About postnatal depression
What causes postnatal depression?
While anyone who gives birth is vulnerable, there are certain factors that increase the chances of developing postnatal depression.
Risk factors before pregnancy and birth:
- Past history of depression or other mental health problem(s).
- Relationship difficulties, especially with the father of the baby or with own mother.
- Having little social support.
- Onset of depression during pregnancy.
- Hormonal problems.
- Life stresses or difficulties such as money or housing problems.
Risk factors related to the birth:
- Birth complications, such as caesarean delivery can lead to experiencing ‘birth trauma’.
- The birth did not live up to expectations, e.g, birth in hospital or with medical intervention
- when the person wanted a home or natural birth.
- Baby has health problems, including damage caused by birth
Risk factors after birth:
- Ongoing postnatal blues.
- The mother experiences sleep problems.
- The baby is fussy, has problems feeding, or has colic or reflux.
Signs to look for (symptoms)
- Feeling low, sad or depressed. You might feel sad or empty, you might not feel anything at all. You might experience pain that’s hard to describe or locate. You may cry for no apparent reason. Some people feel sad or low all the time, others have periods where they feel better that do not last longer than a day or two. People from non-European cultures might have different words to describe this feeling. If you’re Māori, you might think of it as feeling wainuku (really low or down in the dumps), whākama (shame) or whākamaemae (emotional pain or distress).
- Losing interest and pleasure in usual activities. This means you don’t enjoy things you usually would.
- Feeling irritable or angry for no reason. Some people find this is the main sign that something is wrong following childbirth. It can make dealing with the frustrations of caring for a young baby more difficult and can cause harm to other relationships.
- Change in sleeping patterns. The most common change is reduced sleep, with difficulty getting to sleep, disturbed sleep, and/or waking early and being unable to return to sleep. While it is usual for new parents to have their sleep interrupted by a waking baby, people with postnatal depression often find they cannot sleep even when the baby is settled. You may lie awake worrying about the next feed or the next day.
- Not feeling connected to baby or feeling overly anxious about baby. Some people experience both these things These feelings can cause whākama or shame and can mean some people are too ashamed to ask for help or share how they’re feeling. Understanding it’s a common part of experiencing postnatal depression and not a sign you’re a bad parent can be the first step toward recovery.
- Change in appetite, often not feeling like eating and, as a result, lose weight. Some people will have increased appetite, often without taking any pleasure in eating.
- Decreased energy, tiredness and fatigue is common. You may feel that the smallest and simplest things are impossible. This makes caring for a baby more difficult.
- Physical slowing or agitation often comes with severe postnatal depression. You may sit in one place for periods and move, respond and talk very slowly; or you may be unable to sit still, pace and wring your hands.
- Feeling worthless or guilty involves loss of self-confidence, and this may make you withdraw from friends and whānau. You may also feel you’re a bad parent or doubt you can care for your baby.
- Having thoughts of hopelessness and death and feeling there is no hope in life.
- Difficulty thinking clearly - you may have difficulty in concentrating or in making simple, everyday decisions.
- Feeling anxious – there are different kinds of anxiety you may be feeling.They may include:
- Excessive worry or fear (often about your baby) sometimes with physical symptoms such as muscle tension, pounding heart or dry mouth.
- Panic attacks, with sudden episodes of extreme anxiety and panic and physical symptoms of fear. Often this will involve panicking about your baby.
- Phobias. Specific fears about situations, fear of open spaces, confined spaces, heights, objects, animals.
- Excessive concern about physical health. You may worry you are physically ill in some way, or your baby is ill or has something terribly wrong with him/her.
How to decide if you have a problem
Remember, depression is a serious illness and you do need to see your doctor if you suspect you may be suffering from it. If you have any concerns or questions, you can contact a PlunketLine nurse 24 hours a day and free from any phone: 0800 933 922
Your GP will recommend a mix of treatment options which best suits you. If you are not happy with the treatment you’re receiving, talk to your GP before stopping.
Try to work with them to identify what isn’t working for you and find a compromise that supports your recovery. If you are on medication, don’t stop taking it without consulting your doctor. Stopping some medications suddenly can make you feel worse.
Therapy, such as counselling
More specific therapies such as cognitive behaviour therapy, (CBT) are very effective to help people recover from postnatal depression. It teaches you to use your skills and resources to cope and recover.
Learning more about postnatal depression
Your doctor may prescribe you with antidepressants. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.
If you are prescribed medication you are entitled to know:
- the names of the medicines
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for and what their side effects (short and long-term) are.
If you are breast feeding no medication is entirely safe. Before making any decisions about taking medication talk with your GP about the potential benefits and problems.
It is important not to stop taking antidepressants suddenly without medical advice.
Certain complementary therapies may enhance your life and help you to maintain wellbeing.
These could include mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy. These have all been shown to have some effect in alleviating mental distress.
When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking.
Having a “Wellbeing Plan”
Make sure others (i.e. family/whānau, partners, and community mental health staff) are aware of your plan and what you’d like to happen if you become unwell again. Plans can detail (in your own words) symptoms, what can trigger these feelings and what things help you.
They can also list the numbers of support people, helplines and more, and outline what you’d like to happen if you need professional support.
Family/whānau support and involvement
The level of family/whānau support and involvement you need is up to you.
Family/whānau members may be struggling to know how to help. If there are specific things that would help you, try asking for them. Say: “it would be really helpful if you helped me fold the laundry/washed the dishes/hold the baby while I shower/take the other kids out for a bit.”
Remember it may be difficult and distressing for family/whānau and friends to see you feeling so low, and they may need to:
- Seek support for themselves from friends, family/whānau and/or counsellors.
- Educate themselves on postnatal depression.
- Get help with understanding what is happening to you.
- Learn to set clear boundaries about behaviour.
- Learn to manage their own stress.
Family/whānau can learn to use words that may help you feel supported:
- “You are not alone in this. I'm here for you”.
- “You may not believe it now, but the way you're feelings will change”.
- “I may not be able to understand exactly how you feel, but I care about you and want to help”.
- “You are important to me. Your life is important to me”.
Support for fathers/partners
Myths about postnatal depression
NOT TRUE Postnatal depression can strike any person after the birth of a baby. While some particular personality types may be more likely to develop depression, the vast majority of people who develop the condition have been previously healthy and led normal lives.
People with postnatal depression can 'snap out of it' or just choose to 'pull their socks up'.
NOT TRUE One of the most disabling symptoms of depression is the fact that it saps the will and makes doing anything an enormous effort. Depression is an unpleasant experience, and most people with this condition would (and do) do anything to get well. ‘Snapping out of it’ is not an option.