health, Parenting, Psychology
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Post-natal depression – healing the baby blues

woman cryingPost-natal illness can affect as many as one in four women and research shows that their babies may also suffer long-term effects from this much misunderstood illness.  Yet still a vast number of cases go undiagnosed while women – and their families – suffer in silence.

When my son James was eight weeks old we went along to the surgery for the standard check-up.  Every inch of his small frame was checked; every reflex tested.   ‘And how are you?’ asked my GP, as an afterthought.  ‘Not great,’ I replied, ‘tired all the time; feeling pretty low and I just can’t sleep.’  He leaned back in his chair and smiled indulgently:  ‘Welcome to parenthood,’ he said.

The next months passed in a nightmarish twilight as I found myself less and less able to cope.  Even the tiniest tasks took on formidable proportions.  If I went out with James I was petrified that he would cry and not stop.  If I went out without James I became obsessed with morbid fantasies that he would die while I was away.  I was totally exhausted and yet I could barely sleep. 

It took me nine months to realise I was suffering from post-natal depression rather than a case of inept parenthood.   ‘It’s not difficult for experienced people to see when a woman is depressed,’ says Professor Vivette Glover of Imperial College London. ‘But often the woman and her family don’t realise it’s depression.   There is still the view that says ‘well what do you expect, you’ve just had a baby?’’ 

In its mildest guise PND comes as the traditional ‘baby blues’ – the often intense form of letdown and weepiness that afflicts around three-quarters of women in the first few days or weeks after delivery but then usually subsides (although for some women it intensifies into full-blown PND).    A small minority of women experience puerperal psychosis, a potentially life-threatening condition which can include hallucinations and delusions.  This is the terrifying illness which lies behind heart-rending headlines such as ‘Mum threw baby out of the window’ or ‘new mother jumps to her death.’ 

In the middle lies ‘ordinary’ PND – with a wide range of symptoms.  ‘Most mothers who have the illness find that they are less able to cope with the demands of the baby and the home,’ says the Association for Post-Natal Illness. ‘Some feel very despondent.  Some feel very sad and cry frequently.  Some feel anxious and fearful; they worry about their own health and that of the baby.  They may suffer from panic attacks and feel tense and irritable all the time.  Most depressed mothers feel tired and lack energy, often they feel unable to concentrate and even simple tasks are confusing and demand too much energy.  Some experience pains for which there is no cause, many suffer difficulty in sleeping and poor appetite.  Many lose interest in sex.’

Sally, now 44, was 35 when she had her son James.  ‘The birth was pretty traumatic,’ she recalls. ‘And afterwards in hospital I was suffering sweats and palpitations.  I just couldn’t sleep.  I remember walking down to the nurses in the middle of the night and saying I felt as if I were dying.  I had sweat pouring down my face.  They just gave me some sleeping tablets and carried on talking.  When I got home I still couldn’t cope.  I couldn’t go out, I couldn’t go shopping – I became completely agrophobic. 

‘You become totally agitated so you can’t sleep which makes you more agitated and snappy.  You just spiral out of control.  People say you should talk about it with other women but there is this kind of bravado.  They are coping and getting on with it, so why shouldn’t you?  So you start to wonder what on earth is the matter with you – why is it that you can’t cope while everyone else can?’ 

As it happens, a lot of women aren’t coping – they are just keeping quiet and suffering in silence.  Official figures guess that around one in ten women experience PND.  But most experts consider this figure far too low.  ‘It may affect up to one new mother in six,’ says the mental health charity Mind. ‘But some researchers think this is an underestimate, and that it may affect as many as one new mother in four.’  Some psychologists believe the figure may be as high as 40 per cent.   ‘We think it is definitely higher than the official statistics,’ says a spokeswoman for the Association for Post-Natal Illness. ‘There is still a stigma attached to depression and women keep it to themselves because they feel they have failed.  They don’t see it as an illness but as a weakness and that is such a shame.’

But the onus really should not be on women to diagnose their condition.  There is a screening tool called The Edinburgh Postnatal Depression Scale which theoretically should ‘catch’ those women showing signs of PND early on.   It involves a simple series of questions to be asked by health visitors at various points in the weeks and months after delivery.  Yet the questionnaire is not universally used.  Some experts believe that health professionals should be looking for predisposing factors before the baby is even born.  For example you are more likely to suffer PND if your mother suffered it; if you have had a psychiatric problem in the past; if you are a teenager or single mum or if you have a history of abuse.  These are simple questions which could be asked as part of routine ante-natal checks.  Yet few people do.

It’s incredible that such simple measures are not being taken to prevent PND or nip it in the bud – particularly when you realise that PND does not just cause misery for the mother but can potentially cause longterm damage for her child.  ‘There has been a lot of research on the effect on the child,’ says Professor Glover. ‘As a group, women with PND are more likely to have problems relating to their children – they are either remote or overly intrusive.  They don’t pick up on a baby’s subtle cues the way a happy mother can.’  This, she says, results in a variety of long-term problems for the children.  ‘With boys there can be definite cognitive and behavioural problems.  A study which followed boys up to the age of 11 showed they had a lower IQ and were more likely to be difficult.  With girls it’s more controversial – while boys are difficult, girls tend to be over-good.  The problems tend to show up when they are teenagers when they become more anxious.’  However she has conducted research on baby massage which seems very promising.  ‘It seems that if mothers with PND go to baby massage classes it can help the mother-baby interaction and normalise it.  There’s nothing psychiatric about it – they just learn how to understand and enjoy their babies.  Everyone enjoys it and it certainly can’t do any harm.’

The other good news is that post-natal depression, once detected, is eminently treatable.  While research still has not concluded whether the causes are hormonal, genetic, social or emotional (or a combination of any or all of these), the studies on treatment are far more conclusive.  ‘At the mild end it responds well to talking therapies,’ says Professor Glover. ‘As it gets more severe, most doctors think you need anti-depressants.  But anti-depressants DO work, they aren’t addictive and they are pretty good drugs nowadays.’  She points out that, despite hopes that hormone treatments might be a solution, no studies so far have backed up the theory. 

Interestingly a controlled study comparing treatment with fluoxetine (an anti-depressant) with cognitive-behavioural therapy (reported in the British Medical Journal) found that the ‘talking therapy’ was equally as effective as the drugs.  I’m not surprised.  The majority of mothers who suffer from milder forms of postnatal depression need support and understanding more than anything else.  They need permission to be miserable at times, to grieve for the loss of their old lives and the restrictions of their new lives, to be able to talk about how they are feeling without being told to ‘pull themselves out of it’ or ‘stop whining’.  They also need to be encouraged to make ‘mothercare’ a priority, to put themselves and their needs first occasionally.

The many women I have spoken with who have battled with PND all say much the same thing.   We all feel that we have missed out on what should have been one of the happiest times of our lives. 

 * The Association for Post-Natal Illness. http://www.apni.org  Advice on the management and treatment of post-natal illness.  They can also put women in touch with other mothers who have suffered PND.

* Meet-A-Mum Association (MAMA) run self-help groups for mothers with small children.  They also have a helpline staffed from Monday-Friday. http://www.mama.co.uk

* On-line bulletin boards can offer support from other women who are experiencing (or who have recovered from) post-natal illness.  Parentsplace is a US based website with an excellent and supportive PPD (post-partum depression, as it is known in the US) board.  http://www.parentsplace.com

* The International Association of Infant Massage UK can put you in touch with your nearest baby massage class.  http://www.iaim.org.uk

  

ARE YOU SUFFERING FROM PND?

The Edinburgh Scale was devised in 1987.  It is considered the most effective means of detecting the presence of PND.

Underline the answer which comes closest to how you have felt in the past seven days, not just how you feel today.

In the past seven days……

1.   I have been able to laugh and see the funny side of things:

a)   as much as I always could   0

b)  not quite as much now         1

c)   definitely not so much now  2

d)  not at all                                3      

 

2.   I have look forward with enjoyment to things:

a)   as much as I ever did         0

b)  rather less than I used to    1

c)   definitely less than I used to  2     

d)  hardly at all                                    3

 

3.   I have blamed myself unnecessarily when things went wrong:

a)   yes, most of the time          3

b)  yes, some of the time         2

c)   not very often                     1

d)  no, never                             0

 

4.   I have felt worried and anxious for no very good reason:

a)   no, not at all                       0

b)  hardly ever                         1

c)   yes, sometimes                   2

d)  yes, very often                    3

 

5.   I have felt scared or panicky for no very good reason:

a)   yes, quite a lot                    3

b)  yes, sometimes                   2

c)   no, not much                      1

d)  no, not at all                       0

 

6.   Things have been getting on top of me:

a)   yes, most of the time I haven’t been able to cope at all     3

b)  yes, sometimes I haven’t been coping as well as usual      2

c)   no, most of the time I have coped quite well                     1

d)  no, I have been coping as well as ever                               0

 

7.   I have been so unhappy that I have had difficulty sleeping:

a)   yes, most of the time          3

b)  yes, sometimes                   2

c)   not very often                     1

d)  no, not at all                       0

 

8.   I have felt sad or miserable:

a)   yes, most of the time          3

b)  yes, quite often                   2

c)   not very often                     1

d)  no, not at all                       0

 

9.   I have been so unhappy I have been crying:

a)   yes, most of the time     3

b)  yes, quite often              2

c)   only occasionally           1

d)  no, never                        0

 

10. The thought of harming myself has occurred to me:

a)   yes, quite often                   3

b)  sometimes                           2

c)   hardly ever                         1

d)  never                                   0

 

Ideally this should be answered at eight weeks, three months and eight months post-partum.  Add up the number of points – any score over 12 indicates you may be suffering from PND.  However it is not a diagnosis of PND – visit your GP and talk about it.

SELF HELP

The Association for Post-natal Illness gives this advice:

1.   Rest, rest and more rest.  Tiredness can easily lead to exhaustion then depression.  If you are unable to sleep, then put your feet up -while feeding the baby or, better still, while the baby is asleep.  Do not rush around trying to catch up on the housework etc.

2.   Do try to eat small regular meals, especially if your appetite is poor.  Don’t rush while eating – try to relax.

3.   Do try to keep yourself occupied with small tasks.

4.   Do make sure that you reward yourself when you have achieved something, no matter how small.

5.   Do try some gentle exercise – some people find that it can help.

6.   Do talk over your worries – bottling them up will only make them seem worse.

7.   Do not dwell on the negative – there is light at the end of the tunnel and you will gradually get better.

8.   Do not be too hard on yourself.  No-one is perfect.  Do whatever makes you feel better and avoid stresses and strains as much as possible.

9.   Do not move house or make major decisions if you can possibly help it.

10. It may help to keep a diary of how you are feeling for you to look back on, or to see if there is a pattern to your good and bad patches.

 

ADVICE FOR PARTNERS

1.   Don’t expect the sufferer to have fears and worries that you feel are reasonable.  When you are depressed quite small things can worry or upset you greatly.

2.   Do try to give her as much practical help as possible.  Depression makes a sufferer feel extremely tired and small tasks feel like huge ones.

3.   Don’t nag.  Try to keep your patience – even though it may be taxed.

4.   Don’t point out shortcomings, unfinished jobs, unkempt appearance.

5.   Don’t say things like:  ‘Pull yourself together.’ ‘You don’t know how lucky you are.’  ‘There are lots worse off than you.’

6.   Don’t leave her alone with the baby if you feel there is the slightest possibility of her doing harm to the child or herself.

7.   Do try to let the mother express her own true feelings of anxiety and fear, even if she repeats herself.

8.   Do allow the mother to talk freely and express her innermost fear without showing shock or amazement.

9.   Do show consideration and sympathy for her in her predicament.  Reassure her that she will recover and repeat this reassurance as often as you can.

10. Do encourage her to have as much rest as possible.

11. Do encourage her to seek professional help if she has not already done so.

12. Do try to get out with friends, without the children if you can – but never force the mother to do anything she doesn’t feel up to doing.

13. Remember she is still your wife/girlfriend – not just the mother to a child.

14. Don’t try to cope alone.  Do talk about your own feelings as much as possible and accept any offers of help.

15. Do not be discouraged – every woman who suffers from PND does recover in time.

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4 Comments

  1. A copy of this should be given to every new mum. I scored 13 on the Edinburgh Scale, but help was only given in this area when you scored 14 or more. Thankfully it passes (I had it with both children). One thing I didn’t know was just how common PND is. Thinking back on that time (when I sat and watched the leaves open on a copper beech – like time lapse photography) I should have realised things weren’t quite right! Great article Jane.

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  2. Thanks Mags….I just feel so cross that I wasted the first nine months of motherhood in a nightmare of anxiety… So many women are being let down by their doctors and health visitors in this area.

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  3. Jacqueline says

    Luckily I was fine after the birth of my son, but had I not been, I don’t think my GP would have picked up on any problems. At my eight week check, my GP asked me how I was, I answered “fine”, and that was that. I think my health visitor would have picked up on something, but maybe not. The first few weeks and months of new parenthood are difficult anyway, without having to suffer with something that should be recognised and treated.

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    • So glad you didn’t suffer this Jacqueline. I couldn’t agree more, the first few weeks and months of parenthood ARE really tough and I don’t think GPs and health visitors are vigilant enough. Amongst the women I know out here PND is the norm rather than the exception (which could have something to do with rural isolation). Thanks so much for commenting.

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