Post-natal depression

Do many women get depressed after the birth of a baby?

Yes, in the early days after having a baby mild depression is so common that it is regarded as normal. It happens after at least 50 per cent of births and usually shows up during the third or fourth day. It doesn’t last very long- normally a day or two, or sometimes just a few hours — and it is rarely troublesome. This brief low is often called ‘baby blues’.

At the other end of the scale one or two mothers in every thousand suffer from depression so severe and intense that it causes derangement, loss of contact with reality and the risk of suicide. Such deep depression as this is called psychotic depression.

The condition in between these two extremes is called post-natal depression which follows about one in 10 births. It is not as mild nor as common as baby blues. It happens more often than psychotic depression, however, and it’s consider-ably less severe. 11’ s certainly not a normal event any more than catching’flu could be considered normal. But it’s not so rare that it’s very abnormal either, any woman can get it Post-natal depression is one of die most common and unpleasant complications of the puerperium – the period of six weeks or so after having a baby when the body is supposed to be getting itself back to normal.

Its perhaps rather artificial to try to draw a clear-cut distinction between ‘the blues’ and post-natal depression. Most women have their babies in hospital these days and they can easily feel under a certain amount of strain in trying to establish some sort of routine for the new baby. This strain could be expressed as anxiety, spells of despondency and a few tears.

Ifs not clear whether this readjustment period is normal or something in between ‘blues’ and post-natal depression – but it’s not usually something to worry too much about However, a woman who is still troubled by despondency between six and eight weeks after the birth and who is not usually so depressed, is suffering from post-natal depression.

Post natal depression – What are the typical signs?

Not unexpectedly, the main symptoms of a woman with post-natal depression are that she feels low and depressed. The new mother is unhappy, fed up and demoralized. She is sad, tearful and feels guilty. The mood can vary every day, but often gets worse as the day goes on.

Usually the mother cannot explain her misery, especially at such a traditionally happy time. When other mothers in her social circle have appeared to cope happily with motherhood she blames herself for her self-pity and inability to ‘pull herself together’. To be in such a state is an unusual, perhaps unique, experience for her. She is often irritable, particularly with her partner as well as with any other children she has, and this makes her feel all the more guilty.

She is anxious to the point of panic and feels diat she cannot cope. She worries unduly if the baby doesn’t take all its feeds, doesn’ t bring up its wind, keeps crying or even if it sleeps too soundly. These are common, and natural anxieties for many new mothers, but they utterly and painfully pre-occupy the mother who is depressed.

Fatigue nearly always goes hand in hand with die depression. It adds to the awful feeling of not coping. By the end of the day a depressed mother is completely exhausted and longs to go to bed. But when she gets there she cannot sleep, tossing and turning instead. Eventually, when she does drop off, sleep is fitful and disturbed by alarming dreams whicn generally involve the baby. By this time, because she is so weary, she may think that diere is something physically wrong with her. She may well visit her doctor for iron or a tonic to treat imagined anaemia or a hormone change.

Depression usually causes a loss of appetite and therefore of weight, but sometimes it has just the opposite effect. Eating for comfort and consolation leads to weight gain which does nothing at all for an already poor self-image.

A number of depressed women go off sex too. This denies them an important source of pleasure, closeness and self-esteem. It may also estrange the baby’s father who is already perplexed.

Baby blues cause tearfulness, despondency, anxiety and difficulty in coping too, but the symptoms are short-lived and never severe. Psychotic depression goes much further than post-natal depression and is so severe that the mother feels both she and the baby are beyond hope. She feels unfit to live and is preoccupied with desperate ideas of removing herself and the baby from her wretched world. Tragically she sometimes acts in accordance with such dismal thoughts.

Rather surprisingly there have not been many follow-up studies of post-natal depression, so there is no accurate answer to this question.

To be recognized for what it is, the depression has to last at least a month. After that the mood usually runs its course in a matter of weeks, but it can sometimes last for months or even for longer than a year.

Baby blues are over within a day or two. Psychotic depression is less likely to go unrecog-nized and untreated than post-natal depression. Though if s a more severe disorder this means, ironically, that psychotic depression stands a better chance of being curtailed quickly.

There are several possible causes, none of which apparently apply in all cases. A stillbirth, early death or severe handicap of the baby are events which anyone would find depressing. Generally, however, there isn’t such an obvious cause for post-natal depression.

Some sufferers have gone through similar bouts of depression which have no connection with childbirth. They may well be the type who experience depression anyway when under stress. This is very much so in cases of psychotic depression where there is often a personal and family history of severe depression. However a lot of women who suffer from post-natal depression never get depressed at other times, not even after other births.

On occasions there seems to be a reason why the birth of one particular child should bring about depression. A woman who had coped well with her first daughter became very anxious and low after the birth of her second. She explained that as a second daughter herself she had felt that her older sister was their mother’s favourite. She was afraid that history might repeat itself.

There is litde evidence to connect post-natal depression with complications in pregnancy, difficult childbirth, hospital confinement or the use of anaesthetics which may prevent the mother and baby being together after delivery. (This separation can delay the attachment or’bonding5 process.)

Although hormone theories are popular, none are proven. For example, there is a huge buildup of oestrogen and progesterone during pregnancy, followed by a sudden fall after delivery. It has been suggested that this change in hormone levels contributes to baby blues. But this doesn’t explain post-natal depression which develops more slowly and lasts a lot longer. No hormone dierapy has proved to be effective in the treatment of post-natal depression. don’t?

Doctors don’t know. The few clues they have fall a long way short of’giving a complete picture.

It has been suggested that personality contri-butes to post-natal depression. For example the obsessional, compliant woman who is brought up always to do what she’s told and not as she feels may be more at risk. Her instincts have been thwarted for so long that they don’t tell her how to deal with an uncontrolled, demanding newborn baby. Ifs difficult for her to identify and cope with her offspring. An immature woman who may see her baby as a rival is also said to be at risk. But there is no really solid evidence to relate this type of depression to personality.

Current theories include suppressed anger and a learned state of helplessness as factors which provoke depression. Following these lines, situations which give rise to anger that cannot be aired, or which promote feelings of incompetence or helplessness, may lead to depression.

The loss of a woman’s mother at a tender age through death or divorce has been associated with increased risk of post-natal depression. A spate of bad luck during the year before the birth of the baby, and the absence of a supportive partner or friend are also contributing factors.

In the first place ifs an enormous relief for a depressed mother to be told that she is suffering from post-natal depression. If s a well recognized disorder which is unpleasant while it lasts but likely to get better nonetheless.

She is not a spoilt brat, wallowing in self-pity, ungrateful or unmotherly. She is not physically ill, she is not a freak, nor is she going mad. It is her sheer bad luck to be afflicted this way.

It is good for her to talk about how she feels. She will appreciate the chance to cry on someone’s shoulder without being interrupted too quickly, scolded or being’jollied along5.

The health visitor, the family doctor and occasionally a psychiatrist should be involved. Sometimes an anti-depressive drug helps a lot The husband or partner and other members of the family (the grandmothers for example) should be brought into the picture so that they can understand whaf s going on, and help out.