A Clinical Guide for GPs and Allied Health
Anxiety is the most prevalent mental health condition in the perinatal period, affecting approximately one in five pregnant people and new parents. It’s also among the most frequently underidentified, because some degree of worry during pregnancy and early parenthood is considered normal, and because perinatal anxiety often presents in ways that don’t match the standard picture.
This post is for GPs, obstetricians, midwives, maternal and child health nurses, and allied health professionals who want a clearer picture of how perinatal anxiety presents, which screening tools are most useful, and when a referral to a perinatal therapist is the right next step.
What the perinatal period covers
The perinatal period begins before conception and extends through the first year after birth. Anxiety can emerge at any point across this span, including during preconception, through pregnancy, immediately postpartum, or in the months that follow. It’s worth screening at multiple points rather than only at a single postnatal visit.
How perinatal anxiety differs from generalised anxiety
Generalised anxiety disorder involves persistent, difficult-to-control worry across multiple areas of life. Perinatal anxiety tends to organise itself more specifically around the pregnancy, the birth, or the baby. This focus can make it easier to normalise in a clinical setting, particularly when a patient frames their distress as concern for their child’s welfare.
Common presentations of perinatal anxiety include persistent or excessive worry about the baby’s health or safety, fear of childbirth including in people who have previously given birth, difficulty sleeping even when the baby is sleeping, physical symptoms such as nausea, palpitations, muscle tension or shortness of breath, and avoidance of situations related to the pregnancy or the baby.
It can also present as difficulty accepting help from others, including a partner, and an inability to allow anyone else to care for the baby without significant distress.
Intrusive thoughts and what they mean clinically
One presentation that’s worth understanding clearly is intrusive thoughts about harming the baby. These thoughts are ego dystonic, meaning they are distressing and inconsistent with the person’s intentions or character. A parent experiencing these thoughts is typically horrified by them and wants them to stop.
This is clinically distinct from active thoughts of harm, which carry intent. Intrusive thoughts of harm are more common than most people realise, in both parents and non-parents, and they are not a reliable predictor of risk. They are, however, a reliable indicator that the person needs clinical support and that those thoughts are not going to resolve without it.
If a patient discloses this kind of experience, it’s worth responding calmly and without alarm. Panic or an overly serious reaction can cause the patient to shut down and avoid seeking further help. Acknowledge what they’ve shared, normalise the experience appropriately, and refer.
Screening tools for general practice
The Edinburgh Postnatal Depression Scale is the most widely used screening tool in the perinatal period and it includes an anxiety subscale. While its name suggests postnatal use only, it can be administered across the full perinatal period, including during pregnancy.
The GAD-7 is a validated measure for generalised anxiety disorder and is useful alongside the EPDS when a more detailed picture of anxiety severity is needed. The PHQ-4 offers a brief combined screen for both anxiety and depression when appointment time is limited.
None of these tools replaces clinical assessment, but they can support the conversation and provide a useful baseline for monitoring across appointments.
Signs a referral to a perinatal therapist is warranted
Consider referring to a perinatal therapist when a patient presents with anxiety symptoms that have persisted for more than two weeks, are increasing in intensity, or are interfering with daily functioning, sleep, or their relationship with their baby or partner.
Earlier referral is more effective than waiting for the presentation to become severe. Many patients will minimise their symptoms or express uncertainty about whether what they’re experiencing is serious enough to seek support. Normalising the referral as a practical and proactive step tends to be more effective than waiting until the patient presents in crisis.
A referral is also worth considering after pregnancy loss, infertility treatment, a difficult birth experience, or a significant neonatal health event, even when the patient doesn’t present with obvious distress. These experiences carry a high risk of delayed anxiety and grief that may not surface immediately.
What perinatal therapy involves at The Therapy Hub
Michelle Phan is an Accredited Mental Health Social Worker and perinatal therapist at The Therapy Hub. She works with pregnant people and new parents experiencing anxiety, depression, birth trauma, perinatal loss, and the emotional complexity of the transition to parenthood.
Michelle uses a trauma-informed, evidence-based approach drawing on CBT, ACT, EMDR and mindfulness-based therapies. She is neuroaffirming and LGBTQIA+ affirming, and she works with both birthing and non-birthing parents.
She is currently available with no waitlist, in person in Footscray and via telehealth across Victoria.
Sessions from $200. Medicare rebates are available with a valid Mental Health Care Plan.
How to refer
You can refer by fax to (03) 9923 6856, by email to hello@thetherapyhub.com.au or by phone on (03) 9958 8772. Clients can also self-refer directly through our website.
If you’d like to discuss whether a patient is suitable for referral before making contact, we’re happy to take that conversation.
For a patient-facing resource on recognising perinatal depression and anxiety, you’re welcome to share Michelle’s blog post: How Do I Know If What I Am Feeling in the Perinatal Period Is Normal or a Sign of Perinatal Depression and Anxiety at thetherapyhub.com.au
thetherapyhub.com.au | 1/45 Ryan Street, Footscray VIC 3011 | (03) 9958 8772
Relevant resources
https://marievakakis.com.au/rethinking-who-you-are-after-having-kids/
Postnatal Support: https://thetherapyhub.com.au/postnatal-support/
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