It’s normal to feel a little down following childbirth. But what if your feelings don’t improve, or you aren’t coping? You may have postnatal depression, also known as PND. Maternity nurse and postnatal advisor Katie Thomas explains.
There is an expectation in our society for pregnancy, birth, and motherhood to be the happiest, most fulfilling time in a woman’s life. And all too often, we get the idea that pregnancy should be glowing, with a straightforward, easy birth and a post-baby body that bounces immediately back into shape – all the while raising a beautiful, healthy, happy child who sleeps through the night, and at the same time maintaining a perfect home and making great strides in our career. For a majority of women, this fantasy is not even remotely close to reality – and that’s okay.
The typical nuclear family of a mum, partner, and children living alone in a household is a relatively recent phenomenon. This leaves a huge number of mothers or carers at home alone with their baby for the most part of the child’s upbringing. The phrase “it takes a village to raise a child” is the beautiful truth, simply meaning you cannot do it alone, and you are not expected to. Whether you have extended family around you, a close group of friends, or even caring neighbours nearby, you are never alone and shouldn’t feel that way. Having a baby can be incredibly isolating, and even with the most supportive network of people around you, it can be an overwhelming and scary time.
The hormone factor
Pregnancy, birth, and early motherhood are a rollercoaster ride of hormones. From the minute you conceive, you have increased levels of progesterone and oestrogen pumping through your body (20-30 times more than normal), often causing drastic changes to your mood. Some women hardly notice a change in themselves; craving a few odd foods and having slightly tender breasts can be the worst of it. But for many it is a struggle to find the energy to get out of bed, keep any food down from the nausea, and just generally feel lousy. Luckily, these symptoms mostly settle down by the end of the first trimester. After the baby is born, hormone levels drop abruptly, and once the endorphins following birth begin to fade out, moodiness and emotions can take over.
The “baby blues” are a widely known mood drop occurring at around two to three days post-partum, peaking at five to seven days, and improving by two weeks at the latest, affecting up to 80% of all mothers. The baby blues may have symptoms of feeling low, weepy, anxious, unable to cope, unable to sleep, crying spells, irritable, feeling overwhelmed, lonely, and just generally sad. It is extremely important to remember that this is a completely normal part of the post-partum period and that most women do experience it. Be sure to speak to your lead maternity carer as openly as possible regarding your feelings and any concerns you may have.
Risk factors for PND
If you are still suffering from these symptoms two to three weeks post-partum and they are intensifying, then it has possibly progressed into postnatal depression. This term is nothing to be afraid of, nothing to be ashamed about, and nothing to hide. Around 10-20% of mothers suffer from PND. Those who have experienced some level of depression in the past, be it themselves or someone close to them, may have different fears and worries to those that are living it for the first time.
There are certain situations and risk factors that may be influencing the onset of PND, including:
- Being a first-time mother
- Having a particularly traumatic birth
- A history of depression, PND, bipolar, or other mood disorders
- A lack of support from family, friends, or partner
- A history of infertility
- Recent trauma or stress
- Biological/physiological factors (genetics, hormones, or physical injury at birth)
- Infant-related issues (challenging temperament, health issues)
- Your physical environment
- General extra life stresses
Most likely it is a combination of a lot of things, but it is important to remember that it isn’t your fault you are feeling this way, there is nothing you have done wrong, and whatever else is going on is secondary to you and your baby during this time.
Symptoms of PND
The more extreme symptoms following the baby blues may include some or all of these:
- Insomnia even though you are exhausted
- Lack of appetite
- Frequent crying
- Difficulty concentrating
- Lack of interest in the baby
- Lack of interest in activities you would normally enjoy
- Feeling worthless, anxious, obsessive, nervous, helpless, angry, scared or guilty
- Feeling like you are incompetent is very common and often goes with feeling guilty
As important as it is to acknowledge these feelings and not shut them away, try to remind yourself that you are doing the best you can and it will not always feel like this. Finding at least one person you can openly speak to, if it’s your partner, a friend, family member, or a postnatal professional, is crucial to help you through this time.
Experiencing one or two symptoms mildly from the above list does not necessarily mean you have PND, particularly if you have suffered with the symptom in the past. Speaking to your LMC or GP will help to resolve what is thought to be going on, and further help can be received from the right source.
PND is often confused with other post-partum issues such as baby blues, post-partum anxiety, post-partum obsessive compulsive disorder, or post-partum psychosis. Post-partum anxiety affects approximately 10% of women and has symptoms such as extreme anxiety, restlessness, agitation, shortness of breath, dizziness, sweating, cold or hot flushes. Post-partum OCD is less common, at around 3-10% affected, and mostly consists of distressing thoughts and images, or overwhelming fears of hurting your baby. This can be so extreme that you may refuse to touch your baby out of fear that you might harm them somehow. Post-partum psychosis is the least common, with only one in 1,000 women affected. This is the most severe and dangerous post-partum illness, causing hallucinations and manic behaviour; it must be treated as soon as possible as it can develop very quickly and both mother and baby are at risk of harm. There are certainly overlaps with all of these conditions, and some women can experience symptoms of more than one.
How to cope
If you or someone you know have any symptoms, there are some positive methods that can help. Rest and physically take care of yourself as much as you can, simply having a nutritious meal and a shower can make the world of difference. Venturing outside for a walk with your baby or meeting a good friend for coffee can put things into perspective; sunshine and fresh air will be extremely beneficial for you both. Ask a trusted friend or family member to watch the baby for an hour or two so you can have some alone time to do something enjoyable for yourself; get your nails done, go for a walk in nature, or just sleep! Slow down your usual life routine, try not to stress about the housework, and get rest when you can. If you have older children, ask family or other mothers to help out with them if possible.
Be kind and gentle to yourself, and try to remember that these feelings will diminish eventually and you are doing an amazing job. It is so easy to get lost in the emotions of guilt and feeling incompetent, but recognising that you are not coping and could really benefit from some help shows strength and the desire to make a positive change.
Try to be open and confide in family and friends, speaking with loved ones will immediately make it feel less overwhelming in your head. If you are close to someone that is suffering from PND or something similar, there are many things you can do to be helpful and supportive. Being an ear to listen and shoulder to cry on is absolutely invaluable, as well as offering to help with childcare, housework or cleaning around the house. Be reasurring, patient and understanding; it can be extremely difficult to express personal pain without fear of being judged, so giving them a safe and loving environment is the best gift you can provide.
Plunketline and Healthline are 24/7 helplines that you can call to discuss post-partum issues with a nurse. Sometimes talking on the phone can be a good start to building up courage before you see a doctor. Speaking to your LMC or GP is a really good idea, so they can determine what exactly is going on and what is going to be the best solution. Follow their lead and be as honest as you can; they have helped a lot of other mothers in the same situation. They may suggest a number of things like community post-natal depression groups, counselling, therapy, home help, community mental health services, or anti-depressants.
It is so important to remember that there is help available for whatever your situation may be. No one should suffer in silence. Motherhood is the most incredible and rewarding job you will ever have. You can and will get to a place of loving it. Contact Katie for support and guidance.