How do I know if I have postnatal depression?

Postnatal Depression PND, mother holding baby
Author: Dr Peter England, Obstetrician and Gynaecologist.

No matter how much a woman is looking forward to having a baby, the arrival of her baby brings major changes to her life. While some women adapt to these changes comfortably, for others there are considerable difficulties with coping. This can lead to regular periods of ongoing distress that are not easy to understand, which can present in different ways and be harmful to the mother’s wellbeing, and by extension to her new family as well. When this happens, it’s called postnatal depression, or referred to as PND.

What are the “Baby Blues?

At least 50% of women experience a day or two of feeling sad, teary and out of sorts. This usually occurs 3-6 days after your baby is born and tends to be short lived. The baby blues occur for a few reasons, including;

  • coming down off the enormous emotional high of the first couple of days after birth
  • the normal dramatic drop of very high levels of sex steroid hormones after the placenta has been delivered.
  • sleep deprivation which, put simply, is bad for all of us.

Usually, the blues pass within a few days to a week and need not be confused with the more serious problem of PND.

What feelings might suggest I have PND?

The symptoms vary but most women with PND can identify some of the following:

  • feeling miserable, hopelessness, or worthlessness
  • physically and mentally exhausted most of the time
  • poor concentration even for simple tasks
  • insomnia, not just when the baby is awake either, but trouble sleeping at all
  • loss of appetite and enjoyment of food
  • irritability with partner, other children, friends and relatives 
  • persistent feeling of guilt
  • fear of being alone with your baby, or over anxiety about your baby’s health
  • loss of interest in socialising, physical activity and sexual activity.

How common is PND?

Postnatal depression is very common. Around 1 in 6-7 women having symptoms of PND, which can, like any medical condition, vary from mild to severe. It may occur from the very start and be dramatic, or, more commonly there is a gradual and insidious onset over weeks to months associated with chronic tiredness and sleep deprivation. PND is easy to overlook, and sadder still, easy to deny even when the woman or those around her know things are not right for her.

Are there risk factors for PND that can help me or my partner be alert for its onset?

Yes, the following signs and symptoms can indicate your risk of postnatal depression.

  • feelings and symptoms of depression often begin antenatally
  • you may have a past or current history of depression requiring treatment
  • there may be a family history of depression
  • you may have experienced a complicated pregnancy and difficult birth
  • breastfeeding may be really challenging or not going smoothly
  • you might be isolated and lacking a supportive partner, family, or friends to talk to
  • major life stressors regarding finances, housing problems, moving house /renovations (don’t underestimate this one), or family crisis of any kind.
  • you may be used to being in control and successful, have your first baby at later stage ( >35yoa), and have difficulty becoming used to the unpredictability of babies: it really  is a big  and inevitable change

How can I get help for postnatal depression?

The first step is reaching out to your GP, midwife, Obstetrician, maternal and child health nurse, psychologist or other health professional you have had recent dealings with. I always say the lowest point you reach with depression is when you open up and tell someone close that you are not feeling good. Women can sometimes feel guilty or ashamed of their feelings, which can delay them opening up. Once that big step is out of the way, help can be organised and things will start to get better.

You won’t always feel like this.

Counselling and psychological therapies are useful to allow you to share your feelings in a safe and nonjudgmental environment, and to identify triggers and strategies that can contribute to your recovery from PND.

Support groups and professional organisations such as PANDA are an invaluable resource when you don’t know where to turn.

Antidepressant medication is a common, effective and safe way to help treat PND. They are effective within 2-4 weeks and usually will be required for around 6 months, but, possibly longer. Many of the modern antidepressants have a very good track record from a safety point of view, and can be taken while breastfeeding.

Remember, PND takes a while to come on and medication and therapy sessions will take a little time to return you to normal.

Admission to a mother baby unit for rest, treatment and education in mothering and settling skills with your new baby is usually always of benefit if required.

What if the PND is severe and I feel lost and want to harm myself or my baby?

This represents a medical emergency and you need urgent help. Admission to hospital or a mother baby unit and expert psychiatric and nursing input will help you recover. Call your doctor, midwife, obstetrician or the hospital where you had your baby. Call 000 if you ever feel like harming yourself or your baby.

How can I help myself?

Be open to your loved ones or health professionals when you think you are at risk of PND. Speaking to other people, accept all forms of help with caring for both you and your baby.

If you know you are at risk, plan ahead with family and health professionals to smooth the impact of the arrival of your little one into the world.

Take time out for yourself every day: even 15-30 minutes is a circuit breaker. Regular short periods of time out from your baby (using a friend or family member for a bit of babysitting) are a good thing

Don’t try to be superwoman. Being a mother to a new baby is a fulltime job, and then some!

Be realistic about what else can be achieved in the first year of a baby’s life and avoid setting the bar too high. There is no such thing as “having it all”.

Establish a routine of healthy meals, get outside each day for some fresh air and set a dedicated rest time each day to compensate for the interrupted nights.

Support Services for Postnatal Depression: