After The baby.
Post Natal Depression in Women and Men
By Sarah Godfrey
If there is one life changing event we choose to have it must be the decision to have a child. The excitement, responsibility, hope, changes to lifestyle, time, impact on our existing relationships and self-conceptions, ensures that one of the happiest times in your life can also be one of the most complex. It is pretty common that some mum’s, up to 80 per cent, may develop low mood (often termed the baby blues), between day three and day ten after the birth of their baby. Giving birth is a huge physical and emotional experience and it would be reasonable to expect a little emotional turbulence. Low mood levels where you experience feeling flat, tired or a little teary generally pass in a day or two.
The baby blues is quite different from postnatal depression (PND) which extends beyond the first week or so and persist for weeks or months after the baby has been born. The most important message is that PND is a serious illness and not a character flaw or weakness on the mum’s behalf. It does not discriminate between socio-economic status, religion, culture, educational background or family of origin. It can develop at any time after the birth of the baby and may present suddenly or over an extend period of time. It can develop after the first child or second, third or seventh child. It can be present in all new births or only in one. In other words it is random and unpredictable.
PND (or often called postpartum depression) is one of the most prevalent mood disorders associated with childbirth, affecting up to 15% of mum’s (or around 1 in 7 to 10 new mum’s). The definition of PND is when a mum, following childbirth, suffers from a combination of hormonal changes, psychological adjustments to motherhood, and fatigue. It is a combination of factors that include shifts in her mental, physical and social well-being.
There are, like most psychological and physical illnesses, some factors that may predispose someone to experiencing PND. Some of these are:
Having a history of depression.
Experiencing depression during or before pregnancy (antenatal depression).
Difficulties in the relationship or marriage.
Significant stress such as the death of a loved one or moving house.
A complicated or prolonged delivery.
Problems with the baby’s health or a very unsettled baby.
The absence of emotional and family support.
A family history of mental disorders.
Inability to breastfeed.
These events can be a warning sign for some mum’s to begin a conversation with their doctor. Being mindful of past and current issues that could impact a mum is recommended as it can help with self-care and awareness. It helps the family to be watching for the onset of symptoms. These factors are not, however, predictors of someone having PND, merely contributing issues known to be common with mums experiencing PND. PND symptoms vary from mum to mum but there are a few themes we should be aware of. These are:
An overwhelming sense of inadequacy or failing as a mum. This can include feelings associated with the care of the baby to the upkeep of the home and normal day to day activities they previously coped with.
A sense of hopelessness about the future.
Feelings related to anxiousness, panic, emptiness, sadness and exhaustion.
Irrational fears for the baby or of the baby.
Changes in appetite, sleep (insomnia beyond the normal disruption of feeding and nursing a baby), or nightmares or over sleeping.
Thoughts about suicidal or self-harm.
Any of these symptoms could be a sign that you are struggling to cope and PND is setting in. Talking to your partner, family and doctor can help give you perspective. However if the symptoms persist it is important you seek psychological treatment to help you overcome the fears and negative thinking associated with PND.
But let’s not forget the new dad’s.
Just as it is for women, watching your partner change as the baby becomes a physical realty and an awareness of the changes you are about to experience throughout pregnancy, can be a very anxiety provoking moment for men. Men often have fears about their ability to be a good dad and partner and whether they can do the selfless job of fatherhood. Normal levels of antenatal and postnatal anxiety are felt by most dads at some time during the pregnancy. As with the baby blues, the symptoms generally subside as the adjustment to, and excitement of, parenthood begins.
However statistics suggest that around 3-10% of men may experience more significant symptoms of depression after the birth of their baby. PND in the partner of a new dad is the biggest predictor of a man experiencing paternal postnatal depression (PPND). Although this is not always the case. Men can and do develop depression independently from their partner’s mental health condition, after the birth of their baby.
PPND can occur later than the onset of PND with the depression increasing between six weeks and six months after childbirth. An issue with PPND is that too often dad’s don’t recognise their symptoms until they are in crisis mode or their partners have emerged from their own illness. They rarely seek support and discuss their emotional struggles. In the article Men Don’t Like Talk Therapy: Myth or Fact, Chloe Della Costa reported that research over the years repeatedly indicates that men don’t recognize the symptoms of depression and other mental disorders. Alternatively men can often be aware they have a problem but allow it go untreated. Many researchers attributed this reluctance to men being socialised to view asking for help as a sign of weakness. The added stigma surrounding mental illness likely acts as an added deterrent.
Yet even for those new dad’s seeking help, there are very limited supports for men. Unlike the community and social supports available to new mums (such as child and family health nurse or maternal health centres and mother’s groups), little is available for dads. These community based support services usually identify PND in new mums quite early, assisting them for prompt intervention. For men PPND often develops over a longer period of time, remains unseen and untreated. PANDA (Perinatal Anxiety and Depression Australia) have listed some issues related specifically to PPND which include:
The impact of changing social roles for fathers in the family.
A change in family dynamics – some men might feel excluded from the parenting role or from the relationship with their partner, which can result in resentment towards the baby
Worries about extra responsibilities, financial burdens and managing the stress of work.
Unmet expectations about having sex again, in the early postnatal period.
Pregnancy, particularly early on – this appears to be the most stressful period for a man in the transition to fatherhood. This might be because of the changes in his partner’s body, how supported and included he feels, concern about the impending changes to his life, and feelings of uncertainty about his role in caring for his partner
A lack of opportunities to bond with the baby until after birth, unlike mothers, who can bond during the pregnancy.
The symptoms for PPND are a little different to PND and include;
Tiredness, headaches and pain
Loss of libido
Changes in appetite
A tendency to take risks
Changes to sleep patterns, especially a lack of sleep
Feelings of isolation and disconnection from partner, friends or family
Withdrawal from intimate relationships and from family, friends and community life
Increased hours of work as a part of the withdrawal from family
Increased use of alcohol and other drugs instead of seeking treatment for depression and anxiety.
If you are concerned PANDA and Beyond Blue have some good resources including an online assessment (The Edinburgh Postnatal Depression Scale-EPDS), that can help you and your health professional get a better sense of how you’re feeling.
The good news is that PND and PPND are treatable. As always early intervention yields the quickest path to recovery. If a new mum or dad is feeling low for any extended length of time support them to seek help, offer kindness and compassion. Most of all, be non-judgmental as they work their way back to experiencing the joys and excitement of having a baby and becoming a parent to a new life.