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Perinatal services are overstretched and a post code lottery means women often struggle to access support. So, how can independent pharmacies help? Kathy Oxtoby explains…

Perinatal mental illness, which occurs during pregnancy or in the first year following the birth of a child, affects up to 27 per cent of new and expectant mums and covers a wide range of conditions, according to NHS England.1

But perinatal services are overstretched. A report by the Maternal Mental Health Alliance (MMHA) reveals that women in England are suffering due to patchy Maternal Mental Health Service provision.2

Analysis from the Royal College of Psychiatrists (RCPsych) finds that almost two thirds of Integrated Care Boards in England planned real terms cuts to funding to perinatal mental health services in 2024-2025, despite demand being as high as ever.3 The College warns that without UK Government prioritisation, progress in increasing access to maternal mental health services could stall.3

Record numbers of patients

Dr Livia Martucci, Chair of the Royal College of Psychiatrists’ Perinatal Faculty, says specialist perinatal and maternal mental health services are seeing “record numbers of patients”.

“Despite this, the number of people in need of care continues to outstrip service capacity. The UK Government must therefore reinforce its ambition to provide specialist perinatal mental healthcare to all women who need it in the upcoming NHS 10-Year Plan.”

She says pharmacy staff “also have a role to play in signposting mothers and their partners to sources of support and might find it useful to learn the signs of perinatal mental illness, which can often be masked by other feelings commonly experienced during pregnancy”.

“They may also be able to provide people with advice on how to take their medication and what side effects it might cause,” says Dr Martucci.

“Decisions about taking medicines during pregnancy and breastfeeding require careful consideration, and advice from the prescribing doctor should be sought before discontinuing or changing treatment.

“This highlights the importance of continued funding for specialist services, so that expert advice can be provided in a timely fashion.”

Good position to spot early signs of perinatal mental illness 

“As a community pharmacist, you are highly accessible and often see new and expectant mums regularly, says Professor Claire Anderson, Royal Pharmaceutical Society (RPS) President.

“This puts you in a good position to spot early signs of perinatal mental illness and offer support, whether that’s providing prescriptions or offering advice about symptoms.

“Some women, especially from Black African, Asian and White Other backgrounds, face extra barriers to getting help. You can help bridge this gap by engaging with local communities, using culturally sensitive approaches and signposting to appropriate support,” she says.

Perinatal mental illness refers to “a range of mental health conditions that can affect women during pregnancy and up to a year after giving birth”, says Professor Anderson.

“This can include depression, anxiety, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). It can be caused by hormonal changes, sleep deprivation, birth trauma or previous mental health history. Treatment can include therapy, support from GPs or health visitors, peer groups and in some cases medication,” she says.

“Pharmacists need to be aware when speaking to pregnant women that there can be issues during pregnancy affecting mental health,” says Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

Worrying differences in the patient’s behaviour

Noticeable changes in behaviour could be a cause for concern and a sign that the pregnant woman or new mother may require a referral. To help pharmacists recognise if there are any worrying differences in the patient’s behaviour, they can draw on their knowledge of, and previous encounters with them, she says.

“Look out for signs such as ongoing low mood, anxiety or a mother seeming overwhelmed,” says Professor Anderson.

“A friendly, non-judgemental conversation can make all the difference. If you’re concerned, refer them to their GP, midwife, health visitor or local perinatal health service if available.

“Remember that some women may face stigma, language barriers or may not know what support is out there, so it’s important to approach the conversation with cultural awareness and sensitivity.”

Pharmacists should be aware of the facilities and services patients can be signposted to. “It’s good practice,” says Ms Thakerar.

For example, they can signpost pregnant women and new mothers to mental health charities like Mind, for information and support, she says. [https://www.mind.org.uk/]

At Ms Thakerar’s pharmacy, a laminated poster listing different support organisations is on display where patients are seated waiting for prescriptions. “Pharmacists need to have some kind of signposting poster displayed where patients can easily see it, and, importantly, it needs to be kept up to date,” she says.

To feel confident supporting women with perinatal mental illness, “pharmacists should have access to culture awareness training, clear referral information and time to have thorough conversations with patients”, says Professor Anderson.

“Better integration with GPs and wider primary care teams would strengthen their role and improve outcomes for women. Tailoring services to meet the needs of different ethnic groups is also essential to reducing disparities in care.”

“Ideally, I’d like to work with midwives and with organisations such as Mind. And I would like pharmacists to be involved with other support systems that are set up locally, and have continual communication with GPs,” says Ms Thakerar.

“If we are going to be involved in the care of a new mother or pregnant woman we need to work as a team with other healthcare professionals,” she says.

“Having a new baby, especially a first baby, is a very anxious time, so new mums need to make sure there is a good support system in place, be it family, friends, or neighbours," says Ms Thakerar.

Regarding the ‘basics’ for new mums looking after their babies, pharmacists can advise to ensure that any baby equipment, such as feeding items, are sanitised, and that nappies are changed regularly and are the right size. And new mums need to ensure they don’t run out of nappies or milk products, she says.

If babies are crying a lot or having issues sleeping, then new mums should seek support, including from other mothers, and parent charities, she says.

Pharmacists need to be up to date on how to care for babies with colic, and to use that knowledge, and the knowledge from manufacturers of colic products, to advise new mothers, she says.

“We have a very wide range of colic products available,” says Ms Thakerar. The pharmacist and staff can educate the mother on which products to use, and how to use them, based on what the symptoms are, she says. “And we shouldn't randomly recommend something - there has to be an assessment of the baby’s needs.”

“You can provide trusted advice to new mums worried about colic by helping them understand what’s normal, what might help (gentle soothing or winding techniques) and when to seek further help,” says Professor Anderson.

Pharmacists can help pregnant women stay healthy by offering advice on their lifestyle and healthy eating, as well as supporting them to manage long-term conditions safely and referring them to smoking cessation services if needed, says Professor Anderson.

Pregnant women are advised to have blood tests taken on a regular basis to detect any deficiencies, particularly iron deficiencies, which if identified, a GP may then recommend iron tablets or to add iron to the diet, says Ms Thakerar.

She says advice to pregnant women about staying healthy will also “depend on the individual pregnancy”.

“And it’s not just about mothers looking after their babies,” she says. “Pharmacists should advise mothers: if you look after yourself, your baby will be better looked after.”

References

1. NHS England Perinatal mental health. https://www.england.nhs.uk/mental-health/perinatal/

2. Maternal Mental Health Alliance (MMHA) (2024) Women in England are suffering due to patchy Maternal Mental Health Service provision.  https://maternalmentalhealthalliance.org/news/england-maternal-mental-health-service-progress-report/

3. Royal College of Psychiatrists (RCPsych) (2025) Progress expanding maternal mental healthcare at risk. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2025/05/08/progress-expanding-maternal-mental-healthcare-at-risk