Nip post-natal depression in the bud

01-Sep-2010 by Kim Lahey

Marg was at the brink: New house; Newborn baby; New feelings. “All I could think was, ‘this was not how motherhood was supposed to be, it was too hard’,” Marg says. “I felt I was at the worst point in my life.”

Parenthood has been called the profession created to re-jig our expectations. The perfect-mum-and-dad myths we are fed can be a sure-fire recipe to make us feel like we’re not up to scratch if we stray from the ‘norm’.

We’re not talking about the times when we are just too damn tired to put in the effort and everyone’s grizzly. And we’re not talking about the baby blues, which around 80% of women experience up to 10 days after giving birth. We are talking about when we sink into a lower-than-normal hole and struggle to climb out.

“I was a big emotional mess... I was borderline suicidal...I wasn’t capable of hurting Georgia, but I was hurting her just by my actions,” Marg confesses.

Stages and stats

Little do we know how common our feelings and struggles can be, until we seek help.

Postnatal depression (PND) is defined as depression in the months after the birth and it affects one in seven women. November 14-20 is Post Natal Depression Awareness Week. Interestingly, recent studies show antenatal depressive symptoms (those occurring during pregnancy) are just as common. Studies also show depression identified postnatally begins antenatally in up to 40% of women. That’s the good news because it means problems can often be detected early. But despite the prevalence and far-reaching effects of perinatal depression (the term used to describe both antenatal and postnatal depression) most sufferers remain unidentified and untreated.

What causes perinatal depression ?

A melting pot of factors cause perinatal depression and anxiety. A history of depression or anxiety, a stressful pregnancy, a family history of mental health problems, a drawn-out labour with delivery complications and problems with the baby’s health can all be part of the build-up. Changes in our lives may be difficult to handle. These changes, as well as other psychological and social risk factors, can make certain women candidates for depression and anxiety.

Uncovering anxiety

Recent studies suggest anxiety disorders may be as common as depression in the perinatal period, and even more frequent than depression during pregnancy. Early intervention specialist and psychologist Kathrin Veal says anxiety throughout pregnancy is a key postnatal depression indicator. “Anxiety during and post pregnancy is only beginning to get the attention that it deserves,” she says.

A third of women will suffer from an anxiety disorder at some point in their lives, so it’s hardly surprising anxiety is common among pregnant women and new mums. Kathrin explains some anxiety at this time is universal. “In fact, it would be unusual for mums-to-be and mums to not be anxious during this time,” she says. But for many this normal level of anxiety can escalate and become an anxiety disorder, meaning that it gets more and more difficult to stop the worry.

Kathrin says character traits like perfectionism (buying into the myth of super mum) are strongly related to anxiety. Other key factors to predict anxiety are life experiences such as a miscarriage in the past, high risk pregnancies and IVF.

Perinatal mental health nurse Melissa Homan says the first noticeable symptoms may be social withdrawal and sleep disturbance (as opposed to sleep deprivation) which means a mum cannot sleep when the baby is asleep, because they are anxious. “The anxiety is like they are in a constant state of fright 24-7 – agitated, restless, tight chest and mood changes, Melissa says. And the dad’s most common comment is ‘It doesn’t matter what I do, it’s not good enough’,” Melissa says.

Swinging the focus to life skills

A mental health nurse of 21 years, Melissa says her role is about prevention. She helps parents develop life skills from the moment they conceive. Melissa attended the recent national Mental Health Summit and explains how its prevalent theme was primary prevention by detecting early warning signs. “Perinatal depression is so treatable early enough, she says. But if it’s left for more than 12 months it has a huge ripple effect on the whole family.”

Melissa says her sessions bust myths like “mothers just know instinctively what to do”. “I tell them the reality is it takes six to 12 weeks to form a relationship with anyone,” she says.

Marg says she made an urgent appointment to see Melissa at what was “the worst point” in her life, nine weeks after the birth of daughter Georgia. “At that time I felt like I was being judged, I felt useless, fat, ugly... I just knew I was meant to love this child but I didn’t,” Marg says. “All I could think was, I hate this, I want to go back to work, and my husband was devastated.”

The two-and-a-half hour appointment turned her life around. “When I walked out, I felt 10kg lighter, just getting it all off my chest,” Marg says. She explains how Melissa showed her how to handle Georgia’s 5pm ‘fussy’ period. “At 5pm every day I lost it,” Marg remembers. Then there were the simple sleep tips. “Georgia went from waking up 10 times a night to sleeping 13 hours a night.... within four days!” Marg says.

Melissa believes a marked change in women’s childbirth age impacts on life skills training. “Nowadays they are having children a lot later and it’s a huge issue because they have been in control of every aspect of their life and are goal orientated and babies don’t fit that criteria,” she says. “Everything they are used to changes and they come crumbling down.”

Why don’t we seek help sooner?

Yes, society may be more understanding. Yes, there is more support these days. So why is depression during pregnancy and motherhood still having such a shattering affect on so many families?

Founder of the Sunshine Coast Postnatal Depression Support Group psychologist Lisa Lindley, says there’s still a lack of understanding in the general population and one reason mums still delay seeking help is because of the fear of being thought crazy. There are many other reasons: “They do not want to be seen as a failure, they do not like to admit that they are not coping, they don’t know where to turn, or believe that it will soon get better,” she says. Well-meaning friends might tell them to get over it while guilt, fear and shame often blocks the path to help. This can include “the fear of their baby being removed or being labelled a bad mother,” Lisa says.

Melissa agrees the key reason mums don’t seek help sooner is because of the stigma. “The only thing that keeps people from accessing help is pride – my definition is playing ostrich therapy,” she says.

What about dads?

Recent research shows 50% of men think women get PND because they have unrealistic expectations of motherhood and 25% believe it is a normal part of having a baby. Marg says lack of knowledge about depression holds men back. “We need to help educate them,” she says. Marg says she was abusive to her husband during her illness. “He was scared of me and then he stayed away from home even more.”

Melissa feels women are allowed to be vulnerable but men are conditioned not to be vulnerable. “If they are staying away from home more often than usual and are angry and withdrawn... then getting them to come in is hard enough,” she says. “If a mum is depressed for months, the dad may have had to be mum, dad and caregiver then once the mum gets better he may have reached the stage of male depression.”

Levels of depression for fathers do increase significantly in the year following childbirth, with studies showing 10% of fathers had depression during their partner’s pregnancy and the baby’s first year.

The recipe for recovery

Lisa says a combination of support and treatment helps recovery. Sometimes medication is needed when the condition is moderate to severe, and this can be assessed by a GP. A support network of a GP, psychologist, child health nurse, partner, family and friends is the key. Individual counselling which focuses on looking at negative thinking patterns and ways to replace these thoughts with healthier thought patterns can really help. And she says group support offers a chance to meet other mothers who are feeling the same. This way the sufferer can feel accepted and not have to pretend to be coping.

Lisa says we need realistic expectations about motherhood: It WILL be a challenge, most babies DO NOT sleep through and babies DO cry for no apparent reason.

Hands-up for prevention

Clinical psychologist Dr Emma Harley says perinatal anxiety and depression are still very much under-reported and under-diagnosed by GPs due to time-limits. “Given the real demands on GPs the best hope is we can make women and their partners better educated about the issue so that they’re able to raise their concerns with their GPs directly, and ask for appropriate referral for help,” Emma says.

If those at risk are identified during pregnancy, postnatal depression could be prevented altogether. Beyond Blue is sponsoring a national program which standardises procedures and encourages all GPs to use the Edinburgh Postnatal Depression Scale antenatally, so the help can kick-in during pregnancy if need be.

But one thing many parents (and many GPs) don’t know is specific Medicare funding is available for mothers to see a perinatal mental health specialist. “They just need to speak to their GP about this,” Emma says.

Rewards a plenty

Seeking help pays off in a multitude of ways. Clinicians see pregnancy and motherhood as a window of opportunity to get to know ourselves better – to reflect on our own childhood, face our fears about losing our identity and respond to our anxiety about our ability to be a parent. Because the well-being of the whole family is at stake, the better understanding we glean from seeking help ripples out to everyone and creates a strong base for future challenges.

Mental health champions like Melissa find their work enormously rewarding. “I get a lot of job satisfaction. “I tell them ‘I’m your coach and cheer squad and I expect to be made redundant’,” she says.

Marg wonders why she waited so long to act during that low point of her life, because now she feels so different. “Georgia is the best thing that ever happened to us,” she says.

On-line help with Beyond Blue

Symptom checklist – Simple checklists that will tell you (or someone you know)if you have symptoms that are common in people with depression, anxiety or related disorders and indicate whether you may need to talk to a health professional. Visit: www.beyondblue.org.au/ index.aspx?link_id=103.991

The Emotional Health during Pregnancy and Early Parenthood guide – provides information about symptoms and effective strategies to deal with them. It includes an outline of local services for perinatal depression in each state. Visit: www.beyondblue.org.au/index. aspx?link_id=94

For more information:

Sunshine Coast Postnatal Depression Support Group: www.sunshinecoastpnd.com Heath Contact Centre: 13HEALTH (13 43 25 84) and ask for contact details for your nearest Community Child Health Centre

Beyond Blue: 1300 22 4636 or www.beyondblue.org.au

Nambour Selangor Private Hospital’s Mental Health Consulting: 5459 7444 (this service is available to any woman regardless of whether they have given birth at Selangor).

What do you think?