A perinatal psychiatrist specialises in mental health during pregnancy and the year that follows birth, a period where two things change the usual rules of psychiatric care. First, some conditions behave differently: mood can shift more sharply, and a past history of bipolar disorder or postpartum psychosis carries a real risk of recurrence around childbirth that needs planning for in advance. Second, every decision about treatment now affects two people rather than one.
Medication in pregnancy and breastfeeding
Deciding whether to start, continue or stop a medication during pregnancy or while breastfeeding is not something to work out alone or guess at from general information. A perinatal psychiatrist weighs the risk of untreated illness to the mother against any risk a medication might carry to the baby, a balance that shifts depending on the specific drug, dose and stage of pregnancy involved.
Planning ahead
Where someone has a known history of bipolar disorder or a previous episode of postpartum psychosis, a perinatal psychiatrist will often be involved before birth to put a plan in place for the days and weeks afterwards, when risk is highest. Postpartum psychosis itself is a medical emergency: it develops quickly, usually within the first two weeks after birth, and needs urgent same-day assessment rather than a routine appointment booked further ahead.