Perinatal Mental Health and ways to get support

Perinatal mental health in parents of twins, triplets or more

Perinatal mental health describes emotional wellbeing from conception, through pregnancy and birth, until your child’s second birthday. It includes mothers, fathers, babies and the wider family.

Perinatal mental illness is when difficulties go beyond everyday stress. Left untreated, it can have a significant and long-lasting impact on you, your children and your relationships. Getting support early can make a real difference.

The first one thousand days of life, from conception until your child turns two, strongly influence their development and later health. This is why perinatal services often support parents until their child’s second birthday.

Research, including Twins Trust State of the Nation report (LINK), shows that families with twins, triplets or more are much more likely to develop perinatal mental health problems. High levels of anxiety can continue into the second and third year after pregnancy.

Perinatal mental illness affects fathers as well as mothers. PANDAS reports that around one in 10 fathers experience a perinatal mental illness, and between 25% and 50% will experience anxiety or depression when the mother also has a perinatal illness.

A 2022 multinational study led by Johns Hopkins School of Medicine, Flo Health and the Reproductive Psychiatry Research Program used the Flo app to survey more than one million people, including over 26,000 parents of twins. Mothers of twins reported more postpartum depressive symptoms than mothers of singletons, at 11.3% compared with 8.3%. For mothers of twins aged 40 and over, this rose to about 15%.

These findings reflect what many parents of multiples feel in real life. Caring for more than one baby at the same time is rewarding and also very demanding, so it is understandable to need extra support.

How perinatal mental illness feels and key triggers with multiples

Common perinatal mental health conditions include antenatal and postnatal depression, antenatal and postnatal anxiety, perinatal obsessive compulsive disorder, postpartum psychosis, postnatal post-traumatic stress disorder and tokophobia, which is an extreme fear of childbirth. Some women also notice changes in eating patterns during and after pregnancy.

Depression may show up as feeling low most of the time, losing interest in things you used to enjoy and finding it hard to concentrate or make decisions. You might feel exhausted, tearful, irritable or numb, lose confidence, feel guilty or worthless or have thoughts of harming yourself or ending your life. You may struggle to bond with your babies, which can be very frightening.

Anxiety can mean feeling on edge most of the time, with racing thoughts and a strong sense that something bad is going to happen. Physical symptoms can include a racing heartbeat, chest pain, shortness of breath or hyperventilation, dizziness, sweating, shaking, tingling in your hands or feet, stomach churning and general aches and pains.

Some experiences can increase the chance of perinatal mental health problems, especially when you have more than one baby. Key triggers include:

• Previous mental health problems, childhood trauma or difficult early parenting experiences
• Low or no social support, and caring for more than one baby with little practical help
• Domestic abuse, substance misuse or serious relationship conflict during pregnancy or after birth
• Major life stresses such as bereavement, job loss, separation or housing problems
• Financial strain
• Limited childcare options, difficulty finding enough nursery places and relatives feeling unsure about caring for more than one baby
• Pregnancy illnesses such as hyperemesis or symphysis pubis dysfunction, which are more common in multiple pregnancy
• Pregnancy and birth complications, including caesarean birth and several obstetric problems that can mean a longer recovery
• Prematurity, time on a neonatal unit and babies with additional or complex needs
• The loss of your own mother in pregnancy or early parenthood, or parenting as a teenager

These patterns were highlighted in the State of the Nation report (TT - LINK), which also shows that families with multiples often face several of these triggers at the same time. None of this is your fault, and asking for support is a sign of strength, not failure.

Treatment and support choices for your mental health

Perinatal mental health problems are treatable. With the right help, you can recover and enjoy life with your children.

Self-help strategies can sit alongside professional care. These might include regular meals, gentle movement, keeping in touch with friends, joining mother and baby groups, using peer support from other parents of multiples and trying mindfulness, journalling, art or crafting to manage emotions.

Psychological therapies are another key option. Your GP, midwife or health visitor may refer you for cognitive behavioural therapy, counselling, psychotherapy or eye movement desensitisation and reprocessing. These approaches can help you make sense of your thoughts and feelings, process trauma and build new coping skills.

Medication can also play an important role for some parents. This might include antidepressants, antipsychotic medication or other medicines recommended by a GP or perinatal psychiatrist. Your team will talk with you about benefits, possible side effects and safety in pregnancy and breastfeeding so you can decide together what feels right.

Severe illnesses such as postpartum psychosis usually need urgent specialist care. Parents are often admitted to a mother and baby unit, so they can stay with their baby while receiving intensive treatment. Before you go home, staff will work with you to create a wraparound care plan, including medical follow up, clear support at home and gradual day visits to help you feel ready for discharge.

Everyday ways to protect your wellbeing as a parent of multiples

If anything in this article feels familiar, talk to your GP, midwife or health visitor as soon as you can. You can also speak to trusted friends or family or get in touch with our helpline. Reaching out early can reduce how long perinatal depression or anxiety lasts. With the right help, it doesn’t have to overshadow your children’s early years.

Connecting with other parents of twins, triplets or more can help you feel less alone. You might find this through your local twin club or through our online communities.

Partners have an important role too. Keep asking each other how you really are, not just how the babies are. It’s okay to say you’re struggling and to ask for a break or extra support. Fathers and partners can experience perinatal mental illness themselves and deserve help in their own right. Connect with another dad through our Dad Peer Support Service

Friends and family can make a big difference by offering very practical help. They might bring food or arrange online shopping deliveries, help with feeding, settling, changing nappies and clothes, prepare simple snacks and meals or do light housework so you can rest. Loved ones can also research local services, share information and gently encourage you to speak to professionals.

You may also want to explore specialist organisations such as PANDAS, which offers information and support for parents affected by perinatal mental health problems.