Coping with postnatal depression

The joy of giving birth to a child may also come with a dark side: postnatal depression. Clinical psychologist Michelle Nortje gives us the lowdown.

For many women, giving birth to a child can come with mixed feelings and mood changes. As much as a child can bring joy and excitement to a new mother, the experience also brings with it feelings of being overwhelmed with new responsibilities, and a loss of a previous freedom.

These mood changes can occur on a continuum from the very common and expected changes of the ‘baby blues’ on one end, to more severe and debilitating symptoms of post-natal depression or post-natal psychosis on the other. It is important, however, to remember that with early intervention and treatment, research reports high rates of recovery.

What is postnatal depression?

Most women will experience the ‘baby blues’ after giving birth. This marks the initial period after having a baby where a mother may feel down due to the many changes and adjustments that must take place: hormonal changes, interrupted sleep patterns, physical healing from the birth and learning about breastfeeding and nappy changing. It is completely expected that in the face of all these stressors and changes that a mother might struggle emotionally.

On the other hand, post-natal (PND) or post-partum depression (PPD), which can affect up to 10% of women,begins within four weeks of having a baby. These symptoms must occur for longer than two weeks.

PND includes symptoms such as tearfulness, mood changes or a low mood, a lack of interest in things you used to enjoy, sleep disturbances, hopelessness, suicidal thoughts, thoughts of one’s inadequacy, fatigue, weight loss or gain, poor concentration or decision-making, feelings of guilt, and even delusions or thoughts of hurting your baby in severe cases.

One doesn’t need to have every symptom for a diagnosis of PND, and even up to three symptoms can be a concern. If one already has a personal or family history of depression, this can place you at a higher risk.

In some instances, PND can lead to over-concern or to anxious ruminations about the baby. This can include thoughts that something is wrong with the baby, or even a denial of the birth. For example, some mothers may become so worried about the baby that they may continually wake the child up to ensure the child is alive.

At other times, the negative thoughts and low mood can lead to an increased risk to you and the baby. It can also lead to parenting that is less responsive and a lack of interest in the baby, emotionally detached, and a mother may feel helpless to soothe the baby especially, during separations.

These symptoms and examples may sound incredibly scary to experience. This can make it very difficult for women to accept their thoughts, feelings and behaviours and reach out for help and support. Coping with the baby blues and postnatal depression involves asking for help and understanding that an early intervention can be invaluable.

How do you cope with postnatal depression?

Here are some simple self-help tips:

• Take care of yourself!
• Don’t skimp on sleep
• Set aside quality time for yourself to relax and take a break from your ‘mom duties’, pamper yourself, take a bubble bath, savour a hot cup of tea, or light scented candles.
• Make meals a priority. What you eat has an impact on your mood, and the quality of your breast milk. Ensuring you have enough energy to manage the tasks of motherhood is essential.
• Get out in the sunshine. Sunlight lifts your mood, so try to get at least 10 to 15 minutes of sun per day.
• Ease back into exercise. Studies show that light exercise may be important in treating depression, so try a short walk or stretching each day. For example, try taking a short walk with your baby in a pram around your neighbourhood.
• Make your relationships a priority. Stay connected to family and friends ‒ even if you’d rather be alone. Isolating yourself will only make your situation feel even bleaker. Let loved ones know what you need and how you’d like to be supported. One’s relationship with the father of the child can often take strain in dealing with PND. It is important to include your partner in the process of recovery.
• Find people who can help you with child care, housework, and errands so you can get some much needed rest.
• Keep a diary of your emotions and thoughts to keep track of your progress as you begin to feel better.
• Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day. Be kind to yourself: being a mom is a hard job! Give yourself permission to feel overwhelmed.
• Don’t keep your feelings to yourself. Share what you’re experiencing ‒ the good, the bad, and the ugly ‒ with at least one other person, preferably face to face.
• Join a group for new mothers. Even if you have supportive friends, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings.
• Be honest about how much you can do and ask others for help.
• Remember that no one expects you to be supermom!

When should you seek professional help?

Many mothers experience so much pressure to be perfect straight away. This means that you sometimes don’t feel like it is okay to ask for help when things feel like they are becoming a bit too much to handle.

Interventions for post-natal depression can include both psychiatric and/or psychological interventions. Some of these difficulties and emotional changes can be managed with adequate self-care and support. However, it is when the feelings and stress become so bad that it impacts negatively on your and your baby’s well-being that you need to stop, and ask for additional help.

Psychotherapy can help patients accept their mothering role and to facilitate increased support from the father and extended family. If you already suffer from depression or anxiety before falling pregnant it is important to talk to your psychologist or psychiatrist to prepare you for the process of pregnancy and the birth.

Parent-Infant Psychotherapy (PIP) is an approach to psychotherapy whereby a mother (or mother and father couple) will be seen with the child. This approach is aimed at facilitating bonding and a secure attachment between the parents and child, despite the emotional difficulties that PND creates.

This can help mothers to learn how to love their baby and find enjoyment in the relationship again, how to respond to the baby when the baby is in need (tired, crying, hungry etc.), how to accept the mothering role, and to facilitate increased support from the father and extended family.