There is a persistent myth that pregnancy is a time of happiness and that new motherhood, despite its challenges, comes with a natural euphoria that carries women through. I encounter this myth regularly in clinical practice. I encounter it most often in the stories of women who spent months suffering in silence because they thought something was uniquely wrong with them for not feeling what they were supposed to feel.
Perinatal mental health problems — those occurring during pregnancy and in the first year after birth — affect approximately 1 in 5 women. Black and African women are at significantly higher risk of postpartum psychosis and postpartum depression, are less likely to be screened effectively, and are less likely to receive appropriate treatment.
This article will not fix the systemic failures. But it can give you information that helps.
The spectrum of perinatal mental health conditions
Baby blues (very common, not a disorder): Tearfulness, mood swings, emotional sensitivity in the first 2 weeks after birth. Extremely common — affects up to 80% of new mothers. Caused by rapid hormonal shifts. Resolves on its own. Requires support and rest, not treatment.
Postnatal depression (PND): Persistent low mood, loss of enjoyment, excessive anxiety, difficulty bonding with the baby, feeling overwhelmed or hopeless. Starts anytime in the first year after birth. Affects approximately 1 in 7 mothers. Requires treatment.
Anxiety disorders: Excessive worry, intrusive thoughts about harm coming to the baby (not the same as wanting to harm the baby), panic attacks. Often unrecognised as a perinatal mental health problem.
Postpartum psychosis (rare but serious): Rapid onset (usually within 2 weeks of birth) of severe symptoms — hallucinations, delusions, confusion, extreme mood swings. Medical emergency. Requires immediate hospitalisation.
Prenatal (antenatal) depression and anxiety: Mental health problems during pregnancy, not just after. Significantly underrecognised. Affects around 1 in 10 pregnant women.
Why Black and African women are at higher risk
The research is clear that Black women face compounded risks:
Higher rates of traumatic birth: Black women in the UK are significantly more likely to experience adverse birth outcomes, including emergency interventions, which are risk factors for PTSD and PND.
Racial bias in screening: Studies show that Black women are less likely to be asked the standard mental health screening questions during antenatal appointments, and more likely to have their concerns dismissed.
Cultural expectations: In many African communities, mothers are expected to be strong. Expressing difficulty is seen as ingratitude or weakness. "At least the baby is healthy" is something many distressed mothers hear — as if their mental health does not count.
Social isolation: Many African women in the UK are away from their extended family support networks. The "village" that traditionally surrounds a new mother in African cultures is simply not there.
Economic stressors: Financial pressures, immigration status uncertainty, and insecure work all compound mental health risk.
Case study: Grace's postnatal depression
Grace, 29, from Ghana, living in Birmingham, came to see me eight weeks after the birth of her second child. She had come because she thought she might have a urine infection.
During the appointment I asked how she was feeling in herself. She said fine. I asked specifically about her sleep (beyond the baby), her mood, whether she was enjoying things. She paused.
She told me she had been feeling "nothing" since the birth. She was feeding and caring for the baby, but felt no joy. She was crying privately at night. She had not told her husband because "he has enough to worry about." She had not told her mother in Ghana because "she would think I am not coping." She had not told her friends because "in our culture, you just get on with it."
She scored 18 on the Edinburgh Postnatal Depression Scale — moderate-severe depression.
"I thought I was a bad mother," she said. "I thought something was wrong with me specifically."
Nothing was wrong with Grace specifically. She had a common, treatable medical condition that had been compounding for 8 weeks without recognition.
She started sertraline (safe in breastfeeding) and was referred to the perinatal mental health team. She joined a postnatal support group. Her husband attended a session with her specialist. Four months later she told me: "I feel like I got my brain back."
Treatment options
Psychological therapy: CBT and interpersonal therapy (IPT) are first-line for mild-moderate PND. Access via NHS Talking Therapies (self-referral at talkingtherapies.nhs.uk) or ask for a perinatal mental health referral.
Medication: SSRIs (sertraline is preferred in breastfeeding — it passes into breast milk in very small amounts and is considered safe) for moderate-severe depression. Some women are reluctant to take medication while breastfeeding — discuss the risk-benefit with your doctor. Untreated severe depression also carries risks.
Perinatal mental health teams: Specialist NHS teams for perinatal mental health exist in most areas. They offer more intensive support. Ask your GP or midwife for a referral.
Postpartum psychosis: This is a psychiatric emergency. If you or someone you know has suddenly developed confusion, hallucinations, or extreme mood changes within weeks of giving birth — call 999 or go to A&E immediately. Do not wait.
What to tell your midwife or GP
Be direct. Healthcare providers sometimes miss the signs. Say:
"I think I might have postnatal depression and I would like to be assessed."
Or: "I have been struggling with my mood since the birth and I would like to talk about it."
You should not have to fight to be heard. But unfortunately, sometimes you do. Be persistent.
Sources: NICE Clinical Guideline CG192 — Antenatal and Postnatal Mental Health (2014, updated 2020); Maternal Mental Health Alliance — Inequalities in Perinatal Mental Health 2022; MBRRACE-UK — Saving Lives, Improving Mothers' Care 2023; Cox J et al, Edinburgh Postnatal Depression Scale original publication.