Understanding Postnatal Depression

Recent media coverage has talked about the lack of services out there to support women suffering with postnatal depression (PND). This is a worrying report given that PND affects almost 1 in 10 women after having a baby.

So what is postnatal depression?

It can be quite common for women to feel a bit down after giving birth and this is usually referred to as the ‘baby blues’ but tends to fade within a few weeks. PND can come on after a few weeks but may not be fully apparent for six months. It is a sustained feeling of depression that does not go away.

What is important to remember is that PND is an illness just as serious as any other type of depression. The good news is that it can be dealt with by seeking treatment and support. Having PND does not mean that you do not care about your baby or that you are an unfit mother. As highlighted in media reports, there is a lot of pressure on the 21st century woman to be ‘practically perfect in every way’ – perfect career, perfect wife, perfect cook, perfect body and be the perfect mother. It is therefore crucial that if you feel you may have PND that you seek support straight away; do not try to ignore it as this will only prolong any distress.

How do I know if I have PND?

Most symptoms of PND start during the first year after the birth of your baby. These usually occur within three months of the birth and are similar to symptoms of depression at other times in life. Symptoms of PND can include:

• Sad mood
• Tearfulness
• Feeling unable to cope
• Finding it difficult to concentrate
• Lack of interest in the world around you
• Loss of interest in the things that used to give you pleasure
• Tiredness and difficulty sleeping
• Lack of energy
• Appetite issues – loss of appetite or comfort eating
• Anxiety and panic
• Tension

How do I get help?

If you suspect that you have PND, you should speak to someone as soon as you can, for example your health visitor or GP. You should also seek help and support from family and friends if they are available, as the more support and people you can talk to, the better.

The main element to making a lasting recovery is through therapy such as counselling, psychotherapy or cognitive behavioural therapy (CBT). There is also a wealth of information, advice and support available online from the NHS and through charities such as PANDAS, Mind and NCT. It is important to remember that you are not alone; treatment and support is out there.

Top tips from Priory to help you to deal with PND

Therapy can be delivered in many different ways; here’s an outline of the therapy offered at Priory Hospital Roehampton alongside discussion points which can be used to help deal with PND.

1. Normalising – raising awareness and understanding that low mood has some underlying causes like: 

• Lack of sleep and physical exhaustion
• The unrelenting nature of baby care – it is a solid 24/7 job even when you have help at home
• Poor support structure – you may have no (or very little) hands-on support to give respite or help on a practical level
• Poor self-care – a common mistake is to always put everyone and everything else first before your own needs – sometimes your needs must come first
• Sense of failure if things are not maintained to the same standard as before the baby
• Significant reduction of time available for your relationship with a partner and fear that you are not a good partner/wife/lover, that you have neglected your career, you’re not as good a cook, you’re not hosting social events and so on
• Too strict rules about what it means to be a good mother: reading about ‘good parenting’ and beating yourself up for not doing as well, comparing yourself with other mums ‘who are doing so much better than me’
• Pressure to regain your previous figure and often having unrealistic expectations of yourself, strict dieting and exercise, measuring your progress by fitting into your old clothes

2. Emotional regulation – addressing a vicious cycle of negative, unhelpful thinking patterns, which are the underlying cause to low mood and low self-esteem:

• I am a bad mother because my baby is crying a lot of the time
• I should be able to cope better with the housework and keep the house tidy
• I must be a bad mother as I feel like running away from it all
• Other mothers are coping much better
• I should fit into my old jeans
• I must return to work soon as I could lose my job
• If I don’t greet my partner/husband with a smile, nice dinner and return to a sexual relationship, he may be tempted to have an affair
• My mother coped with 4 children, I can’t manage 1
• Other mothers from my NCT group are all having nice holidays, I couldn’t possibly show up in my bikini when I am so fat

3. Self-care: 

• A common mistake during the postnatal period is to forget or neglect self-care
• This is often based on thinking that ‘to put myself first is selfish’
• It is central to recovery that it is sometimes necessary and okay to put yourself first as this would enable you to cope with the demands of the postnatal period
• Taking some regular breaks from childcare is a sensible and a responsible thing to do because of the unrelenting nature of caring for a young baby
• Asking for help is a strength not a weakness

4. Making adjustments:

• PND has a lot to do with your capacity to adjust and make changes
• Understanding that your life will never be quite the same after childbirth is the key to adjustment and subsequent expectations
• Adjusting previously held idealised pictures of having a new born baby of bliss, love, smiling, cute bundle of joy etc. to a more realistic view involving sleepless nights, changing nappies, difficulty feeding, piles of washing, etc
• Relationship adjustments to share parenting responsibilities and your different lifestyle

5. Support structure:

• The more support a mother has in the postnatal period, the better they cope with pressure
• Where it is not possible to have hands-on family support, it is important to organise alternative substitutes like your partner, friends, NCT group and/or paid help to give you respite

6. Last but not least…

• Whatever is difficult, you must remember it is a temporary state of mind, or temporary lifestyle; this will not go on forever. Temporary problems require temporary solutions. Your life will be different once your baby starts to grow and you will enter new phases together