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Postnatal Depression

The time has finally come – you have a baby! You’ve been waiting and dreaming about this moment for such a long time and now it’s here. Yet…something doesn’t feel right. You’re weepy, despondent and don’t feel as bonded with your little one as you feel you should.

The truth is, baby’s early days can be a difficult time. Your body is adjusting after pregnancy and the trauma of birth. Hormones are adjusting after labour. You’re exhausted from lack of sleep and those night feeds. Plus, you’re adapting psychologically to the pressures of being a mum – newly so if it’s your first, or working to juggle your other children if it’s your second or third. In any case, those early days are tough, and it’s perfectly normal and natural to feel a whole mixture of emotions.

But what do you do when those feelings just don’t wear off? What is the difference between postnatal depression and the ‘baby blues’? Here at Private Pregnancy UK, we’ve taken the time to demystify the condition for you so that if you’re worried about it, you can spot any warning signs early and seek support.

Postnatal Depression – what is it?
Having a baby is often referred to as the happiest or most momentous time in a woman’s life – and of course, it very often is. But in those very early days, you may experience a spell of being teary and extremely sensitive (what’s commonly known as the ‘baby blues’).

Doctors tend to say that the baby blues is caused by changing hormone levels following giving birth, but some others believe it’s a result of disorientation due to being in hospital. While the baby blues is of course upsetting, it’s good to remember that it won’t last long – only a matter of days in most cases. Doctors and nurses usually aren’t very concerned about it and it tends to be seen as ‘par for the course’. However if the depression worsens or continues, there’s a chance it could be Postnatal Depression.

Postnatal Depression (PND)
At least one in ten new mums will experience Postnatal Depression (PND). Often PND develops when the baby is between four and six months old, although it can actually come on at any point in the first year after birth. It can develop gradually or come on very suddenly. It may be relatively mild or very severe.

What are the common symptoms of Postnatal Depression?
If you have Postnatal Depression, you may encounter one or more of the following problems, although it’s unlikely that you’ll experience all of them:

  • Feeling lethargic and tired, or even somewhat numb. Being disinterested in activities and in the outside world.
  • Feeling very down. Thinking that everything is bleak and that there’s no hope.
  • Experiencing feelings of hopelessness, helplessness or a sense of being unable to cope
  • Having a sense of guilt about not coping well or that you don’t ‘love the baby enough’
  • Being irritable, which can in turn intensify feelings of guilt
  • Being tearful
  • Losing your appetite, or feeling constantly hungry but being unable to eat
  • Feeling irritated, hostile or shut down from your partner
  • Experiencing problematic sleeping patterns – for example having trouble getting to sleep, experiencing nightmares or waking very early
  • Feeling indifferent or being hostile to your baby
  • Experiencing panic attacks, which involve racing heart, sweating, and faintness or nausea
  • A loss of interest in sex or intimacy
  • Overwhelming anxiety, often regarding everyday things such as being alone at home
  • Persistent indecisiveness and problems concentrating
  • Recurring thoughts of death
  • Physical symptoms – for example headaches, stomach cramps and blurry vision
  • Obsessive fear about your little one’s health, or about your own health and the well-being of your family

If you don’t want to talk about it…
Thoughts of death or other morbid or violent thoughts can be very scary, and you may wonder if you are going mad or losing control. You may be scared to talk to anyone about these thoughts and feelings, for fear that people may think you can’t look after your baby or are actually ‘mad’.

In fact some research suggests that about 50% of all women who experience Postnatal Depression are afraid to talk to their health visitors about it for fear of being seen as an unfit mother in some way.

At such a difficult time, it’s really important to remember that such thoughts don’t actually mean you are going to harm yourself or your little ones. The more you can verbalise and get support through these feelings from a trusted person, the less likely you will be to act on anything.

Postnatal Depression is assessed, mostly by health visitors, through a questionnaire known as the Edinburgh Postnatal Depression Scale – usually within two months after the birth. Some researchers have questioned its usefulness for some minority ethnic women since it was put together with British women in mind but it is the standard assessment tool.

What causes Postnatal Depression?
PND can develop regardless of a woman’s circumstances – for example her all-round health, financial status and family situation. There is no ‘one cause’ for Postnatal Depression but a variety of different possible triggers has been put forward. Here we’ll discuss a number of them in turn.

Shock at being a new mother:
Not only does labour take an enormous physical toll, but the sudden change in responsibilities, schedule and way of life has an enormous psychological effect on a new mum.

After all your years on the planet responsible only for yourself, all of a sudden you have a helpless human being depending on you for their very survival 24 hours a day. On top of which, their only means of talking to you is crying – something which you as an adult naturally equate with distress.

It is not uncommon to become very anxious about your little one at this point, or feel overwhelmed by the weight of this new responsibility. Some mothers become very worried about things like cot death. You may even lie awake at night listening for your baby’s breathing.

As a new mum, you may find you can’t go anywhere without your baby and you might not want to either. All of a sudden your freedom to come and go as an adult has been cut off. When you do venture out with your little one, you may struggle to navigate familiar routes because of the pram or buggy, and it’s suddenly difficult even getting into some shops or using transport.

Often, you might find yourself on your own in the house with no grown-ups to interact with. This can take a lot of adjusting to. Becoming a mother involves letting go of a lot of things – for example income, independence and freedom – even your normal sense of your own self.

Changed Relationships:
Having a child can really change your relationships with the people who mean the most to you – your other children, your own parents and not least your partner.

Your other little ones might feel jealous or have trouble adjusting. If you’re a new mother, your parents have become grandparents – and you may feel the loss of your role as their little girl. Sleepless nights, exhaustion and a massive increase in responsibilities can affect your sense of intimacy with your partner.

You may well have also given up a job, if only for a while, and will experience being dependent on someone else financially – perhaps for the first time in adulthood. All these changes take getting used to. Everyone needs time and support to adjust – most of all, you.

Lack of Support:
In the past, most new mothers had a lot of support from their extended family, as people lived in much closer-knit communities. When a new baby was born, a fleet of female family members would descend upon the home to help the new mum adjust. These days as a new mum you may be hundreds of miles from your family, and those early days of learning to cope could feel a lonely time.

The truth is, although motherhood is often thought of as an instinctive skill, in fact in many ways it needs to be learned. Many times without the continual support and advice from female family members on hand, a new mother may unjustly blame herself for not knowing everything or being able to glide through the new tasks – catalysing or worsening feelings of depression.

Other Stresses:
If you are experiencing additional stresses for any reason, you are at greater risk of experiencing PND – for example if there is a death or an illness among your loved ones, or if you are moving house or job.

Sometimes women that have recently moved country and are away from family, friends and familiar rituals can find giving birth incredibly distressing and disorientating, making them more likely to experience PND.

Research suggests that women who have no job outside the home, no one to talk to intimately, or three or more children aged 14 years old and under living at home, are more likely to experience Postnatal Depression.

Difficult Labour:
If you’re unlucky enough to experience a long, especially painful delivery or an unplanned caesarean or emergency care, it is possible to suffer a kind of post-traumatic stress disorder – which is somewhat distinct from Postnatal Depression per se.

Many times people can overlook the significance of this trauma, assuming that the gift of motherhood itself will be enough to offset it. However there are plenty of instances when this is not the case.

Sometimes a traumatic birth can affect the bond between you and your partner, or you and your baby. You may not feel like sharing intimacy. You may feel closed off or upset and not know why. You may have listened to other mothers talk about profound birth experiences and feel cheated, or you may question whether others could have done more to help you.

Ultimately, if you’ve suffered a traumatic birth experience you need to seek help. Speak to your doctor or midwife – there are trauma treatments that can help to minimise the risk of developing long-term depression, enabling you to move on and look forward to motherhood once more.

Dramatic Hormonal Changes:
Hormones like oestrogen and progesterone have an effect on a woman’s emotions. Progesterone levels are very high in pregnancy and some doctors have suggested that Postnatal Depression can come about as a result of the sudden fall in progesterone levels after giving birth.

Having said that, when women were prescribed progesterone to try to stave off depression, the depression actually worsened. But treatment with an oestradiol patch has been found to help.

What you’re eating:

There has been some evidence to suggest that a lack of some nutrients in pregnancy can result in depression – for example omega 3 oils (which you can find in nuts, seeds and oily fish like salmon or mackerel), magnesium (look for seeds and leafy green veg) and zinc (nuts and seeds).

Oscillating blood sugar levels – caused by a deficiency in some nutritious foods or irregular eating – can also be a factor in depression.

Childhood Experiences
Childhood can be a painful time for some people for whatever reason and sometimes, the intensity of childbirth can push long-buried feelings to the surface.

It is believed that people who were separated from their own mothers for any considerable period of time (for example because of illness or the birth of another child) before aged 10 or 11 could be more at risk of postnatal depression.

When old and perhaps unconscious emotions surface in this way it can be bewildering or even frightening. However with the right support, it can present a unique opportunity for healing and renewal.

What can I do to help myself get better from PND?
PND usually improves with time, although sometimes it can take up to a year to get better. Having the support and love of family and friends around you makes a big difference. Reach out whenever you can.

Find someone to talk to
If you are experiencing PND, it’s really important that you get personal support. Chatting with friends and family can really take the pressure off. This is where you really may need to choose wisely among your loved ones as to who you really open up to. Not everyone is always capable of just sitting and listening without judging or bombarding you with advice.

Many women find it helpful to speak to a counsellor or psychotherapist (your health visitor should have some useful names and numbers to help you). Spend time with people as much as possible and have a good think about who might be the best people to talk with in depth. It can work wonders, honestly!

Meet other parents
At a time like this, you really need to meet and chat to as many other mums and dads as possible. It makes a world of difference to know that you’re not alone in your fears and frustrations. You can also share tips for childcare and funny stories about the whole process, which can really help to decompress the stress for you.

Talking to other mums can also help to renew your sense of purpose and self-esteem. Try to keep in touch with the women you met at antenatal class and get out to local parent-and-baby groups as much as possible. There are also a lot of organisations that put local mums in touch with each other, such as NetMums.

Eat Well
Easier said than done when a baby is demanding he/she be fed all the time, but it really is so important. Nutrient deficiencies such as a lack of iron can affect your mood and energy levels, and poor eating patterns can lead to oscillating blood sugar levels, creating mood swings.

Try to eat as much fruit and veg as possible, and combine slow release carbohydrates with protein (nuts and seeds are a good, convenient source, and they also contain omega 3 – a real brain food).

If you want to know more, try investing in a food and mood guide, such as Amanda Geary’s The Food and Mood Handbook.

Take a break when you can
Yes, we know it can feel physically impossible to tear yourself away from your little one but if you have an offer of help from someone you trust, then why not take a few hours off? Run a bubble bath or go for tea and cake with a friend.

You should be trying to get as much rest and sleep as possible – not easy with a young baby, admittedly, but tiredness can make your depression worse. You may even want to invest in some meditation or relaxation CDs – these can be a good way of de-stressing without having to leave the house.

If your baby is bottle fed, try to arrange for someone else to do the night feeds, even if it’s only for a night or two. If you breastfeed, try to keep the cot by your bed so you can feed with the least amount of stress.

In time, you and your little one will fall into a rhythm of sleeping and feeding together. Try to sleep when the baby sleeps. If you’re really exhausted, avoid driving or operating any tricky machinery – your concentration is likely to be impaired.

Get as much help as you can around the house so you can concentrate on looking after you and the baby.

Get some exercise
Okay, so we know it’s the last thing you feel like doing but physical activity is an antidepressant – especially when it’s enjoyable! Drag yourself along to that Tai Chi class, give yoga a go, have a dance – go on, you’ll feel so much better for it!

What sort of treatments are available for PND?
Postnatal Depression can be serious, so the sooner you can seek help, the better. If you think you may be suffering from PND, have a chat with your GP or health visitor. Honestly, they really have seen it all before and they aren’t there to judge you. There are a number of different treatments available for PND and it may well be necessary to try more than one. Try to be open-minded, but above all you need to be comfortable with any help you’re receiving.

Counselling and psychotherapy:
This can be enormously helpful in allowing you to come to terms with any difficult feelings you may be experiencing. Often, PND can be compounded by feelings of guilt and a host of ‘shoulds’ – thinking you should be feeling better than you do or be more bonded with your baby and so on.

Counselling can provide a safe space where you can air all this, enabling you to see that this is really not your fault, and helping to create self-supporting, constructive ways of coping that will be helpful to you and your little one. Cognitive Behaviour Therapy has been shown to be very effective in cases of depression.

Antidepressants:
In some instances, medication can be very helpful for treating PND but it’s very important to think carefully because antidepressants can enter breastmilk. For most breastfeeding mothers, sleeping pills and tranquilisers are inappropriate because they can affect breastmilk and be unhealthy for infants – there is also a risk of dependency if they are taken several nights in a row.

While some medications appear to be quite safe, others have been shown to be harmful to infants, so you really should spend a lot of time talking to your GP and weighing up the pros and cons.

If you do decide to try medication, be sure to check in regularly with your doctor to monitor your progress. Also keep in mind that medication takes time to work. Also any antidepressants should be reduced very gradually before you stop taking them – sudden withdrawal can make depression worse and lead to a whole host of unpleasant side effects.

Complementary therapies
Complementary therapies are definitely worth thinking about, even if it’s alongside other treatments like counselling. Many mums have found herbal remedies, homeopathy, aromatherapy and cranial osteopathy to be helpful so have a look around and try some different things.

Keep in mind that some herbal remedies may not be safe if you’re breastfeeding though – always do your research before you start taking something.

Referrals and further treatments
In severe cases of PND, you may be referred to a psychiatrist. Try not to panic, this is very rare, and even in cases where it does occur, it simply means you need a bit more help and support.

If you were ever referred, a psychiatrist would look at which treatments and remedies you may have tried and what else might be effective. Try not to worry – it’s rare for a woman to need this.

Keeping it all in perspective
Postnatal Depression can be a very frightening and isolating condition but there is light at the end of the tunnel. If you think you may have PND, talk to family, friends and your GP as soon as possible. The sooner you catch it, the less likely it will be to worsen or drag on and on.

Not least, remember that these kinds of problems can happen to anyone – particularly after something as uprooting as having a baby. You’re having a hard enough time as it is without beating yourself up for feeling down.

While taking care of your little one, try also to mother yourself whenever you can – with kind words and a fun treat wherever possible. And remember, you can and will beat this. You had a baby didn’t you? How many things could be more challenging than that? You’re here, getting through it a day at a time and if you seek help, the day will come when all this will be a distant memory.

Good luck, and above all look after yourself!

Related Video: Depression During Pregnancy & After Birth – Causes, Symptoms & Treatments

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