Post natal depression
Post; natal; depression; mothers; new; parenting; baby; blues; postpartum; partum; PND; post; natal; postnatal; languages; multicultural; ;
Contents
Post natal depression (PND) is a mood disorder that affects many women all over the world after they have given birth. Post natal depression is not the fault of the person, it is an illness. It happens for a variety of reasons and it will get better over time.
Post natal depression affects amost one in six women giving birth in Australia.
Alert!
Sometimes when depression is very severe there is a risk that the woman will harm herself or her baby. Emergency action is needed.
If this is you
Go to, or ring a taxi and ask to be taken to, a hospital that can help you (in South Australia this could be the Royal Adelaide Hospital, Flinders Medical Centre, TQEH, or Lyell McEwin Hospital, or a local hospital if you are in the country,
Call the Emergency Psychiatric Helpline on 13 14 65).
If you don't feel able to do that, ring anyone whom you know will come and be with you and help you to get help. Tell the person how you are feeling.
If this is your friend or partner
- it is important not to leave her alone, and to help her to get help. If she is so depressed that you are unable to pursuade her to go with you, stay with her and phone for help.
In South Australia
- ACIS (24 hour line for emergency psychiatric help on 13 14 65)
- her family doctor
- Crisis Care (13 16 11 after hours only).
- Helen Mayo House 8303 1183 or toll free on 1800 182 232.
What is post natal depression?
Post natal depression is one of the names used for the severe mood changes that a woman can experience after childbirth (usually in the first year after the birth). It is natural for a woman to experience mood changes after she gives birth, but post natal depression is when the feelings last more than two weeks, or are very severe, and have a significant negative affect on her life.
This is different to the feelings that are called the ‘blues', when a woman feels down or weepy in the first few days after childbirth. It is very common for women to have bad days and feel a whole range of emotions at this time, after all, her body, lifestyle and family have just undergone a massive change.
What are the causes of post natal depression?
Like many things, it is difficult to know in advance who will experience post natal depression. However, there are some factors that have been found to affect the likelihood of a woman developing PND. (But someone who has some of the following will not necessarily have PND).
Biological/physical reasons
- Depression in the family.
- Having previously had depression herself.
- Lack of sleep.
- Low levels of thyroid hormone.
- Anaemia.
- Having been physically unwell during the pregnancy, maybe with high blood pressure.
Psychological/emotional reasons
- Already existing low self esteem (not feeling good about herself).
- Troubled memories of her own family and how she was parented.
- Being a perfectionist who wants (and expects herself) to do everything perfectly, and then blames herself when she can't.
- Feeling a need to always be in control, which is not possible all of the time with a baby.
- Past grief and loss from a death of a child or loss of pregnancy (miscarriage).
- Having a caesarean section delivery when a natural childbirth was wanted.
- Experiencing a difficult labour and delivery.
Social reasons
- Changed social circumstances, like being a long way from family and friends
, making her feel alone and isolated.
- Relationship problems with her partner. This major change could make it difficult to understand each other, particularly at this important time.
- Problems with her parents (new grandparents).
- Major social changes for the woman, including her identity, activities, friends, interests, home, employment circumstances, independence and financial status.
- The pregnancy having been unwanted.
Women who come from other countries to Australia may be isolated and even more at risk of postnatal depression. The Beyondblue website has information about postnatal depression in many different languages http://www.beyondblue.org.au/index.aspx?link_id=102.944
Do I have post natal depression?
You may be thinking that you have not been feeling yourself since you had the baby. You may have wondered about why this is, and put it down to reasons such as increased pressure, lack of sleep, overwhelming sense of responsibility and so on. You would probably be right, but it is important to seek support and advice to help you with this difficult time. You may actually be experiencing something more serious and long term than the initial "baby blues".
Getting a diagnosis doesn't have to be a very difficult or complicated process. Some people like friends and family (even yourself) may have suspected it. Diagnosis is a process of a doctor asking questions about certain symptoms and behaviours that you might be experiencing if you are depressed.
Following are some symptoms that a woman with post natal depression could relate to. (For a diagnosis of PND to be made, you would need to experience several of the symptoms on this list)
- Choosing to stay at home and avoiding the stress of social situations (like not going out and meeting friends and other mothers).
- Fear of going to a group like baby clinic in case a professional worker (or another mother) will criticise what she is doing/how she is caring for the baby.
- Worrying a lot about issues such as the amount of breast milk and not feeling supported or reassured by anyone.
- Being preoccupied with the baby and not taking care of herself.
- Feeling like crying all the time, or wanting to cry but not being able to. For example, becoming very weepy during a conversation with a friend.
- Keeping her baby with her in the bedroom because of fear and not sleeping because she always wants to be ready to respond to a small movement or cry.
- Depressed mood that started just after childbirth (could start two weeks or more after childbirth).
- Depressed mood that started during pregnancy.
- Lacking energy or the opposite, not being able to slow down at all.
- Sleep disturbance (not the general sleep disturbance that comes with a crying baby), but rather not being able to get to sleep because of worry about the baby and then feeling tired during the day. She may go to bed to avoid others and to think rather than sleep.
- Irritability, for example, with her partner, toddler, or baby.
- Feelings of incompetence and guilt. Worry that she cannot cope with the baby (maybe not as well as her mother did) and then feeling guilty about this.
- Feeling extremely alone and worried about telling anyone about how she feels in fear that they won't understand and that they may judge her - or take her baby away.
- Also feeling confused about who she is and her identity, having gone from feeling like a competent woman to a person who feels she can't cope (although she could be doing well).
- Considering harming herself or harming her baby.
- There may be fleeting or more serious thoughts about harming herself because she is "failing" at what she is doing and hoping that this will help the problem go away.
- Feelings of wanting to harm the baby may be related to wanting to "get rid of" the cause of the problem, or because she thinks that life will be too hard for her baby.
- There is a difference between a fleeting thought of regret about having the baby and actually contemplating this as an option.
- See alert note at the top of the article.
- Rejecting the baby, by not wanting to touch it, respond to or nurture it.
- This may because she feels that there is no bond between her and the baby and she may begin to treat it like it is someone else's.
- It can be very frightening for a new mother to feel like she is not bonding with her child, (particularly when there is so much pressure to have a "perfect" bonding relationship).
- Not feeling any emotions at all, and certainly none that are "expected" after childbirth. Feeling numb, rather than happy, emotional, or even sad.
- Loss of sexual libido, mainly due to tiredness and depression.
- Hating her self, her body and who she is, feeling very ugly with the changes that have gone on with her body and being most worried about her body. She may also have fears about becoming pregnant again.
- Eating disorders like over and under eating can be common. Food may give a strong sense of comfort. Other women can be so preoccupied with other issues that they forget to eat.
- Anxiety with symptoms such as headaches, heart palpitations and so on.
- Obsessional ideas about a number of things such as needing to wash her hands over and over again or not letting anyone else touch her baby.
Coping with post natal depression
- It can be very helpful to consider that post natal depression is an illness, with the need for ‘treatment' (which may include medication) plus the need for taking care of yourself and having support from others.
- Take one step at a time and try not to be overwhelmed by what is happening to you. Set small goals that might be for the next hour or day. That way you will feel like you are achieving.
- Do some physical exercise. This only has to mean going for a walk. This may help you to relax. You may like to walk with someone else.
- Eat a balanced diet. Your body has just undergone a significant change and you need to provide it with all of the necessary nutrients and vitamins. It can take a long time for your body to become stabilised again after pregnancy and childbirth. Also if you are breastfeeding it is necessary to consume more calories. You may be so busy caring for your baby and family that you are putting your needs last. It will not be good for anyone (especially you) if you get sick and run down. Try and keep some foods handy that are easy to snack on such as fruit, cheese, bread, and vegetables.
- Don't expect too much from yourself. If you are trying to be "perfect" at everything for yourself or others it is likely that you will feel worse. Having a baby around is extremely demanding and you cannot predict what they want and always be able to respond. When you (or others) stop expecting the impossible you will know you have started to get better.
- Talk to someone as soon as possible about how you are feeling, try not to delay sharing your feelings, the longer you wait, the harder it can be. Maybe you could talk to your partner, mother, sister, friend, counsellor.
- Seek professional help from your family doctor, obstetrician or other trusted person.
- In South Australia, contact Helen Mayo House 8303 1183, or the Parent Helpline 1300 364 100. You can speak to a staff member for advice and support 24 hours a day - see resources below.
Using medication
As with any severe mental illness, medication might be useful to help a woman feel better about herself, to cope better with the tasks of being a mother, and also to shorten the time spent feeling depressed (and missing out on the positive experiences of being a mother). Talk with your doctor about whether medication could be helpful for you. Some, but not all, medication can be safe for a breast feeding mother to take.
How do I help my friend/partner?
If you are a partner, friend or family member of someone who is experiencing post natal depression, it may be a confusing time for you. You may wish to help them but not know what to do.
- Post natal depression is not something that the person can help. If she is angry and irritable with you, this is part of the illness. Try to go on being supportive rather than reacting angrily yourself. Avoid responding to anger with anger.
- Post natal depression takes a long time to get through. Don't expect too much too soon.
- Try to understand her feelings. Even though they may not seem reasonable to you, they are real for her at the time.
- If you are a partner, spend time with your baby. Making a close relationship with your baby and doing lots of caring for him or her will help the baby to be able to relate to your partner when she is better, and also help your baby not to miss out while she is not well. At the same time reassure your partner that you are wanting to support her, not to take her place as mother.
- When women are depressed and tired, sexual intercourse may seem like just another demand. It may take a while, but with patience and understanding things will get better.
- Things that won't help your partner are:
- telling her to pull herself together
- telling her to be grateful she has a lovely baby
- telling her she will get through it and that everyone feels bad sometimes
- telling her to relax and she will feel better.
- Take care of yourself. Make sure you have some breaks because you will probably be your partner's best support and you need to ensure you can stay in there for the long haul.
- Let your family and friends know what is happening (with your partner's permission). Support from others can be a big help at this time.
- Don't be too proud to accept help. Everyone needs it sometimes.
It can be very hard for partners to keep coming home to an unhappy house but it is important to hang in there - getting better takes some time but it will be worth it.
Resources
South Australia
- Helen Mayo House - runs inpatient and day patient services, telephone hotline, sends out printed information to read, advises about other services like current post natal depression support groups in the community.
Ph: 8303 1183 or toll free on 1800 182 232
- The Child and Youth Health Parent Helpline 1300 364 100
- Women's Healthline 1300 882 880
- Lifeline 13 11 14
- Rural Mental Health Information and Referral Line 1300 13 11 14
- Mensline 1300 789 978
Australia
References
Brockington I, ''Postpartum psychiatric disorders'' The Lancet Vol 363, January 24 2004, p303-310
www.thelancet.com
Ellis P M & Smith D A R, "Treating depression: The beyondblue guidelines for treating depression in primary care." Medical Journal of Australia 2002 www.mja.com.au/public/issues/176_10_200502/ell10082_fm.html
Postnatal depression: a systematic review of published scientific literature to 1999 (Republished 2006).
http://www.nhmrc.gov.au/publications/synopses/wh29syn.htm
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).