What is Postnatal Depression (PND)?
Most women have high expectations of motherhood and assume that they will cope with and enjoy caring for a new baby, as well as finding fulfillment in the experience. So if you find yourself feeling stressed and unhappy, or beginning to doubt that you can cope, it can come as quite a shock. It may be hard to admit how you are feeling - even to yourself - because you do not want it to be true or are afraid of being judged, yet trying to deny the problem tends to make it worse.
Many mothers find that they become tearful and despondent, anxious, tense or irritable and don't know what to do about it. You may be aware of some of the causes, but sometimes there is no clear reason for it and this can make matters worse as you may then feel guilty and inadequate as well. You probably never imagined that having a baby would make you feel like this.
Postnatal depression is more common than you may think. Opinion varies, but it is believed that up to 10 - 15% of women are affected and possibly many more, who do not disclose their condition. It can begin straight after the baby is born or it can develop months later. It can start very suddenly or slowly take hold. Women of all ages and backgrounds are affected, both first-time mothers and those with older children. It is possible that you may feel fine throughout having your first child but become depressed with the next and vice-versa - because of the many factors involved every situation is different. However, research shows that women are more likely to develop PND if they have had it or other forms of depression before.
Remember, mothers need mothering too!
“It felt as if I was just... it was lonely, and I felt as if I was inside this box, just all by myself, with nobody to help me, or to help me understand why I was like this... I have been sad before and I have been unhappy, but never like after I had Thomas, to the point where I just didn’t want to live any more... I enjoyed my pregnancy and I enjoyed having him, it was the greatest thing I have ever experienced until I came home. And then I thought, God, I don't want you, I know that was rotten, but I think, why does a woman go through all that, and end up feeling this way?”
Each woman is affected in her own particular way. These are some of the feelings and experiences which women describe:
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Feeling depressed and tearful. Everything can seem a struggle. Feeling bad about yourself and everything around you.
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Feeling anxious and worried - for example about the baby's health or the rest of the family. This anxiety may extend to feeling afraid of being at home or going out - even to the shops.
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Feeling irritable and frustrated. You may snap at your children, partner or friends or find yourself flaring into anger.
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Feeling physically and emotionally exhausted and unable to cope with family demands.
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Feeling guilty about not being "a proper mother".
You may also notice changes in the way your body functions and the way you behave generally:
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Concentrating on even the simplest task may be difficult.
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Your usual sleep patterns may be upset. You may feel that you want to sleep all the time or it may be hard to go to sleep or to stay asleep long enough to be rested.
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Your appetite may be affected so that you lose all interest in food, or eat much more than usual for comfort or to get through the day on little sleep.
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Your body may seem to slow down. Making decisions of any sort, even about what to wear, can seem impossible.
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Alternatively, you may feel full of nervous energy and keep constantly busy but you feel you don't really achieve much.
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You may have less interest in sex than before and not want to engage in it at all.
Women are affected in different ways and to varying degrees by postnatal depression. Some struggle on with life although it can feel a huge effort and everything can seem flat and dull. You may become caught in a vicious circle that traps you. Being tired through lack of sleep can make you tearful, anxious and irritable. You may then feel guilty about your behaviour or lack of functioning and feel still more useless.... and so it goes on. It is common for women with PND to have negative thoughts about themselves and/or their baby at times and also to feel guilty about having them. Some mothers even end up believing that life no longer has much to offer them and then fantasise of escaping from their situation. Some mothers also consider hurting themselves. It is important to know that this is a temporary state of mind. These thoughts are symptoms of how much you are suffering and feeling trapped and alone. They are signals that you need to seek help and support, which is available.
Thankfully, for almost all women, postnatal depression does not last. You will not always feel like this. Recognising the problem is the first step to recovering from it and is usually a huge relief in itself. It is then important to be able to talk about your feelings and experiences with people whom you can trust and to seek out the kind of support that you need. This is how your postnatal support group can help you.
What Symptoms will I have?
There are many symptoms and you may have some or all of the following to a greater or lesser extent:
- Mood change (high/low)
- Change in appetite
- Chronic tiredness
- Hyperactivity
- Crying (perhaps uncontrollably)
- Poor concentration
- Loss of interest in sex
- Irritability
- Memory loss
- Negative thoughts
- Confusion
- Anxiety / panic attacks (anxiety can lead to physical symptoms like headache, neck stiffness etc.)
- Loss of enthusiasm
- Feeling guilty
- Feeling inadequate
- Fear of being alone
- Fear of being in company
Puerperal Psychoses
Puerperal psychoses are uncommon psychiatric disorders and follow 2-3 live births per 1000 live births, 0.5%-0.6% of mothers giving birth experience this very distressing condition. It is a full scale mental illness with a loss of contact with reality. Generally it takes the form of other affective mental illlnesses, i.e. there may be a schizophrenic episode where the mother has delusions and hears voices. Also manic reactions including talking wildly and dramatic swings in mood can manifest along with feelings of restlessness and voicing threats of violence towards others.
The mother may have suicidal feelings towards herself or her baby.- as she believes herself to be so bad and unworthy that the baby is better off dead. The usual onset is either immediately after birth or 1-3 weeks after delivery. This condition is so serious and debilitating that it is usually detected quickly and pscyhiatric help is required.
These signs could be summarised as follows:
- Insomnia [sleep disturbances]
- Mood disturbances [mother is distressed]
- Unusual behaviour [restlessness; extreme excitement]
- Unusual beliefs [delusions; special powers; persecution; suicidal thoughts]
