Mood changes after childbirth
You might be reading this article for a variety of reasons. You might be worried that you will get depression now that your baby is born, or you might be experiencing these feelings already. It is probably a good idea to acknowledge that in our society and in many others worldwide, ‘problems with your mind’ are not accepted as an illness as much as are, for example, a broken limb or heart or renal (kidney) disease. Among the positive and sometimes overwhelming feelings of joy and achievement associated with motherhood, dark and negative ones can also arise. Women try to convince themselves that they should ‘get over it’ on the assumption that this is something that is within their control. This article has been written to try to explain the changes that can occur in the early weeks and months after you have given birth to your baby, and to help women who are suffering from these very common problems to talk about them and seek the help they need.
Mood changes after pregnancy
Most women experience a range of feelings when they first have a new baby, ranging from extreme happiness to anxiety, mood swings, exhaustion and tearfulness. These feelings are often part of the ‘baby blues’ that affect over 50 per cent of women in the first week to ten days after childbirth, with a peak on the fourth to fifth day postnatal. These feelings are usually short-lived, and women should be back to what is, for them, their normal emotional state within a few hours or days. It is not known why the blues occur, but studies suggest that they are probably related to the hormonal and body changes that take place after a woman has given birth. The ‘blues’ is actually a very good description of the range of emotions that many women report experiencing. Many describe feeling down, upset, tearful, or being overly-sensitive, although they are simultaneously happy – very confusing for all around them, especially their loved ones!
What are the symptoms of postnatal depression?
Approximately one in 10 women experience more severe mood changes after they have had a baby and it is this that health professionals often call postnatal depression (often abbreviated to PND). These feelings may begin during pregnancy and extend into the period after birth or start in the first few months of the baby’s life and may include the following:
- feeling low (ie in a depressed mood) on most days
- lack of interest or pleasure in usual activities
- loss of appetite
- difficulty in sleeping
- loss of energy
- anxiety and excessive worry, often about how to care for their baby
- difficulty in concentration
- feelings of worthlessness or guilt about not being able to look after their baby or feelings of being a bad mother
- feelings of not bonding with, or even liking their baby
- avoiding caring for their baby
- morbid thoughts (suicide) or thoughts of harming their baby (although these are rarely acted upon).
Who gets postnatal depression?
Any new mother can get postnatal depression, but research shows us that some women seem to be at higher risk than others. If you have the following ‘risk factors’ then you have a higher probability of developing postnatal depression than other women, but the chance of this is still low and it does not automatically mean that you will get depressed. Known risk factors for postnatal depression are as follows:
- a history of depression, particularly if this is previous postnatal depression
- history of other psychiatric illness/disorder
- poor social support – being alone or socially isolated
- a poor relationship with your partner
- having experienced a recent stressful event, for example, bereavement, separation, moving house
- very severe postnatal ‘blues’.
There is also some new evidence that suggests that a few women experience postnatal depression because of hormonal changes, which can be balanced with appropriate treatment. There are other quite ‘ordinary’ things that also appear to contribute to a woman developing postnatal depression, which relate to the needs of caring for a newborn baby. These include the baby’s temperament (particularly where the baby is fractious or a poor sleeper); overwhelming feelings of tiredness from having to cope with disturbed sleep patterns/sleep deprivation, as well as, social isolation from being alone all day with just you and your baby.
However, the majority of women with some or all of these ‘risk factors’ will not develop postnatal depression despite their seeming to be at increased risk. It is therefore impossible to accurately predict those mothers who will go on to develop postnatal depression.
The consequences of postnatal depression
Some studies have reported that postnatal depression can be associated with the mother’s ability to bond with her new baby and that where this relationship is poor, later difficulties can arise in the baby’s intellectual and emotional development. However, the research evidence has not yet discovered exactly why these associations exist but they have shown that this can be improved if the woman’s partner is more involved in the care of their baby, or the mother’s depression does not last for several months or longer. It is important that the baby is stimulated and cared for in the early postnatal months but it has been shown that this does not necessarily always have to be done by the mother, as long as it is done with love and attention. Therefore, extra help from the baby’s father and/or grandparents, friends and relatives can also make a huge difference.
Treatment for postnatal depression
Support from their partner, family and friends are important in helping women who are suffering from postnatal depression. Although many women with this condition find that they feel better over a period of three to six months, it is recognised that some women’s postnatal depression will last for much longer. Research has shown that many treatments, not all of which are prescribed medications, are effective in reducing the longer-term effect of depression. You may need to ask whether such opportunities are available in your area.
Talking to someone has helped many women suffering from postnatal depression. This might be a health visitor who will listen to your difficulties and help you think about your problems through offering a series of extra visits known as, ‘active listening’ visits or ‘non-directive counselling’.
Other psychological treatments have also been found to be effective for postnatal depression and include cognitive behavioural therapy, interpersonal therapy and psychodynamic therapy. These use different techniques, carried out by therapists with specific training, but they have also been shown to be equally effective in helping reduce the symptoms of depression. Early results of newer treatments such as infant massage and pram walking exercise programmes, which are designed to help mothers develop a closer relationship with their baby, have also shown promising results.
Where some women have more severe postnatal depression, prescribed medication (antidepressants) is probably the most appropriate and effective treatment. It is best to discuss the effects of individual antidepressants with your doctor so that you can reach a decision that is best for you and your individual needs. In rare cases, some women become very severely depressed and may then need admission to hospital for their own safety and to receive specialist help. In many parts of the United Kingdom, mother and baby units are available so that women can receive specialist treatment without being separated from their baby; most of these units will care for women and their babies up to a year old. Throughout any treatment, the intention is to avoid, or minimise, any separation of the mother from her baby and family members.
Can postnatal depression be prevented?
There have been many research studies that have looked at the different ways to try and prevent postnatal depression through the use of antenatal and postnatal support groups. Although these studies have had mixed success, going to antenatal and/or postnatal groups for support, as well as asking family and friends to help with baby care and housework would appear to be helpful. Don’t feel that you should have to cope with a new baby alone.
If you have concerns about anything raised in this article, feel that you are already experiencing mood changes or depression, or think you might be at risk of developing them, you should seek advice. It may be easier for you to contact someone you already know and feel comfortable talking to, for example, your GP, midwife or health visitor. Alternatively, you may prefer to contact a self-help organisation.