Post Natal Depression (PND)

Before we say anything else the first thing to realise about post natal depression is that it is common, yet many women still suffer in silence.

Woman who have suffered say that they hid their feelings because they were terrified of people's reactions, they thought people would think that they were a bad mother, that they were weak because they couldn't cope, some thought that they may take their baby away because they are not fit to look after them.

The simple fact is that no one should be ashamed, it is an illness, there is help out there and the good news is that most women do recover and go on to lead normal (whatever that is) lives

What is Post Natal Depression?

Post Natal Depression PND or Post natal illnesses PNI are used as an umbrella term to describe a range of symptoms. This is why it is so important to describe your symptoms carefully when telling your doctor. The symptoms suffered typically fall into the following categories:

Depression
Post Natal Stress Disorder
Anxiety
Obsessive Compulsive
Behaviour/Thoughts

There are varying degrees of PND which can range from mild to severe. It is thought that around 80% of all mothers’ experience the baby blues which normally improves within a few weeks, the symptoms are weepiness, sleeping difficulties and mood swings.

Doctors suggest that the baby blues may be down to changes in hormone levels that happen after the birth, but others say it’s brought on by the experience of being in hospital. Although having the baby blues is distressing, it’s important to know that it clears up quickly, usually within a couple of weeks.

If the depression continues then it maybe Post Natal Depression, it is estimated that up to 50% of mothers experience some form of mild Post Natal Depression with between 10-20% experiencing the illness in its more severe form. 1-2% of mothers will develop Post Natal Psychosis which is different to Post Natal Depression and the most severe form.

The causes of Post Natal Depression are not entirely clear though there are identified risk factors which, when combined, may contribute to the development of Post Natal Depression:

Upheaval due to moving house or job

Difficulties Conceiving

Loss, or unresolved emotional issues with mother

Past miscarriage or loss of child

Loss of identity due to loss or change in work life

Hormonal Change

Past life trauma associated with parenthood, childhood, neglect or abuse

Low self esteem

Bereavement

Lack of support from partner

Unresolved emotional issues with partner

Past history of depression or anxiety disorder

Post Natal Depression can occur with any baby, a woman may be fine with the first but then develop it with her second baby, or have Post Natal Depression with number one but not with subsequent babies, it is also worth noting that the symptoms of PND can develop during pregnancy.

It can happen to anyone regardless of status, wealth, age, IQ, race, etc. It effects up to 100,000 women every year that is roughly 1 in 10 new mothers.

Post Natal Depression can occur anytime during the first year after delivery though most cases present in the first 4-6 weeks. Sometimes PND starts right after delivery but it can also develop more slowly, often becoming evident 3-4 months following the birth. It is very common for a mother with Post Natal Depression to be unaware of what is happening to her and, if she has never experienced depression before, she may well not realise what is happening to her until the illness has become established and debilitating.

Often looking after a little one means that the mother's focus is on the baby, not herself, and she may not pick up on warning signs of which she might otherwise have been aware. She may also be unwilling to acknowledge that something is wrong. A woman who is developing Post Natal Depression may initially have symptoms of anxiety and so may not recognise her symptoms as 'Post Natal Depression' since depression is only one symptom of the illness

There are a number of warning signs which can mean that a woman is developing Post Natal Depression. These are listed below:

Warning Signs:

problems with sleep such as difficulty falling asleep or staying asleep, or having vivid nightmares

feeling very low, or despondent, thinking that nothing is any good,

palpitations

obsessive fears about the baby’s health or wellbeing, or about yourself and other members of the family

thoughts about death.

panicky feelings, panic attacks

feeling like you are putting on a front, forcing yourself to do things when all you want to do is sleep

feeling of overwhelming exhaustion or even quite numb like you have gone past the point where a good night's sleep would make you feel better

exhaustion following the birth which has developed into extreme fatigue rather than resolving itself within a few weeks following delivery

bouts of crying or wanting to cry over things which would not normally provoke such a reaction

being short tempered or snappy an overpowering anxiety, often about things that wouldn’t normally bother you, such as being alone in the house

desperation for rest, feeling trapped and unable to find a moment to relax

feeling unable to cope and then guilty about not coping, or about not loving the baby enough

headache, night sweats, stomach pains, blurred vision

being hostile or indifferent to your husband or partner or the people around you

difficulty in concentrating or making decisions

You may go through one or more of the experiences, although it’s extremely unlikely that you will go through all of them. If you think you have any of the warning signs or just 'aren't feeling yourself' talk to someone you trust and go and see you’re GP or other Medical Practitioner if only for reassurance. If you are developing Post Natal Depression, the quicker you receive treatment the faster you will recover.

Puerperal psychosis

Warning: IF YOU HAVE ANY OF THE SYMPTOMS BELOW YOU NEED IMMEDIATE HELP:

severe Insomnia (i.e., no sleep at all )
loss of control with huge mood swings
loss of confidence ( e.g. fear of leaving house, of social interaction, or seeing friends, fear of or withdrawal from looking after baby, fear of being on your own)
thoughts of harming yourself or your baby
scary fantasies
manic behaviour (e.g. cleaning in the middle of the night)
hallucinations or delusions

It may be that you are suffering from puerperal psychosis, fortunately it is fairly rare, affecting only one in 500 new mothers, but it’s the most serious kind of postnatal illness. It can come on suddenly a few weeks after the birth, and starts with the mother being very restless, excited or elated and totally unable to sleep. She may have delusions or hallucinations. She may be manic or have wild mood swings from high to low. Her behaviour may become increasingly bizarre and disturbing to those around her, and she may lose touch with reality. It soon becomes very clear that she needs help, and medical and social support and it is very important that she receives it.

Treatment of Puerperal psychosis

Treatment often involves a hospital stay and the use may include stabilising drugs, strong antipsychotics, and antidepressants. In extreme cases the doctors may want to use electroconvulsive therapy. It may take a long time to recover completely, but the sooner it is diagnosed the better the prognosis.

Treatment in PND

You may well not need medication to begin feeling better. If your symptoms are mild our mums say that often just talking about how you feel can make a huge difference, many have turned to self help books or groups and found them hugely beneficial. Medical experts suggest that the best treatment for PND may be a combination of practical support and advice, counselling or psychotherapy, and if necessary, antidepressants.

Below are some simple tips that may help:

Tips to help PND

Try to get half an hour a day me time as often as possible every day if it is possible. All mums need a little space to themselves it is not a crime

Try to get as much rest as you can

Ask for help with the house work, most partners or families will not help if you don't ask, they don't want to offend or interfere

Try to get as much fresh air as possible, go for little walks with the baby

Try to get help with the feeding routine if you are breast feeding then express the milk and let someone else feed them this is especially good at night as being tired worsens the symptoms

Try to be flexible, e.g. with sleep times, feeding times etc - it's less stressful for you and your baby

Sometimes its hard but try to see all the amazing things about your child just look at them and remember that they are a little miracle

Above all else give yourself a break, new mums are often their own worst critic, just remember that there is no such thing as a perfect mum
Go to mother and baby groups, meeting other woman in the same position as you will give you a chance to share skills and experiences and to realise you are not alone. Some of our mums have not enjoyed these clubs because the mums have been competitive and false but if you feel that try another group, most are great and you can find life long friends
Above all to get some emotional and practical support try to speak to your partner, family or to a mid wife or a G.P

If your symptoms are severe there is no point in ignoring them or trying to be brave they will only get worse as time goes on. The first thing to do is to admit how you are feeling and then tell someone who can help, the first step is often the hardest but once you take that step you are on the road to recovery. There is no shame is admitting how you are feeling you are suffering from an illness like any other. Your child needs a mum who feels well and for that to happen you will need help.

How to help a woman with PND

It can be both difficult and frustrating to live with someone who has PND. Perhaps the most important thing is to recognise that someone suffering from PND may need encouragement to seek help, and support to get it. Help her to find someone to talk to in depth, and reassure her that she is not going mad and that she will get better. Make sure she knows that you will support her, and not abandon her.

Practical steps include helping her to get enough food, rest, and exercise. Try to ensure that she doesn’t spend much time alone to cope with the baby. A sense of isolation can be the most stressful aspect of mothering. Support the idea that she deserves to have a daily treat, and enable her to get it. Above all try to listen to how she feels and be patient.

Read stories from women who have suffered or husbands, families and friends who have seen the effects.

There are many useful organisations try: www.pni.org.uk or www.mama.co.uk