Most mothers have days when they feel really down. This is perfectly normal. Looking after a baby, being constantly on call and coping with the daily demands of life is not easy. However, some mothers feel low, anxious, depressed, and miserable most of the time. Others are so utterly exhausted that they feel physically ill. These mothers may be suffering from postnatal depression, a debilitating illness that can spoil the experience of motherhood, interfere with the development of the mother-baby bond, and put an immense strain on adult relationships.
What is postnatal depression?
To get the mother through the birth, endorphins, adrenaline, and natural chemicals course through her body. After a few days, the post-birth euphoria declines leaving the mother with a strong sense of anti-climax or the ‘Baby blues’. The rapid decline in hormone levels can make the mother feel weepy, irritable, anxious, or lonely. These feelings are perfectly normal and are not the same as postnatal depression. The ‘Baby blues’ are more common in first-time mothers and those who have experienced problems with pre menstrual tension. The condition usually sorts itself out within a few days and does not require treatment other than reassurance and support from family and friends.
Postnatal depression, also known as postpartum depression, is much more serious and can occur anytime within the first year after the birth. It can develop suddenly, it can be mild or severe and it can happen to mothers with their first, second or last child. About 10% of new fathers may also suffer from postnatal depression.
The difference between postnatal depression and the ‘Baby blues’ is that the disorder affects the mother’s wellbeing and her ability to cope with her baby and the daily demands of life. Without treatment, postnatal depression can last for months or even years. The National Childbirth Trust (2018) suggested the number of women suffering from the illness to be as high as 30% after the first year.
The development of postnatal depression
Most researchers believe that postnatal depression may be the result of a combination of life changes that occur after the birth. Stress, relationship problems, financial difficulties, isolation, loneliness, tiredness, lack of sleep, and poor diet may all be linked to the development of the illness. In general, mothers who are well nourished and in good health during pregnancy, and rest well afterwards are less vulnerable to postnatal depression.
Numerous studies suggest lack of social support to be a significant contributory factor. Mothers who find themselves without the support of their partner, friends and family may be at increased risk of developing postnatal depression.
What are the symptoms?
The symptoms of postnatal depression are very similar to those seen in 'ordinary' depression and may include:
Fatigue - the mother may be so utterly exhausted that she feels physically ill. Even a simple task such as getting dressed may seem an impossible one.
• Sleep disturbances - although the mother feels tired, she may find it hard to get to sleep and may wake up very early in the morning.
• Feelings of worthlessness or hopelessness - the mother may find that she is unable to organise a routine, do anything well or work out what her baby needs or wants. She may also fail to take care of herself and how she looks.
• Anxiety - the mother may be obsessed with the baby’s health and development and concerned that the baby will come to harm if left alone.
• Despair - feeling unhappy and wretched can be worse at particular times of the day. Occasional good days may be followed by bad days which can make the mother feel tearful for much of the time.
• Irritability - feelings of irritability are common and may be aimed at her partner or family members, who may not understand what is happening.
• Reduced libido - postnatal depression can take away the desire and enthusiasm for sex. If the mother’s partner does not understand this, he may feel rejected.
• Guilt - even though the mother has really looked forward to motherhood, she may find it hard to love the baby, which increases her sense of guilt.
• Appetite changes - although the mother needs all the energy she can get, she may forget to eat or lose her appetite. Some mothers may eat for comfort and then feel bad about putting on weight.
• Panic attacks - headaches, stomach pains, heart palpitations or hyperventilation can make the mother fear that she is going to have a heart attack or a stroke.
• Social withdrawal - the mother may lose interest in activities that she enjoyed before the birth and may not want to go out at all.
• Delayed attachment - the mother may be unable to respond to her baby’s need for love and affection. This is an important concern because emotional availability in the first six months of life is crucial to the baby’s overall health and future development (see ‘Forming a loving bond’).
• Harming the baby - the mother may worry that she may harm the baby. However, most mothers look after the baby at least as well as other mothers. Very rarely a mother may harm her baby. This may be because she is suffering from postnatal psychosis, a severe form of depression. Fortunately, this is unusual.
• Thoughts of suicide - the mother may feel that suicide is the only way out of her problems. This should be taken extremely seriously - help and support should be sought straight away
Postnatal depression is diagnosed on the basis of what the mother, or her partner or family, tell the GP about her symptoms. Many GPs use a short questionnaire to help confirm the condition. The GP may also give the mother a blood test to eliminate underlying physical problems such as anaemia.
The first stage in treatment might be the development of a recovery plan, which includes good nutrition and plenty of rest. Both are important for emotional health, strength, and energy. Regular meals, adequate intake of protein from meat, eggs and cheese and natural sources of omega 3 fatty acids from certain fish and vegetables can make a real difference. Some studies have also found the daily intake of B vitamins to be beneficial. Hydration is important. The recommended daily intake is about ten tall glasses of water.
The use of complementary therapies such as massage, yoga, aromatherapy, and acupuncture can help relieve stress, and regular exercise such as walking, swimming, jogging, or cycling can boost mood and wellbeing.
For advice and support on postnatal depression and other aspects of parenting, parents may find the following links helpful:
Association for Postnatal Illnesses (APNI)
www.apni.org Helpline: 020 7386 0868. APNI offers help, advice and support to women affected by postnatal depression. It exists to increase public awareness of the illness and to encourage research into its cause and nature.
Mums Meet Up - Support & Friendship For Mums Meet other mums in your area and across the UK.
www.cry-sis.org.uk Helpline: 020 7404 5011. Support for families with excessively crying, sleepless and demanding babies.
www.fathersdirect.com Helpline: 0845 634 1328. Information aimed specifically at fathers on all aspects of parenting.
National Childbirth Trust
www.nct.org.uk Helpline: 0870 444 8707. Information and advice on all aspects of pregnancy, breastfeeding and early parenthood.
Parenting and Family Support
(formerly Parentline Plus) www.familylives.org.uk Helpline: 0808 800 2222. Advice and information for parents and carers.
www.samaritans.org Helpline: 116 123. Confidential and emotional support to any person who feels suicidal or despairing.
Dr Lin Day