POST-NATAL DEPRESSION
WHAT IS POSTNATAL DEPRESSION?
Having a baby is a big life event, and it's natural to experience a range of emotions and reactions during and after your pregnancy. But if they start to have a big impact on how you live your life, you might be experiencing a mental health problem.
Around one in five women will experience a mental health problem during pregnancy or in the year after giving birth. This might be a new mental health problem or another episode of a mental health problem you've experienced before. These are known as perinatal mental health problems.
What does 'perinatal' mean?
'Perinatal' means the period of time covering your pregnancy and up to roughly a year after giving birth. It's made up of two parts:
- peri meaning 'around'
- natal meaning 'birth'
You might have also heard terms used to describe the time specifically before or after giving birth, such as:
- postnatal or postpartum meaning 'after birth'
- antenatal or prenatal meaning 'before birth'
There's no right or wrong word to describe the period of time around pregnancy and after birth, and you might hear your doctor or midwife use any of these.
It can be really difficult to feel able to talk openly about how you're feeling when you become a new parent. You might feel:
- pressure to be happy and excited
- like you have to be on top of everything
- worried you're a bad parent if you're struggling with your mental health
- worried that your baby will be taken away from you if you admit how you're feeling
But it's important to ask for help or support if you need it. You're likely to find that many new mothers are feeling the same way.
POSSIBLE CAUSES FOR POSTNATAL DEPRESSION
There are different theories about why you might develop a mental health problem, and particularly why you might develop one during or after pregnancy, but no-one knows for sure.
Some mental health problems like postpartum psychosis or postnatal PTSD have clearer causes, but for many people it may be a combination of risk factors that mean you develop a mental health problem. These include:
Previous experience of mental health problems
If you have experienced a mental health problem in the past, being pregnant or having a baby can put you at risk of experiencing another episode of poor mental health. If you have a diagnosis, or know you struggle with your mental wellbeing, it's important to understand what might trigger an episode and what can help you look after yourself.
If you experienced a perinatal mental health problem around the birth of one child, you are at increased risk of developing one around the birth of your next child. However, you may have coped well with your first child but struggled with your mental health after your second, or the other way around. Your experience of your mental health, and of becoming a parent, will be personal to you.
Biological causes
Some people think it is likely that there is a biological cause – changes in your body, for example, including hormonal changes. However, while some studies show that changes in the level of hormones during pregnancy and after birth can trigger changes in mood, only some women go on to develop a perinatal mental health problem – so hormones are unlikely to be the only cause.
Lack of support
Lack of support from a partner or other family members can put you at risk of developing a mental health problem in the perinatal period.
Having a baby is a major life event and can be stressful, exhausting and overwhelming. Lacking a support network, and people to help you, can increase your risk of developing a mental health problem.
Difficult childhood experiences
There is good evidence to show that going through difficult experiences in your childhood can make you vulnerable to mental health problems later in life. This could be:
- physical, sexual or emotional abuse
- neglect
- loss of someone close to you
- traumatic events
- unstable family situation
These experiences can have a big impact on how you feel about becoming a parent. If you experienced abuse while growing up, for example, you may now find it hard to relate to others, including your baby.
If your own parents did not have good parenting skills, you may find it hard to adapt to your new role as a parent. For example, you may feel unsure how to interpret your baby's needs. You may even fear that you are going to harm your baby somehow, because you are unsure how to take care of them.
Experience of abuse
Experiencing abuse and assault can trigger anxiety, depression and lower your self-esteem. This might be:
- domestic violence
- verbal abuse
- emotional abuse
- sexual assault and rape
- violent assault
- financial abuse – for example, if a partner tries to have power over you by stopping you having control over your own money
If you experienced abuse as a child (or later in life) you may also have post-traumatic stress disorder (PTSD), which can further add to your risk for postnatal depression.
Low self-esteem
If your self-esteem is low, you may doubt your ability to cope as a new mother. When your baby cries, for example, you may think it is because of something you have done wrong, or because of something you haven’t done. The way you think about yourself can put you at risk of developing common perinatal mental health problems like depression and anxiety.
Stressful living conditions
It can be difficult for anyone to deal with stressful living conditions, but if you are also trying to cope with becoming a new parent it can make it even harder and put you at risk of developing a mental health problem. You might be struggling with:
- poverty
- insecure or poor housing
- insecure employment
You may feel that you are unable to provide your baby with everything that he or she needs, and you may feel that you are failing your baby. Dealing with stressful living conditions can be particularly difficult if you are also living alone with little or no support from others.
Major life events
Major life events can include:
- an illness or death in the family
- the break-up of a relationship
- moving house
- losing your job
Each of these events can add serious stress to your life. If you experience any of these in addition to having a baby, this can increase your risk of developing a perinatal mental health problem.
Having a baby is a major life event in itself, as it is likely to involve many changes in your life. You may have had to give up your job and lose your financial independence. You may also have had to give up social activities and have limited or no opportunities to meet up with your friends.
Being responsible for a baby 24 hours a day means that your day is likely to revolve around your child’s needs rather than yours. All of this can have an impact on your vulnerability to developing a mental health problem.
SYMPTOMS FOR POSTNATAL DEPRESSION
You may experience one or more of the following symptoms:
How you might feel
- sad and low
- tearful for no apparent reason
- worthless
- hopeless about the future
- tired
- unable to cope
- irritable and angry
- guilty
- hostile or indifferent to your husband or partner
- hostile or indifferent to your baby
How you might behave
- lose concentration
- have disturbed sleep
- find it hard to sleep – even when you have the opportunity
- have a reduced appetite
- lack interest in sex
- have thoughts about death
Some of these experiences – like lack of concentration, disturbed sleep and lack of interest in sex – are all common after becoming a parent, but it's still important to mention them to your doctor if you're concerned you might have PND.
HOW TO PREPARE FOR THE BIRTH AND REDUCE THE RISK OF POSTNATAL DEPRESSION
Postnatal depression can happen to anyone. However, the risks of developing postnatal depression can be reduced during pregnancy and following childbirth.
In order to reduce the risk of postnatal depression, it is important for the pregnant woman to tell her GP or midwife about any previous depression she has had or if she has started to feel low or anxious during her pregnancy.
Keeping the GP or midwife informed will ensure that they are aware of the possibility of postnatal depression after the baby is born. This helps prevent delays in diagnosis, and allows treatment to begin earlier. In the early stages, postnatal depression can be easy to miss.
It is difficult to estimate the exact risk of women developing postnatal depression as many factors are involved.
These include:
- Previous medical history
- individual social and psychological circumstances
- Current relationships.
- Complications during labour.
Even if a pregnant woman haws a high risk of developing Postnatal depression, the risks associated with development can be reduced. In the first instance, seeking support from her GP, midwife and other healthcare professionals will help reduce the risk developing postnatal depression. The following self help measures can also be useful.
During pregnancy a mother to be should:
- Rest and avoid becoming overtired.
- Eat regular meals and healthy snacks.
- Avoid major stress such as moving house.
- Make friends with other mothers to be so that they can share experiences and develop relationships.
- Talk to others if they have concerns.
- Attend antenatal classes and appointments to prepare for the birth and ensure that they are healthy.
Following the birth a mother should:
- Talk through concerns and feelings with friends, family and/or her partner
- Speak to their GP, midwife or health visitor if they have concerns or worries.
- Relax and rest.
- Eat healthily
- Make time for themselves and partner
- Avoid blaming themselves if feeling unable to cope or depressed.
SELF HELP MEASURES FOR POSTNATAL DEPRESSION
Acknowledging postnatal depression is the best way to begin to manage the condition. By understanding that having a constantly low mood and feeling of distress is not normal, a mother can seek support and help from professionals/
Self help techniques for post natal depression include:
- Talking to relatives, friends and sharing feelings with a partner will help the mother feel supported.
- Resting and relaxing
- Sleeping when the baby sleeps.
- Maintaining a good diet and exercise regularly.
- Taking care of personal hygiene
- Setting realistic goals to help manage the routine of the new baby.
- Recognising positive achievements and paying attention to good feelings about these achievements.
- Contacting local support groups.
- Joining baby groups and playgroups to establish new friendships.
- Not becoming too anxious over bonding with the new baby.
- Keeping a diary.
TREATMENTS AND RESOURCES FOR POSTNATAL DEPRESSION AND PEOPLE WITH PUERPERAL PSYCHOSIS
If you admit to feeling depressed, anxious or having distressing thoughts (for example, about harming yourself or the baby) you may fear that your baby will be taken away. But it's only in very rare cases that parents are separated from their children, and there's lots of support available to help you make sure that never needs to happen.
It's important to ask for help because you don't need to cope with these difficult experiences alone.
There are many health professionals who you can talk to about your mental health, and who can provide you with support in several different ways. These may include general health and pregnancy support services like:
- your GP
- antenatal care (with your midwife or obstetrician)
- your health visitor
There are also more specialist services to support you if you are at risk of becoming (or become) more unwell:
- perinatal mental health services
- community mental health teams (CMHTs) and crisis teams
- hospitals, and mother and baby units (MBUs)
You can also access support and services through:
- voluntary organisations and charities
As symptoms of perinatal mental health problems can change a great deal from day-to-day, it might be hard for your health professionals to understand what you're experiencing and to accurately assess your mental health. If you don't feel like you're being offered the help and support you need, you can bring this up with your health professional.
You may also need to be persistent in asking for the support you need. This can be really hard when you're struggling with your mental health. You can ask a loved one to support you in seeking help, or you might want the support of an advocate.
Your GP
You can always talk to your doctor about your mental health. They can discuss your options for treatment and support, refer you to services and prescribe medication.
Antenatal care
While you're pregnant, you're likely to be in contact with several different health professionals. At some point you should be asked about your mental health and how you're feeling during pregnancy. If they don't ask, you can always bring up any concerns you have.
Your health visitor
Your health visitor can offer support, advice and information on looking after your baby while managing your mental health. You can also talk to them about anything you're worried about, or any difficult feelings or thoughts you're having. They can let you know about other services in your area, or might suggest you speak to your doctor.
Specialist services
Perinatal mental health services
There are specialist mental health services for mothers, called perinatal mental health services, in some parts of the country. This includes specialist nurses and doctors, as well as specialist inpatient wards called mother and baby units (MBUs).
If you've had significant problems with your mental health in the past (for example, if you have a diagnosis of bipolar disorder or have experienced psychosis) you're likely to be in contact with the perinatal mental health team throughout your pregnancy to check how you're doing, assess your medication and plan your birth.
Unfortunately these services aren't consistently available across the country, and access can be difficult.
Community mental health teams (CMHTs) and crisis teams
If you have a diagnosed mental health problem, you may already be in contact with your local CMHT or crisis team. They may be able to support you if there aren't any specialist perinatal mental health services near you.
Mother and baby units (MBUs) and hospitals
Mother and baby units (MBUs) are specialist psychiatric wards in hospitals, enabling you to be admitted to hospital with your baby. The MBU can give you treatment and support for your mental health problem, while also supporting you in developing parenting skills and bonding with your baby.
Unfortunately there are very few MBUs around the country, with limited places. If you are admitted to a regular psychiatric ward, you're unlikely to be able to keep your baby with you – but if you do have to be away from your baby while you're being treated, this should be for as short a time as is safe for you.
