The birth of a new baby can bring incredible joy for a family, but it can also be a time of stress, worry and sadness. If you combine this with the exhaustion that comes from weeks of sleepless nights, it's easy to see why some parent really struggle to cope.
Although most women report feeling tearful at times during the postnatal period, there is a significant difference between this "baby blues" and true postnatal depression. Recognising which is which, and getting help early if things are not improving, is crucial, for the well-being of the mother as well as the baby.
There are three main types of mood disorder that can affect women in the weeks and months after their baby is born:
Up to 80 per cent of women report "the blues", usually within the first week after birth. It often coincides with an increase in breast milk supply. Women may feel teary, sad, anxious or struggle to concentrate.
"The blues" are usually self-limiting and no treatment other than reassurance and support is required.
Postnatal depression (PND) affects approximately 15 per cent of women in the months following the birth of a baby, so is a lot more common than some might imagine. It is more severe and prolonged than "the blues", and can substantially affect the relationship between the mother and baby during this critical period. Women who suffer from PND frequently report feeling sad, tearful, anxious or guilty, often without an obvious "trigger" that they can identify.
Other common symptoms include lack of energy and lack of any enjoyment in life, an overwhelming feeling of failure especially when it comes to their parenting skills, difficulty bonding with the baby, lowered confidence and self-esteem, and a desire to withdraw from other people.
Physical symptoms might be present too, such as a change in appetite, disrupted sleep patterns, poor memory or altered concentration.
In severe cases, the mother might experience thoughts of harming either herself or her baby – this should always be taken seriously, and medical help should be sought immediately. Luckily PND is treatable, but it often takes many weeks or even months to be recognised, prolonging this difficult time for the parents and baby.
Also known as puerperal, this condition is thankfully very rare, affecting only 1 in 500 pregnancies. It is a serious psychiatric disturbance, and often the mother is "out of touch" with reality. It is much more serious than PND, and requires urgent, highly specialised treatment.
Risk factors for PND and postnatal psychosis
When it comes to developing mental illness, anyone can be affected – culture, background and age are not protective. However, having any of the following risk factors does make PND more likely:
- a past history of depression, anxiety or other mental illness
- poor social support
- life stressors (such as housing or financial difficulties)
- poor sleep
- relationship difficulties or being a single parent
- having a baby who is sick or has developmental difficulties
- the birth not matching the "expectations" of the parents, for example a baby who was born in hospital or with medical intervention, when the parents were hoping for a natural or home birth
- having a baby who is very hard to settle, e.g due to colic or reflux.
If you are pregnant or have just had a baby, it is important to recognise these risk factors early. Your midwife or GP will be able to suggest some strategies that can reduce the likelihood of you getting PND. This might include practical solutions such as extra support for meals and childcare to help ease the load once your baby arrives. Getting regular rest and breaks from your baby is really protective in terms of PND, so don't be afraid to say "yes" if people have offered to help.
If you think you or someone you know may already have PND, don't be afraid to talk or ask about their feelings – it could be the first, important step towards recovery. There is often no single treatment that fits all situations, but the following options may be helpful, and often a combination of things is the most effective approach:
- support groups can be really helpful and reassuring to be around other parents who are going through the same thing
- practical and emotional support – either from friends, family or via more official organisations, this type of help is invaluable and may be all that is needed to get parents through a very difficult time
- medication – antidepressants certainly won't be required in every case, but can be highly effective and are safe to take when breast-feeding
Postnatal depression can last from a few weeks to many months, and can have a huge impact on all the family. The sooner help is sought, the sooner the mother will be able to recover and enjoy this very special time with her newborn.
For more information visit the PANDA website or phone the National PANDA helpline on 1300 726 306.
Cathy Stephenson is a GP and medical forensic examiner.