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Did you know that Brooke Shields, Courtney Cox, Gwyneth Paltrow and Elle Macpherson all suffered from postnatal depression? Postnatal depression (PND) has been named the silent epidemic. It affects ten per cent of mothers, yet it is rarely talked about. Indeed, there is often a lot of confusion as to what it really is.
Having a baby is a life-changing experience. Pregnancy and the first year after the baby is born are frequently experienced not only as a time of joy but also a time of stress. Unwanted and unexpected feelings of sadness, exhaustion, worry and irritability are frequently common and can leave a new mother feeling confused and frightened. These feelings generally come and go and are, on the whole, manageable. Sometimes, however, feelings of depression persist for weeks or even months after the birth of the baby. This is known as PND. People sometimes use the term ‘baby blues’ when talking about PND, which can add to the confusion, making it difficult for women to know what are normal feelings and what are part of a condition that they need help with.
Eight out of ten mothers suffer from the baby blues. It is not an inevitable part of the postnatal days but it is very common. In effect, the baby blues is not so much a ‘condition’ as a natural part of the birth process. The baby blues do not last very long, normally starting around the third day after the birth and lasting until the tenth day. Mothers often feel upset, mildly depressed or feel like crying for no apparent reason. Sometimes the baby blues can be triggered by real concerns over the baby’s or the mother’s health. They can also be triggered by the separation from one’s partner that a prolonged hospital stay can involve. Often, however, there can be no apparent reason and it is easy for a mother to become frightened or to convince herself that she is depressed. However, this is generally not the case. These tears are the result of the physical and emotional anti-climax after the birth and the hormonal chaos your body is going through, adjusting to no longer being pregnant and starting to produce milk. It is often best just to go with it and have a good cry. Frequently, these tears and feelings of upset disappear as suddenly as they appeared.
Postnatal Depression (PND)
Postnatal depression is not at all like the baby blues. It can grow and
develop gradually from the baby blues or it can hit a mother suddenly. It usually develops in the first four to six weeks after childbirth; however, in some cases it may take several months to set in. Either way, it should not be ignored. Depression is an illness and it is treatable. Those who suffer from it — and ‘suffer’ is no exaggeration — are left feeling depressed, anxious, unable to cope, tearful, irritable and exhausted. Getting up in the morning can feel extremely difficult and there is a desire to withdraw from others. Feelings of guilt and self-criticism are common, as are feelings of worthlessness. For some people, depression is experienced physically with headaches and muscle pain, a loss or increase in appetite, and problems with sleep. Suicidal thoughts can occur. PND will affect a mother’s ability to engage with her baby. Providing for the baby’s physical care will take great effort and interacting and bonding with the baby becomes difficult. Symptoms will not pass overnight; untreated they can last up to a year or more. That is why getting help is so important. With psychological therapy and/or medication, PND is very treatable. Indeed, recovery can be markedly quick.
Doctors are not sure what causes PND but hormonal changes are now thought to play a limited role, if any at all. We know that for those who are vulnerable to depression, a major life-change or upheaval such as divorce, bereavement, moving house or relocating can trigger it. Having a baby will be one of the greatest adjustments that a woman will make in her life and it can feel like everything has been turned on its head. Paid employment might be brought to an end, or at least a temporary cessation. Past routines and social activities will markedly change, at least in the short-term, and a mother’s relationship with her partner will take on a different complexion. Motherhood, and in particular those early days, can be filled with uncertainty. Throw in two other factors also known to trigger and/or deepen depression — exhaustion and social isolation — and we can see how having a baby can leave some mothers particularly vulnerable to PND. In Hong Kong, where family can be far away for women in the expatriate community, this sense of isolation can be heightened, particularly if the mother is relatively new to the city and has not had the opportunity to build a solid network of friends.
PND is very specific to motherhood, which brings with it a new and changed identity. In the early weeks and months it can be difficult for a mother to feel like an individual in her own right. Her body is no longer her own but an extension of the baby, there solely to meet his or her needs. Likewise, her time is dictated by her baby’s need for food, sleep or comfort. Being responsible for a wholly dependent and desperately vulnerable infant can be difficult, leaving some mothers anxious, irritable and claustrophobic. A mother’s own experience of having been parented can also come into play here.
It is hard to identify who will suffer from PND. However, as with all types of depression, there are certain factors which make some people more susceptible. A past episode of depression, postnatal or otherwise, is top of the list, particularly if a woman has experienced depression throughout her pregnancy.
Other factors (in no particular order) include:
- Having perfectionist tendencies
- Social pressures, such as financial difficulties
- Relationship problems, particularly with a partner
- A history of childhood traumas and difficulties
- Social isolation
- A traumatic birth experience
- Having a sick and/or difficult baby
- Having experienced a recent bereavement, particularly if the grief is unresolved
- Other recent life changes, such as relocating
A common myth is that PND will not affect a woman if she did not suffer after the birth of her other babies. This is not true. A mother can develop PND after the birth of any baby.
Treatment and Recovery
The most important step in treating PND is to recognise the problem and talk about it. The support and understanding of a partner, family, friends and health professionals can play a big part in recovery. Getting a mother to talk to those who are close to her is often easier said than done, so it’s vital that those around her watch for the signs of PND. Obtaining help is crucial as PND is also about the baby. Depression will rob the mother of her capacity to find joy in her interactions with her baby, and likewise, it will rob the baby of the chance to be not just a responsibility for the mother but also a source of great pleasure. Crucially, how a baby understands itself is based on how he perceives the mother to see him.
Every mother’s experience of PND is unique, as will be her recovery. However, research suggests that all mothers with PND benefit from support and companionship from other mothers. The research also suggests that getting professional help is vital. Just talking to a nurse or GP can help. More structured help has also been shown to be very effective. This can take the form of anti-depressant medication and/or psychological therapy such as Cognitive Behavioural Therapy (CBT). CBT can help a mother to make sense of what it is that is happening to her and can give her the coping strategies to help her manage. Medication and therapy can also be combined. Ultimately, what type of help a mother finds most effective will depend on her needs. The most important message is that PND is an illness. It is treatable and with the right kind of help, a mother’s suffering can be dramatically reduced.