to talk to your GP. They will then be able to recommend which
treatments might be helpful for you. Here are the main treatment options…

 Psychotherapy – this is often a common choice because of concerns about taking

medication while breastfeeding.
 Antidepressants – for severe cases of postnatal depression where the mother is
unable to care for herself or her baby. In these instances it is important to gain an
understanding of some restrictions involved with taking anti-depressants whilst
breastfeeding.
 Group Cognitive Behavioural Therapy (CBT)
 Hormone therapy – oestrogen replacement therapy
 Marriage counselling – experiencing marital difficulties or feeling unsupported at home

First Steps - 25 - Emotional health and pregnancy

Additional support and information

First Steps
Helpline: 0808 801 0325, Monday and Wednesday 10am to 4.30pm and
Thursday 11am to 5.30pm
Web: http://firststeps-surrey.nhs.uk
Email: first.steps@nhs.net
 Contact us for more advice and information

Children’s centres

From pregnancy through to primary school Sure Start Children's Centres support children
and their families. They offer services for families at times when life is a bit of a struggle.
Children’s centres can be a great place to meet other Mums and get advice, information and
support on issues related to parenting. There are 68 children’s centres in Surrey and you can
either be referred to a children’s centre or can just turn up and refer yourself.

Surrey Maternity Services

Phone: 01932 722903
Web: http://www.asph-maternity.org.uk/
 Provide support during and after labour

Parent and Infant Mental Health Surrey CAMHS

Web: http://www.surrey-camhs.org.uk/en/content/cms/parents-carers/about-us/
 Provide support in the early stages of your baby’s life

Baby Massage

Parent Infant Health can help you with baby massage. The scheme is run by Cathy Madley-
Dowd the Specialist health Visitor in the South and North West of Surrey. Baby massage can
help your baby to:

 strengthen his or her attachment to you

 stay relaxed and not get upset
 cry less
 sleep better

CareConfidential Helpline
Helpline: 0300 4000 999
 CareConfidential pregnancy and post-abortion helpline is available to anyone in the
UK. CareConfidential provide information, advice and support if you are facing an
unplanned pregnancy, are concerned or struggling after an abortion or have
experienced baby loss. All advisors are trained and experienced in counselling women
and their partners facing these situations

First Steps - 26 - Emotional health and pregnancy

NCT
The UK's largest charity for parents.
Helpline: 0300 330 0700
Web: http://www.nct.org.uk/
 Get practical and emotional support in all areas of pregnancy, birth and early
parenthood including help with feeding

SMA Careline
Call free: 08000 81 81 80 in the UK
 Free support and advice during pregnancy and after giving birth. SMA Careline is
open 8.00am to 6.00pm Monday to Friday or go to the website to email

Pandas Foundation
Phone: 0843 28 98 401. 9am-8pm Mon-Sun
Web: http://www.pandasfoundation.org.uk/
 Offering pre and post natal depression advice and support

First Steps - 27 - Emotional health and pregnancy