Your feelings after birth and postnatal depression

Postnatal depression (PND) is a mood disorder which often affects women in the weeks and months after birth. It can also be experienced by fathers, and either parent is likely to be affected by concern about the other. PND can seem very isolating and people who experience it often feel unable to make sense of their own feelings or to seek help. Feeling down and experiencing self-doubt over parenting is very common, and admitting that you might need treatment for depression is not being a failure or a bad parent.

In a 2007 survey for the Royal College of Midwives, 27% of mums said they had felt some symptoms of PND, with some estimates putting the figure even higher. It is important to remember that it is not unusual to feel this way, and that there is help available.

What causes PND?

There is no single answer as to why some new parents are affected by PND and not others. Having a baby is a huge upheaval in your life and this can feel very scary and unsettling. Changes in your relationships and friendships, issues from your own childhood and challenges to your sense of self can all contribute to PND. If you have feelings of low mood before or during pregnancy, you are more likely to experience depression after birth.

Some women who have had a difficult labour or traumatic birth find that this triggers PND. Women who experience depression and anxiety before giving birth (antenatal depression) have symptoms very similar to PND and these can continue once the baby has been born.

Feelings during pregnancy

The following information may be useful if you are reading this before the birth of your baby. Because PND is more likely to occur if you have experienced depression before, it may be helpful to think about these recommendations, made by the Royal College of Psychiatrists:

• Don’t try to be ‘superwoman’. Try to do less and make sure that you don’t get over-tired.

• Do make friends with other women who are pregnant or have just had a baby. It may be more difficult to make new friends if you get PND.
• Do find someone you can talk to. If you don’t have a close friend you can turn to try the NCT’s Early Days groups. Your local group can be very supportive both before and after childbirth.
• Do go to antenatal classes. If you have a partner, take them with you. If not take a friend or relative.
• Don't stop antidepressant medication during pregnancy without medical advice. Around 7 in 10 women who stop antidepressants in pregnancy relapse if they stop the medication.  You need to discuss the risks and benefits of continuing treatment in pregnancy and while breastfeeding.
• Do keep in touch with your GP and your health visitor if you have had depression before. Any signs of depression in pregnancy or PND can be recognised early.
• Do make sure that you have treatment for depression in pregnancy. This may be a talking therapy or medication.

• Do accept offers of help from friends and family.

Common symptoms

People with PND can often experience:

• feeling low, unhappy and finding it hard to enjoy everyday activities
• loss of appetite
• feeling irritable
• physical symptoms – headaches, blurred vision or stomach pain
• anxiety attacks – fast heart rate, sweaty palms and feeling sick or faint
• sleeping too much or finding it hard to sleep
• feeling guilty or overwhelmed

The Baby blues and PND

The baby blue's can start a couple of days after birth and last a few hours or days with weepiness and sad feelings being the most common symptoms. The baby blues, unlike PND, does not normally require special treatment. Understanding, emotional support and as much rest as possible will help.

Do I have PND?

If you are concerned that you may have PND, talk to your GP or health visitor. You may be asked to fill in a multiple-choice questionnaire about how you are feeling as your GP will want to know how long you've felt low and how this is affecting you. Professional help can make a positive difference to how you feel. Sharing your worries and feelings is an important first step.

Thinking of a friend?

If you think your friend, partner, son or daughter may be depressed, there is help available. If you can, encourage them to talk about how they are feeling to someone they trust whether that is you, a family member, friend or healthcare professional. Attitudes to mental health have changed in recent years and new parents should be supported and listened to.

Helping to prevent or reduce feelings of depression

The suggestions below are relevant for all parents but especially for those feeling they may be experiencing depression.

• Share your feelings with people you trust; you'll find both you and your baby benefit from company.
• Give yourself time to adjust to motherhood and recover from giving birth.
• Try and get help with the childcare and take some time for yourself, even an hour here and there, if you can, will be helpful.
• Take some exercise each day, like a walk with the buggy or swimming: exercise has a positive effect on mood and sense of wellbeing.
• Maintain a healthy diet; eating badly or skipping meals can make you feel tired and irritable, so try to eat simple and nutritious meals.
• Studies suggest that if one parent is suffering from PND then, often, the other one will be too. Try to share as many jobs around the house as possible. Helping to support each other will make things easier.
• Meeting with other parents can be a great source of support: call NCT to see where your nearest Bumps & Babies group meets.

Treating PND

There are a range of approaches for treating PND, which include general counselling, psychotherapy and taking prescribed antidepressants. Your GP should be able to give you any information you need to help you make a choice that feels comfortable for you. Some people respond better to one method rather than another while others find both therapy and antidepressants together to be the most helpful approach.

What should I choose?

This is ultimately your decision, although there are a number of factors which may influence your choice of therapy. Services vary across the country and where there are appropriate services available on the NHS, waiting lists for treatment can be long. Private treatment is expensive, costing upwards of £30 per session, although it may be possible to find clinics where services are offered for less. Some people prefer an in-depth, emotionally intensive therapy that can give a great deal of personal insight, whereas others prefer more practical therapeutic approaches that aim to change behaviours and symptoms quickly. Talk about it with your GP, or other specialist services and organisations, such as: Mind (in England and Wales), Well Scotland or Niamh (in Northern Ireland). Details for contacting these organisations can be found at the end of this page.

Evidence has shown that many psychotherapeutic treatments are as effective as a course of antidepressants in the treatment of depression and PND. If a friend recommends a therapist, this can be an excellent way to find someone. Remember that if you don't feel that the method of therapy or the therapist isn't working for you, you can always change and try someone else. Whichever you choose, make sure your therapist is registered with an accreditation body such as the British Association for Counselling and Psychotherapy (BACP), United Kingdom Council for Psychotherapy (UKCP) or British Psychoanalytic Council (BPC).

Medication

Your GP may prescribe antidepressants which can help to ease many of the symptoms of moderate or severe PND and give you some breathing space to adjust to the changes involved in becoming a parent. Antidepressants are prescribed for at least four months, often longer, although your dose may be reduced gradually if you respond positively. They also take several weeks to reach their full effectiveness, during which time they may initially heighten some of your symptoms, such as insomnia and anxiety. These should pass, but if you are concerned about the side effects, see your GP to discuss other options.

Breastfeeding

If you are prescribed antidepressants for PND, then you should check with your GP that they are appropriate to take whilst breastfeeding. Generally speaking, it should be possible to take antidepressants whilst breastfeeding. Few adverse responses have been reported.

Getting better

Whatever way you choose to approach PND, over time and with some help you should start to see an improvement in how you feel day-to-day: many women describe recovery as feeling as though a cloud has lifted.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.

You might find attending one of NCT's Early Day's groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Further links

The Royal College of Psychiatrists has information on postnatal depression.

Effective psychotherapeutic treatments may be found in your area. Check out the British Association for Counselling & Psychotherapy, the United Kingdom Council for Psychotherapy (UKCP) and the British Psychoanalytic Council (BPC) for a list of recommended therapists.

Mind's website and infoline 0300 123 3393 provide information on a range of topics including postnatal depression and other mental health problems and where to go for advice and support.

Well Scotland and Niamh (in Northern Ireland), leading providers of mental health information in their regions, also provide further information on postnatal depression.