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
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
Read more stories that people have shared with us with the aim of helping others.
Only by joy and sorrow does a person know anything about themselves and their destiny
To understand everything is to forgive everything