Psychiatry: disorder groups
Perinatal psychiatry
Perinatal psychiatry looks after women's mental health during pregnancy and the first year after birth, including postnatal depression, anxiety and postpartum psychosis. Psychiatrists balance the risks of illness and of medication to protect both mother and baby.
Depth by stage, Pre-U → Consultant (details)
What is it?
Pregnancy and the months after birth are a time of high risk for mental illness. Postnatal depression affects a significant minority of mothers. Anxiety, OCD and trauma after a difficult birth are also common. Postpartum psychosis is rare but a psychiatric emergency, usually starting within days or weeks of delivery.
Women with existing conditions such as bipolar disorder or schizophrenia need careful planning before and during pregnancy, because stopping medication suddenly can trigger relapse, while some medicines carry risks for the baby.
The mother-infant relationship, partner and family support, and practical issues such as sleep and confinement customs all shape care. Perinatal services link psychiatry with obstetrics, paediatrics and primary care.
Why does a psychiatrist need it?
Psychiatrists of every type see women of childbearing age. They must give balanced advice on medication in pregnancy and breastfeeding (for example avoiding valproate), recognise and urgently treat postpartum psychosis, assess risk to mother and baby, and work with maternal health teams.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalUnderstandsLearns about postnatal depression and baby blues during O&G and psychiatry postings.
- HousemanshipUnderstandsScreens for low mood in postnatal wards and recognises postpartum psychosis as an emergency.
- Medical officerUnderstandsAssesses perinatal referrals and advises on common medication questions with supervision.
- Psych traineeAppliesManages perinatal conditions, pre-conception counselling and risk to mother and baby.
- Specialist / consultantAppliesProvides complex advice; a few develop special perinatal expertise and services.
What are the key topics?
Conditions
- Baby blues (normal, short-lived) vs postnatal depression
- Perinatal anxiety and OCD
- Postpartum psychosis
- Relapse of bipolar disorder or schizophrenia around birth
- Birth trauma and PTSD
- Tokophobia (severe fear of childbirth)
- Perinatal loss and grief
Assessment
- Screening tools such as the Edinburgh Postnatal Depression Scale (EPDS)
- History of previous episodes and family history of bipolar disorder or postpartum psychosis
- Risk to mother and infant, including thoughts of harm
- Mother-infant bonding
- Social support and practical needs
Treatment
- Psychological therapies (CBT, IPT) for mild to moderate illness
- Medication in pregnancy and breastfeeding: weighing risks; reference sources
- Valproate avoidance in women who could become pregnant
- Emergency management of postpartum psychosis, often admission
- Pre-conception planning for women with serious mental illness
- Liaison with obstetrics, paediatrics and maternal child health clinics
How is it learned and assessed?
- O&G and psychiatry postings in medical school
- Housemanship O&G posting
- Liaison and perinatal exposure during specialist training
- MMed Part II; MRCPsych Paper B (prescribing in pregnancy) and CASC stations
Typical textbooks and resources
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley (pregnancy and breastfeeding section)
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- NICE guideline on antenatal and postnatal mental health — NICE (UK)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
What is the difference between baby blues and postnatal depression?
Baby blues are common, mild mood changes in the first days after birth that pass within about two weeks. Postnatal depression lasts longer, is more severe and needs treatment.
Can mothers take psychiatric medication while breastfeeding?
Many medicines can be used with care. The choice depends on the drug, the baby's health and the mother's illness, so it should be planned with a doctor rather than stopping or starting medicines alone.