HealthAgenda

Pregnancy & birth

Pre and postnatal depression: when to seek help

How to spot the signs of perinatal anxiety or depression, and what to do about it.

Natasha Phillimore
July 2018

Carrie* lives in Sydney’s Northern Beaches, has a growing young family and works full-time as a marketing executive. She also experienced perinatal anxiety and depression (PAND) after the birth of her first child.

Carrie admits she’d had anxiety and bouts of depression before but was unprepared for her feeling of powerlessness with an unsettled newborn. The move from a world of structure and control to the opposite was overwhelming.

“There was one day about two weeks after Gracie* was born, when everyone had stopped visiting, my husband had gone back to work and I had severe sleep deprivation," she said.

"I was inconsolable. I spent the whole day sobbing, and when my husband came home from work I said to him, ‘We have to see someone.’ I just wanted the doctor to send me to a hospital so I wouldn’t have to take care of Gracie.”

“It doesn’t matter where you live, your culture, your socio-economic background – PAND doesn’t discriminate,” says Perinatal Anxiety and Depression Australia (PANDA) CEO Terri Smith. “We’ve spoken to doctors, midwives, neuroscientists… And every woman is really surprised that it happens to them.”

Risk factors

One of the risk factors for perinatal anxiety and depression, Smith explains, is an earlier mental illness. “If, for example, someone has been treated for anxiety for their year 12 exams, it puts them at slightly higher risk,” she says.

Most new mothers experience some teariness, anxiety and irritability – but with support and understanding this usually resolves in a few days. In PAND these feelings persist; Smith advises that anyone feeling mood swings for 2 weeks or longer should reach out to someone.

Newsreader, columnist and beyondblue ambassador Jessica Rowe can relate. The mother of two often speaks out about her experiences with PAND. “Despite the sleep deprivation, I couldn’t sleep. My waking hours were consumed by anxious thoughts,” she admits.

“Why couldn’t I breastfeed? Was my baby putting on enough weight? Did using formula mean I was setting my daughter up for a life of obesity and lowering her IQ? I wondered how I could feel so wretched when I finally had my darling girl. Wasn’t I meant to be the superwoman who could deal with anything life threw at me?”

Smith points out the realities of new motherhood. “There’s so much pressure even just planning for babies. A natural birth, where a particular music is playing… then the baby comes 3 weeks early and it’s a caesarean. Basically, we feel like we’ve failed on day one.”

According to Smith, it’s a common journey. “Women tell us all the time that [the birth] didn’t happen the way they wanted it to. We have a very idealised view about bringing a new baby into the world, one that rarely addresses that it’s a time of extraordinary transition – the biggest many people will experience.

“Your life as a couple is turned on its ear. Your career is turned on its ear. And there you are, at home, looking at this lifelong decision you’ve made, wondering how you’re going to do it.”

Prevention

For anyone experiencing PAND, mum and partners, there are ways to make the transition to parenthood easier.

Firstly, don’t expect too much of yourself. Make time to slow down, rest and relax. Leave the washing. Don’t put pressure on yourself to do anything more than care for yourself and your baby.

If you have a partner, talk about the difference a baby will make to your lives, both positive and negative. Arrange as much time as you can for both of you to be at home after the baby is born.

Government-funded Dad and Partner Pay provides up to 2 weeks’ paid leave, and you may be able to negotiate additional time off with your employer – it pays to ask.

Set up extra support for the first few weeks after the baby’s birth, both immediate (to help with night feeds) and long term (mothers’ group can be a great resource: contact your local early childhood clinic to find one in your area).

One of the most important factors, and one that is hard to quantify, is sleep. According to the Division of Sleep Medicine at Harvard Medical School, scientists have found that a small nightly decrease in sleep has serious cumulative effects. This is a tough one for any new parent, making immediate support (from a grandparent or friend perhaps) even important.

Getting help

If you’re struggling, talk to someone: your GP, your mum, a fellow mum, your partner. It’s about finding the best way to get help.

“Speaking to my husband was one of the hardest thing I’ve ever had to do because for me to say ‘I’m not coping and I need help’ is so difficult,” Rowe says.

Just reading about other people’s stories – you can find many at beyondblue and PANDA – “can help provide a language about what’s going on with you,” says Smith.

Other mothers, however, may require more substantial support. According to University of Melbourne Professor Jeannette Milgrom at the Parent-Infant Research Institute, medication, including antidepressants, may be prescribed in pregnancy or during breastfeeding. She also mentions cognitive behaviour therapy (CBT), counselling and psychotherapy as possible solutions.

Warning signs

Seek help from your family, doctor or the PANDA hotline on 1300 726 306 if you experience 2 or more of the following symptoms for longer than two weeks:

  • racing heart
  • palpitations
  • shortness of breath
  • shaking
  • feeling physically ‘detached’
  • obsessive or compulsive behaviours
  • abrupt mood swings
  • feeling constantly sad or low
  • crying for no obvious reason
  • persistent or generalised worry regarding the health or wellbeing of your baby.

“The most important thing is to get help, to speak up,” says Rowe, who wrote Is This My Beautiful Life? about her experience. “I know that made all the difference for me, and then I could focus on being a mum and getting to know my baby, which is what it’s all about.”

 

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