Many types of antenatal stress, not only a diagnosed mental illness, can alter fetal development with a long-lasting effect on the child. There is an increased risk of many types of neurodevelopmental disorder in the child, as well as some physical problems such as asthma, although most children are not affected; the underlying biological mechanisms include alterations in the function of the placenta, the HPA axis and immune system, and epigenetic changes in the child; the impact may be even greater in lower- and middle-income countries, with added stresses due to poverty, food insecurity and high levels of domestic violence among other factors; the implications are that the mental well-being of all pregnant women should be considered and causes of stress addressed where possible. These stresses include the relationship with the partner, pregnancy-related anxiety, exposure to a disaster, or early childhood trauma.

Published studies examining medically unexplained symptoms (MUS) in perinatal women are thin on the ground. Keyword searches of research databases bring up titles such as ‘Psychosomatic Obstetrics and Gynaecology – a neglected field?’ However, whilst there is little research on this narrow topic, there is an extensive literature on MUS in other populations. This chapter draws mainly upon that literature and attempts to apply it to pregnancy and the puerperium in a way that will, it is hoped, prove clinically useful.

Difficult lessons from the Confidential Enquiries into Maternal Deaths remind us that thorough clinical assessment, detailed mental state examination and an appreciation of the dynamic nature of risk and its management are central to the effective treatment of women with perinatal mental illness. This is underpinned by the establishment of a trusting, respectful and honest relationship with the woman, which sees her as a partner in decision-making, and a detailed knowledge of the distinctive presentations and risks associated with illness in pregnancy and after childbirth, and its consequences for the woman and her infant.

Eating disorders can have a profound impact on women during the pre-conception, antenatal and postnatal periods, and this has implications for their care and treatment. This chapter describes the rate, course and risk factors for eating disorders within the context of the perinatal period. It covers what is known from current research and clinical evidence about the effect of the most common eating disorders on pre-conception health, pregnancy and birth outcomes. Drawing on existing clinical guidance and research evidence, it provides an overview of the guidance and recommendations for the assessment, management and treatment of eating disorders from pre-conception through to the postnatal period.

Millions of women and girls worldwide experience violence. Violence against women and girls takes many forms, including physical, emotional and sexual violence and abuse, which is associated with a range of adverse impacts on women, their families and society as a whole. Health professionals supporting women during the perinatal period should assess the risks posed by exposure to previous or current violence and how this may affect them during pregnancy. As an important risk factor in a woman’s mental health presentation, psychiatrists working with pregnant and postpartum women should consider the presence of violence in their formulation; it can increase the risk of anxiety, depression and post-traumatic stress disorder (PTSD). Domestic violence and abuse increase the risk of domestic homicide and may play a role in many perinatal suicides. Sensitive assessment and effective management of women exposed to violence can improve engagement with mental health services and response to treatment.

The UK has led the development of specialist perinatal mental health services since the latter half of the last century. However, new innovations in service design and delivery continue to present challenges for commissioners and providers. This chapter reviews the evolution of specialist care across the UK and in Ireland and identifies how services may need to respond to changing demand.

Postpartum psychosis is a condition of great clinical and public health importance. Severe episodes of mental illness in the perinatal period can result in significant distress, may disrupt the developing relationship between mother and child, and have long-term implications for the well-being of the woman, her baby, family and wider society.

In this chapter we will discuss what we know about this condition and its relationship to bipolar disorder, how it might best be defined, what we still need to find out, and consider how it should be managed.

Personality disorder (PD) is a complex condition, which has been the subject of both debate and research. However, maternal PD has only been the focus of research in the last two decades. In this chapter I discuss that research in the context of what is known generally about PD, as a disorder with a predictable presentation of signs and symptoms; an aetiology, and indications for effective treatment. There has been more research on maternal PD in the last 15 years, which shows that mothers with PD may struggle to care for their children, especially in the postnatal period, and their mental health may also deteriorate during pregnancy. In this chapter I describe the issues described above and discuss how clinicians approach the management of mothers with PD. I place special emphasis on the impact of maternal PD on mother-child relationships and attachment, and the implications for child health.

During the first three years of life our brain develops exponentially, and synaptic connections are formed faster than at any other period of our lives. The organisation of its processes is directly affected by early life experiences. It is therefore vitally important that families, healthcare providers and early intervention professionals understand early brain infant development so that they can fully support infants on to achieving their full potential. This chapter provides an insight into the typical development of core occupations and sensory systems by age, in the first year of life, highlighting the essential role that parents, carers and health professionals have at each stage. Sections on sensory deprivation and carers’ mental health issues are included.

Despite increasing ethnic diversity and a rising proportion of births to migrant women, inequalities in health and care experiences for racial and ethnic minority groups have been a persistent challenge in the UK, with perinatal mental health being no exception. Whilst it is important to acknowledge that inequities in maternal health are a global phenomenon, there is a clear and alarming pattern of people from racialised groups (i.e. those who, based on their skin colour, are disadvantaged due to normalisation of an array of dynamics that favour white people) experience worse maternal outcomes in many high-income countries. Which specific groups experience worse outcomes is dependent on the sociocultural context rather than biological determinism. Childbirth has both a biological and a cultural definition. It is also a political and social phenomenon shaped by the society we live in. Humans’ actions such as the cultural creation of traditions, customs and rules affect childbirth practices directly. These actions take place through social interactions, communication and exchanges inside social institutions and can often be dismissed in the current culture of medicalisation of birth.

Leadership is a very fashionable term and firmly established in the lexicon of managers in both the private and public sectors and within domestic and international politics. As a concept, it is complex, multifaceted, dynamic and invariably influenced by the context and organisational culture in which it occurs.

The chapter begins with an overview of different ideas about leadership, examining ‘wicked’ and ‘tame’ problems, the distinction between leadership and management, psychiatrists as leaders and different leadership styles. We then delve into the emerging fields of compassionate and systemic leadership, emphasising relational trust, diversity and collaboration. We explore the role of contention, developing collaborative relationships, the centrality of developing relational trust and working with diversity. The chapter concludes with a discussion focused on the ubiquitous influence of conflict in organisations. Throughout, we will explore leadership through multiple lenses to unlock new possibilities for practice.

Suicide remains a leading cause of maternal death in the UK and in other high-income countries. While there are clear risks in severe mental disorder, those who die have experienced a range of mental illnesses and often come from more deprived communities. The Confidential Enquiries highlight the distinctive patterns of occurrence and progression in perinatal mental illness and the need for improvements in clinical evaluation of risk, effective risk management and the availability of high-quality perinatal mental healthcare as important factors in helping reduce progression to suicide.

Pregnancies among individuals with schizophrenia spectrum disorders have increased in recent years. In the perinatal period, individuals with schizophrenia spectrum disorders are faced with managing the unique effects of their symptoms on pregnancy and parenting, which fluctuate through the perinatal period with the early postpartum being a high-risk time for relapse. Their pregnancies are also associated with a range of adverse pregnancy, neonatal and long-term child outcomes, the risk for which may be related in part to modifiable factors. Prejudice, discrimination and subsequent isolation of perinatal individuals with schizophrenia spectrum disorders may limit health care and social support opportunities in this group, further exacerbating the risk for negative outcomes. These issues underscore the need for comprehensive management approaches including attention to pre-conception health, medication management during pregnancy and postpartum, and multifaceted support for the parent and family. This chapter is an overview of schizophrenia spectrum disorders in the perinatal period, including a summary of the epidemiology, clinical presentation, course, outcomes and management.