6 General adult psychiatry6.2 Pregnancy, childbirth and the menstrual cycle
6.2.2 Perinatal risk assessment
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Assess the parent and infant together
Perinatal risk covers more than suicide. It also includes self-neglect, harm linked to substance use, domestic abuse, and whether the infant is safe and has their care needs met.
Symptoms can change quickly, especially after childbirth. A reassuring interview is not enough on its own. Look at how the person has behaved recently and gather collateral information from others who know them.
Protective relationships and practical support matter. But having a baby does not rule out suicide risk.
Area | What to find out |
|---|---|
Self-harm and suicide | Thoughts, intent, plans, access to means, past acts and reasons for living |
Infant harm | Thoughts, beliefs, intent, impulses, behaviour and the circumstances in which the infant is cared for |
Neglect | Feeding, hygiene, safe sleep, medical care and supervision |
Parent's health | Nutrition, hydration, sleep, medication, intoxication and physical illness |
Environment | Abuse, coercion, housing, other children and whether reliable help is available |
Understanding thoughts about harm
Thoughts about harming the baby mean different things depending on where they come from.
Obsessions are unwanted, distressing thoughts that the person fears and tries to resist. Ask about insight, rituals and avoidance, as well as any intent.
Delusions or commands involving the infant can occur in psychosis. Here the risk can change quickly, particularly if the person is agitated, not sleeping or disorganised.
Ask directly, calmly and specifically. This makes it easier for the person to tell you what is happening. Do not assume that having a thought means the person intends to act on it.
Acting on the assessment
Immediate danger needs urgent emergency or specialist assessment. Make a safe arrangement for the infant, with appropriate supervision.
Safeguarding action should match the actual concern and follow local procedures. Where it is safe to do so, explain to the person what information you will share. Document your reasons.
A practical plan names who provides care, how sleep and treatment will be supported, and what happens if that person becomes unavailable.
Mother and baby units allow treatment while keeping the relationship between parent and baby going when inpatient care is needed. How much contact there is depends on the assessed risk.
Reassessment
Review again if any of these happen: sleep gets worse, new unusual beliefs appear, medication is stopped, the person is intoxicated, support is lost, or feeding and self-care deteriorate.
Coordinate care with maternity, primary care, perinatal services, health visiting and children's services as needed. Each service should have named responsibilities.
Document what you found and what remains uncertain, the protective actions agreed, and when and how the next review will happen.