Perinatal anxiety and depression

postnatal depression
postnatal depression 

Many of us have heard of post natal depression. Some high profile women have even spoken about their own experiences: Brooke Shields, Courtney Cox, Australia's Jessica Rowe and most recently Hollywood actress Gwyneth Paltrow. The illness is now referred to as perinatal anxiety and depression, because the illness can occur during pregnancy, not just after the birth.
Pregnancy and the birth of a baby can bring an immense amount of joy into a couple's life. There is also considerable adjustment for you and your partner: the change in roles if you are taking maternity leave, the changes in your body post pregnancy and during breastfeeding, and the general changes to your routine and everyday life.
Around 20 percent of women suffer from perinatal anxiety and depression, which equates to 50,000 women each year. The illness does not discriminate, and if left untreated can have far reaching effects on a woman's health and wellbeing as well as that of her partner and other children.
There are many varying symptoms that women with perinatal anxiety and depression may experience from an inability to sleep, to a lack of appetite or ability to enjoy things they used to.
Women also experience the illness in different ways - some present a very controlled public face, suffering behind closed doors, while others clearly withdraw from family and friends and do not cope with day to day tasks. Many women are reluctant to admit they are not coping. Society and the media place immense pressure on women to be "natural mothers", to take it all in their stride and falling short of this can be perceived by the mother as failure.
Perinatal anxiety and depression is transient, but the earlier it is diagnosed and treated by a health professional, the sooner a woman will recover, giving her the opportunity to enjoy her baby and new life.
Below are two women from the Gidget Foundation who have shared their stories of perinatal anxiety and depression:

Gloria, 28 year old, mother of one
I had heard of post natal depression before but I never once thought I may get it. Throughout the pregnancy I was focussed on the little person growing inside me - I spoke, sang and read to him at every opportunity.

My husband and I did some hynobirthing classes and decided to have a natural water birth with no drugs. I later learnt that labour doesn't always go to plan, you need to remain flexible. My high expectations of the birth, breast feeding and motherhood were contributing factors in me developing post natal depression and anxiety.
After 23 hours of labour I had an emergency caesarean. The operation made it hard for me to get out of bed and feed my baby. Differing advice about breastfeeding from midwives and lactation consultants left me overwhelmed. I felt guilty about my inability to breastfeed, something I had planned to do for 12 months. Many people assume that breastfeeding is a choice, but it doesn't always work for mother and baby.
I was used to having an answer, but all of a sudden I had this little bundle that was very unsettled - he would writhe around, arching his back and crying until his little face was beet red.
I longed for my old life and wondered how I could have made such a big mistake. As my body was recovering, I started to spiral into an almost constant state of anxiety. I was frightened of being alone with my baby, as I didn't know what to do if he started to cry inconsolably.

I had trouble sleeping, even when I had the chance, I could feel and hear my heart beating, I was restless but lethargic and my mind was racing. I was scared of feeding, dressing, or wrapping my baby, I found the smallest tasks daunting and I felt like a failure.
I couldn't concentrate, I tried to read but I would get stuck on the same line. I was just plodding through the days, sometimes not getting out of my pyjamas at all. Everyone around me was propping me up and looking after my baby for me. I wanted to disappear, to run away and start a new life, or to go to sleep for a very long time and wake up to a life that was bearable.
Friends and family wanted to visit but I didn't want anyone to see that I wasn't coping so I shut myself off. I didn't want to go out because I felt my baby was the only one screaming. When I did go out alone, I enviously watched other mothers with their babies. I felt robbed of the beautiful, loving experience I had expected and had so often seen portrayed in the media. I felt immense guilt for not having had a natural birth and being unable to settle my baby.
About five weeks after the birth it became clear that my depression wasn't lifting. After advice from my GP and the local perinatal mental health nurse I started on anti-depressants and reluctantly admitted myself into a mother and baby unit at St John of God Hospital. I had run out of options and finally accepted I needed more help and fast.
Taking these steps changed everything. The medication was relatively short term and helped me get some much needed sleep. In hospital I was able to bond with my little boy and slowly take over the majority of care for him. I had mothercraft nurses at hand, I was involved in talking therapy, relaxation classes and met other mothers experiencing similar situations. It was a slow process but there was improvement and I made some enduring friendships.
At times I wondered if I would ever find myself and feel happy again. By Christmas I was out of hospital, my baby was 12 weeks old and had settled into the world a little more. Slowly I began to feel more normal. I wanted to spend time with friends, I had gained confidence as a mother and most of all I was enjoying it.
At my lowest I felt everyone would be better off without me - I will be forever grateful that I got the right professional help and had the family support to help me recover. The joy I know feel at sharing my life with baby is sometimes coupled with a moment of awareness which reminds me I could have missed out on all of this, had I given into the anxiety and depression.
I now know that perinatal depression and anxiety is common and an illness which doesn't discriminate. Women need to be honest about how they feel so they can reach out for help, recover and get on with enjoying motherhood.

Cathie, mother of five
Perinatal depression has left a permanent rawness within me although it is some years since my chance diagnosis and admission to the psych unit where I spent four weeks in a surreal twilight zone. Two sad years followed filled with turmoil and lost opportunities. The excruciating memories have never faded and ten years passed before I could share this dark secret. 

I collided with the birth industry and its prescriptive messages and regulations for good pregnant mother behaviour. I found this surveillance very disempowering.

Motherhood was thrust upon me - two unplanned pregnancies - two babies 11 months apart.

I collided with the birth industry and its prescriptive messages and regulations for good pregnant mother behaviour. I found this surveillance very disempowering and I developed a resistance to every issue.  

My unrecognised descent into antenatal depression began with this loss of control. Postnatal depression gathered momentum as I found myself unable to cope with society's expectations and my own idealised views of me as a mother. Here I was, the typical high achiever, completely diminished by my experiences. I "failed" all aspects of my first pregnancy: contraception, pregnancy, natural childbirth, and then breastfeeding. I was to be the perfect herbal birth mother. I became a medical emergency. Not one person, professional or friend, actually asked me how I was feeling, surrounded by all this failure.

I denied my second pregnancy, and although I had the herbal endorphin filled labour I'd dreamed of, out came the baby along with the endorphins leaving me in a state of serious weeping distress.  


While comparing myself to socially acceptable ideals I felt more and more distressed and isolated with the realisation that my life was a train wreck, not the Brady Bunch.  

I lived a highly functioning double life. I maintained a public image of the well presented coping mother with two babies, while in the privacy of my own home I de-compensated. My feelings scared me. My repetitive thoughts intruded constantly. My days were spent crying, alone, rocking, self -harming. I prayed for a tragedy to hit my family, putting myself and my babies into some extreme situations hoping there would be an accident. Desperate women do desperate things.

Feelings of grief and anger overwhelmed me along with a constant ache. I felt these black feelings would be with me for the rest of my life and contemplated that a short life was therefore the best option.

I just wanted my old life back.

When I was finally professionally assessed and diagnosed I felt such relief to hear that there was a name for this insanity. This extreme experience was being validated.  

I had no idea just how long and hard the recovery journey would be. It involved the help of a wonderful psychologist - she was the saviour of my sanity and our marriage. It involved antidepressants, long term Cognitive Behaviour Therapy, and a lot of determination. My recovery was a battle with myself, while enjoying the (close) support of my partner and the birth of more (planned this time) children - I wanted to be the master of my destiny.

Perinatal depression is a complex cocktail of biosychosocial ingredients. The surging waves of hormones and chemicals create a perfect environment for the raw emotional reactions to our new surroundings. Adjusting to motherhood can involve feelings of grief and loss, with some mothers having difficulty redefining their role, and renegotiating their identity. The transition to parenthood is a major life change for both partners and a bit of self awareness goes a long way.  

Mothers are the connectors of our communities and communities need healthy mothers who feel supported and valued. We need to have realistic expectations. While life with a new baby can be wonderful, filled with gummy smiles and milky kisses, it can be relentless and mothers need to be resilient.

Understanding the reality while ignoring the romantic fantasies and the "cult of perfection" helped me to finally move away from the blackness. Eventually I did find myself again, but it was a different self in a different place - like I'd fallen down one hill only to struggle up another steeper one. But it is a place where I could embrace the chaos of my new life with my partner and children.

This article has been provided by the Gidget Foundation. The foundation exists to promote awareness of Perinatal Anxiety and Depression amongst women and their families, their health providers and the wider community to ensure that women in need receive timely, appropriate and supportive care. The foundation is based in NSW and was established in 2001 after the tragic death of a young mother suffering from postnatal depression. A not for profit organisation, recognised by the Australian Tax Office which receives no Government funding, the Foundation is based in NSW and provides synergy between individuals and institutions supporting women with perinatal mood disorders. All funds raised are directed to programmes supporting women during the perinatal period.

Discuss depression and mental health issues with Essential Baby members.