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Postnatal depression

"Having a baby is a significant time and becoming a new parent can be an enormous life adjustment. While it is both a challenging and overwhelmingly positive experience for most parents, it can also be a time when a woman develops depression, especially if she has experienced depression before. Depression is always serious, but when it coincides with the arrival of a new baby, it can be particularly difficult to deal with. Postnatal depression is not uncommon, it is nothing to be embarrassed about, and it is important that you are cared for.

If you are unsure about whether you may be affected by postnatal depression, see your GP."

Dr Christine Bennett,
Chair, Medical Advisory Panel, Bupa Australia

What is postnatal depression? 

Many women can feel a bit teary or down a few days after the birth of a baby, especially if it's your first. This is often referred to as the 'baby blues' and it affects around 80 percent of new mothers.1 Usually, most women will find their mood improves after a few days.

Postnatal depression is different to this; it's much more than just the 'baby blues'. 'Postnatal' means 'after the birth' and depression that develops within a year of having a baby is called postnatal depression. Postnatal depression is actually quite common - around one in eight mothers will be affected by the condition.

Symptoms vary in severity but are generally similar to those of depression. Many women blame themselves, their partners or their baby for the way they feel after giving birth. Others may be reluctant to admit to themselves or others that they may be suffering from postnatal depression or are not coping with their baby.

Society and the media project images of happy mothers with contented babies and it may be difficult to admit to yourself or to your friends and family that this is not the reality. Friends or family members who are new mothers may also not admit to what motherhood is really like for them, adding to your feelings of inadequacy.1

Some mums try hard to 'snap out of it' without understanding that women with postnatal depression have little control over the way they are feeling and need to seek help from a supportive GP or other health provider. If new mums and their partners learn to recognise the signs and symptoms of postnatal depression, they can find help and support as soon as symptoms appear.

The important thing to remember is that there's plenty of support and resources to help parents through the ups and downs.

What are the symptoms of postnatal depression? 

Symptoms usually begin within four months of the birth but can begin at any time within the first year. Signs of postnatal depression may include:

  • persistent low mood
  • low self-esteem, with thoughts of worthlessness or guilt
  • not enjoying time with your baby
  • not enjoying other things in your life that you used to enjoy
  • tearfulness
  • difficulty sleeping, despite feeling tired and even when the baby is settled
  • irritability
  • panic attacks and/or phobias
  • extreme tiredness and difficulty coping with caring for your baby and any other work
  • excessive worrying about your baby
  • loss of appetite or excessive eating
  • thoughts of hopelessness and maybe death.1

You might worry that you are going to harm your baby but women with postnatal depression rarely do so. Women often dismiss their feelings through fear of being labelled a bad mother but it's important to seek help early.

What can cause postnatal depression? 

The exact cause of postnatal depression isn't known - it may be several factors working together:

  • Physical changes. Giving birth is an exhausting experience for the female body. The change in hormones after birth may affect your mood. The demands of becoming a new mother may be overwhelming - broken sleep and tiredness can play a part in postnatal depression.
  • Emotional changes. Adjusting to the extra responsibility of looking after a totally dependent baby is significant. Some babies cry more than others, which can make them more difficult to look after. Your relationship with your partner may change as you focus your energy on caring for your child. You may be less interested in sex for some time after childbirth, which may cause an additional strain on your relationship with your partner. The birth experience itself can sometimes be disappointing or occasionally traumatic.
  • Social changes. Babies take up a large amount of time and attention, often leaving little time for things like work or socialising. You may have stopped work so you are living on a lower income. Your social life is probably less active. Lack of support or difficult relationships within the family can also be factors.
  • Genetics. Depression can run in families but the genetic factors are not clearly understood. Just because your mother or sister suffered postnatal depression doesn't mean you will. And just because it doesn't run in your family, doesn't mean you aren't at risk. Familiarising yourself with the signs and symptoms of postnatal depression can help you recognise them if and when they occur.
  • Underlying mental health condition. Some women who are at risk of depression or who've already experienced it may be more likely to suffer depression associated with pregnancy or childbirth. This may explain why symptoms are sometimes detected in some women during pregnancy - this is called antenatal depression ('antenatal' means 'before the birth').2

Who's at risk of postnatal depression? 

Any pregnant woman is at risk of postnatal depression. It can happen after a miscarriage, stillbirth, normal delivery, or caesarean delivery.1

However, you are more likely to have it if: 3

  • you've had depression or postnatal depression before
  • other family members have depression or postnatal depression
  • you have a poor relationship with your partner where you don't feel you can discuss your feelings
  • you don't get much support from family or friends
  • you've had other recent stressful events in your life (for example, moving house or bereavement)
  • you're in your teens or over 40
  • the pregnancy was unwanted or unplanned.

What should I do if I think I have postnatal depression? 

Many women feel confused or ashamed about their symptoms and delay seeking help. If left untreated, postnatal depression can last for months or years and affect your relationships. It's very important that you speak up and get help. You can talk to your midwife, maternal and child health nurse or GP, who will ask you about your mood, your health and your baby. You may be referred to a community child health centre for support, a psychologist or counsellor.1

If you think you may have postnatal depression, bring your symptoms to the attention of your midwife, maternal and child health nurse or GP. If your partner or other family members express concern that you may have postnatal depression, discuss this with your health provider. You can reduce the impact of depression during this time if you recognise and managed it as early as possible.4

How is postnatal depression diagnosed? 

Doctors, midwives and other health professionals are trained to be aware of the symptoms of postnatal depression and can offer sympathetic, prompt treatment. They'll most likely discuss with you how you're feeling, ask you how long you've been feeling down, and how you're coping with the added stress of life with a new baby.

They may also ask you to complete a brief questionnaire which helps identify if you're at risk. A commonly used questionnaire is the Edinburgh Postnatal Depression Scale, which has 10 simple questions and a scoring system.4

Can postnatal depression affect fathers as well? 

Currently, about three to 10 percent of new fathers experience postnatal depression. Men who suffer from postnatal depression also need help and support. Men can experience postnatal depression either parallel to or independently of the mother's depression. Many of the risk factors for men are similar to those for women. But some that are specific to fathers include: 5

  • the impact of change in the social role of fathers and family dynamics
  • worry about the financial burden, and stress of work and parenting
  • unmet expectations around sex after birth
  • worry about their relationship with their wife or partner
  • lack of opportunity to bond with the baby.

New fathers don't have the same level of regular access to health and support services that new mothers do. They tend not to see their GP as often and may not visit pregnancy and baby-related health services, so their problems are less likely to be recognised.

If you suspect that your partner is suffering from postnatal depression it's important that you help him. As with women, it's important that depression in fathers is recognised and treated early and effectively. This will help avoid long-term effects on his mental health, and will benefit all his relationships including his relationship with you, his children, family and friends.5

How is postnatal depression treated? 

Your GP can arrange counselling and other forms of psychological treatments such as cognitive behavioural therapy (CBT). CBT aims to reduce unhelpful thoughts and behaviours, and improve coping.

Your doctor may talk to you about antidepressant medication. To help prevent postnatal depression recurring, the course of medication will usually last for some time after your symptoms clear up. There are some antidepressants you can take while breastfeeding and it's important to follow your midwife or doctor's advice about timing of feeds while on these medications.1,3,6

Attending parenting classes or groups, preferably with your partner, may help you to feel less isolated and more in control. Practical measures can also be beneficial, such as help with childcare so you can have time off. Sharing experiences with other mothers affected by postnatal depression may also help.

Ask your GP, midwife or community health nurse about support groups in your area.6 More information about finding help for mental health conditions.

Is postnatal depression preventable? 

Recent studies show that well-informed support in the first few weeks of childbirth can help prevent postnatal depression. The research found that new mothers who receive support from well-trained health providers and other women who've had postnatal depression were less likely to develop postnatal depression.

The Bupa Health Foundation is partnering with the Parent and Infant Research Institute (PIRI) at Austin Health to find suitable treatments in both the antenatal and postnatal periods to reduce the impact of postnatal depression.

Further information 

Beyond Blue
www.beyondblue.org.au

Post and Antenatal Depression Association (PANDA)

www.panda.org.au/practical-information/80-whats-happening-to-me

Raising Children Network

raisingchildren.net.au/

Parent-Infant Research Institute (PIRI)

www.piri.org.au

Sources 

  1. Post and Antenatal Depression Association (PANDA). Postnatal depression factsheet. [internet] [accessed 25 Jun 2011] Available from: http://www.panda.org.au/practical-information/panda-fact-sheets .
  2. Better Health Victorian Government. Postnatal depression. [internet] c2010 [Last reviewed Jul 2009, accessed 25 Jun 2011] Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Postnatal_depression_(PND)
  3. Virtual Medical Centre. Postnatal depression (postpartum depression). [internet] May 2004 [last updated 27 May 2010, accessed 25 Jun 2011] Available from: http://www.virtualmedicalcentre.com/diseases.asp?did=479
  4. beyondblue. Postnatal depression: Signs and Symptoms. [internet] 7 May 2007 [Last updated 23 Feb 2009, accessed 25 Jun 2011] Available from: http://www.beyondblue.org.au/index.aspx?link_id=94.576
  5. Raising Children Network. Men and postnatal depression. [internet] [Updated 14 Jan 2010, accessed 25 Jun 2011] Available from: http://raisingchildren.net.au/articles/men_and_postnatal_depression.html/context/305
  6. beyondblue. Fact sheet 22: Postnatal Depression. [internet] Aug 2008 [Last updated Aug 2010, accessed 25 June 2011] Available from: http://www.beyondblue.org.au/index.aspx?link_id=7.980&http://www.beyondblue.org.au/index.aspx?link_id=6.1068&tmp=FileDownload&fid=1114

Last published: 30 July 2011

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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