January 29, 2024

Maternal mental health: Let’s talk about Post Natal Depression

By Emily McRae

As we cast a spotlight on maternal mental health this month, it is important to talk about Postnatal Depression (PND). PND is a condition that can affect many mothers and can make motherhood a difficult, traumatic and lonely time.

In this article:

What emotions can be expected after having a baby?
What is postnatal depression?
How do I know if I have postnatal depression?
What can I do if I have postnatal depression?

What emotions can be expected after having a baby?

First of all, let’s acknowledge what normal human emotions are. All human emotions such as fear, anger, jealousy, rage, grief, worry, happiness, or joy, are normal. Although we may prefer certain emotions (like joy), and struggle with others (like grief) this does not make one more ‘normal’ than the other.

Despite this, we tend to categorise certain emotions (like anger) as “bad” and feel guilty for feeling a certain way. At times, we may even think there is something “wrong” with us if we experience a certain emotion (like sadness or worry).

When we categorise normal human emotions as “right or wrong” or “good and bad” we are less likely to open up and talk to others about how we are feeling as we may feel too embarrassed or might worry that we will be judged for feeling a particular way.

When it comes to parenting, it is really important that we normalise how we feel and accept that we are going to feel every single emotion possible. For example, it is normal to feel hopeless when you are getting up night after night and feel absolutely exhausted. It is normal to feel worried about your baby’s health in the midst of a global pandemic. It is normal to feel angry or frustrated if you just cannot settle your baby, and so on.

It is also really normal for mothers to experience the ‘baby blues’. The baby blues is where, shortly after a baby is born (usually around days 3-5 post-delivery), you might become very emotional. You may find yourself crying continually and often for “no reason”. You may also find yourself feeling more on edge, or irritable and the slightest thing can set you off.

While the baby blues are largely due to a significant change in hormones, it can also be partly explained by what we endure in those early days, such as a long and difficult pregnancy, a potentially difficult or traumatic labour, and of course adjusting to life with a little newborn and the challenges that come with this (like breastfeeding and chronic sleep deprivation!).

When we objectively look at the realities of these early days, it is not surprising why many women experience the ‘baby blues’. It is simply a physical and emotional reaction to a significant life event – and is to be expected.

As a general ‘rule’, the baby blues only tend to last a few days, or up to one week. Similarly, when we experience normal human emotions, like worry, these also tend to be short-lived. Often our mood will improve within a day or two, or in response to something that typically makes us feel good (e.g., socialising or exercise) or after a decent rest.

When we do start to worry about a mother’s wellbeing and might consider a diagnosis of postnatal depression is when a mother continues to feel down, sad, worried, irritable, or “not themselves” for longer than a few weeks, if their mood worsens over time, and if they feel this way for most or all of the day.

What is postnatal depression (PND)?

What I’d like to state up front is that having postnatal depression does not mean you are a failure as a parent. Far too often women feel ashamed, or embarrassed to admit to experiencing PND, as if it somehow suggests that you have failed in your role as a mother and that there is something wrong with you. PND can happen to anyone. It does not discriminate, and you are not a bad parent if you experience PND.

It is vital that if you feel you have PND, or are worried for your wellbeing, that you seek help. Do not let your fears or insecurities about feeling this way impact your ability to receive support.

How do I know if I have postnatal depression?

At times it can be hard to distinguish between baby blues and PND. Often, the total time you have been feeling down or worried is a good indication. As mentioned earlier, if you have been battling the baby blues (or just feeling really down/sad) for two weeks or longer, it might be that you have PND.

Keeping track of how long you have been struggling for, or if things are getting worse, is really important. The best advice is that if you have been battling the ‘baby blues’ for 10-14 days and it is not resolving, seek help. Below are some other key symptoms or features of PND:

Feeling depressed/flat/melancholy/sad – for all or most of the day, and your mood does not seem to get any better.
Experiencing suicidal thoughts/thoughts of death Please note – if you do have any suicidal thoughts (thoughts about ending your life) it is very important to seek immediate help. Help is there for you and we’ve provided some resources at the bottom of this article.
Feeling irritable or on edge, or you may find yourself quick to anger
High anxiety – you may have constant worrying thoughts, fears of something really bad happening, or at times, panic attacks
Distorted thinking – with PND, it is common to have negative or worrying thoughts. For example, you may have negative thoughts about yourself as a mother, excessive feelings of guilt, or you may have thoughts of harming yourself or your baby. If you have these thoughts, please seek immediate help.
Difficulty concentrating, remembering things or making decisions
Change in appetite – you may lose your appetite, or struggle to eat food, or you may find that the more upset you are, the more you want to eat
Decreased energy - this can be quite a tough one to determine because a lack of energy is quite common in the early days of having a baby! However, with PND often you can experience a very debilitating exhaustion where even the ‘simplest’ tasks feel like a real challenge. In addition, even if you have managed to get some sleep, you still wake feeling exhausted in the morning.
Trouble sleeping - this is perhaps one of the crueller symptoms of PND. You have finally managed to get your baby to sleep, yet you simply cannot get to sleep yourself! With PND, it is common to have troubles falling and staying asleep.

What can I do if I have postnatal depression?

The first step in managing PND, is to acknowledge how you feel. Consider how you feel most days of the week, and whether you identify with any of the symptoms listed above. If you do identify with these symptoms, it might be time to reach out, and accept, help.

When you are ready to talk about how you feel, you might want to reach out to your partner, another family member, or a close friend first. Then let them support you in seeking the right professional help.

Help is out there and can come in many different forms. In some cases, you might be advised to take medication, such as an antidepressant. Medication can be prescribed by a doctor (like your family doctor). Your doctor will ensure that the medication is safe for you, and your baby if you are breastfeeding. Your doctor will talk you through how to take your medication, possible side-effects and how to assess if it is making a difference. If you are prescribed medication, it is important that you keep taking it, even if you start to feel better. If you feel worse taking medication, talk to your doctor immediately.

Aside from medication, you may also be offered therapy by a registered psychologist or counsellor. During these sessions you will be given information on PND and effective psychological techniques to manage this condition. For example, you may be taught ways to manage unhelpful thoughts, techniques to manage panic attacks and anxiety, or behavioural techniques to manage your low mood. Often these sessions can help highlight additional forms of support which you may otherwise not have known about. Therapy can often work well in conjunction with medication.

‘Alternative therapies’ can also make a significant impact on PND, and baby blues in general. Alternative therapies have the name ‘alternative’ because they deviate from mainstream or traditional interventions, such as medication. However, they are still robust and can make a big difference to your overall mood (especially if used in conjunction with the more mainstream measures). Examples include:

mindfulness meditation
hypnotherapy
yoga
exercise
relaxation
massage

These interventions can all help to reduce anxiety and stress and can give a lift when you are in a depressed mood. It is important, however, that if you have quite severe PND, that you do talk to your doctor about more mainstream approaches (like therapy and medication), rather than these therapies in isolation.

If you are confused about where to seek help, your family doctor or lead maternity carer is a good place to start. Although it can feel hard, that first step that you take to receive help can make a massive difference and go a long way in improving how you feel.

Summing up…

As we manage the highs and lows of parenting, we are going to experience a range of normal human emotions. It is really important to remember that these emotions are normal, and to be expected. However, at times you may feel like you are struggling more than you are thriving. You may feel down, more than you feel up. You may have a desire to hop into bed and never get back up. If you are struggling like this, it is time to consider whether you may need some extra support.

Although it can feel daunting, receiving the right support can make all the difference in the world. Never forget – there is nothing wrong with you for feeling this way. Do not let your worries or fears stop you from getting the help you need.

If you aren’t personally struggling with PND, but you are worried about someone else – reach out and see how they are and whether you might be able to support them. We all have a role to play in protecting maternal mental wellbeing.