What is It?
Everybody feels down from time to time but depressive illness is more than that. It is when several symptoms occur over the same time period. PND is very similar to clinical depression occurring at any other time except that there is the added complication of a baby (or two!).
PND can range from mild to severe. There are also different types of mood disorders or depression and this can affect how dangerous it is. At its most mild it is not at all dangerous and generally gets better with good support (emotional and practical), sleep and time. At it’s most serious it can be life threatening (from suicide or inattention) and can pose a risk to the baby. If you have any serious concerns then assessment by a mental health professional is needed. An unwell mother should be asked “have you ever thought of taking your own life”, “have you ever felt scared you might hurt yourself” “have you ever had scary or dangerous thoughts about your baby? …what were those thoughts?” “Have you ever felt like harming your baby?”
Asking these questions could save someone’s life. Suicide has been the single biggest cause of maternal death (death in the first 6 weeks after having a baby) in several western countries in recent decades.
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Depressed mood or loss of interest/pleasure: Either a persistent feeling of low mood or an absence of any pleasure. This may include a lack of positive feelings towards the baby or alternatively the baby may be the only source of pleasure or interest.
Low Energy: Marked tiredness, lethargy, lack of feeling refreshed in the mornings or poor motivation. If observed for significant periods of time by others they would notice a slowness or loss of vitality.
Sleep disturbance: This can be insomnia or hypersomnia (excessive sleeping). It may be attributed to the baby waking. To differentiate between waking due to the baby vs sleep disturbance due to depression, ask if they wake before or after the baby wakes (before suggests depression) and how long it takes them to get back to sleep after they have fed their baby (most non-depressed mothers fall back to sleep readily)
Appetite changes: Depression is often associated with a decrease in appetite resulting in weight loss however in postpartum women there is frequently an increase in appetite.
Negative thoughts: Thoughts of inadequacy, especially as a mother, worthlessness or excessive guilt. Exaggerated negative thoughts towards others, especially those closest are also common.
Cognitive Difficulties: Deceased ability to think clearly. This may include difficulty concentrating, or indecisiveness, or memory difficulties. This makes it difficult to multitask and to think ahead which, in turn makes looking after other children a major challenge.
Morbid Thoughts: Recurrent thoughts of death, particularly fears that the baby will come to harm or that she, or her partner will die and therefore leave the baby uncared for. Alternatively she may be preoccupied with suicidal thoughts and feel the baby would be better off without her.
Symptoms are present and persistent throughout at least a two week period. Significant distress or impairment in day to day functioning results. This can be easily missed by others as many mothers spend a considerable period of the day ‘alone’ with their baby.
What can you do?
How to support a mother
Listen quietly but with interest.
Try to understand – it’s hard for someone who is depressed or anxious to explain how they feel. Avoid judging or getting angry – it’s no one’s fault.
Be there (this means to be emotionally available as well as physically present). Be patient.
Help reduce stresses. Offer practical help. If a person isn’t sure what help they want, offer alternatives or suggestions e.g. “I would like to help, can I cook a meal or take the older children out?” “Your house looks fine but I know some people find they don’t have the energy to do any housework can I vacuum or hang out the washing, or something?” (Don’t have your own agenda about what you think needs doing – do what they want done!).
Support her to do the baby cares herself rather than take over and do them (unless she asks you to). Just being with her and her baby when she is anxious will help. (If she is very unwell she may not be able to do this).
Give positive words of support, affection and encouragement. Be positive about any accomplishments, no matter how small they might seem.
Don’t take what they say personally. Remember that when a person is unwell or stressed, they can say things they don’t mean, and their mood can change quickly.
Remain positive. Provide encouragement and lots of positive reinforcement – even if what you are saying seems obvious. When someone is depressed they are not thinking in their usual way and they have great difficulty seeing the positives.
Try not to dismiss a persons concerns. Instead of saying something isn’t a problem, say, for example, “I can see that is really worrying for you – I will be with you to help with that”. Due to the indecisiveness of depression, a person may need guidance and support with decision making – but don’t jump in too early with your solutions.
Offer distracting thoughts or activities, especially if you can see that they are going round and round in circles by their thinking or are overwhelmed by their feelings.
Help them to get out and have fresh air and exercise. They may not feel motivated to do so but will often feel better if they do.
Help get regular meals/snacks especially if breastfeeding.
Help her to have time away from her baby doing something pleasurable, such as getting her hair done, having a massage – but not doing the groceries.
If she is suffering a lot and not getting better, help her to get help
Take seriously any negative thoughts she may have about harming herself, or her baby, and get help urgently
Treatment & Support
It is important to tell a professional how you are feeling. They can help assess ho much it is affecting you. You can be taught ways to reduce anxiety and depression. These techniques are often successful. Sometimes medication is needed as well. There are no guarantees that medication won’t affect the baby although it is thought that most medication is safe. It is also thought that that if you have significant anxiety or depression this may affect your developing baby. See medication section.
The use of medication depends on several factors:
- How unwell you are
- Whether you agree
- What has already been tried
There are other treatment options which you can discuss with your health professional. Remember also, that going on medication is not a failure no one likes to need medication but there are many illnesses where medication is needed. Having depression is like trying to play cricket with a broken bat. Sometimes medication can fix the bat but you still have to do the batting and face the balls (stresses of life) yourself.
The sharing of stories helps women and their families identify with others and not feel so alone with their illness.
Jenny and Burton Shipley on Postnatal Depression
Postnatal depression can happen to anyone, in all walks of life. It cuts across all socio-economic groups and happens to “full time at home” mothers as well as “working” mothers. Most commonly women have mild symptoms and they do not require medications or hospital admission but do need recognition, help and support. Jenny Shipley was one such woman. One thing all women with postnatal depression have in common is the huge impact this condition has on them and their families, even years after the event. Here is Jenny and Burton Shipley’s story.
“An experience with postnatal depression is one of the most debilitating things I have ever endured. It was made worse by the fact that I saw myself, others saw me and family members expected me to cope and yet I was so aware inside my head and body that I was not coping. It compounds the desperation you feel when you are confronted with postnatal depression as the mother of this beautiful baby and yet “a nobody” in your head in terms of the sense of loss and debilitation you sometimes feel.
I was very fortunate to only suffer a mild period of postnatal depression, but certainly for me it was a dramatic experience and it needed all of the support I could engage from the medical fraternity and all the willpower I could muster within myself to both recognise this issue and then take positive steps forward to cope with it.
How I wish that a website like mothers matter had been available to me at that time. Most of the written material was terribly boring and extremely poorly directed in terms of supporting the woman from her point of view. A great deal was available from the clinical point of view describing some of the symptoms, but again confirming that the mother was a sort of an abstract object in this wider debate.
My recovery from postnatal depression was very much dependant on me feeling that I was both supported and could be in control as a loving mother to my child, but also a worthy person in my own right. I would want to encourage other women to feel that motherhood is still a most wonderful gift, even though the days can be traumatic when things are not going well. As a mother of a 31 and 30 year old those dramas were worth it in hindsight!
I hope that Mother’s Matter website will allow a lot of women who either are in this position themselves or are supporting another friend, or perhaps a partner who is worried about their partner, or a mother or father, grandmother, grandfather who is concerned about a new mother, that they will go there and seek advice. There you will find strategies that will help support women and their families who are suffering from this very debilitating clinical condition.
I think it is brilliant that GPs, psychiatrists, nurses, mothers and others who have been associated with this issue have had the foresight to establish this website, and I have no doubt it is going to be an incredibly powerful tool that will help many women and their babies in the future.”
“I remember being completely bewildered when Jenny, after she had one of our children seemed to be continuing to be a very diligent mother, but lost her sense of self confidence and self belief. It was so uncharacteristic that it was hard for us to come to terms with it, let alone to recognise the need to support her. Thankfully we had a terrific general practitioner who helped Jenny, but also helped me understand what Jenny needed, and while it was a pretty rocky road for us all for a little while, with good advice and good support we were able to come through that.
We are both delighted that this initiative is taking place with the launch of a new website that will be available to couples who may find themselves in the situation that we were in. I am sure that if I had known more about PND earlier as is the information available on Mother’s Matter, it would have made a big difference in my being able to support Jenny sooner and recognise what was going on. It is terrific that parents in New Zealand are now going to have this option of an informative site which will give them support and help them to develop their own strategies to cope.
I want to endorse Jenny’s best wishes to those who had the foresight to establish this service, and to parents in the future who find themselves in this position. There is light at the end of the tunnel, even though those tunnels feel pretty dark at the time you are in the middle of them. We wish parents well as they explore the journey of parenthood which we both highly commend as a rewarding and special opportunity despite the rocky road that postnatal depression can create.
With respect and my strongest support”
More mothers’ Stories
The following are stories that women have shared with us with the aim of helping others.
I am a mother who suffered from postnatal depression (PND) and an anxiety disorder. Most people are aware that PND exists, but it’s not something you give much thought to during pregnancy because you don’t want anything to cloud your wonderful dream of becoming a mother.
Before my daughter was born, I had trained and worked for many years as an early childhood teacher. This was a job I was confident in, and passionate about. I worked mainly with two-year-olds so I had a lot of experience working with babies and toddlers. Therefore, I assumed I would be the last person who would suffer from PND.
My beautiful daughter, Zoe, was finally born and then the problems began. Firstly, minor birth complications, and then there was the sheer hell of breastfeeding. All this time I felt totally exhausted. I was a time bomb waiting to explode. This tiny baby was totally dependent on me. This thought caused some anxiety but as a new mother, I assumed this to be the norm.
The anxiety continued along with the extreme tiredness that never went away. My moods fluctuated and I began getting severe headaches daily along with jaw pain. This constant pain just wore me down. I was suffering PND but didn’t know it.
I thought of every excuse for what was causing my problems. Here I was with a small baby – this was supposed to be the happiest time of my life. Simple things such as maintaining a house were difficult for me.
Finally, after a year had passed, I visited my doctor and was diagnosed with PND and anxiety. I was prescribed antidepressant medication. I was opposed to taking medication. “What would people think?” “Would my friends and family think I couldn’t cope?” Reluctantly I took a very low dose of medication. All this did was prolonging my agony. Finally, I gave in and took the recommended amount.
Slowly things improved. I was lucky to have good family support and friends who listened to me. With medication, counselling and group therapy, I finally saw the old me again. Thankfully, my daughter was a happy healthy baby who continued to sleep and eat well.
Looking back on this experience, I now realise that I put so much pressure on myself to be a “super-mum”. The old saying “Something good comes out of something difficult” is true. I have learned a lot about the inner me and I wouldn’t change that for the world. I talk openly about my experience in the hope that maybe I could help someone else, and to help change the stigma attached to PND.
My name is Kathryn and this is the story of how I ran into the brick wall of depression when my first child was born. Depression at its greatest intensity is all consuming, like suffocating with no visible sign of anyone or anything doing the suffocating. Writing about it, even though it was over 13 years ago, has challenged me emotionally but having been through this experience I am a different person, more accepting, compassionate, and happy for the small things that bring me joy. This is the hope that I want to share with you.
The pregnancy was uneventful and on the whole, it was a very happy time. I left work a month before the baby was due and did the nesting thing that most of us seem to go through. I was induced 10 days past my due date and after a tiring and lengthy labour, my beautiful daughter was born.
When I look back on my time in hospital, this is when I began to feel overwhelmed and as my mother later said, I looked “bewildered”. I muddled through, trying to get to grips with breastfeeding, engorged breasts, cracked and bleeding nipples, etc…. I had no idea what I was doing and felt very out of control.
When I got home, the house was untidy and unclean, my baby was unsettled, and I couldn’t even think clearly enough to make up her bassinet properly. I panicked, heart racing, sweating, dry mouth, nauseous. What the hell was I doing! My midwife came over straight away and tried to reassure me. I just felt so useless.
The next two weeks were a steady decline each day into what I now know to be a state of severe depression. During this time, I started a course of antidepressants. It was very difficult to eat anything – I forced down some food in order to keep breastfeeding.
I had frequent panic attacks, which would grip me in the stomach mainly and cause me to shake. I dreaded the sound of my baby’s cries thinking I had no idea what to do to help her. I had no connection emotionally with my baby.
I couldn’t laugh, watch TV, or read. All the things that I knew used to make me laugh and feel good were gone. It felt like looking at one of those music videos where everything rushes past except for the singer who is moving in slow motion and the video is shot in black and white. I felt nothing. The energy I normally got from looking at colour was gone. My joy at seeing a sunrise or sunset vanished.
Then one awful day, I lay on the couch for hours and hours, staring up and out the window at the sky and knew I wanted to die. This out of control, panicked, incredibly sad pain was unbearable. I had a plan of exactly where and how I would do it. I became desperate and rang my midwife in a mess. She immediately got me the help I needed and a few hours later, I was being assessed by Psychiatric Emergency.
I was admitted to hospital. I didn’t want to be there at first. It was frightening but what was the alternative? I was too scared to go home. One of my overwhelming feelings was one of wishing to be looked after, just as my baby was being cared for-in a cot, asleep, with all my needs met.
Eventually, the medication started working, and I felt less anxious and sad. It was then hard to leave the safety of the hospital, a remarkable turn around but predictable. My crisis of confidence took a long time to improve – it was a full year before I started to be a relaxed and happy mum.
I have gone on to have two more children; both times, I have taken antidepressants at the time of the birth as a precautionary measure. I still felt at times depressed and out of control but not with the same intensity and duration.
PND is generally considered a depression with a good outcome for recovery. In my experience this is true. Just hold on to hope. Many of us have experienced it. Support is crucial, especially from people who are able to sit, listen, and make no judgments about your feelings and thoughts.
Nine years ago, I had a life-changing experience when my partner and I had our first (and only) child. We had planned to have this child, and my pregnancy went well. I was able to maintain a high degree of physical and mental wellbeing right up until the time our baby was born.
I was well organised, having left work six weeks before baby was born. I had prepared all the clothing, the baby’s room, and family and friends had equipped me well for this new child. Life seemed well in control, even the day that my contractions began. I was a little frightened by the intensity of the contractions, but I was confident that all was well. .
And so our little girl was born, after a wonderful sunrise, and a relatively quick birth. I remember being ecstatic. I mean highly ecstatic, yet bewildered at the same time. It was then that things started to become difficult for me.
I had difficulty trying to breastfeed my wee baby girl. This might have seemed the norm, but why did this continue with every single breastfeed, why did my child cry so much, and why did I feel so lost and so panic stricken. I stayed as long as I could in hospital before going home.
It wasn’t long until things began to really spiral out of control. I couldn’t feed my child properly, but worse for me, was that I couldn’t get any rest. We quickly limited friends from visiting too often, but I could sleep neither by day nor by night. This lack of sleepwent on for an agonizing ten days until I could bear it no longer.
I started to panic and phoned any “helpline” I could. I started having delusions. My body shivered uncontrollably, especially at night and I couldn’t sleep at all. My partner and I could not understand what was happening to me. We never even considered this was a medical condition. I was asking for help, but I had no idea what for – just that life was almost unbearable with a new baby child.
Finally, (it seemed for me) I got the urgent help that I needed and was admitted to hospital where my daughter and I stayed, on and off for three months. I was diagnosed with bipolar disorder which I didn’t realise can present for the first time after having a baby.
Once home, I continued to improve with the support of my wonderful partner and family. I have since learnt to take care of my sleep patterns and stress levels and continue to keep a watchful eye on my health and wellbeing.
Only by joy and sorrow does a person know anything about themselves and their destiny
To understand everything is to forgive everything