Postnatal disorders

It is generally thought that about 10 per cent of new mothers suffer from postnatal depression (PND). However, a survey carried out in 2006 for the Royal College of Midwives suggested that the numbers could be much higher. 27 per cent of women with children under the age of one said that they had received some form of treatment for PND.

Postnatal depression is not the same as the baby blues. The baby blues start a couple of days after the birth. Mothers feel weepy and miserable, worried about their baby or themselves, tense, tired and on edge. It may be that the huge changes in hormone levels that occur after birth are responsible for these symptoms. Baby blues disappear within a day or two.

Symptoms

Below is a list of the most common symptoms. You're probably not suffering from postnatal depression if you have a few of them every now and again. After all, becoming a mother is a physical and emotional rollercoaster -- you can expect to have highs and lows! But if you have a lot of the symptoms and they're there constantly, you should talk to your health visitor or GP.

You may feel:

• Miserable most of the time and especially bad in the mornings and/or evenings

• That life is not worth living and you have nothing to look forward to

• Guilty and very ready to blame yourself

• Irritable, snapping at your partner or other children

• Tearful

• Constantly exhausted, yet not able to sleep

• Unable to enjoy yourself

• That you have lost your sense of humour

• You can't cope; things easily get on top of you

• Terribly anxious about the baby, so that you're constantly seeking reassurance from health professionals that she or he is all right

• Worried about your own health, perhaps frightened that you have some dreadful illness

• Unable to concentrate on anything

• That your baby is a stranger and not really yours.

You may also have:

• Loss of sex drive

• Low energy levels

• Problems with memory

• Difficulty making decisions

• No appetite OR be comfort eating so that the weight piles on

• Disturbed sleep, including early morning wakefulness.

Causes

What is referred to as having the "baby blues" frequently occurs among new mothers. The symptoms are similar to those associated with depression in general, but normally go away within a week or two. If mood swings persist beyond that, postpartum depression may require treatment.

Emotional Causes

A woman may feel inadequate in her new role as a mother, causing her to feel anxious and guilty much of the time. Anxiety may escalate into panic attacks, and a new mother may be afraid to be left alone with her baby. Some women have difficulty dealing with insecurities related to feeling unattractive until they lose weight and get back into shape.

Physical Causes

Even though fatigue, loss of appetite, and lack of sleep and energy are common physical symptoms following childbirth, they can also contribute to depression. Getting enough rest is not always easy to do with a newborn in the house; however, a woman needs to take care of herself so that she can care for her baby. Inadequate levels of thyroid hormone, a difficult birth or premature delivery, and other health problems following delivery can also cause depression. Women who have suffered some sort of physical trauma or abuse during pregnancy can sometimes feel depressed following the birth of a baby.

Previous History of Depression

A past history of depression can trigger postpartum depression in women who get depressed when they become stressed. How long the depression lasts varies among women. For women who have experienced depression in the past, it may take several months before they begin feeling better. Postpartum psychosis, which is rare, affects about one out of every thousand women who give birth. Despite what one might think, worsening postpartum depression does not cause the condition. While symptoms of psychosis may include hallucinations, delirium, extreme agitation, or thoughts of suicide or of hurting the baby, in most cases, the condition can be treated successfully. Women who are more at risk for developing postpartum psychosis are those who have bipolar disorder or schizophrenia.

Loneliness

A sense of loneliness caused by problems in the marriage, or a recent death in the family may bring about depression in some women. It is not uncommon for a woman to feel isolated and lonely, especially during those first weeks after giving birth. Although a lot of women experience some degree of postpartum depression, it becomes a problem when those feelings intensify or fail to go away. It may be necessary for a physician to prescribe antidepressant and anti-anxiety medications to treat postnatal depression. A woman can also seek emotional support whether through counseling or by joining a support group (see Resources below). Talking to other women who feel the same way often helps.

Loss of Control

Having a baby requires making major adjustments; therefore, loss of control over their lives contributes to depression in some women. Women who tend to be perfectionists frequently feel overwhelmed once they realize that having a baby in the household means they may not be able to keep their lives as orderly. Loss of freedom or of self can also trigger depression.

Inability to Cope

Becoming a new parent can be a frightening challenge. One of the most practical things you can do to cope is to keep things in perspective. If you have to, ask your spouse, family, and friends for help with childcare and household tasks. Find someone to whom you can talk openly whenever you feel overwhelmed. Keep in mind that motherhood takes practice. Both you and your baby will be much less anxious and a lot happier once you accept that your baby isn't perfect and neither are you.

When is it right to seek help

Always trust your instincts, if you become more concerned about her wellbeing, the wellbeing of the children or about any deterioration in her postnatal depression. It might mean that you need to contact her partner, family member, medical adviser or support services directly to let them know or to seek advice.

For example, the mother might show any of the following signs and symptoms:

Talk of harming herself or the baby
Bizarre thoughts or speech patterns, or risk-taking behaviour
Behaviour that seems odd or is out of character
Severe change in mood
Withdrawal from all social contact
Extreme despair
Obsession with morbid ideas, or statements like: 'They'd be better off without me'.

Types of treatments

If you do not feel the way you expected to feel during your pregnancy or after having your baby, it is very important that you talk to someone you trust.

Accept the depression
The first step towards getting better is to accept that you don't feel the way you want to and to seek help for this. This will mean starting to talk to people about how you feel and letting go of the many defences and masks you have created.

Medical assessment
Because depression is a medical condition you will need to make an appointment to see your medical adviser. It is important for you to have a series of basic medical tests to rule out any other conditions.

Medication
Antidepressant medication, in conjunction with support and counselling, is a very effective treatment for many women with either antenatal or postnatal depression. Antidepressants do not necessarily treat the cause of the depression or take it away; they can however help speed up the recovery process and support other forms of treatment.
Unfortunately there are many misconceptions about antidepressants and many women who could benefit from them refuse to take them because they are afraid the medication is harmful, particularly if they are pregnant or breastfeeding.
Antidepressants do not change your personality; they act on the brain chemicals that are thought to affect depression and anxiety. Antidepressants are not addictive and some can be safely taken while pregnant and breastfeeding.

Counselling
Counselling and support can help you to understand what has contributed to your postnatal depression and help you to adapt to your role as a mother. With any degree of postnatal depression, particularly long term, it is important for you to investigate all the possible contributing factors (for example unrealistic expectations of motherhood, rigid and controlling thinking, past history of child abuse or grief and loss) to help prevent depression with any future pregnancies and to develop problem-solving strategies.

Lifestyle Changes
 Although it can be difficult for you to make changes to your daily life when you are feeling very depressed or anxious, making some small changes can be helpful. For example, resting when your baby is sleeping rather than doing the housework, sitting to eat your lunch every day or having a shower every morning can help to restore some normality to your life, even if you don't feel like doing these things. Making time to go for a walk, either taking baby in a sling or stroller, or leaving him with your partner, a trusted family member or friend can allow you some time for yourself.
Good nutrition is important to health. Your diet needs to be balanced - preferably low in saturated fats, refined sugar and caffeine and high in fruits, vegetables, and whole grains. Any intake of alcohol or other non-prescribed drugs may have an impact on your body's wellbeing.
Exercise is also an effective form of treatment for depression. Daily physical exercise boosts mood by increasing the levels of positive neurotransmitters, and the release of endorphins will help to create a sense of wellbeing. Relaxation and meditation can also be very effective.

Mother the way you want to mother
Many of the issues the mother with postnatal depression faces are the same as those of all mothers, for example the baby's feeding, settling and sleeping. Part of your recovery will involve a growth in your confidence with making decisions about the care of your baby and how you want to be as a mother, in partnership with your partner.
For many mothers, being supported to continue breastfeeding is important to their recovery from postnatal depression. The skin-to-skin contact that comes with it can have a positive effect on your relationship with your baby. Sleeping with your baby or having your baby near you when you sleep may also help your relationship. For other mothers who are more anxious, the closeness of the baby can be disruptive. Note that bed-sharing with your baby is not recommended if you are taking medication that may make you sleep more heavily than normal, and never sleep with your baby on a chair or couch.

Support
Support and patience from family and friends are perhaps the most crucial factors in your recovery. All women with postnatal depression need emotional support from family and friends. It can feel much easier to withdraw from friends and family because of how you feel but isolation from others can actually make you feel worse. Belonging to an Australian Breastfeeding Association group, new mothers' group or other support group is an important part of managing your depression, even though it may be difficult to get there. Being with other like-minded mothers, especially those who have experienced or who understand postnatal depression and women who are supportive of breastfeeding, is very helpful.

For the future
If you plan another pregnancy, it is important to consult your medical adviser for guidance, as there is a higher risk of it recurring. Most medical advisers recommend a woman should have discontinued medication for at least a year before attempting a subsequent pregnancy. 
 

		back to top
Disclaimer
All content within is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.LSCT is not responsible or liable for any diagnosis made by a user based on the content of the LSCT website.Always consult your own GP if you're in any way concerned about your health.
Source information
some useful direct links click here