About postnatal depression
I did not realise that so many women experienced postnatal depression. Quite a few people in my antenatal group did. We discussed it after the fact, but some of them did not feel comfortable sharing with the group at the time. There is a feeling of stigma for some of us. I wish I had known how common postnatal depression can be.
People who have never been mentally unwell before can experience postnatal depression. Others may have had depression or a psychotic illness in the past. Regardless of whether you have prior experience of mental distress, the symptoms and treatment of postnatal depression are similar. The major difference between this form of depression and other forms is you have a newborn baby to look after while you’re experiencing depression.
Because postnatal depression can affect how you feel about and care for your baby and other children, it is important to get help and support as early as possible and not to ignore any signs that something may be wrong. You’re not a bad parent, and postnatal depression doesn’t mean you don’t love your baby. It just means you’re human and you need some extra support. Talk to your midwife or doctor as soon as you can.
If you fear you might harm yourself, it is vital that you seek help immediately by dialing 111.
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 include:
- past history of depression or other mental health problem(s)
- relationship difficulties, especially with the other parent of the baby or with one’s own parent
- having little social support
- onset of depression during pregnancy
- hormonal problems
- life stresses or difficulties such as money or housing problems.
Being a sole parent, having little support from family or friends, getting very little sleep and being financially under stress all make caring for a baby very difficult and increase the risk of postnatal depression. At the same time, people with lots of support, good financial status and a stable relationship can and do also experience postnatal depression. In either case, it doesn’t mean your brain is broken. It just means you need some help.
Risk factors related to the birth can include:
- birth complications, such as an unplanned caesarean delivery, leading to experiencing birth trauma
- the birth not meeting your expectations: for example, you may have wanted a home or natural birth but had to have a birth in hospital or with medical intervention, or you may have felt like healthcare workers were not listening to you or were not taking your wishes sufficiently into account
- a baby with health problems, including injuries caused by birth.
Risk factors after birth:
- ongoing postnatal low mood
- sleep problems
- a baby that is fussy, has problems feeding or has colic or reflux.
What would I have wanted to know when I was experiencing postnatal depression? That it wasn’t because I was a bad mum. That it didn’t mean I was failing as a mum. That it didn’t mean I didn’t love my baby. And that getting help was a strength, not a sign I was failing.
When accessing support, the first step can be going to your GP. It is important that people take a support person with them. When you have depression, it is hard to retain information and the support person can make notes. If you do not feel heard or supported by your GP, try another doctor. Keep trying until you get heard, and if you are unable to advocate for yourself, ask a family member or friend to help you.
Treatment of postnatal depression can involve different things, each of which can be tailored to your individual needs. Your health provider will recommend a mix of treatment options which best suit you. If you are not happy with the treatment you’re receiving, talk to your doctor 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.
Supportive counselling is an effective treatment for milder forms of postnatal depression – in fact, it is as effective an antidepressant medication. Talking therapies such as cognitive behaviour therapy (CBT) or acceptance and commitment therapy (ACT) are very effective in helping people recover from postnatal depression. Therapy teaches you to use your skills and resources to cope and recover.
Your doctor may prescribe you with antidepressants. Finding the right medication can be a matter of trial and error – there is no fool-proof way to predict which medication will be effective for and well 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
- what their side effects (short- and long-term) are
- what you can expect when or if you stop using the medication.
Even if you are breastfeeding, there are medications you may be able to take. It is best to discuss with your health provider what might be on offer for you. 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.
A big learning curve was for me was learning how to take care of myself after having a baby. I remember the Plunket nurse coming around to check baby and he was doing great, and she asked if I had eaten, but every time I put baby down, he would cry, so I had not. She said put him down where he is safe and make a sandwich. I was so focused on his needs and was not taking care of my own.
Other strategies to support recovery
Learning more about postnatal depression
Education about postnatal depression can be extremely important to help you and your family/whānau and supporters to understand and help in your recovery. Talking about it with friends and family/whānau will help.
The term complementary therapy is generally used to describe therapies and treatments that differ from conventional western medicine and that may be used to complement and support it. Certain complementary therapies may enhance your life and help you 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.
Postnatal depression is common. Connecting with others who have experienced it can be very valuable and can make you feel less alone. You may connect in person or online, and you may enjoy talking to people with the same background, age, ethnic group, sexual orientation etc as you. It is often useful to see how others have recovered and that there is a way forward.
Ask your peers. In our online support group, mums get great advice from each other as well as the support team – questions about how to access support, which GP to go to, etc.
You’re the expert in your own mental health and wellbeing. Taking charge of your recovery and doing things that make you feel better, stronger and more in control will help your recovery from postnatal depression.
When you have depression, it can be hard to find the energy or motivation to look after yourself.
Start small – return a text message, open a window, close your eyes and listen to the birds singing. Slowly build up to bigger things and try to notice what makes you feel better.
Make a list of things that feel good and keep it on your phone, in your diary or on the fridge. When you’re struggling, check your list and pick one thing you can do right now that might help.
These may include:
- learning about postnatal depression and reading/listening to stories of other people who have found a way through
- keeping a mood diary to learn what can bring on low mood for you – there might be signs or indicators that tell you that you need a break, and the diary can also show you what makes things better
- identifying and reducing stressful activities
- ensuring you are eating healthy food
- cutting back on non-prescribed drugs and alcohol
- using relaxation exercises, yoga, meditation, mirimiri or massage
- using online tools or apps that support recovery
- getting enough sleep – this can be difficult for new parents, but sleeping when you can is important
- spending time in nature – even just sitting in the sunshine listening to the birds singing for a few moments can be really helpful
- getting some exercise
- getting practical support, tautoko and companionship from family/whānau and friends
- humour – comedies on TV, funny movies
- fun – make sure you regularly do things that you enjoy and that give your life meaning
- being kind to yourself and others
I have found journaling helpful, to express my feelings and make sense of them. Regular exercise and eating well also help my mood. Talking to close friends and family about how I am really feeling, I have found, supports me well. Planning something I do socially without my child and outside of the house helps too.
Having a Wellbeing Plan
Many people find that having a written plan, developed together with your health provider, can help you to feel you’re in control if difficult feelings return. Make sure others (your whānau, partners, and any health professionals you work with) are aware of your plan and what you’d like to happen if you become unwell again. Plans can detail (in your own words) indicators, what can set off 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.
Myths about postnatal depression
Myth: “Postnatal or any depression is a sign of a weak character.”
Fact: NOT TRUE. Postnatal depression can strike any person after the birth of a baby. While some people may be more likely to develop postnatal depression, the vast majority of people who develop the condition have not experienced depression or other mental health difficulties before at all.
Myth: “People with postnatal depression can ‘snap out of it’ or just choose to ‘pull their socks up’.”
Fact: 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.
Thanks to Joanna McFarlane clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.