Prenatal and Postnatal Depression
Having a baby is usually a joyous experience for parents. It is a time for making new plans for a life together as a family. During this time it is quite normal for parents to experience some doubt and anxiety about the future and their ability to cope. However for some people this can escalate to more intense periods of anxiety and depression that impact their daily life.
In Australia it is estimated that around 1 in 10 women will experience some level of depression during their pregnancy with this figure increasing to 1 in 16 women in the postnatal period.
Prenatal or antenatal depression
During pregnancy, hormonal fluctuations have a huge impact on a woman’s emotions, energy levels and general wellbeing. It is not unusual for some women to experience these changes as extreme mood swings. However, in some cases, other factors come into play leading to more serious levels of depression and anxiety.
A pregnant woman may be unhappy about the circumstances of the pregnancy such as the timing or choice of partner which could lead to her resenting the baby. She may feel she will not make a good mother, she may be fearful of the pregnancy and birth and worried about the upcoming changes to her body. She may also feel guilty because everyone expects her to be happy about the pregnancy and frustrated that she can’t tell anyone how she really feels.
Postnatal depression
After giving birth, a woman’s hormones change rapidly and they generally feel exhausted, stressed, emotional and tearful. This can impact on the whole family. Most parents go through an intense period of adjustment often called the ‘baby blues’. This period usually lasts for around 3 weeks. However for some people the problems continue over many weeks, months or even years. When this happens it is referred to as postnatal depression (PND).
Postnatal depression is caused by any particular factor but rather by a combination of factors that are different for each individual. It is can be triggered during or after childbirth. Many of the symptoms are common to those of general depression and they can vary greatly in intensity. Sufferers often feel completely overwhelmed by the situation and their behaviour can change dramatically. They may feel emotionally detached from everyone including the baby. Without appropriate care and support, sufferers may lose the ability to function well in daily life and their depression may have a snowball effect on the baby and their family and friends.
Prenatal and postnatal depression in men
While prenatal and postnatal depression is a widely recognised issue for women, what is not so well known is that it also affects around 1 in 20 expectant fathers in the antenatal period increasing to as many as 1 in 10 fathers after the baby is born. As with women, many men also experience anxiety alongside depression.
There are 2 key factors that are believed to significantly affect an expectant father’s mental health and these can increase the chance of him moving from being a normal ‘anxious dad’ to a father with antenatal or postnatal depression. These are:
Having a strained relationship with their partner – when the relationship is already under stress the father is far more likely to develop symptoms of depression both during the pregnancy and following the birth.
Having a partner experiencing prenatal and postnatal depression – studies have demonstrated that when a mother suffers from prenatal and postnatal depression it can put a lot of extra strain on the father and his risk of developing the condition is greatly increased.
Social and financial responsibilities and the change of lifestyle after the child is born can put additional pressure on both parents and increase their likelihood of developing prenatal and postnatal depression. Younger fathers on low incomes are especially at risk.
While many family and friends know to keep an eye on an expectant mother and to watch for signs of anxiety or depression, it is equally important for them to look out for an expectant father and to let them know that they are not alone. For both parents, the earlier that help is sought, the more equipped they will be to understand and manage prenatal and postnatal depression resulting in a better outcome for the whole family.
What causes prenatal and postnatal depression?
As with other forms of depression, a pregnancy related depression has no fixed cause and is often triggered by a combination of biological, environmental and social factors. It is generally accepted that a person is more likely to develop prenatal or postnatal depression if they have:
- Had other mental health issues in the past - including depression
- Experienced depression or anxiety during previous pregnancies
- A lack of support from their partner, family and friends
- Low self-esteem
- Experienced some form of trauma; for example the death of a loved-one, losing a job, or ending a relationship
- Suffered abuse such as child abuse or domestic violence
- Stress from finances, social circumstances or relationships
Many studies also indicate that genetics can play a role and that some people can be predisposed to developing prenatal and postnatal depression and other mental health conditions.
Other physical factors can increase a woman’s risk of developing the condition such as a traumatic delivery, an under-active thyroid or some physical illnesses.
The hormonal fluctuations and dramatic mood swings that many women experience during pregnancy and after childbirth are very often a contributing factor of prenatal and postnatal depression. While it is relatively normal for women to experience these mood changes they usually disappear within a few weeks after the birth. However, if the ‘low’ moods continue for extended periods and affect the woman’s ability to function normally then they are more likely to be symptoms of prenatal and postnatal depression.
Very often, the sheer physical and emotional stress of caring for a newborn child can trigger depression in either parent, particularly if they are suffering from sleep deprivation.
Too often, parents simply don’t realise they have pre and postnatal depression and may not express their feelings to anyone. Some may feel too ashamed to admit they have negative feelings about the situation; not even to themselves. However receiving help for depression as early as possible is crucial for helping the person to improve their quality of life and to be able to enjoy being a parent.
Signs of prenatal and postnatal depression
Prenatal depression symptoms
The depression and anxiety experienced by either parent during pregnancy can be different for everyone; however there are some thoughts and feelings that appear to be fairly common such as:
- “Why do I feel so sad/angry/scared when pregnancy is supposed to be a joyous time?”
- “I didn’t really want this baby in the first place”, or “having this baby now will jeopardise all my / our plans.”
- “Why am I not excited about this new life forming? I just feel numb and disconnected.”
- “I really resent the way the pregnancy has changed my body / my partner’s body.”
Other symptoms can include, but are not limited to:
- Experiencing general nervousness or panic attacks
- Feeling constantly irritated or angry
- Feeling a shortness of breath, increased heart rate or feeling shaky
- Having fears for the baby’s health
- Being worried about the future and the ability to cope emotionally, physically and financially
- Withdrawing from social activities
- Losing confidence and self-esteem
- Feeling constantly tired or having difficulty sleeping
- Finding it difficult to stay focused at home or work
- Finding it difficult to concentrate or remember things
- Feeling sad or low for long periods
- Having feelings of worthlessness, guilt, blame or despair
- Crying for no reason
- Feeling generally detached or apathetic
- Losing interest in intimacy and sex
- Experiencing unusual changes in weight or appetite
- Turning to alcohol, drugs or other addictions as a form of escape
- Having thoughts of death or suicide
Postnatal depression symptoms
While it is well known that some parents do get the ‘baby blues’ for several weeks after the birth of a child, the symptoms are generally not severe and will soon go away. However some parents can go on to develop postnatal depression. This is a diagnosable illness that can last for weeks, months or years.
The symptoms are generally the same as those listed above but may also include:
- Having no bond with the baby and not enjoying spending time with them
- Feeling overwhelmed with responsibility and unable to cope
- Feeling hostile or indifferent to the baby or the other partner and family members
Psychotic symptoms
About 1 in 1,000 women may experience some psychotic symptoms after giving birth. They may start to hear voices or see things that aren’t there (hallucinations) or they may develop illogical beliefs and thought patterns (delusions). Some may also develop bipolar disorder; switching from deep ‘lows’ to extreme ‘highs’ with no control over either.
Frightening thoughts
Depression can cause major changes in thoughts and behaviour as the brain’s chemical messengers (neurotransmitters) get confused and send out strange signals. New parents may picture themselves harming the baby or themselves. They could also experience overwhelming feelings that they will never be a good parent or that the baby doesn’t love them. These thoughts are rarely acted upon but they can cause great fear and distress for the parents.
While these thoughts may be scary or shameful to admit, sharing them with someone else can help ensure the well-being of the parents and baby. Professional counsellors can provide the emotional support and appropriate advice needed to get past this period.
Increased anxiety
Anxiety is also a common issue with postnatal depression. New parents can become overwhelmed by the weight of responsibility and the realisation of their new situation. They may experience irrational thoughts and concerns like:
- The baby is too quiet and may not be breathing
- The baby is not gaining enough weight
- The baby is sick
- The baby is crying too much and they can’t settle him/her easily
In some cases, the parent may be too frightened to be left alone with their child while in others they may not want to let the child out of their sight. They may have serious doubts about their ability to cope as a parent and may consider themselves unfit for the role. Increased anxiety can induce symptoms such as sweating, palpitations and feeling breathless. In this vulnerable state, they need lots of emotional support as well as constructive advice on how to ease their anxiety symptoms.
Diagnosing prenatal and postnatal depression
In order to overcome prenatal or postnatal depression the sufferer first needs to be aware that there is a problem. Often they are so immersed in their situation that they can’t see it clearly. It may take a friend or family to notice that the changes in the person’s behaviour have moved beyond the ‘normal’ baby blues. Sometimes the person may not want to acknowledge their own negative thoughts or feelings for fear of being seen as a bad parent – especially if they have experienced frightening thoughts.
Like any other illness, prenatal and postnatal depression treatment has the best chance of a positive outcome if discovered and acted on early. Again, like other illnesses, once a problem is suspected, the best person to turn to initially is a GP. They will ask a few questions to help identify the issues. The questions are common to the diagnosis of many forms of depression and will help the GP gain an understanding of how far the condition has progressed. The sufferer may be asked about:
- Their general mood over the previous month or since the birth of the baby
- Whether they have taken pleasure in the things that would normally make them happy
- Whether they have had any negative thoughts or feelings about themselves or the baby
The doctor will usually also look at other possible physical factors that could be contributing to the situation such as anaemia or thyroid issues. Once a diagnosis of depression is confirmed, the GP can then put in place an appropriate team care arrangement involving other health professionals such as a counsellor, community nurse or social worker. Depending on the circumstances, the service of these professionals may be subsidised by Medicare.
In all cases, the focus will be on the health of the baby and parents and on helping them all bond together. It is important for the parents to be reassured that nobody will want to take the baby from them and will only ever do so in extreme circumstances if the baby is at risk.
Treatment for prenatal and postnatal depression
There are a number of approaches that can be taken to treat prenatal and postnatal depression. A GP will help the parent or parents by discussing all the possibilities and helping them to choose those that they are comfortable with and that best suit their circumstances.
Medication
Those with severe cases of prenatal and postnatal depression may be prescribed anti-depressants. These can help to ease the symptoms by calming the rogue neurotransmitters in the brain without interfering with normal function. They don’t instantly fix the situation as they can take a few weeks to take effect however they do allow the person to see their situation with better perspective and allow them to find ways to move forward. Some people may experience side effects and these will vary, however the GP will weigh up the risks versus benefits before prescribing anything. Some anti-depressants are specifically designed for breastfeeding mothers.
Support Groups
Many people suffering prenatal and postnatal depression and postnatal depression in particular find it very beneficial to talk to other parents who have had similar experiences. Groups can be organised and facilitated by health care professionals or also by other parents who have overcome the condition. Having the support of caring people is often regarded as crucial to recovery from depression and anxiety.
Counselling
Many sufferers of prenatal and postnatal depression find that counselling sessions with a professional therapist give them a wonderful outlet to share their thoughts and feelings. Talking therapies such as Cognitive Behavioural Therapy (CBT) have been proven to be an extremely effective way to treat depression. Often a combination of medication and CBT is used as they work well together.
During CBT, the therapist will help the person to reflect on the nature of their depression and to identify the negative thought and behaviour patterns at the root of the problem. Central to all these sessions is the provision of a safe and non-judgemental environment in which the person can feel comfortable sharing their inner most thoughts and feelings. They can then work together to develop a new, more constructive set of thoughts and behaviours that can be used to help the sufferer deal with their situation and find a way to enjoy and celebrate their parenthood.
As perinatal (the period covered by pregnancy as well as the 12 months following birth) depression usually affects other family members, the therapist may also involve them in the treatment process though one-on-one and group counselling sessions. The ultimate aim is to bring the family together as a happy functional unit.
What should I look for in a mental health service provider?
There are a wide variety of people who offer mental health services. The generic terms ‘Counsellor’ or ‘Therapist’ are used to describe various professionals such as psychologists, psychiatrists, social workers or occupational counsellors. They all generally discuss your particular issues and work with you to find ways to address and overcome them. Most have undertaken years of study or additional professional development in their chosen fields however anybody can call themselves a ‘counsellor’. Also, some highly qualified counsellors may not necessarily have training in specific mental health conditions such as perinatal depression.
You may want to ask your counsellor about their type and level of qualifications or see if they are registered in Australia with a professional society or state body. Only certain kinds of practitioners can be registered with Medicare and process Medicare rebates, however most private health insurance companies in Australia have some provision for mental health care cover as part of their ‘extras’ packages.
Where can I find help near me?
Our directory lists hundreds of psychotherapists, psychologists, counsellors and other therapists from around Australia. These mental health experts offer counselling over the phone and online in addition to one-on-one consultations. Many also offer workshops and seminars.
Enter your postcode or suburb into our search box to see a comprehensive list of the health care professionals near you.
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