Therapy alone isn’t going to fix what’s missing in maternal health care

This fact might surprise you: mental illness is the number one complication of pregnancy and the postnatal period. Not high blood pressure. Not postpartum haemorrhage. Nothing “physical” comes close - in terms of numbers - to the amount of reports clinicians receive regarding mental health.

Issues can accumulate or arise at any point: pregnancy anxiety can build from a positive pregnancy test, perinatal depression, OCD and intrusive thoughts can be triggered by hormonal and neurological shifts. Once pregnancy is over, many grapple with birth trauma, and feeding issues and sleep deprivation can heighten emotional challenges.

The need for support is - an this is one area where experts across maternal health agree - immense. And still, it is deeply lacking.

We are not (just) talking about access to therapy.

We are talking about creating the kind of conditions where mental health issues don’t even arise in the first place or are caught early, and one of the most impactful levers in this pursuit is fantastically simple: seeing the same midwife throughout your perinatal journey.

How continuity of care impacts emotional health in the perinatal period

Research confirms the hunch so many women have - that being able to form a bond of trust with your midwife not only improves your experience and outcomes (Sandall et al., 2016), but also allows for earlier and more thorough screening, should mental health support be required.

It can also tackle the huge number of emotional and mental health issues that are never reported: A paper in the Journal of Midwifery and Women’s Health describes how midwives are uniquely positioned to identify emotional difficulty early and make psychological support more accessible - because some people who feel reluctant to seek mental health care may be more receptive when support comes via a clinician they already trust (Felten et al., 2024).

And when both continuity of clinical care and specialist therapeutic support are in place, outcomes improve dramatically:

A 2025 study published in BMC Pregnancy and Childbirth evaluated an NHS integrated service combining psychological treatment with specialist midwifery support for women experiencing perinatal trauma, loss, and fear of childbirth. Among women with completed outcome measures, clinically significant psychological distress fell from 77% at the start of treatment to 29% by the end. Symptoms of post-traumatic stress dropped from 80% to 15%. Women who provided qualitative feedback described feeling supported, listened to, and advocated for throughout their maternity care (van Rhijn et al., 2025).

What this looks like in practice

Imagine you are 24 weeks pregnant and sitting at your midwife appointment. Your midwife is the same one you saw at 10 weeks, and at 14 and 18. They know that you went through three rounds of IVF to get here. They know that the 12-week scan left you shaking in the car park for an hour before you could drive home. They know you are working with a therapist and that the nights are getting easier. You do not have to explain your whole story from scratch.

At 24 weeks, they notice something in the way you answer a question. They ask, gently, how things really are. You ask them the birth questions that you’ve been carrying anxiously: what your options are, what happens if something becomes complicated, and how to make sure your preferences are known and respected by whoever is in the room when the time comes.

They answer clearly and without rushing. They tell you what to expect, what you can decide, and what can be put in writing. They explain how they will advocate for you within the clinical system.

This is what continuity of clinical care can provide: answers, presence, advocacy, and early escalation. It provides a solid clinical foundation that works because the relationship you have with your midwife is at the centre of things.

Who this helps most

1) Pregnancy after IVF, loss, or a “hard-won” pregnancy

For women who have been through fertility treatment, a previous loss, or a pregnancy that felt precarious from the beginning, the first trimester is not simply the start of something. It is 12 weeks of holding your breath. Every twinge, every absence of symptom, every day without visible proof that things are still progressing can feel like evidence of what you most fear.

Perinatal therapy can help you stay present, reduce catastrophic thinking, and process grief over past losses or the pain of getting to this pregnancy, fear, or hypervigilance.

A dedicated midwife can provide clinical reassurance: a question answered promptly, a plan clarified, a nuanced response that takes into account your actual context.

Together, they address fear from both sides: emotional and clinical.

2) Fear of childbirth (tokophobia), trauma history, or previous difficult births

Fear of childbirth affects an estimated one in seven women, and rates are higher among those with a history of trauma, difficult previous births, or pregnancies following loss (O’Connell et al., 2017).

By the third trimester, fear often intensifies because birth is no longer abstract.

Perinatal therapy supports the emotional roots: intrusive thoughts, loss of control, previous trauma, and what your body has already been through.

Continuity midwifery care supports the practical/clinical layer: what your options are, how different pathways work, how to document preferences, and how to plan for changes.

Postnatal: why early noticing matters

In the early days after birth, practical issues (feeding, recovery, sleep) and emotional shifts (tearfulness, anxiety, numbness, fear) can move quickly.

A midwife who knows you well is more likely to notice small changes: a flatness that wasn’t there yesterday, a carefulness in how you answer, a pattern that feels different for you.

That noticing matters because early support can reduce the chance that someone has to deteriorate to be taken seriously. It can mean getting help when things are only just beginning to shift rather than months later, when you are at breaking point.

Two practices, one intention

The Motherhood Practice and Mothering Minds share a conviction: that mothers, women, and birthing parents deserve coordinated, professional, human support in one of the most sensitive periods of their lives.

The Motherhood Practice

The Motherhood Practice provides a dedicated expert midwife from early pregnancy through birth and the postnatal period — with continuity and clinical expertise. The same midwife throughout, NMC-registered, with the time and relationship to understand context, notice change early, and advocate within the wider maternity system.

Mothering Minds

Mothering Minds provides specialist perinatal therapy online, delivered by BACP- and UKCP-registered psychotherapists working in this field. Whether you are navigating pregnancy anxiety, trauma, postnatal depression or you’re struggling with the identity and relationship shifts of new motherhood, Mothering Minds offers a space built specifically for this season of life.

When multiple forms of care work alongside each other, the evidence suggests that experience and outcomes for most women improve, because they benefit from support that addresses both the medical and the emotional layer of the perinatal phase.

What to do next

If you are pregnant or postpartum and want support, you can:

• speak to your GP, midwife, or health visitor about NHS perinatal mental health support
• consider additional continuity midwifery care to complement NHS maternity care
• consider specialist perinatal therapy, especially if you want your sessions to be built around the physical and mental changes of the perinatal period.

Book a free introductory call

The Motherhood Practice: If you are pregnant and want additional support from a midwife who will know you (not just your notes), complementary to NHS care: Book a free introductory call with The Motherhood Practice.

Mothering Minds: If you are navigating pregnancy or postpartum and would like specialist talk therapy to support our emotional and mental health, or identity and relationship challenges: Book a free consultation with Mothering Minds.

References

Felten CL, Smith KS, Aylesworth MB. (2024). An integrated approach to address perinatal mental health within an obstetrics practice. Journal of Midwifery and Women’s Health, 69(5), 778–783.

NHS Digital. (2022). Infant Feeding Survey.

O’Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O’Neill SM. (2017). Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 96(8), 907–920.

Sandall J, Soltani H, Gates S, Shennan A, Devane D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004667.

van Rhijn S et al. (2025). Transforming care by integrating maternity and psychological support: a mixed-methods evaluation of a Maternal Mental Health Service. BMC Pregnancy and Childbirth, 25, 1111.