Understanding Postnatal Depression & Anxiety
- Dr Gemma Gladstone
- July 20, 2019
About 1 in 6 new mothers experience some degree of postnatal depression. Postnatal anxiety is just as common, and many woman experience both anxiety and depression simultaneously. Postnatal anxiety and depression can be worrying and isolating experiences for a new mum as she tries to deal with her own feelings and symptoms at the same time as trying to best care for her baby and deal with all the new changes and challenges confronting her.
Postnatal depression is very different from the “baby blues” which up to 70% of women experience after birth. This is a transient mood shift that occurs a few days after giving birth where a new mum can feel down, teary and overwhelmed with her new situation.
Postnatal depression can vary in severity like any mood disorder, and for some it can be a very serious condition that requires prompt and targeted treatment. It typically occurs within the first four weeks after childbirth (although it can come on gradually after this time) and sufferers can experience the following symptoms:
- Low mood
- Feeling overwhelmed and extremely anxious
- Panic attacks
- 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
- Excessive guilt caused by having transient negative feelings towards the new baby. Typical emotions that women describe as distressing are anger, resentment or hostility.
- Problems with mother-baby attachment
- In more serious cases, suicidal thoughts or urges may be present (a very small percentage of woman experience ‘postnatal psychosis’ – which is a very serious condition requiring immediate medical attention and usually an inpatient stay in a mother-baby mental health unit). However recovery is usually excellent, with no ongoing serious complications.
Causal pathways or “risk factors” for Postnatal Depression
Like all mental health conditions, 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.
Risk factors that can be present before the birth of your baby might 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 (having very high standards and expectations of yourself) or dependence (doubting yourself and your ability to handle things on your own).
- In schema terms, having a very high ‘unrelenting standards’ and/or a ‘incompetence/dependence’ schemas can increase your risk
- Stressful family relationships or relationship breakdown
- Social isolation or financial difficulties
- Physiological stressors such as hormonal changes, fatigue and any physical complications
- A previous history of pregnancy or birth-related difficulties such as miscarriages, terminations, stillbirths, premature birth or the death of a child
- Poor social supports
- Protracted fertility difficulties and IVF treatments
Risk factors that can arise once the baby is born can include:
- A traumatic birth experience (e.g., high intervention births, post-birth surgery)
- The new baby having a serious illness or medical condition
- Prolonged feeding difficulties and disappointments
- Ongoing and serious sleep deprivation
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 and childbirth can trigger a lot of worries and anxieties as well as old wounds from childhood. If you experienced a childhood which was difficult, neglectful or abusive, having a baby is a major life event which may trigger painful memories and feelings from your own childhood. You may experience difficulties with attaching to your own baby or become at greater risk of developing depression. If you are worried about this, getting help before the arrival of your baby is important.
Also, sleep deprivation alone is enough to cause significant mood disturbance in many mothers. People tend to under-rate the degree to which sleep deprivation and interrupted sleep can affect mood.
At this time you are more vulnerable emotionally due to hormonal fluctuations and therefore pre-existing worries and anxieties are likely to flare up. 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 your parenting 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 and overwhelmingly positive experience. There are certainly many positive and joyful aspects, but there are also difficult ones as well. You may find that you judge 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 your pregnancy you can greatly increase your psychological resilience in preparation for the challenges of motherhood.
Things to remember to help you cope during the early months
- Get support – don’t be afraid to ask for help. Once you know who the good people are that you can rely on, make a plan for how they can best help you get through the first 12 weeks and beyond.
- Reconsider your own expectations. Lower them! and then lower them again! Woman who expect themselves to be perfect and have high standards for themselves (their partner and their baby!) are more likely to get depressed and experience high anxiety. If you are holding, nurturing, caring for and bonding with your baby – you are winning! You don’t have to be anyone’s super-mum and you don’t have to be running around pleasing other people and making afternoon tea for Aunt Martha and her friends. Stop, listen to your baby, listen to your body and follow those instructions, rather than anyone else’s. Don’t beat yourself up for staying in your PJs for most of the day and hanging out with your baby enjoying each other and watching the odd movie. When your baby sleeps, you need to sleep or at least rest. Do the absolute minimum of ‘house-work’. Your baby doesn’t care that the house is messy, they only care that their mummy is taking good care of herself!
- Have faith and believe in yourself. Sure, listen to and use advise if it comes from supportive and reliable people or sources. But it’s also good to tune into and sense what your own intuition is telling you. Also, try to put yourself in your baby’s place when thinking about what they need. For example, don’t get unnecessarily hung up on things like ‘routines’. The first 12 weeks of your baby’s life is also referred to as the ‘fourth trimester’ – and for good reason! It takes your baby that long to even figure out that they are no longer a part of you, so to speak. It is therefore normal and natural (not to mention beneficial) that you are as close physically to your baby as possible and that you get as much skin to skin contact as you can.
- Receive psychological and medical help if needed. If you are struggling to have any positive feelings or if you feel disconnected from your baby, then you probably need professional help as soon as possible. There are safe and effective anti-depressant medications that can be used during this period, so don’t delay in speaking with your doctor or a perinatal psychiatrist for expert guidance. Speaking to a psychologist with experience in postnatal depression as well as recruiting practical support from family and friends will be very helpful.
- Go for walks with your baby. It’s important to keep active and get fresh air and exercise. Plenty of sunlight is good for your mood and exercise is also excellent for managing stress and anxiety.
- Listen to uplifting or fun music and dance at home with your baby. Music helps with mood and fatigue and dancing is a great way to get incidental exercise.
- Refrain from comparing yourself to other new mums. Unfortunately, some new mums are preoccupied with wanting to appear flawless and completely sorted! Perhaps they are overly concerned with and worried about appearing like a ‘failure’. They may appear like everything is running smoothing and that they are having a hassle-free time of things. Do yourself a big favour and just accept that this is all BS! Smile politely and concentrate on your own experiences and your own baby’s development one day at a time. It might be helpful to listen to “Buddhism for Mother’s” as an audio book and remind yourself that this time of your life is both short and precious.
- Remember that any difficult time you are going through now will pass. If you are going through a rough time, know that it will get better. All you can do is get whatever help you can and speak to helpful friends or family and to health professionals when you need extra support. Let yourself receive the help that is offered, rather than expecting yourself to do everything. Everything comes and goes in phases, better times will follow. Remember that any problems you experience now will seem more intense and upsetting due to hormonal stresses, sleep deprivation and the steep learning curve you are facing. While its good to welcome helpful support, its also good to encourage yourself for everything you are dealing with and to spend time with encouraging people.
- Find and connect with like-minded new mums and dads. Make sure you go to your local mother and baby group so that you can at least make initial contact with other new mums. As your baby gets a little older it will be important for you to do more things with other mothers and babys so you can experience a sense of shared community and support. Avoid other mums and dads who you find critical, condescending and who only like to talk about themselves. Spend time with other parents who make you feel good, who want a mutually supportive relationship and who are kind and non-judgemental.
- Try not to delay getting extra help and professional or medical help if you need it. Keeping yourself well is paramount!
- Enjoy your baby!
For more information and support go to: https://www.panda.org.au/