When we talk about mental health in pregnancy, the conversation tends to stay pretty surface level. How are you sleeping? Are you eating well? Are you feeling anxious? These are important questions. But they only tell part of the story. Because here is something that really stayed with me when I completed my perinatal mental health training, and it has completely shaped the way I think about the women I work with. When we look at why some women struggle during pregnancy or after birth, we do not just look at what is happening right now. We look at everything. Childhood. Relationships. Previous pregnancies. Whether she feels safe and supported. Her own mental health history. Her culture, her context, her whole story. All of it matters. Every bit of it shapes how she experiences this season of her life. And yet the way we tend to talk about perinatal mental health in this country, it would be easy to think it all starts and ends with pregnancy itself. It does not. Not even close.
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What the research actually tells us
A history of prior mental health issues is the strongest predictor of mental health problems during the perinatal period. ¹ That is not a minor detail buried in a research paper somewhere. That is one of the most significant findings in the field, and it has enormous implications for how we support pregnant women and new mothers.
Around 600,000 women give birth in England every year, and research shows perinatal mental illness affects up to one in five new and expectant mums. ² One in five. That is not a niche group. That is likely someone in your antenatal class, your baby group, your WhatsApp chat. Maybe it is you.
And yet so many of those women will go unrecognised and unsupported. Not because nobody cares, but because we are not asking the right questions. We are not looking at the full picture.
The role of childhood experiences
One of the most important things I learned in my training was the concept of Adverse Childhood Experiences, often referred to as ACEs. These are difficult or traumatic things that happen to us in childhood. Things like emotional, physical or sexual abuse. Neglect. Growing up in a household affected by addiction, domestic violence or mental illness. Losing a parent. Experiencing significant instability.
Research shows that these experiences can make women more vulnerable to perinatal mental health problems. Childhood experiences can also have a big effect on how you feel about becoming a parent. If your own parents did not have good parenting skills, you may find it hard to adapt to your new role, feel unsure of how to interpret your baby's needs, or even fear that you will not know how to care for them properly. ³
Adverse childhood experiences have been shown to put women at increased risk of mental illness during pregnancy and in the postpartum period. ⁴ And importantly, this is not about blaming anyone for their past or suggesting that a difficult childhood automatically leads to a difficult experience of parenthood. It absolutely does not work like that. But it does mean that for some women, pregnancy stirs up things they thought they had long moved past. Old feelings resurface. Old fears feel suddenly very present. And that is not weakness. That is a completely understandable response to one of the biggest transitions of a human life.
For women with a background of adverse childhood experiences, the perinatal period may be experienced uniquely, with their sense of identity and relationships shaped by their past. ⁵ This is why the way we support women during pregnancy and after birth really matters. It is not enough to ask a tick box set of questions at a midwife appointment. Women deserve to be seen as whole people with whole histories.
Your mental health history matters too
It is not just childhood experiences that play a role. Women with a pre-existing mental health condition are at increased risk of a recurrence or worsening of symptoms during the perinatal period. ⁶ This means that if you have previously experienced depression, anxiety, OCD, PTSD, eating disorders or any other mental health condition, pregnancy is a time when that history becomes particularly relevant.
Not because you are guaranteed to struggle. But because the hormonal shifts, the identity changes, the physical demands, the sleep deprivation and the weight of responsibility that come with growing and caring for a new life can be significant triggers for someone who has previously been vulnerable.
Having a history of mental illness is associated with more than double the odds of experiencing mental illness in the second postpartum year. ⁷ That is a significant finding and one that I think deserves far more attention in conversations about maternal wellbeing.
The social picture matters just as much
It is also worth saying that mental health does not exist in a vacuum. The circumstances of a woman's life play an enormous role in how she copes during pregnancy and early parenthood.
Common risk factors for perinatal mental health problems include lack of social support, domestic abuse, financial hardship, unplanned pregnancy and young age. ¹ Isolation is a particularly significant factor and one that I see come up again and again in my work.
Research has shown that women who feel well supported by their partner, family, friends and healthcare providers report significantly lower levels of anxiety during pregnancy. ⁸ Having people around you who genuinely support you is not a luxury. It is a protective factor for your mental health.
This is one of the reasons I feel so strongly about the kind of community we build at Nurtured Birth and Beyond. It is not just about the yoga moves or the hypnobirthing techniques. It is about making sure women feel less alone in this season of life. That matters. It genuinely, measurably matters.
So what does this mean for you?
If you are pregnant right now, or you are in the postnatal period and things feel harder than you expected, I want you to hear this.
You do not have to have a diagnosable condition to deserve support. You do not have to be in crisis. You do not have to have the "right" kind of history. You just have to be a woman navigating one of the most significant experiences of her life, and that is enough.
Your whole story matters. Your past matters. Your context matters. And you deserve to be supported by people who understand that.
Every woman should have access to comprehensive perinatal mental health care, involving both professional support and community connection. ⁹ That is not asking for too much. That is a basic right.
This week I am going to be talking about all of it. The conditions that do not get enough airtime. The thoughts that leave mums feeling ashamed. The complicated grief of pregnancy after loss. What depression actually looks like when you are living inside it.
It is a big week. And if any of it resonates with you, I hope you will reach out. You do not have to carry this quietly.
Bex x
References
- National Institute for Health and Care Research (2025). Overview of perinatal mental health. NCBI Bookshelf. ncbi.nlm.nih.gov/books/NBK618809
- NHS England (2024). Record numbers of women accessing perinatal mental health support. england.nhs.uk
- Mind (2024). What causes perinatal mental health problems? mind.org.uk
- Racine, N. et al. (2021). Adverse childhood experiences and maternal anxiety and depression: a meta-analysis. BMC Psychiatry. bmcpsychiatry.biomedcentral.com
- British Journal of Midwifery (2024). Adverse childhood experiences' impact on the perinatal period: a scoping review. magonlinelibrary.com
- The Lancet Psychiatry (2024). Community perinatal mental health teams and associations with perinatal mental health outcomes. thelancet.com
- The Lancet Regional Health Europe (2025). Prevalence and incidence of moderate and severe mental illness in the second postpartum year in England. pmc.ncbi.nlm.nih.gov
- BMC Pregnancy and Childbirth (2022). The mental health crisis of expectant women in the UK. bmcpregnancychildbirth.biomedcentral.com
- eClinicalMedicine / The Lancet (2024). Safeguarding maternal mental health in the perinatal period. thelancet.com