Postnatal Depression: Experiences and Advice

The article below was recently shared with NCT editors for use in their newsletters. As someone that has suffered from postnatal depression, I thought it would be useful to share it on our blog. 

My daughter, Maria, is now 17 months old. I found the first year of motherhood very difficult. She didn’t sleep at all well and she wouldn’t be put down during the day. I didn’t adjust well from having routine, independence and lots of company every day to being completely depended on, tired and lonely!  I felt like I’d completely lost my freedom and I couldn’t get anything done! 

The worst effects were on my sleep. After a few months, I developed insomnia – I could never sleep during the day when Maria slept and my sleep patterns were so disturbed that I would lay awake at night for hours. I dreaded going to bed. It was exhausting and I was tearful a lot of the time. I felt much better when I was out and about but I didn’t like to plan anything in advance in case I didn’t sleep well.

I also received quite a lot of criticism from family, friends and health professionals about my parenting choices. Because Maria was quite an unsettled baby, some family members thought that my breast milk wasn’t enough for her so were convinced that I should bottle feed her! She wouldn’t take a bottle – she’d scream if I tried to put one in her mouth – and trying to get her to take it was an added stress!  

She would only sleep in a sling during the day and in our bed at night. I was told that this was the “biggest accidental parenting mistake” I could make! Even a health visitor, a doctor and Maria’s eczema nurse said I should try controlled crying. So I tried to get Maria to sleep in the cot. Again, she would cry and scream until she made herself sick and bang her head against the side of the cot! Another added stress!

I kept my feelings well hidden (I think!), pasting the smiles on when I was out! I remember being at one of our baby groups and other mums seemed so happy when I just wanted to cry! 

For many months I didn’t attribute my feelings to PND. I thought I’d just developed insomnia and the way I felt was a knock-on effect of that. It was only when my mum said she thought I had it and I looked up the symptoms online that I accepted it could be PND. 

I didn’t feel that the doctors were particularly supportive at first. When I originally went about not being able to sleep, I was just given some fairly rubbish advice about developing good sleeping habits and was told I couldn’t take any sleeping tablets because I was breastfeeding. PND wasn’t mentioned. 

Eventually, the need for me to take some sleep medication was behind my decision to stop breastfeeding after just over a year. It was then that the doctor also prescribed me some antidepressants. 

Since then, things have definitely improved. I’ve slept better and started enjoying motherhood! One of the factors behind feeling much better has been accepting that I’ve made the right parenting choices for my child. She’s now a very bright and happy toddler and it no longer bothers me if I get any negative comments about things such as bedsharing! I can just brush them off! And after almost five months, I’ve halved the dose of my antidepressants (with the consent of my doctor) and hope that I can come off them altogether soon.

If you have been experiencing similar problems or feelings, the following advice may be useful. It was written by Dr Charlotte Granger. She is a clinical psychologist working on a research trial for the University of Oxford, which aims to develop effective psychological therapies for postnatal depression.

Understanding postnatal depression

Having a baby involves considerable adjustment for a woman, whatever her age, lifestyle or how many children she already has.  From conception, pregnancy and birth, to the practical demands and responsibilities that take over daily life, it is a transformation on many levels, biological, physical, social and emotional. Every baby will be different in the challenges they present from pregnancy onwards, and each mother different in how she is able to cope with these and what other pressures she will also have to cope with during this time. In 10-15 per cent of new mothers, the changes and challenges involved in this adjustment will overwhelm their usual coping strategies, and they develop postnatal depression.

Symptoms of postnatal depression are similar to that of typical depression, and happen within the first year after having a baby. Natural adjustment to motherhood often includes feelings of being tired and overwhelmed, changes in sleep and appetite, and less time to relax and enjoy things.  In the first 10 days after giving birth, 80% of new mothers will experience ‘baby blues’, feeling tearful, exhausted and tense, and these feelings typically go away by themselves. Post-natal depression differs from these natural feelings when feelings of sadness, being overwhelmed or feeling anxious last longer than two weeks and are around most of the time. This persistent low mood is accompanied by difficulty in sleeping even when the baby is asleep, lack of energy, feelings of worthlessness or guilt, struggling to concentrate or make decisions, or thoughts about harming oneself. It can develop at any time in the first year of having a baby, although between three to six months after the birth is the most common time for it to occur.

Difficulties in seeking help

For many women, getting help for postnatal depression can be difficult due to the emotional impact that asking for help involves. There a number of reasons why women can find it particularly hard to admit to anyone else that they are struggling. Often women feel that they shouldn’t be depressed after having a baby, and this leads to a sense of guilt and unwillingness to talk about how they feel. They may also feel that they have no ‘obvious’ reason why they should feel sad, particularly if the baby was planned and they have a comfortable, settled lifestyle. Fears that family and friends will think they are a bad mother who should be coping better are common, particularly if experiencing low mood which increases negative thinking and makes it difficult to make decisions such as who to talk to. Often not talking about how difficult it all is leads to the depression increasing, as the mother may feel a sense of loss about not enjoying their baby’s first year, and worry that their baby is being affected.

Treating postnatal depression

Treating postnatal depression is in some ways very similar to treating typical depression; the most effective treatments are anti-depressant medication and talking therapies e.g. cognitive behaviour therapy or counselling. GPs and health visitors are widely familiar with the symptoms and will know what help can be offered in the local area.  Anti-depressant medication can be rapidly effective, and GPs can discuss what type of medication may be suitable for those mothers who are breast-feeding.

Talking to your GP or health visitor is the best way to get help if you feel you are experiencing postnatal depression. It can often be the hardest step, and if it is difficult, choose a trusted friend or family member to try talking about it with first. It is important to remember that health professionals see talking about feelings and asking for help as effective coping, rather than not coping.

Self-help strategies

There are also a number of self-help strategies that you can try to lift your mood.

Talk

Having the support of people who know you well is very important. It can also be a little too easy in modern life to not get enough daily human contact. Online shopping, emailing and texting can all give us fewer reasons to get out of the house or pick up the phone. Talking to people about the daily delights and stresses of having a baby is an anti-depressant for a number of reasons. It puts life in perspective and makes worries seem more manageable, and may lead to useful advice. It can also distract you from how you are feeling, and help you feel relaxed and supported. Be honest about how you feel with people who you trust and feel safe with. You may help more people than just yourself. The more the reality of motherhood is discussed, the more women will feel normal and understood about how they feel after having a baby.

Organise your week

Getting organised is no mean feat with any amount of small children, and therefore both the difficulty and the benefits should not be underestimated. Getting a regular routine for the week is a great anti-depressant. When feeling low, it can be too easy not to do things that are good for us. Most people will have days when they don’t want to go to work, however because they have to, they do, and generally after a short while they will feel better for having done it. Having a baby and being at home can make it much harder to get things done or go out. Make a routine for the week and schedule in baby groups, walks, time to do chores and time for yourself. Sticking to the routine even when you don’t feel like it can help you feel more in control and keep you doing things that will help with feeling better, such as getting physical exercise or seeing other people. Try to get a good balance of activities across the week, including time for what your baby needs, time for what your house and family need, and time for your own needs. 

Be kinder to yourself

Often our harshest critic is ourselves, particularly when we have a lot to cope with. Again, modern life is a major contributor to us developing a way of talking to ourselves which is harsh and judgemental. Television and the internet help us believe there is not only a right way of doing things but that everyone else is doing it right already. However, learning to talk to yourself in a warmer and encouraging way is not only likely to help you achieve more than self-criticism, but chances are if you model this to your child, they’ll grow up knowing how to talk to themselves the same way. Specifically, it is through seeing you as their parent make mistakes and recover from them that children learn mistakes are okay and how to work them out. Practice noticing your own self-critical thoughts and gently challenging them with warmer and more accepting thoughts. It can be surprising how hard this is and will take regular practice. Keep at it: even small changes to your daily life will add up over time and help life feel more manageable and enjoyable.

Advice on postnatal depression can also be found on the NCT's website http://www.nct.org.uk/parenting/postnatal-depression

Sleep Problems Worsen in Late Pregnancy

This probably won't come as a surprise but a recent study has confirmed that sleep problems increase in late pregnancy.

Sleep disturbances in late pregnancy are common. The study, 'A postal survey of maternal sleep in late pregnancy,' aimed to survey sleep problems in third trimester pregnant women and to compare sleep in the pre-pregnancy period with the third trimester.

Third-trimester women were sent a postal survey containing questions relating to sleep experience, including perceived sleep quality, sleep difficulties, night waking, sleep environment, snoring, daytime tiredness and daytime napping. The women were asked to report on sleep before pregnancy and in the last week.

The main findings were as follows:

• Before pregnancy, the average reported duration of night-time sleep was 8.1 hours; in the last week this had decreased to 7.5 hours. 
• Only 29% rated their sleep quality in the last week as very good or fairly good, compared with 82% rating their sleep this way before the pregnancy.
• The main reasons for sleeping difficulties were discomfort (67%) and pain (36%).
• Snoring increased significantly over the course of the pregnancy, with 37% reporting snoring often or every night in the last week. Those with a pre-pregnancy body mass index of greater than 25 were significantly more likely to snore.
• Only 4% of women had an abnormal Epworth Sleepiness Scale score prior to pregnancy, whereas in the last week 33% scored in the abnormal range.
• 5% had regularly napped during the daytime before pregnancy, compared with 41% in the last week. 

The study concluded that sleep problems are common in women in late pregnancy, and increase markedly compared with before pregnancy

A postal survey of maternal sleep in late pregnancy. Hutchison BL; Stone PR; McCowan LME; et al, (2012). BMC Pregnancy and Childbirth , vol 12, no 144, 10 December 2012 .
Full text available via http://www.biomedcentral.com/bmcpregnancychildbirth/contenthttp://midirs.us5.list-manage1.com/track/click?u=e4298fe3c18412b19e25c1507&id=70179eea15&e=709b0c7d49> 

Review: The Essential Baby Care Guide

The Essential Baby Care Guide is a fabulous new DVD set that has been created by the Essential Parent Company. The 8 hours of content provide comprehensive information on 1. Feeding, 2. Care & Development, 3. Sleeping, and 4. First Aid and Accident Prevention.

The resource has been created with new parents in mind and is designed to provide information on everything you need to know from birth to 12 months, though as the parent of a 14 month old I can confirm that it contains some very valuable information which extends beyond it's target audience.

I have to say that having agreed to review this item I was a tad surprised when it arrived and was over 8 hours long! Not only did I think that sounded very long, I also thought it would need 'expert' reviewers to do it justice. As soon as I sat down to watch, I was hooked. Robert Winston is a great presenter. His gentle voice is easy to listen to and informative. At the beginning of each disc, he describes this resource as a parenting course which you can attend from your living room. That's just what it is: it covers everything, from the very basics, yet without being condescending. The advantage of being on disc rather than a course is that you can watch it again, whenever you wish, or when the information is needed.

If I was expecting my first baby now, I would definitely be buying this. I remember that feeling of getting home with Arthur and thinking, "right, we have a baby - what on earth do we do now?"  Of course I had books, but, well, when you're just had a baby there's not a great deal of time to read books! Watching a DVD is much more manageable. I could have sat in the nursing chair and watched this quite easily. It's also better than a book because you can see what they are talking about, they show you how, instead of just telling you.

Although my son is now 14 months, I still found the resource valuable. For example, after watching the section on sleep I realised that actually we could have a sleep problem. I hadn't noticed because Arthur sleeps well at night and always has, but having seen the DVD I decided that we would tweak his nap times slightly, and rearrange our schedule on a Friday to make sure he got his afternoon nap. He now sleeps even better.

As I mentioned, I am not an expert on any of the topics, but as the resource is advised and narrated by Professor Robert Winston and includes expert advice from The Royal College of Paediatrics and Child Health, UNICEF UK Baby Friendly Initiative, St John Ambulance, Midwives and Sleep Experts, Meningitis Research Foundation, The National Literacy Trust, and the Child Accident Prevention Trust, I think we can be sure that it offers sound advice.

I certainly makes sense to me. A great resource.

If anyone else would like to borrow these DVD's and write a review that would be great. We already have an expectant first time mum lined up to take a peek, but if there are any new parents out there (who have the time) who would like to view please let me know.

We are hoping that once the review process is over the resource will be held by the antenatal teachers so that more parents to be get the chance to preview the resource.

There are several  official videos to be found on YouTube, and you may also want to like the Essential Parent Facebook Page to get updates, tips and competitions

If you would like your own copy, it is available nationwide from John Lewis, Amazon and www.essentialparent.com.  This website also has more information about the resource, plus some videos, tips and previews. You can buy the whole set for £35 or individual DVD's for £10 each.

If you wish to buy the full set, you can get £5 off  and purchase at reduced price of £30 by purchasing direct from www.essentialparent.com and entering the code ElyNCT at checkout. For each DVD set sold The Essential Parent Company will donate £5 to the branch.

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Controlled Crying "Safe"

Research published in the peer-reviewed medical journal Pediatrics, on long-term effects of controversial sleep-training techniques, found that there was no harm on children’s emotional development, their mental health and ability to deal with stress nor the child-parent relationship. The study did not include infants younger than seven months old. The researchers noted that behavioural techniques are known to effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term.

For more information on the study and a detailed explanation of the research and its conclusions, read the NHS Behind the Headlines article on it.

It could be YOU that's keeping baby awake: Babies more likely to have sleep problems if mothers are depressed

Researchers from Pennsylvania State University found that mothers with greater symptoms of depression and worries behaved in ways that disrupted their babies' sleep. The depressed mothers were more likely to pick up their sleeping babies and move them into their own bed to silence fears about whether the child was hungry, thirsty or comfortable, the study published in journal Child Development found. They were also more likely to respond to baby sounds that don't necessarily require a response.

The MailOnline 18/4/12