Postnatal and antenatal depression and anxiety, online across NZ

What is perinatal anxiety and depression?

Perinatal anxiety and depression are mental health difficulties that begin during pregnancy or in the first year after birth. They go beyond the ordinary ups and downs of new parenthood: persistent worry, low mood, irritability or numbness that lasts weeks and affects daily life. They are common, affect partners as well as birthing parents, and respond well to psychological therapy.

Baby blues or postnatal depression?

In the first week or two after birth, most new mothers have days of feeling tearful, overwhelmed and unlike themselves. The Mental Health Foundation estimates three in four experience this "baby blues". Hormones are shifting, nobody is sleeping and your life has just reorganised itself around a very small person. The blues pass on their own within days.

Postnatal depression is different in severity and duration. The low mood, anxiety or flatness persists for weeks rather than days, deepens rather than lifts, and starts to affect how you function: eating, sleeping when you have the chance, caring for yourself, feeling anything for the baby or for the people around you. It can start in pregnancy, straight after birth, or months later, when everyone assumes you are fine.

It is common. Healthify He Puna Waiora, New Zealand's health information website, puts perinatal depression and anxiety at roughly 10 to 15 percent of women in the months after childbirth, and some New Zealand sources estimate up to one in five. Perinatal anxiety on its own, without depression, is also common and often missed because worrying about a baby looks like good parenting.

Much rarer, and different again, is postpartum psychosis, which the Mental Health Foundation estimates affects fewer than two in a thousand women. It involves confusion, hallucinations or beliefs that are clearly out of touch with reality, and it is a medical emergency: call 111 or go to an emergency department.

How perinatal anxiety and depression show up

Few people recognise themselves in a list of symptoms, so here is what it often looks like in an ordinary week:

• Dread building through the afternoon as the evening, and the long night, approach.
• Lying awake while the baby finally sleeps, because your mind won't stop running through what could go wrong.
• Crying in the car park at the supermarket and not being able to say why.
• Feeling nothing when the baby smiles at you, then shame for feeling nothing.
• Snapping at your partner, then deciding you are a terrible person.
• Constant worry about weight gain, feeding, milestones, the gap between you and the mums on Instagram.
• Not wanting to be left alone with the baby, or not wanting anyone else to hold them.
• Rehearsing what to say to the Plunket nurse so nobody realises how you're coping.
• Thoughts that your family would be better off without you. If you are having these, please tell someone today: your midwife, your GP, or call or text 1737. If you feel you might act on them, call 111.

Anxiety and depression often travel together in this period, and it is common to swing between racing worry and flat exhaustion in the same day. You don't need to work out which label fits before you ask for help.

Some parents also have sudden, unwanted thoughts or images of harm coming to the baby, which they find horrifying. These are most often a feature of perinatal OCD rather than depression, and they are treated differently. Our perinatal OCD page explains the distinction, without judgement.

Partners get it too

Perinatal depression and anxiety are not confined to the person who gave birth. A meta-analysis of 43 studies involving more than 28,000 participants found depression in about one in ten fathers during pregnancy and the first year, rising in the three-to-six-month window after birth, and found that when one parent is depressed, the other is more likely to be. Healthify gives a similar figure of around 10 percent of New Zealand fathers.

In partners it often shows up sideways: irritability, withdrawing into work or the garage, drinking a bit more, feeling shut out of the bond between mother and baby, or quietly deciding that their job is to hold everything together and that their own feelings don't count right now.

Partners can book with us in their own right. Sometimes the most useful thing is a session or two for the non-birthing parent on how to support someone with postnatal depression without disappearing themselves.

Book a session How booking works →

Therapy when you've had three hours' sleep

Therapy for perinatal anxiety and depression draws on the same approaches that work at any other stage of life, adapted to the realities of a newborn.

Cognitive behavioural therapy has the most evidence. A systematic review of 40 trials found CBT reduced depressive symptoms in both treatment and prevention studies across the perinatal period, with interventions begun after birth particularly effective. CBT here means working with the harsh, catastrophic thinking that sleep deprivation amplifies ("I'm failing", "something is wrong with the baby and I'm missing it"), building small, achievable moments of rest and connection into a day that has no structure, and gently reducing the checking and reassurance-seeking that feed anxiety.

In practice your psychologist will keep between-session tasks tiny and realistic. Nobody is asking you to journal for twenty minutes a night. A task might be one phone call to a friend, one short walk with the pram, or practising a two-minute breathing exercise during a feed. Healthify notes that most parents prefer a combination of practical support, talking therapy and peer support, and your psychologist will help you line up all three.

Where there has been a frightening or traumatic birth, trauma-focused approaches including EMDR may be part of the plan.

Medication, breastfeeding and your GP

Psychologists don't prescribe, and we won't advise you to start, stop or change any medication. Many parents recover with therapy and support alone. For others, medication is part of the picture, and the Mental Health Foundation lists it alongside talking therapy and peer support as a standard option.

If medication is on the table, your GP or a perinatal psychiatrist is the right person to weigh the options with you, including questions about pregnancy and breastfeeding, where the specifics matter and change over time. Your psychologist can help you prepare for that conversation and will continue working with you alongside any medication you and your doctor decide on. If you are already taking something, tell your psychologist so they understand the full picture.

Free and public support in New Zealand

You do not have to pay for help, and the public pathway is worth knowing even if you choose to see us.

• Your midwife or LMC and your GP are the front door. They can assess you and refer you to maternal mental health services, the publicly funded specialist teams for more severe perinatal difficulties. Referral usually goes through your GP, midwife or Well Child provider.
• PlunketLine, 0800 933 922, is a free helpline staffed by Plunket nurses 24 hours a day, for anything from feeding to how you are feeling.
• PADA (Perinatal Anxiety and Depression Aotearoa) provides information and a directory of local support groups at pada.nz.
• 1737: free to call or text at any hour, including the 3am feed, to reach a trained counsellor.

Private psychology makes sense if you want to start quickly, prefer to choose your psychologist, want online sessions you can do during a nap, or fall into the large group whose difficulties are real but not severe enough for specialist public services. Many health insurers contribute to the cost; we provide receipts.

Why online works for new parents

Getting a newborn, a nappy bag and yourself into a car and across town for a 10am appointment is a project. A video session is not. You can have your session while the baby naps, feeds or sits on your lap. If they cry, your psychologist will wait. If you are in pyjamas, nobody minds. Rural parents and parents without transport have the same access as anyone else.

The evidence supports the format. A 2022 meta-analysis of randomised trials found no difference between telehealth and face-to-face care for depression severity or satisfaction, and a broader 2021 meta-analysis of video-delivered psychotherapy reached the same conclusion across anxiety and mood problems. For many parents, the question isn't whether online is as good; it's that online is the only version that would actually happen.

A few things make it work better. Headphones help you hear over background noise and keep the conversation private if someone else is home. A laptop or tablet propped on the kitchen bench is easier than holding a phone with a baby in the other arm. And it is fine to say at the start of a session that you've had a terrible night; your psychologist would rather plan the hour around how you actually are.

What to expect at Mindwell

Katherine Lee's focus includes fertility and perinatal mental health, relationships and parenting, and sleep, and she works with parents, in individual sessions, on relationship and family dynamics. Candice van der Merwe's focus includes anxiety, depression, trauma and grief. Inge Prince's focus includes perinatal mental health, anxiety, mood, grief and emotional regulation. Any of them can be selected at booking, or we'll match you with the first available.

Booking is online, no referral needed, and first sessions are typically available within 7 days. Sessions are 50 minutes, $199 + GST ($228.85 incl. GST), paid at booking, with 48 hours' notice needed to reschedule, which we know is harder with a baby, so please tell us early if a time won't work. Your first session is a conversation about how you are, how the pregnancy or birth went, what support you have and what you want to change. Your sessions are confidential under the Health Information Privacy Code 2020, and we will not share information with other health providers without your agreement, except in the rare situations where the law allows it, such as a serious risk to your safety or someone else's.

Related support: Perinatal OCD · Depression counselling · Anxiety therapy · Insomnia and sleep