An interview with Merril Winney MAPS FCCLP Clinical Psychologist at Yarra Psychology.
1. Perinatal, antenatal and postnatal depression what is the difference?
Postnatal depression (PND) is the more common term referred to as the onset of depression, after the birth of a baby and within the first 12 months post birth. Antenatal depression refers to the onset of depression due to and during pregnancy. More recently the term “Perinatal depression” is used to acknowledge the changes in mood and behaviour during pregnancy and occurring during the first 12 months post-birth.
According to the Gidget Foundation, anxiety and depression during pregnancy and the first year of parenting (the perinatal period) affects around 20% of mothers and 10% of fathers, almost 100,000 parents in Australia. According to Milgram, Martin & Negri (2006), 50% of cases of PND start within the first three months and 75% within the first six months postpartum. PND is not to be confused with the baby blues. The baby blues affect up to 80% of women during the first two weeks postpartum, resulting in mood swings such as feeling happy then sad, irritability, feeling anxious or crying for no apparent reason. The baby blues can last up to two weeks but gradually dissipate, whereas the symptoms of PND are more severe and of longer duration due to constant negative thoughts and feelings.
PANDA identify that there are a number of factors that can contribute to developing perinatal anxiety and depression and they include:
- History of anxiety and depression
- Family history of mental illness
- Previous reproductive loss (infertility, IVF, miscarriage, termination, stillbirth, death of a baby)
- Difficult or complex pregnancy
- Premature or sick baby
- Challenges with feeding or settling
- Sleep deprivation
- Pre-existing physical illness
- Financial stress
- Relationship stress
On a positive note PND is responsive to treatment and psychological treatments are effective in reducing symptoms in postnatal women.
2. How can we read the play better? What are the signs not just in ourselves but in others?
PND is accompanied by a range of symptoms that women cannot make sense of and find overwhelming.
The signs and symptoms of PND are varied and can include:
- Lowered mood and sadness
- Tearfulness and crying uncontrollably
- Feeling worthless
- Anxiety or panic attacks
- Self-blame or guilt
- Worries about health and their baby
- Lack of energy and feeling exhausted
- Slowed speech and movements
- Agitation or feeling hyperactive
- Loss of interest in activities, including sex
- Feeling irritable
- Appetite disturbance, eating too much or too little
- Reduced concentration and decision-making ability
- Sleep disturbance, not being able to sleep even when the baby does
- Confused thought and becoming forgetful
- Feelings of hopelessness, inadequacy and constant pessimistic thinking
- Severe mood swings
- Thoughts about death and at times suicide
Generally, if a mother is experiencing strong emotions which are impacting negatively on her ability to function as usual, and have lasted for two weeks or more, professional help is recommended. Parents who do not seek assistance can struggle for years with depression and anxiety which in turn impacts all aspects of their life. If left untreated, the impact on the mother, father, child and other family members can be profound. Seeking help is a positive step which can lead to a faster recovery.
3. Why are women ashamed of having PND when it is so common? How can we support women to better speak up and get the right help?
The birth of a child, with the associated demands on newly acquired skills is a significant stressor in the lives of parents and nothing really prepares one for the experience and challenges faced by new parents.
PANDA describe mothers’ who have PND with the following experiences and thoughts as:
- Anger or guilt about not having “normal feelings of maternal or paternal love
- Confusion or frustration about feeling low during a time when everyone is saying “you must be so happy”
- Being overwhelmed or confused by the advice or opinions of doctors, family or friends about how to manage their baby
- Wondering if their relationship with their partner will ever be the same
- Resenting physical changes to their bodies after childbirth and motherhood (“I was just a mum in some puked dressing gown, day in day out”)
Pregnancy and parenthood is a time of great change, mixed with a range of emotions and often new parents find it more challenging than they anticipated. Many mothers suffer in silence feeling guilty or ashamed that they are not experiencing the joy and excitement that the “Johnston and Johnston” commercials portray of early parenthood.
PANDA identify the typical changes and challenges faced by new mothers to include:
- Exhaustion while adapting to a demanding sleep/feed schedule
- Physical demands of breastfeeding – pain associated with latching-on, cracked nipples and mastitis
- Recovery from birth whilst caring for a newborn
- Demands of running a household while managing the baby’s needs and less focus on her own needs
- Changes to personal identity, loss of work role/status, loss of social life, loss of sense of freedom
- Change in relationship with partner
- Change in family dynamics with addition of another baby
Generally, no mother wants others to know that they are struggling and not coping. Often new mothers have trouble asking for help resulting in a downward spiral of unrealistic expectations on how to manage a totally new experience, resulting in feeling frustrated, guilty or resentful. Encouraging mothers to recognise and acknowledge the mixed joy and distress of parenthood can be a first step. Encouraging new mothers to access assistance in person or via reputable websites and help lines can provide necessary support.
Some suggestions are:
- Regular contact with GP and or gynaecologist/obstetrician
- Maternal and child health clinics
- Local playgroups
- Home assistance and nanny services
- Parenting skills and support programs
- Sleep clinics
- Counselling services
- Psychiatrist and or Psychologist
- Gidget Foundation www.gidgetfoundation.org.au
- PANDA 1300 726 306 panda.org.au
- Black Dog Institute blackdoginstitute.org.au
4. What are the three most important steps a woman can take to get herself back on track?
Self-care is the first priority. Often mothers are consumed with caring for their baby and forget that self-care is important for their personal health and wellbeing and in turn assists the mother to care for her baby. Sleep, diet and exercise are often the first things to be compromised when stressed or tired from uninterrupted sleep and the 24 hour demands of parenting.
Some suggestions for sleep and diet are:
- During the day rest when the baby is sleeping, even quick naps of 20 minutes can improve your alertness and assist functioning
- Go to bed at the same time each night
- Discuss options for night time feeds
- A warm bath or shower prior to bed can regulate your body temperature for sleep
- Avoid stimulating activities before bed
- Make the bedroom as restful an environment as possible
- If you can’t sleep, get up and do something quiet in another room and when tired return to bed
- Take up offers of help in preparing meals
- Prepare meals earlier in the day ready for reheating at dinner time
- Keep a bottle of water handy, as dehydration can make you irritable and tired
- Focus on realistic expectations, on difficult days allow for something easier such as a toasted sandwich
- Home cooked meals may not be an achievable goal every day, consider options of healthy take away if required
Plan at least one pleasurable activity per day and take time for yourself. This nurturing time might mean different things for different mothers but it is important to do something for yourself, even for a short time during each day. Some activities include going for a walk, going shopping without the baby, listening to music, watching a movie, reading a book, taking a relaxing bath, engaging in a hobby or craft that is enjoyable, meeting friends for coffee/ lunch/dinner/drink, having a massage, haircut or pedicure, sitting outside enjoying sunshine and fresh air and re-engaging with nature.
Sometimes this requires structuring time during the day or arranging with the other parent or a carer to help. However, the added benefit of one on one time for the other parent or carer with the baby can also help their bonding and confidence and allow the mother some precious time out from the caring role.
Being at home can feel isolating for many mothers and often they feel withdrawn from adult contact. Activities such as new mother’s groups, playgroups, story time at the local library, and activities run through the local maternal health centres or mother/baby pilates or yoga classes are activities possible to do with the baby or infant and can help mother connect with other adults in the local community. Re-engaging with existing social networks and friendships can also help new mothers feel connected to other adults.
5. Here at PP we believe movement is medicine. Can exercise benefit women with PND? What form of movement would you prescribe?
Regular physical exercise is highly beneficial as it can increase serotonin levels and getting out in the fresh air and sunshine can lift mood and boost vitamin D. Setting achievable, realistic goals is important and these goals need to be dependent on your personal circumstance, previous physical exercise history and physical recovery after birth. In the early days it’s helpful to schedule in exercise time, which could be as simple as aiming for a short walk during the day with the baby in the pram.
As childbirth often impacts on pelvic floor function, sometimes it is beneficial to see a physiotherapist for assessment, treatment and strengthening exercises. If you have any concerns it is important to consult your doctor prior to undertaking strenuous exercise. Be reasonable with yourself and ease into appropriate exercise. Sometimes gentler activities such as breathing exercises, mediation, or yoga are just as beneficial and resuming gently and gradually building up is recommended.
At Studio PP, we love to help mums ensure a healthy pregnancy and with a successful recovery following pregnancy. Find out more about our pre/post natal offering here.
Gidget Foundation www.gidgetfoundation.org.au
Milgrom, J., Martin, P., & Negri, L.M. (2006). Treating Postnatal Depression. Queensland: John Wiley & Sons.