Post Natal Depression

Postnatal depression is very different from the “baby blues” which up to 70% of women experience after birth. Postnatal depression is a serious disorder that requires prompt and targeted treatment. It typically occurs within the first four weeks after childbirth and sufferers can experience the following symptoms:

  • Low mood
  • Feelings of being overwhelmed and extremely anxious
  • Panic attacks
  • Irritability
  • Difficulty concentrating or remembering things
  • Sleep difficulties (not just due to a disrupted sleep cycle due to night feeds etc)
  • Appetite disturbance
  • Feelings of hopelessness and being unable to cope
  • Loss of confidence and low self-esteem (particularly in perceived ability to be a good mother)
  • Extreme indecisiveness, this may also manifest as excessive reassurance seeking from other regarding decisions about caring for baby
  • In more serious cases, suicidality or even attempts
  • Excessive guilt caused by having negative feelings towards the new baby. Typical emotions that women describe as distressing are anger, resentment or hostility.
  • Problems with mother/baby attachment

 

Causal pathways or “risk factors” for Postnatal Depression

As with all mental disorders, the causes of postnatal depression are multi-faceted. It is useful to differentiate those risk factors that pre-exist before the arrival of your baby and those that arise after your baby is born. Those that can be present before the birth of your baby include:

  • A genetic vulnerability to mood disorders such as depression or bipolar disorder
  • A previous history of a mood disorder
  • Previous history of an anxiety disorder
  • Pre-existing psychological vulnerabilities such as perfectionism or dependence
  • Dysfunctional relationships
  • Concurrent social stressors such as relationship breakdowns, social isolation or financial difficulties
  • Physiological stressors such as hormonal changes, fatigue, physical complications
  • A previous history of pregnancy or birth-related difficulties such as miscarriages, terminations, stillbirths, premature birth or the death of a previous child
  • If the current pregnancy is unwanted
  • Poor social supports
  • Protracted fertility difficulties/treatments

Those that can arise in the postnatal period commonly include:

  • A traumatic birth experience (e.g., high intervention births, post-birth surgery)
  • Prolonged feeding difficulties and disappointments
  • If the baby is ill or there are physical complications
  • If the birth process did not fit with previous expectations


If you recognise any of the antenatal risk factors shown above, you can reduce your risk by intervening early. In particular you can address the psychological risk factors and also plan adaptive coping strategies to put in place after your baby has arrived. Seeking help before your baby is due can reduce the risk of developing postnatal depression as studies have shown that mood and anxiety symptoms during pregnancy increase the risk of developing post-natal depression.

It is also important to remember that a pregnancy can trigger a lot of worries and anxieties. Sleep deprivation alone, is enough to cause significant mood disturbance in many mothers. You are more vulnerable emotionally due to hormonal fluctuations and it is possible for pre-existing worries and anxieties to flare up during this time. For example, you may find yourself worrying about all the uncertainty around the birth and your transition into motherhood. You may also be concerned about how the way you parent is going to be influence by how you yourself were parented. A frequent concern is “I don’t want to make the same mistakes my parents did”. This can also fuel a lot of anxiety and worry. There is also increasing pressure for women to find motherhood and pregnancy an amazing, overwhelmingly positive experience. There are certainly many positive exciting aspects to it but also difficult ones as well. You may find yourself judging yourself harshly e.g., “I don’t know what is wrong with me, everyone thinks I should be so excited”. By addressing any anxieties and worries before or during a pregnancy you can greatly increase your psychological resilience in preparation for the challenges of parenthood.