Postnatal Depression

Having a baby is supposed to be one of the most exciting and joyful experiences you’ll ever have. But often the reality feels quite different. You may be surprised, and even alarmed, to experience feelings you hadn’t expected. Childbirth can leave you feeling exhausted and anxious, as well as shocked by the sudden changes in your life as a result of becoming a mother.

Instead of being in control of your life, you may feel taken over by the constant demands of a baby, who never seems to let you rest and recover your strength.
You may not have the social or work life that you used to enjoy.
Your relationship with your partner and older children may become strained because you haven’t got much energy to give them.
You may feel you need more help and support than you’re getting or are able to ask for.
Whether or not you have a partner at home, you may feel alone and unsupported.
Many mothers suffer from some form of depression after they have given birth. It is very important for a mother not to blame herself.

The baby blues

The ‘baby blues’ is the most common and mildest form of depression. A few days after the birth, you may feel elated one moment, and a moment later feel very emotional and upset and cry for no particular reason.

The blues may be caused partly by sudden changes in a woman’s hormone levels after birth and partly from the emotional shock of giving birth, the dawning realisation of the responsibility of caring for a small baby, and all the sudden changes that she and the family are going through. The baby blues usually disappears after a few days and you feel more ‘yourself’ again.

Postnatal depression is a more serious and long- lasting condition than the baby blues. It has an impact on the whole family. Many babies can weather this. But it can interfere with the growing relationship between your baby and you and your family, so the effects may last after the depression itself has lifted. It’s therefore important to identify postnatal depression and to ask for help early.

How is postnatal depression different from the baby blues?

Postnatal depression can affect you soon after the birth, starting sometime after you have left hospital and the midwife’s care. It can also develop gradually any time up to a year later, so that you, and those around you, may not realise the extent of your distress for weeks or months.

It is not your fault that you feel the way you do. Postnatal depression is a real condition – it can, and should, be treated.

How does postnatal depression feel?

Postnatal depression can show itself in different ways. Some symptoms – lack of concentration, for instance – are experienced by almost everyone when they have just had a baby. With postnatal depression the symptoms are far more extreme. You may experience it as a kind of ‘emotional loneliness’.

Some or all of the following signs mean that you and your family may need help.

Moods and feelings

Feeling miserable and sad most of the time.
Feeling scared, panicky and anxious for no good reason.
Unable to enjoy life (including a loss of interest in sex).
Unable to look forward to things and to laugh.
Feeling useless or worthless, and a failure, blaming yourself unnecessarily
when things go wrong.
Having thoughts about harming yourself, including suicidal thoughts.

Feeling unable to cope

Everything seems too much of a burden.
Unable to make even small decisions.
Finding it difficult to concentrate and remember things.
Avoiding friends and social contact.

Physical symptoms

Unable to sleep or eat or, alternatively, wanting to sleep or eat all the time.
Suffering from physical symptoms: aches and pains, headaches and being more vulnerable to infections.

Why do some mothers suffer from postnatal depression?

Having postnatal depression does not mean that you don’t want, love or welcome your baby.

There is no simple explanation for what causes it. However, a combination of stresses and worries may make it more likely that a woman will become depressed after giving birth.

Difficult birth

A mother may perceive the birth itself as difficult or traumatic.

Hormonal changes

Biochemical and hormonal changes following childbirth may trigger postnatal depression, although the effect of these is still not clear.

Rekindled grief from previous losses

The loss of another baby through bereavement, abortion, miscarriage, stillbirth or other causes.
Bereavement or the loss of a close friend or family member while the mother was pregnant.
The new mother’s own mother not being around to help, particularly if she is no longer alive.

Demanding baby

Some babies feel more difficult to take care of than others. Although this doesn’t mean there’s anything wrong, it’s easy to feel overwhelmed and ‘got at’ by their needs, creating a sense of not being effective as a mother.

Family relationships

A woman may feel her partner is unsupportive or too demanding.
She may not have anyone to confide in and may feel isolated.
A woman may have an uneasy relationship with her own mother.

External stresses on the family

Other difficult life events, such as redundancy, may occur around the time of the birth.
The family may be facing chronic problems, such as unemployment, housing difficulties and lack of money.

Postnatal depression and the baby

A mother is usually the most important person to a small baby. In the early weeks a baby needs her in order to make sense of the world outside the womb. For this to happen, the mother needs to have enough energy and interest in her baby to be able to try and understand what their crying means – whether the baby is hungry, tired, uncomfortable, has a dirty nappy, or is feeling lonely.

How can their mother’s postnatal depression affect babies?

Because this period of emotional and physical closeness is so important, babies can be very sensitive to their mother’s moods. They quickly notice when you are unable to ‘be there’ for them because you are depressed and wrapped up in your own thoughts and feelings. This could mean that you and your baby miss precious time together.

Babies and young children need a lot of help to manage their experiences and feelings.

A baby who doesn’t get much response or doesn’t get the right kind of response without having to wait, can quickly become confused and worried.

Being so helpless and dependent in every way, it can be frightening for a baby to feel that they can’t even make their mother smile or respond.

The baby may experience their mother as rejecting and become distressed. It is difficult for you to respond to the baby’s distress or fear when you may feel filled up with anxiety and distress yourself.

The baby may react by:

becoming withdrawn, avoiding eye contact and turning away from their mother’s face
appearing to be ‘easy’, able to be passed from one strange person to another, showing little preference for their mother or awareness of her as the special person
appearing to be fine during the day but becoming unsettled and clingy at night – the time when they may feel that they need the most reliable protection and care.

Does the baby’s temperament affect the mother’s depression?

Babies are born with different temperaments. From the start, the kind of baby a mother has can influence whether she becomes depressed, or stays depressed, particularly if she is vulnerable to postnatal depression.

Undemanding babies A mother’s lack of energy may be ‘picked up’ by the baby and the baby may make as few demands on her as possible. The baby may sleep a great deal, through the night as well as many hours in the day. The mother may feel lucky to have such a ‘good’ baby – but a baby who is too sleepy and undemanding may not be getting on with the work of developing. Babies also need time to be awake, alert and together with their family.
Good babies Many depressed mothers are helped by a baby who is easy to please, responsive and rewarding. Some babies work extra hard at getting their mother to notice them, doing whatever they sense will please her most, trying to be ‘good’ and co-operative, smiling and cheerful to help lift mother’s mood. These babies are tolerant of their parents’ mistakes and make good use of whatever is offered to them. However, having to be too ‘good’ can make a baby feel responsible for looking after their mother, rather than the other way around. This can be hard on a baby, who needs adults to help them manage their upset, angry feelings.
Demanding babies Some babies are sensitive and may react strongly to their environment. They may cry for long periods, giving their mother the sense of never quite being able to offer the right thing or to satisfy them. This can be very discouraging to a depressed mother. It is helpful for a mother’s confidence if a supportive friend or partner can help her to understand the baby’s difficulties and when it is better to be firm about not giving in to every demand.

Meeting the baby’s and the mother’s needs

Babies need attentive responsive parenting to nurture their emotional development and to build on their natural capacity to think and learn.

But it does not have to be provided only by their mother all the time.

You have to be protected and have time to recover your energy – you cannot be on duty all day and all night.

Fathers, grandparents and others, if available, can help to give the baby the loving attention and care that is essential for their development.

Getting help

Postnatal depression affects many mothers and is nothing to be ashamed of.

It is important to be able to recognise that you may be suffering from it and to seek help as soon as possible. Health visitors in many parts of the country are trained to identify it. You may feel relieved to be told by your health visitor or doctor that you are definitely not going mad, but that you are suffering from postnatal depression, which can be effectively treated in a variety of ways.

Fathers can also get depressed after the birth of a baby. Even though the father may not spend as much time caring for your baby as you do, for his own sake as well as the wellbeing of the entire family, it is just as important for him to get support.

Medication

In consultation with your general practitioner, you may decide to take antidepressant medication. These drugs are often an effective treatment for postnatal depression. They can lift your mood and shift the worst symptoms of the depression, helping to make you feel more ‘yourself’ again and able to be more responsive to the needs of your growing baby.

Antidepressants are nonaddictive and are best taken for several months. If you are breastfeeding, your doctor can select appropriate antidepressants.

Medication is not always necessary and, in any case, is often not sufficient on its own. It may be offered alongside support and counselling.

Support and counselling

If you are depressed, you can benefit from being offered some form of support and counselling, usually from a trained professional. Together you can give thought and attention to your emotional needs at a time when you may feel emotionally isolated and drained.

The form this support takes will depend on the severity of the condition and what is available locally.

It may be from:

a health visitor with counselling skills
a counsellor employed by the GP practice
a mental health worker, such as a community psychiatric nurse or psychiatrist.

Mother and baby counselling from a child psychotherapist, or family therapy for the entire family, may be offered locally. Any of these services might see both parents together if that seems the best approach, and everyone involved agrees.

What is important is for you to have sufficient space and opportunity to talk about your own situation and your feelings about it. This may involve reflecting on your own experiences – of pregnancy and birth, your own childhood and parenting, and possibly other relevant life experiences.

Some helpful practical tips

You may know before the birth that you are vulnerable to postnatal depression because:

you have been depressed before
you have suffered a recent bereavement
you have lost a baby before
you are experiencing difficulties in your relationship with your partner.

Here are some suggestions to help you prevent some of the problems that can arise.

During your pregnancy, tell your family and friends that you are worried about the possibility of developing postnatal depression and talk about the kinds of support they could give you. Discuss your worries with your GP or midwife as well, so that arrangements for support can be made before the baby is born.
If possible, try to avoid too many other changes in your life at the same time as the baby’s birth. The upheaval of a house move, with the usual worries and physical work involved, can be stressful, especially if you are moving to an area where you don’t know people and are removed from your support network.
Try and make contact with other pregnant women, possibly through antenatal classes. Isolation and lack of support make you more likely to become depressed.
You need to look after yourself if you are going to take good care of your baby. It’s important to take as much rest as you can, as tiredness can make depression worse.
It may be difficult for you but try to arrange some special baby-free time, even if it’s just long enough to have a relaxing soak in the bath.
Accept as much help as you can get during the early weeks and months after the birth. You are not letting the baby down – both of you will benefit from this.

If you do become depressed, the sooner you get help the better things are likely to be for you, your baby and your family. Ask for professional help early.

If your partner or friends become concerned about you, allow them to get you some help. Get them to read this leaflet and help them to understand how you are feeling.

Remember, postnatal depression is a treatable condition and in time you will feel better.

About this leaflet

Understanding Childhood is a series of leaflets written by experienced child and adolescent psychoanalytic psychotherapists to give parents, grandparents, carers and professionals additional insight into children’s feelings and view of the world and to help make sense of their behaviour. Originally written for the Child Psychotherapy Trust they have been reviewed and updated and are now published by the ACP. The full series is available on the ACP website https://childpsychotherapy.org.uk/