Perinatal Mental Health

Before you become pregnant

You, your partner, and your family should learn about how pregnancy and the postpartum period (the time after you give birth) can affect your mental health. Lower your stress and find supports. These go hand in hand. Find out who can support you and what they can offer. Here’s how:

  • If you need help with things like money and housing, ask your health care provider (family doctor, nurse practitioner or midwife) for a referral to someone who can help with this.

  • Contact the Family Resource Centre in your area to ask about prenatal classes and other groups.

  • Tell your primary health care provider about any medications you are taking. They will make sure your medications are safe during pregnancy and tell you if you need to make any changes.

  • Talk with your loved ones about how you are doing. Being your own advocate is important and you deserve to be well. You know yourself best. Speak up for yourself to make sure your needs are met.

  • Encourage your loved ones to check in and ask how you are doing.

Learning about your condition can help you:

  • better plan your care.
  • tell your loved ones how to support you.

 

Mood, trauma, and anxiety disorders (like depression, general anxiety, panic, obsessive compulsive disorder, post-traumatic stress disorder, or bipolar disorder etc.): 

As many as 1 in 7 pregnant people and 1 in 10 partners or primary caregivers develop worse or a new mood and/or anxiety disorder in pregnancy or anytime in the first year after baby’s birth[1].

If you are simply not feeling like yourself, you are struggling, or you notice your loved one is not themselves, start by talking to a healthcare provider.

 

Substance use (like smoking, using cannabis, drinking alcohol): 

Substance use is common during pregnancy [2]. It affects the health of the pregnant person and your unborn baby. We understand that substance use may help you cope.

We can help you find other ways to cope that improve the health of you and of your family. Please talk to your primary health care provider or call the Mental Health and Addiction’s Intake Service for help 1-855-922-1122.

 

Family violence: 

Almost half of pregnant and postpartum people experience family violence. Psychological violence is most common [3]. You are not alone. There is help.

Try to talk to a trusted health care provider (like a Family Resource Centre worker, nurse, doctor, midwife etc.), NS Victim Services or Mental Health and Addictions Crisis line 1-888-429-8167.

 

Trauma: 

Up to nearly half of women experience their delivery as traumatic. A small amount of these people goes on to have post-traumatic stress disorder.

Trauma related to pregnancy, birth, or the postpartum period can include:

  • pregnancy loss

  • the delivery itself

  • injury or health issues for the baby or parent

  • trouble adjusting to a new baby

  • relationship difficulties

  • or unplanned events like a longer than expected hospital stay.

Post-traumatic stress disorder can occur with other anxiety disorders and is linked to post partum depression. This can affect your relationships and future pregnancies. If you feel trauma is affecting you, talk to your primary health care provider for supports.

 

Community Supports

  • If it is an emergency call 911 right away.

  • Provincial Mental Health and Addictions Crisis Line: provides crisis intervention for children, youth and adults experiencing a mental health crisis or mental distress. The service is available 24/7. Call (toll-free) 1-888-429-8167.

  • Call 211 or visit ns.211.ca to find community group services in your area. 211 Nova Scotia connects you to get help with a situation like emergency/disaster relief, violence and abuse, housing and shelter, financial assistance, mental health and addiction, plus many more. 

  • Need a family health care provider? The Need a Family Practice Registry is a provincial list for people without a family doctor or nurse practitioner. Once you have registered here, you will be added to the list. When a primary care provider in your area is accepting new patients, Nova Scotia Health Authority will contact you by phone and/or email. Visit https://needafamilypractice.nshealth.ca/

  • Public Health: The Early Years program offers supports and services to help with prenatal and postnatal support, self-care, parenting and links to community resources. For more information on this program, click here. To locate a Public Health office near you, click here.

  • Substance use disorders: To self-refer to Community Mental Health and Addictions, call our Intake Service (1-855-922-1122). There are multiple programs available including Recovery Support Centres, Opioid Recovery Programs, and the Stop Smoking Program.

  • Prevention and Early Intervention: This program within child welfare helps to prevent future problems by strengthening children, youth, and families. Prevention and early intervention within child welfare is a proactive and early approach to strengthening children, youth and families and building their resilience, ultimately mitigating the need for more intrusive, statutory interventions. The focus is on promoting safe, stable and nurturing relationships and environments for children and families through community based programs, services and supports that address their holistic needs.​​​​​ To learn more about the particular programs available, click here.

 

Focusing on Self-care

NEST-S[4]:

  • Nutrition

    • Eat foods that will give you lots of energy throughout the day and night. Snacks with protein are a good choice and will help you to feel full longer (like peanut butter, nuts, cheese, eggs).

  • Exercise

    • Moving or walking outside each day can:

      • give you light therapy from the sun (which can help with feelings of sadness). Consider taking a vitamin D supplement in the winter months when there is less sunlight.

      • help your body release hormones that make you feel good.

    • Try walking around outside, feeling the rain or wind on your face, or dancing or swaying (moving side to side) with your baby.

  • Sleep and rest

    • Sleep is very important for physical and mental health. Getting at least three to four hours of uninterupted sleep is best for your brain.

    • Try:

      • napping from 8:00 p.m. to 10:00 p.m.

      • feeding your baby

      • sleeping from 11:00 p.m. to 3:00 a.m.

      • feeding your baby

      • sleeping from 4:00 a.m. to 8:00 a.m.

      • then napping throughout the day, as needed

    • If you have a mood and/or anxiety disorder and you are chest/breastfeeding your baby, and you feel the lack of sleep is taking its toll on you, talk to your primary health care provider as soon as possible.

    • If you are bottle feeding your baby, take turns with your partner so you can get more sleep. Talk to your primary health care provider for tips on getting more sleep.

  • Time for yourself

    • Taking time for yourself can be hard for new parents, but it is very important.

    • Try taking 15 minutes a day. Take a shower or bath, read, go for a walk, watch your favourite TV show, or talk to a friend.

  • Support

    • Social support is important in helping new parents adjust to the life changes of being a parent. Healthy relationships can help to prevent depression and other mental health disorders, and also help with recovery.

    • Ask your family and friends for help. Drop in to baby groups at the library or at your local family resource centre.

    • If you feel you need more support, contact your local family resource centre or a counsellor by calling our Intake Line.

 

I'm struggling in pregnancy or the postpartum period...I need help.

Online Resources

 

Peer Support - in person

  • Public Health Nurses: Contact your local Public Health office for more information about Early Years services.

  • Local Family Resource Centre: Free, in-person baby groups and programs for families. Click here to find a location near you.

  • Women's Centres Connect: Free programs and counselling. Click here to learn more.

 

Self-help workbooks

Depression:

 Anxiety:

 

Downable apps

  • Mindshift: Free app designed to help you cope with everyday anxiety.

  • Mood Panda: Free app that includes a way to keep track of your moods, and shows a graph of your mood over the day, month, year, etc.

  • CBT-i Coach: Free app people who are doing cognitive behaviour therapy for insomnia with a health care provider, or who have had symptoms of insomnia and would like to improve their sleep habits.

 

Suggested readings

General Postpartum Mood Disorders

  • This Isn’t What I Expected: Overcoming Postpartum Depression by Karen Kleiman and Valerie Raskin
  • A Deeper Shade of Blue by Ruta Nonacs
  • Beyond the Blues by Pec Indman and Shoshanna Bennett
  • What Am I Thinking? Having A Baby After Postpartum Depression by Karen Kleiman
  • Life Will Never Be the Same: The Real Mom’s Postpartum Survival Guide by Ann Dunnewold & Diane Sanford
  • The Mother-to-Mother Postpartum Depression Support Book by Sandra Poulin
  • Understanding Your Moods When You’re Expecting: Emotions, Mental Health & Happiness Before, During & After Pregnancy by Lucy Puryear

Postpartum Anxiety & OCD

  • The Pregnancy & Postpartum Anxiety Workbook by Pamela Weigartz
  • Dropping the Baby & Other Scary Thoughts by Karen Kleiman

Postpartum Psychosis

  • Understanding Postpartum Psychosis: A Temporary Madness by Teresa Twomey

Depression During Pregnancy (Antenatal or Antepartum Depression)

  • Pregnancy Blues: What Every Woman Needs to Know About Depression During Pregnancy by Shaila Misri
  • Pregnant On Prozac: The Essential Guide to Making the Best Decision for You & Your Baby by Shoshanna Bennett

For Dads

  • The Postpartum Husband: Practical Solutions for Living with Postpartum Depression by Karen Kleiman

Memoirs

  • Down Came the Rain by Brooke Sheilds
  • Why I Jumped by Tina Zahn
  • Behind the Smile: My Journey Out of Postpartum Depression by Marie Osmond
  • Daughter’s Touch by Sylvia Lasalandra
  • Inconsolable by Marrit Ingman

For Professionals

  • Therapy & The Postpartum Woman by Karen Kleiman
  • Perinatal & Postpartum Mood Disorders: Perspectives & Treatment Guide for the Healthcare Practitioner by Susan Dowd Stone
  • Motherhood & Mental Health by Ian Brockington
  • Traumatic Childbirth by Cheryl Tatano Beck, Jeanne Watson Driscoll and Sue Watson

 

What if I need more help?

We understand that this can be an overwhelming time. You may want to try:

  • Medication: Talk to your primary health care provider. Ask them if medication to help manage your mood or anxiety is right for you. They may suggest taking an antidepressant if therapy alone is not working or your symptoms are severe (very bad).

  • Added support: Ask your support person(s) to help you so you can get sleep and or a break from daily responsibilities

  • Therapy:

    • Sexualized trauma and general counselling:

    • Find a therapist:

    • If Child Welfare Services is involved, you can ask how you can get connected to counselling services.

  • Substance use disorders

    • To self-refer to Community Mental Health and Addictions call (toll-free): 1-855-922-1122

    • Recovery Support Centres: a welcoming space that provides education, recovery and harm reduction support, along with one on one support and group treatment for people struggling with substance use and/or gambling concerns. Located throughout the province.

  • Go to the nearest Emergency Department right away or call 911 if you or someone you are with:

    • is thinking of or has harmed yourself or someone else.

    • is experiencing dellusions (thoughts that aren’t true to reality) or hallucinations (sensing - hearing or seeing - something is there but it really isn’t).

    • is in withdrawal from any substance(s).

    • is experiencing family violence.

 

What if I have unwanted intrusive thoughts of harm coming to my self or my baby?

Unwanted intrusive thoughts can be disturbing. They do not decide your ability to parent or your worth. To learn more about unwanted intrusive thoughts, click here.

 

What if I have intentional thoughts of self-harm (hurting myself) or of harming (hurting) others?

With help, you will get better.

Depression and/or Anxiety:

  • It is important to get enough sleep and rest as needed.

  • Keep a diary of your mood and how you are doing. Review it with your primary health care provider.

  • Talk with your primary health care provider before delivery about whether medication(s) is right for you and how it may affect chest/breastfeeding.

  • Ask yourself these questions every two weeks (14 days): In the past two weeks (14 days):

  1. Have I felt so low/down, depressed, anxious, or agitated that it has affected my daily activities?

  2. Have I not been able to find interest or enjoyment in activities or people I usually would? Even after resting?

  3. Have I felt hopeless or very critical of myself?

  4. Have I had any thoughts or plans of hurting myself or others? Have I felt a need to escape in some way?

  • See your primary health care provider if:

    • you answer “yes” to most of the questions above

    • your symptoms get worse.

    • you have thoughts of self-harm/suicide.

    • you do not feel a bond with your baby.

  • Make a safety plan. This is a plan that prepares you and your support people in case you need help right away:

    • Find supports, including people who can help and what their role or task will be. For example, assign one person to take care of baby and one person to take care of you.

    • Plan for a way to get to the nearest Emergency Department

    • Keep information for crisis services nearby.

Family violence

 

What if I or my partner wants to or has harmed myself or someone else?

Put your safety plan into action. Get help.

  • Safety comes first. The person wanted to harm themselves or someone else should NOT be left alone or with their baby until they are seen by a health care provider.

  • Call your support person(s) to take care of baby and make sure you are not left alone.

  • Go to the nearest Emergency Department right away.

  • Tell your primary health care provider and your support person(s) what is happening.

 

Birth trauma

After a traumatic event PTSD (post-traumatic stress disorder) can develop up to 6 months later. It can start unexpectedly once you have time and space to process what happened. You are not alone, and you are not to blame.

  • Talk about the trauma with a health care provider (primary health care provider, nurse, midwife). 

  • Write about your experience in a journal.

  • Contact a counsellor who specializes in trauma or pregnancy/the postpartum period.

  • Try doing yoga a couple of hours a week for nine to 12 weeks (two to three months).

  • Listen to instrumental music (like nature sounds) for 20 minutes a day for two weeks.

  • Limit visitors to only those interested in really helping you with taking care of you and the baby.

  • Birth Trauma Ontario Mothers Group: A private space where mothers can share their birth experiences and their journeys towards healing.

 

Grief

Grief is not a disorder. Support is available.

  • Talk with your primary health care provider about local grief counselling.

  • Pregnancy ED: Information for people experiencing first trimester complications in pregnancy.

  • Have your support person call your primary health care provider or prenatal clinic to tell them if you have had an early loss. They can cancel any appointments and make a plan for follow-up.

Resources:

Resources cited: 

[1] Perinatal Mental Health Discussion Tool. Postpartum Support International. Discussion Tool | Postpartum Support International (PSI)

[2] Polysubstance Use In Pregnancy. Centers for Disease Control and Prevention. Polysubstance Use During Pregnancy | CDC 2022

[3] Almeida et al. Domestic Violence in Pregnancy: Prevalence and characteristic of the pregnant woman. National Library of Medicine. Domestic violence in pregnancy: prevalence and characteristics of the pregnant woman - PubMed (nih.gov) 2017

[4] Mental Health Disorders in the Perinatal Period. BC Reproductive Mental Health Program & Perinatal Services BC. (pg. 23)

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