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Perinatal mental health refers to the social and emotional wellbeing of a pregnant person from conception to the baby’s first birthday (Australian Institute of Health and Welfare (d).
While definitions of ‘perinatal’ vary, sometimes extending to when a child starts school, this practice kit refers specifically to the following timeframe:
An infant’s mental health is shaped through interpersonal connections, particularly their interactions with primary caregivers.
Perinatal and infant mental health are inextricably linked, as a parent’s or caregiver’s emotional wellbeing directly affects their ability to form secure, responsive relationships with their baby. These early interactions are critical for shaping the infant’s brain development, sense of safety, and capacity for healthy attachment.
Early relational trauma, such as neglect, parental mental illness or exposure to domestic and family violence, can disrupt this sense of safety, impacting both attachment and development.
Increased period of risk
The perinatal period is the most common time for a pregnant person to experience a mental health issue with anxiety and depression the most common. Men are also affected as well as trans/gender diverse people. Around 30% of pregnant people with depression experience suicidal ideation and suicide is one of the leading causes of maternal death in the first year after birth (PANDA (a).
Symptoms of perinatal mental health challenges vary in presentation and severity. People with prior mental health struggles can experience very different symptoms perinatally (PANDA (a). These symptoms may look and sound like:
- ‘I don’t know how to be a mum, have I made a mistake’
- ‘How are we going to manage? Am I going to lose my job?’
- ‘Everyone is helping with the baby, the birth was so traumatic and I just feel numb’
- ‘I thought I’d be good at being a mum but I feel like such a failure’
- ‘I am so worried about baby – am I a terrible Mum?’
- ‘What If I turn out to be just like my father – they’ll be better without me around’
Many people use alcohol and other substances (prescription, over the counter or illicit) to self-medicate.
The perinatal period is a vulnerable time for all parents, with increased risk of re-triggering trauma such as family violence, sexual assault, childhood abuse, war experiences, and grief and loss. These stressors can contribute to anxiety, depression, and difficulties adjusting to pregnancy and early parenthood.
Aboriginal and Torres Strait Islander parents face additional risks due to the ongoing impacts of colonisation, intergenerational trauma, and higher exposure to stressful life events. Aboriginal parents—especially in regional and remote areas—experience higher rates of perinatal anxiety and depression.
CALD parents may experience perinatal mental health challenges shaped by cultural expectations, stigma, language barriers, racism and limited or conflicting social supports. Acculturation stress, and unfamiliarity with the healthcare system can further discourage help-seeking.
Pregnancy is also a time of high risk for domestic and family violence including emerging partner violence. (Refer to the practice kit Domestic and family violence, Pregnancy or new birth.)
Practice prompt
While a previous diagnosis of mental health issues is the strongest risk factor for perinatal mental ill-health, individuals with this history may also demonstrate protective factors, such as strong help-seeking behaviours, awareness of their warning signs, and established connections with professionals or support networks.
When parents are involved with child safety during pregnancy, birth and postpartum, it is important to consider how Child Safety’s involvement impacts parents’ overall perinatal well-being.
Assess each person’s unique circumstances to identify both risks and supports, tailoring interventions on a case-by-case basis.
The following table sets out questions to prompt conversations about a parent’s perinatal journey.
| Questions for pregnant parents | |
| Pregnancy and planning | Was the pregnancy planned or a surprise? Was the baby wanted? How did you feel when you found out you were pregnant? How did others (partner, family, friends) respond to the news? What kind of support did you have during the pregnancy? |
| Physical and emotional experience of pregnancy | How did you feel physically during the pregnancy? How did you feel emotionally? (e.g. calm, anxious, low, excited, detached) Did you have any worries about your health or the baby’s health? Were there any stressful or difficult events during that time? |
| Birth experience | Tell me about your birth experience? Was it how you expected it to be? Were there any complications or unexpected events? How did you feel about the care you received during labour and after? How did you feel emotionally after the birth? |
| Postnatal period | How were those first few weeks after bringing baby home? How did you feel physically and emotionally? How was your sleep and energy level? Did you feel bonded with your baby straight away, or did that take time? Were there times you felt overwhelmed or low? Did you have support from family, friends, professionals? |
| Current mental health and support | How are you feeling in yourself now? What helps you cope when you’re feeling tired or stressed? Have you ever talked with anyone (GP, midwife, health visitor, counsellor, family member) about your feelings? Are there times you’ve felt you needed more support than you had? |
| Questions for partners Partners can have significant emotional reactions to pregnancy and early parenting and these can often be overlooked. |
|
| Reaction to pregnancy | How did you feel when you found out your partner was pregnant? What was your role during the pregnancy — how involved did you feel? Was the baby wanted? How was your relationship during the pregnancy? |
| Pregnancy and birth experience | What was the pregnancy like for you — emotionally or practically? How did you feel about the birth experience? Were you present at the birth? If so, what was that experience like? Were there any moments that were particularly worrying or stressful? |
| Adjustment to parenthood | How did life change for you after the baby arrived? How have you been coping with the changes (sleep, routine, responsibilities)? How would you describe your relationship with your baby now? How has your relationship with your partner changed since the baby arrived? |
| Mental health and support | How have you been feeling emotionally since becoming a parent? Have there been times you’ve felt down, anxious, or overwhelmed? Do you feel you have someone you can talk to about how you’re feeling? What kind of support would be most helpful for you right now? |
Practice prompt
Ask in a private, safe setting — sometimes one parent may not disclose concerns in front of the other.
Use a strengths-based tone. For example, ‘Tell me what’s been helping you cope?’.
Normalise emotional struggles. For example, ‘Many parents find the early months hard — how has it been for you?’
Note attachment indicators including how parents describe bonding, eye contact and responsiveness.
Be alert to risk factors. For example, trauma, depression, anxiety, isolation, domestic violence, substance use, prior loss.
Postpartum depression
Postpartum depression is a mental health condition that affects some parents after the birth of a baby. It goes beyond the ‘baby blues’ and involves persistent feelings of sadness, exhaustion, anxiety, or hopelessness that can interfere with daily life and the ability to care for the baby.
It may also include difficulty bonding with the baby, changes in appetite or sleep, and feelings of guilt or worthlessness. Postpartum depression is treatable, and accessing support early is important for both the parent and the baby’s wellbeing (Healthdirect Australia).
Perinatal psychosis
PANDA (b) describes psychosis as a rare but serious mental health condition, which affects the way we experience reality. Perinatal psychosis is often a transient experience that can both come on and resolve quickly.
One of the earliest warning signs of psychosis is the inability to sleep (Carr et al.).
Signs and symptoms include:
- hallucinations (sensing things that others can’t perceive).
- delusions (unusual thoughts and beliefs that may not align with our collective perception of reality – delusions persist despite any and all evidence to the contrary).
- mania (elevated and extreme changes in mood, emotions, energy and activity levels).
- mood swings and depression.
- thoughts and behaviour that appear disorganised to others.
- suicidal, infanticidal and/or homicidal ideation (thoughts of harming/killing self, baby and others).
Psychosis is often misunderstood and widely feared, which contributes to the significant stigma surrounding this mental health condition (PANDA (b)).
Cultural context is crucial when working with someone experiencing perinatal psychosis as many people’s belief systems, cultural practices and interpretations of their experiences can help you connect and support a person effectively (PANDA (b)).
Attention
Engage and connect
Parents experience various barriers to acknowledging how they are feeling and help-seeking (PANDA (a)). These include:
- Personal barriers, such as fear of judgement and child removal, shame, internalised mental health stigma and fear of failure to themselves or their family or cultural community.
- Social barriers, including isolation, poverty, low perinatal mental health awareness or feeling society’s expectations on them that they should feel happy as a new parent.
- Health system barriers, such as limited services or access to services and healthcare providers tendency to minimise issues until they are acute.
The journey to recovery can start with a supportive conversation identifying support people and services providing options so the person can elect what type of intervention best suits them (PANDA (a)). These can include:
- talking to a GP
- connecting with helplines or web-based chat support
- crisis services
- referral to a perinatal specialist mental health service or clinician.
Supporting parents to access holistic services, including those for parenting, infant feeding, sleep and settling, playgroups, income or housing assistance, and culturally safe options such as family wellbeing services, can encourage and strengthen help-seeking behaviours.
Practice prompt
Everything needed to support someone contemplating suicide is already within reach: focus on building a genuine connection through compassion, kindness, curiosity, and a non-judgemental approach.
Having this conversation about perinatal suicide is an intervention (PANDA (c)).
(Refer to Suicide and non-suicidal self-injury.)
Further reading
PANDA learning hub – search for the following short eLearning courses:
- Perinatal mental health: an overview
- Perinatal psychosis: what we know about it
- Perinatal suicide: one conversation can save a life.
Support for pregnant person and infant
Physical and mental health are both vital throughout the journey to parenthood, with support provided to the pregnant person directly influencing their baby’s mental health.
Supporting both parent and infant together is essential to fostering a secure and nurturing environment.
Support should prioritise strengthening the parent-infant bond, guiding parents to read and respond to their baby’s cues, and improving parental mental health to foster a secure and nurturing environment. (Refer to Engagement strategies with parents.)
In-patient perinatal and infant mental health care
Queensland provides two specialised in-patient perinatal mental health care options:
- Catherine’s House for Mothers, Babies and Families (Brisbane): Located at Mater Mothers’ Hospital, Catherine’s House offers holistic care for mothers experiencing perinatal mental health challenges. This facility provides integrated support, including mental health treatment, parenting assistance, and family-focused care, all while allowing mothers to stay with their babies.
- Lavender Mother and Baby Unit (Gold Coast): Based at Gold Coast University Hospital, the Lavender Unit is a dedicated six-bed facility where mothers can receive intensive mental health care while remaining with their babies. The unit focuses on treating mental health conditions, strengthening the parent-infant bond, and supporting parenting skills in a safe and nurturing environment.
Both facilities are designed to support the mental health and wellbeing of mothers while fostering the parent-infant relationship.
Out-patient perinatal and infant mental health care
Queensland provides several out-patient options for perinatal and infant mental health care. Identify what services may be available in specific regions by calling ForWhen - Perinatal & Infant Mental Health Care Navigation (Ph: 1300 24 23 22). This is a free, national care-navigation phone service connecting parents to perinatal mental health services and resources. This service is available to:
- new and expecting parents with infants up to 12 months of age
- parents experiencing or at risk of perinatal anxiety and depression
- professionals seeking information on local services.
Infant mental health
Infant mental health refers to the emotional and social development of babies and toddlers from birth to around three years of age. It includes their ability to:
- experience and express emotions (like joy, fear, or frustration)
- form secure relationships with caregivers and others
- explore and learn from their environment.
Healthy infant mental health lays the foundation for lifelong wellbeing. It’s shaped by consistent, responsive caregiving, safe environments, and early relationships especially with parents or primary carers.
These abilities develop best within a caregiving environment shaped by family, community, and cultural expectations, forming the foundation for healthy social and emotional development (Evolve (a)).
A state of coherence of the infant’s support system with the infant at its centre is essential for optimum developmental outcomes.
Positive infant-carer interactions strengthen an infant’s brain development which acts as a buffer against maladaptive brain function and mental illness later in life.
Identifying emotional and psychological harm and risk of harm for infants must therefore consider the health and function of the infant’s whole support system.
Practice prompt
Do the members of the infant’s support system:
- see the infant
- hear the infant
- place value on nurturing the infant.
Here are some observations for infant wellbeing:
Attachment and Relationships
- How does the infant respond to caregivers and familiar adults?
- Does the infant seek comfort when distressed? How easily can the infant be soothed?
- Is there eye contact and social engagement (smiling, cooing)?
- Does the infant show signs of distress when separated from a caregiver?
- How does the infant react to new people or environments?
Emotional Expressions
- Are the infant’s emotional responses appropriate for the situation (e.g., smiling when happy, crying when upset)?
- Are there signs of excessive irritability, withdrawal, or inconsolable crying?
- Does the infant demonstrate positive affect (laughing, interest) during play and interaction?
Regulation and Self-Soothing
- How does the infant manage states of arousal or distress?
- Does the infant use self-soothing behaviours like thumb-sucking or holding a comfort object?
- How long does it take for the infant to calm down after being upset?
- Are there signs of over- or under-stimulation (e.g., hyperactivity, lethargy)?
Developmental Milestones
- Is the infant reaching typical physical, cognitive, and social milestones (rolling over, babbling, responding to sounds)?
- Are there delays or regressions in developmental skills?
Interaction with Environment
- Does the infant show curiosity or interest in toys and surroundings?
- How does the infant engage during play? Are they active or passive?
- Does the infant respond to sensory stimuli (sounds, textures, movement)?
Communication
- Does the infant vocalise and respond to sounds?
- How does the infant express needs (crying, gestures)?
- Are caregivers or parents responsive to these communications, and is there a reciprocal interaction?
Sleep and Feeding Behaviours
- Are sleep patterns consistent or disrupted?
- Are there difficulties during feeding (refusal, distress)?
Further reading
Practice guide Infants at high risk
Child Protection Manual Victoria: Mental health assessments and treatment - advice
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