Postnatal Depression
Becoming a parent is one of the most profound and important life transitions we ever face as adults. It changes our lifestyle, relationships and our whole sense of who we are. During this time, each aspect of life requires rethinking and readjustment - a major challenge!
In reality, women are more at risk of experiencing emotional difficulties following the birth of a baby than at any other times in their lives. Dramatic physical and hormonal changes, chronic sleep deprivation, new responsibilities and a new identity can be very stressful and anxiety provoking.
Increasingly, it is becoming clear that men and couples are also emotionally vulnerable at this time. Whilst having a baby may be an exciting new phase in a couple's relationship, it can also put the relationship under considerable strain. So if you are struggling with your experience of having a new baby, remember you are certainly not alone!
Now let's look a little closer at the baby blues, postnatal depression and puerperal psychosis, all of which can affect mothers during the postnatal period.
The Baby Blues
The Baby Blues tend to occur in the first week after delivery, usually starting around day three after birth and lasting until around day 10 and it is very common. Indeed up to 80% of all new mothers experience baby blues. If you experience the baby blues you may:
- Feel very emotional, sensitive and tearful
- Have mood swings
- Feel anxious sad, guilty and worry that you are not a good mother.
- Feel vulnerable, lonely or irritable
- Find it difficult to sleep (even when the baby lets you)
- Not feel like eating
Remember, it is perfectly possible to experience the baby blues without going on to develop depression. Although having the baby blues is upsetting, it doesn't last long, usually only a few days and resolves on its own without requiring treatment. Reassurance and support from your partner, family, friends and your health visitor, midwife or GP are almost always sufficient.
If your low mood goes on for longer than one week or gets worse, it may be turning into postnatal depression.
Postnatal Depression
Postnatal depression (PND) usually begins in the first six months after childbirth, although it can emerge at any time in the first year. At least one new mother in ten experiences PND and the incidence may be as high as one in five. It may develop suddenly or gradually and can range from being relatively mild to very severe.
Depression can also begin during pregnancy and this is known as antenatal depression (AND). Up to 12% of women experience it and research is increasingly showing that women who experience depression during pregnancy are likely to continue to be depressed after the baby arrives. Pregnant women who are feeling depressed should be encouraged to talk to seek professional help, rather than being told that they will snap out of it once the baby arrives.
How will I know if I have PND?
PND can have a variety of physical, cognitive (your thoughts), emotional and behavioural symptoms Each woman's experience is unique, but common signs of PND include:
Feeling...
- Unusually irritable, angry and agitated
- Inadequate and unable to cope, worthless or a 'failure' as a mother.
- Very low, despondent or hopeless
- Tearful
- Constantly feeling sad and/or guilty and/or ashamed
- Out of control, or a sense of helplessness
- Fearful of being left alone with your baby
- Fearful of harming your baby physically or psychologically or being harmed by the baby
- Feeling that your baby would be better off without you
- Fearful of harming yourself
- Exhausted and very lethargic
- Anger and resentment toward yourself and/or you baby that do not go away
- Nothing - numb
- Overwhelming anxiety, particularly about things that wouldn't normally bother you
- Obsessionally fearful about your baby's health or well being
- A lack of interest in your baby
- A loss of interest in sex
- A lack of interest in pleasure or the outside world
- Uninterested in relating to others
- Having trouble concentrating and feeling distracted
- Finding it difficult to sleep, even when your baby is sleeping well
- Having thoughts about suicide
These symptoms can range from mild signs that come and go, to severely unpleasant feelings and thoughts that persist or become more intense.
Because these feelings can feel frightening or 'wrong', women may feel reluctant to acknowledge them. You may feel you should be happy with your beautiful baby and shocked and guilty that you don't feel happy at this time. Recognising and acknowledging the signs of PND is an important first step towards helping yourself, and getting the appropriate care and support you need.
It is often difficult to distinguish between mixed feelings after giving birth and the signs of postnatal depression, so do speak to your GP, midwife or health visitor if you think you might be depressed. They will be able to help you assess your situation or to arrange for a professional consultation.
Many women who have been finally diagnosed as suffering from PND are relieved that at last there is an explanation for how they have been feeling. Partners may also be relieved, and feel more able to offer emotional support.
Puerperal Psychosis
Puerperal Psychosis (also called post partum or post natal psychosis) is a serious but rare disorder, which affects about one in 1000 new mothers. It usually starts quite suddenly, a few weeks after the birth, with the mother feeling restless, elated and unable to sleep.
As well as the symptoms of severe depression, the mother may experience: hallucinations (seeing or hearing things that others can't), delusions (incredible beliefs, for example believing she is going to save the world), severe insomnia and mania (extremely energetic and bizarre activity, for example, cleaning in the middle of the night), extreme mood swings, from high to low, feeling confused and disoriented.
She may feel suicidal or at risk of harming the baby. It is vital to seek medical help immediately from your GP or from the Emergency Services. Your GP is likely to refer you to a psychiatrist and if inpatient treatment is required, admission should be arranged to a specialist mother and baby unit if possible, as it is important that the depressed mother is not separated from her baby.
What Causes PND?
The cause of PND remains unclear. Research has identified many possible causes and it is likely that a number of factors may interact to precipitate PND. Each woman is unique and the cause of PND in any one mother is also likely to be specific to her.
PND can affect women from all walks of life and from all social and economic backgrounds. It can happen to younger and older mothers. It can happen after a first baby, or a subsequent birth.
It is important to remember that the having a baby is a stressful life transition in itself and it is likely that PND is related to the physical, psychological and social impact of this transition and to the relationship changes it brings.
The following are some possible risk factors that have been associated with an increased likelihood of experiencing PND:
Having...
- A history of previous depression or postnatal depression
- Experienced depression during pregnancy
- A traumatic or difficult birth (this can lead to post traumatic stress disorder which overlaps with PND, but needs to be treated differently.)
- Difficulties in your relationship with your partner
- Unrealistic expectations of motherhood or being unable to realise your expectations
- Money problems and/or inappropriate housing
- A lack of support at home, or isolation
- An accumulation of recent stressful life events such as a serious illness, domestic violence , bereavement, changing jobs
- A number of young children already
- A premature or unwell baby
- Hormonal problems – temporary thyroid gland defect
Other issues can include the pregnancy being unplanned, having undergone extensive fertility treatments to conceive, the baby being adopted, having a child with special needs, being a refugee or asylum seeker.
Childhood experiences can also have a huge influence on the present. Giving birth and becoming a parent can cause long buried upsetting feelings and experiences to resurface. It revives in us our own earliest experiences of being mothered. A psychoanalyst, Selma Fraiberg coined the term 'ghosts in the nursery' to describe the way in which, early childhood experiences from a parent's own past can re-emerge within the relationship with their baby. A history of early loss and separation from her own mother or of her own mother being depressed, may be particularly relevant, for women suffering from PND.
The combination of factors will vary from woman to woman as each has her own life experiences, supportive relationships and ways of managing stressful life events.
Finding Solutions
PND can be very frightening and distressing for new mothers and their families. Unlike the baby blues it does not tend to resolve itself without treatment. It is a myth that PND is less severe than depression, that it is simply caused by hormonal changes and will therefore go away by itself.
It is time to seek help when: your symptoms interfere with your relationship with your baby and your family; you feel isolated and the support of family and friends is not enough; you believe that things are getting worse, not better.
Some women may suffer in silence and find it difficult to seek help due to feelings of shame and anxiety and guilt. They may fear that they will be judged to be not good enough as a mother or fear that their babies will be taken away. Self blame can be compounded by myths surrounding motherhood, that often serve to set women up for feeling they have failed as a mother.
Try not to feel ashamed of how you are feeling and remember you are not alone. It is very important that you get help as soon as you can. Hoping that the feelings will go away on their own and that you just need to tough it out, is not usually a helpful strategy. If PND isn't acknowledged or addressed it is likely to last longer and to be more severe. This not only leaves you suffering, but may affect your ability to respond to your baby in an emotionally sensitive way and interfere with the developing relationship with your baby. Research shows that this can have a negative impact on your baby's development and well-being.
The good news is that there is clear evidence that early treatment is effective and getting help as soon as possible is best for the mother, her baby and family.
Whether you are looking for help for yourself or someone you love, remember, help is available and Postnatal Depression is very treatable. The important part is getting started with a proper assessment by a professional and a treatment plan, based on an understanding of your particular situation.
The National Institute for Health and Clinical Excellence (Nice) have published guidelines on postnatal mental health (2007) which recognise the importance of offering early intervention. They also recommend that the talking therapies should be more readily available for women who are pregnant or breastfeeding, because of the increased risk of using medicines at these times.
Treatment may be a combination of practical support and advice, counselling or psychotherapy, and if necessary, antidepressant medication. Counselling and Psychotherapy allow you to look at the underlying factors that have contributed to your PND as well as helping you change the way you feel.
Couple therapy may be particularly helpful where there are underlying relationship problems as many studies highlight a poor relationship as a risk factor for PND. Parent-infant Psychotherapy may also be offered. This is particularly concerned with understanding and supporting your relationship with your baby. Some mothers find it helpful to attend support groups, where they can share their experience with other mothers.
There is now a large body of evidence that being helped to prepare emotionally for parenthood, can have significant long term benefits for the well being of mothers, fathers, couples and their children. Notably such help strengthens the relationship between partners and a good, supportive couple relationship is protective against PND.
Dads can experience PND too!
If you are a new father reading all this, thinking, “that's how I feel!”, you are not alone.
In recent years it has been increasingly recognised that new fathers can also experience PND. Numbers vary, but about 1 in 25 new fathers are thought to be affected.
As with mothers, a father's depression may begin during pregnancy, when relationships are already changing. Men may feel left out as the pregnant woman receives increasing attention, pushed out by the new baby who needs so much of their partner's attention, and they may struggle with the changes in the relationship with their partner and lifestyle. Men may also feel stressed by the increased responsibility, financial pressure, and workload at home at the same time as being sleep deprived. Witnessing their partner having a traumatic birth whilst being helpless to intervene can also evoke feelings of guilt and depression in new fathers. Partners of women who are post-natally depressed, are also more likely to become depressed themselves.
If you think you may be depressed, don't just soldier on as it is important for you and your family that you get help. Research has shown that in families where fathers were depressed soon after the birth, the children were at increased risk of emotional and behavioural problems, and boys were more affected than girls.
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