“During pregnancy, we lose patients for 9 months and then we get them back,” said Dr Victoria Silverwood, a GP in Macclesfield, England. Until the postnatal review at 6-8 weeks, she said, “we don’t know what they have gone through.”
“No one is truly ever prepared for the difficult, life-changing, life-altering event of becoming a parent. It can be a really difficult, complex thing to manage,” Silverwood, who is a National Institute for Health and Care Research academic clinical lecturer in primary care at Keele University and runs a weekly perinatal clinic at her surgery, told Medscape News UK.
“Women undergo a major shift in identity and may not realise they are struggling. There’s a huge amount of stigma and shame and guilt associated with finding parenting challenging, when women feel like they should be enjoying every moment. In reality, that’s just not feasible.”
The Saving Lives, Improving Mothers’ Care 2026 report from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK), published in September 2026, found that in the UK between 2022 and 2024, suicide remained the leading cause of death between 6 weeks and 1 year after the end of pregnancy. Psychiatric causes, including suicide and substance use, accounted for 33% of the 322 deaths in that period. Over the same 3 years, of the 252 women who died during pregnancy or up to 6 weeks after pregnancy, 35 died from mental health conditions. Of the 252 women who died, 47% had known mental health problems.
Many more women live with perinatal mental health conditions, which are estimated to affect up to 1 in 4 women and birthing people across the UK during pregnancy and in the year after childbirth.
GPs Hold the Front Line but Lack Time and Information
What is being done to address perinatal mental health? And what more could be done to support women and birthing people?
Management of the postnatal period is largely done in primary care, placing GPs at the forefront of perinatal mental health support.
“In the UK, GPs are expected to manage such a breadth of conditions. We handle more complexity in primary health care than we used to since COVID. But if I’m honest, perinatal care hasn’t gotten much recognition,” Silverwood said.
She said communication is part of the problem when women return to primary care after birth: “Postnatally they come back to us, and I think there are some communication issues. Sometimes the discharge paperwork is insufficient.”
The Suicide Prevention Strategy for England: 2023-2028 lists pregnant women and new mothers as a high-priority target group, with multiple measures to be implemented. One of those was developing new guidance for GPs who deliver 6- to 8-week maternal postnatal consultations, which was published in 2023.
For Silverwood, the 6- to 8-week consultation is the crucial time to pick up on any red flags, whether through body language cues, language, or just a general feeling that things aren’t right. National Institute for Health and Care Excellence guidance says identifying and addressing serious mental illness should take priority over anything else in the appointment.
Silverwood acknowledges this is yet another responsibility placed on GPs but encourages doctors to tap into their mental health expertise and not to be discouraged or frightened because a patient is in the perinatal period. She is a board member of General Practitioners Championing Perinatal Care (GPCPC), a network of UK GPs working to improve perinatal care in primary care through guidance and education.
“What we’re trying to do with GPCPC is encourage GPs to use their medical and mental health knowledge when they see women and birthing people. Most GPs are good at it,” she said.
“It’s about feeling confident. But there’s work to be done — there’s upskilling to be done for sure. It’s a work in progress.”
For those who do undertake the postnatal consultations, she, like the guidance, encourages GPs to ask gentle, open questions such as: How do you find being a mother? What things do you like to do with baby?
“We can gently probe further and ask: Do you have any intrusive thoughts? Do you have low mood? Some mums are so sleep deprived that they don’t get time to rest and others may have no support network around them. Some may feel that they can’t rest, that they have to watch their baby. They can then be at risk of perinatal ill mental health like depression, PTSD and anxiety. But when things intervene with sleep and functioning properly, we have to ask: How can we help you? What could work for you?”
Time, though, is a major barrier, when GPs are under intense pressure to do more with less.
“If someone is in distress, 10 minutes will never be enough. Time is a huge barrier. I am very aware of the patients sitting and waiting for their appointment … but I try and give people the time they need,” Silverwood said.
“I’m not a ‘running on time GP’ — some colleagues are. Sometimes it involves taking more time in the moment, giving women a chance to talk but acknowledging there is more to explore and rebooking a patient for the next week and for a longer appointment and ruling out any red flags today.”
Specialist Services Have Expanded, but Access Still Varies
In the past decade there has been progress in recognising perinatal mental health as a pressing public health issue.
The MBRRACE-UK report says rising rates of psychiatric maternal deaths led to specialist perinatal mental health services being expanded to every local area, under NHS England’s 2019 Mental Health Implementation Plan.
Specialist perinatal mental health services provide care to women and birthing people affected by severe mental health problems during and after pregnancy and include specialist community perinatal mental health teams and inpatient mother and baby units.
But for those with moderate mental health difficulties tied to the maternity experience, the wait time to see a professional can be very long. NICE guidelines stipulate women with mental health problems during the perinatal period should be “assessed for treatment within 2 weeks of referral and receive psychological interventions within 1 month of assessment”. However, research looking at the availability of maternal mental health services for those with moderate mental health difficulties found that waiting times for an assessment ranged from being seen immediately, to waiting 26 weeks for an appointment. Moreover, the average waiting time for one-to-one therapy following assessment was 16 weeks, although the actual wait times ranged from 0 weeks to 12 months. Roxanne Keynejad is a clinical academic psychiatrist and senior lecturer at King’s College London and an NHS psychiatrist working in South East London. She is part of a specialist community perinatal mental health team, which comprises a consultant psychiatrist, resident psychiatrist, clinical psychologist, occupational therapist, and a mental health nurse.
Women and birthing people can be referred to the service via a GP or midwife. The service sees a range of people experiencing moderate to severe mental health conditions, including depression, anxiety, schizophrenia, and PTSD.
“It’s a fantastic community model of care — we should have it available for all other life stages,” Keynejad told Medscape News UK.
“But the reality is that we have limited capacity to see women. If they can be supported by a GP through talking therapies and medication, we have to ask: is it enough or is the risk too high?”
Currently, the service stops seeing women one year postpartum. “I often think that given the substantial trauma history of our patients, I can imagine that the challenges you face with a 2-year-old can be more difficult to manage. To me, it’s quite regrettable to not offer a service for that stage of life,” Keynejad said.
Katie Marwick, senior clinical research fellow at the University of Edinburgh and honorary consultant psychiatrist with NHS Lothian in Scotland, works in inpatient perinatal psychiatry.
Marwick believes that the widespread expectation that childbirth and the early postpartum period are joyful can make postpartum psychosis harder to recognise.
“It can be [a happy time]. But it’s also a very high-risk time for women to experience mental health conditions, including postpartum psychosis. It’s a time that most women need a bit of looking after, as well as their babies,” she told Medscape News UK.
“Often partners are the ones who notice something is amiss as the women can’t tell from the inside. Inadequate maternity leave and pay and minimal paternity leave, coupled with the lack of value given to the unpaid labour of childcare, don’t help women and their families during this potentially wonderful but always challenging time.”
Postpartum psychosis, although fairly rare at around 1 in 1000 deliveries, is a sudden psychiatric emergency requiring immediate medical attention. Inpatient mother and baby units provide psychiatric care for mothers and care for the baby, allowing them to stay together. Marwick said the impact of the expansion of such units has been profound because mothers no longer stay in a general adult ward, which “is not a safe space for a baby.”
Access, however, remains a postcode lottery, she said. For example, there are two units in Scotland, each with six beds. “If you live in the Scottish islands, you’re not going to have one. That said, in the past 15 years things have improved a lot. It’s nowhere near as under resourced as it used to be.”
Inequalities and Social Factors Shape Risk
But while a lot has been done to expand services, gaps and inequities persist.
The MBRRACE-UK report found that in England, the maternal mortality rate for Black women was nearly three times that for White women, and that the risk for maternal death was also slightly higher among Asian women compared with White women. Women living in the most deprived areas of England continued to have a maternal mortality rate twice that of women living in the least deprived areas.
Marwick said there was more work to be done to ensure services were appropriate and accessible to all.
“I think we need more peer support provided by the third sector. Women get a lot out of talking to other women who’ve had similar experiences,” she said.
“This is particularly important for those from marginalised communities, who often view what it means to have a mental illness differently. For these women, trust in services has to be earned.”
She added that it would also be beneficial to make pathways to support clearer so that women are not bounced between services.
“There needs to be some lateral thinking on how to make pathways clearer. We need to bring together people with expertise in perinatal mental health.”
For Keynejad, understanding perinatal mental health also means understanding the risk factors, from poverty and unstable housing to trauma, domestic violence, and involvement with social care systems. The MBRRACE-UK report found that of the 252 women who died during pregnancy or up to 6 weeks after pregnancy, 21% had been subjected to domestic abuse before or during pregnancy, 7% had a history of abuse as a child, and 20% were known to social services.
A perspective paper co-authored by Keynejad argues that housing insecurity is one route through which structural violence, meaning systemic inequities built into social structures, harms women’s mental health. The authors say the relationship runs both ways: poor mental health can make it harder to secure stable housing.
“Housing is so influential over people’s wellbeing. So many of our women live in poor housing settings where they just don’t have security. Adverse housing circumstances are really detrimental to recovery,” Keynejad said.
“But in perinatal mental health, prominence really isn’t given to people’s social circumstances, but we can’t disregard them because they’re ‘not medical problems’. They all contribute.”
Marwick pointed to practical steps: more peer support from the third sector and clearer pathways so women are not bounced between services. For GPs, the upskilling is still, in Silverwood’s words, “a work in progress.”
Contributors to this article declared no relevant conflicts of interest.
Sophie Cousins, MIPH, is a global health journalist who has reported from more than 20 countries.
