Postnatal depression (PND)

What is postnatal depression (PND)?

After having a baby, up to 80 per cent of women may develop the ‘baby blues’ between day 3 and day 10 after the birth. This feeling passes in a day or two and is different from postnatal depression (PND). However, around one in 7 to 10 mothers go on to develop PND.

PND is a depression that comes on within 12 months of having a baby, usually during the first few weeks or months. It can start slowly or suddenly, and can range from very mild and transient, to severe and lingering. For most women, it passes quickly, but others will need professional help.

PND is most common after a first pregnancy. Some women experience depression during their pregnancy (this is called antenatal depression). Antenatal and postnatal depression are together known as perinatal depression.

The symptoms of antenatal and postnatal depression depend on the severity of the depression, but may include:

• low self-esteem
• feelings of inadequacy and guilt
• tearfulness
• sleeping difficulties
• panic attacks.

Partners can also develop depression before and after the birth of a child.

Partners, family and friends can all have an important role in recovery from PND. Having a baby and PND both place great stress on relationships. A woman with postnatal depression may withdraw from everyone, including her baby, partner, friends and other family members. The support of family members, friends and health care providers is crucial in helping recovery.

Symptoms of postnatal depression

The range of symptoms experienced depends on the severity of the depression, and may include:

• depressed or sad mood
• tearfulness
• low self-esteem and lack of confidence
• feelings of inadequacy and guilt
• negative thoughts
• feeling that life is meaningless
• feeling unable to cope
• tearfulness and irritability
• difficulty sleeping or changes in sleeping patterns
• low sex drive
• anxiety, panic attacks or heart palpitations
• loss of appetite
• difficulty concentrating or remembering things
• loss of interest in usual activities.

Factors contributing to postnatal depression

The exact causes of PND are still not known. Some contributing factors might include:

• Physical changes – even a relatively easy birth is an overwhelming experience for a woman’s body. In addition, the sudden drop in pregnancy hormones affects brain chemicals (neurotransmitters). Broken sleep and exhaustion can also contribute to depression.
• Emotional changes – adapting to parenthood is daunting. A new mother has to deal with the constant demands of her baby, a different dynamic in her relationships and the loss of independence. Such changes are hard at the best of times, but are even more overwhelming when physically recovering from childbirth and coping with broken sleep.
• Social changes – society puts lots of demands and expectations on a new mother, which a woman may feel she needs to live up to. She may find herself less able to keep up contact with her friends and workmates. Adapting to living on one wage may also be difficult.

A mother’s relationship with her baby during postnatal depression

PND can lead to withdrawal from everyone, including the newborn baby. This is a symptom of the disorder. Bonding between the mother and child does not always occur within the first few days or weeks of birth. This experience is different for all parents and can sometimes take time. The parent-infant relationship is an ongoing process. Once the depression lifts, the mother will be able to once again feel her full range of emotions and start to experience more positive connection when parenting.

Fathers can also develop PND

Research has found that one in 10 fathers experience paternal depression between the first trimester and 1 year postpartum.

Risk factors for PND in fathers and partners include:

• older age
• first-time parent
• small circle of friends
• limited social interaction and support
• limited education
• concurrent stressful life events
• quality of the relationship with wife or partner
• history of mental health problems
• poor physical health.

Postnatal depression and support persons

A woman with PND may also withdraw from her support person(s). The support of family members, friends and health care workers is very important. Mothers have different access to family, spousal, friendship, or professional support persons e.g. doula, psychologist, social worker. During the period of illness, it is vital that the mother accesses support persons to help with her recovery.

Couple relationship and postnatal depression

Postnatal depression can put an enormous strain on any relationship, even when the partner is patient, loving and supportive. Many couples experiencing PND can sometimes believe their relationship had deteriorated. However, relational strain can improve once the mother’s PND is treated.

Suggestions for a couple dealing with PND include:

• Learn together about PND.
• Try to recognise that PND may be contributing to relationship problems.
• Keep the lines of communication open.
• Try not to take each other’s moods or criticisms too personally.
• Limit making big life decisions e.g. career, financial, relationship, at this time.
• Seek out useful stress management techniques, such as exercise or meditation as it may increase a mother’s stress.
• To limit conflict, talk openly about sharing duties.
• Try to make time to reconnect as a couple if possible.
• Seek professional help.

Helping a mother experiencing postnatal depression

If you are know someone who may be suffering from PND:

• Be patient.
• Encourage the mother to talk about her feelings.
• Accept that her feelings are genuine. Try to understand her experience and emphasise with her.
• Try to not take their negative feelings or criticisms personally.
• Encourage her to limit visitors if they don’t feel like socialising, so she can get adequate rest.
• Ask others for help around the house, with chores including babysitting.
• Support with emotional support, baby care and housework.
• Encourage her to practice self care e.g. manage sleep, healthy diet.
• Encourage her and give her positive feedback.
• Avoid criticism of the mother’s post-pregnancy body or suggest she lose weight.
• Stay connected with her as the days of parenting can be long and lonely.
• If you are worried, encourage the mother to talk to their GP (doctor), midwife, obstetrician or maternal and child health nurse, or to call the PANDA (Perinatal Anxiety and Depression Australia) helpline for support on 1300 726 306.
• Go to the doctor yourself for information and advice if the mother initially refuses to go and you are concerned about her risks with PND.

Self-help for postnatal depression

As a new parent, you need to look after your own physical and emotional wellbeing. Suggestions include:

• Make sure you have some time to yourself, apart from work and family.
• Try to keep up important hobbies and interests as much as possible.
• Talk to close friends about your feelings and concerns.
• Try to adopt a routine of self care by getting sufficient sleep/rest, eating healthily, a regular weekly routine and having some social connections.
• Try to make connections with other new parents or your local mother’s group for support.

Suggestions for family and friends

Ways you can help a loved one who has PND include:

• Find out as much information as you can about PND.
• Be patient, empathetic and understanding.
• Ask the parent(s) how you can help.
• Offer to babysit.
• Offer to help around the house.
• Let the mother know you are there for her, even if she doesn’t feel like talking.
• Appreciate that the father may also be emotionally affected by the demands and challenges of new parenthood.

Help and support for postnatal depression

Many kinds of support are available for women experiencing postnatal depression.

Support and patience from family and friends are perhaps the most important factor in a woman’s recovery from PND. Talking about her feelings, particularly with other women in support groups or with a professional counsellor – for example, through the Perinatal Anxiety and Depression Australia (PANDA) national helpline (Tel. 1300 726 306) – can be helpful. In more severe cases, seeing a GP or perinatal psychiatrist to consider anti-depressants and other medications might be used to help bring about a change in mood.

It’s important to remember that PND is a temporary condition that will improve with time.

Where to get help

• Your GP (doctor)
• Professional counsellor e.g. psychologist, psychotherapist
• Referral to a perinatal psychiatrist
• Your maternity or local hospital – many offer support for women (and their families) affected by PND
• Maternal and child health nurse in your local council
• Maternal and Child Health Line (24 hours) Tel. 13 22 29
• PANDA (Perinatal Anxiety and Depression Australia) helpline Tel. 1300 726 306 (Monday to Friday, 9 am to 7.30 pm AEST/AEDT)
• Lifeline Tel. 13 11 14
• Beyond Blue Tel. 1300 224 636
• Gidget Foundation
• Suicide Call Back Service