What is Postnatal Depression?

Our psychotherapist Vanessa Dowling from the Depression Recovery Programme was on Thursday's RTE Four Live talking about postnatal depression.  Watch the Postnatal Depression piece on RTE player (10 minutes into the show) or read Vanessa's blog below.

Approximately 10 % of women experience post natal depression. However recent research conducted with 4000 women in the UK estimates that it could be up to 20%.

Baby Blues

It is estimated that over 90% of mothers experience baby blues which is marked by loss of energy, emotional disturbance, crying, and difficulty coping. Baby blues generally last for a few days. However if symptoms persist after a number of weeks or increase in intensity the individual may be experiencing one of the following

• Post natal depression
• Puerperal psychosis
• Bipolar Spectrum Disorder (Bipolar 1 or Bipolar 11)

Postnatal depression

Indicated by loss of energy and pleasure accompanied by four additional symptoms of depression for more than two weeks duration

Symptoms may fall under any of the following categories:

• Sleep disturbance
• Appetite disturbance
• Negative thinking styles
• Loss of libido
• Emotional disturbance

Puerperal Psychosis

It is not that unusual for human beings to experience hallucinations during periods of severe stress. Many people report such experiences after bereavement for example. If these symptoms continue the individual may experience a loss of contact with reality which is referred to as psychosis. The individual may experience hallucinations or delusions. Hallucinations are seeing hearing, feeling smelling etc sensations that do not exist in reality. Delusions are fixed false beliefs and are often generated as a means of explaining the hallucinations for example believing that a voice that is being heard is the voice of an angel and generating fixed beliefs about why they are speaking etc.

Bipolar Spectrum

Bipolar 1

Marked episodes of depression and elation. Elation may be recognized due to increase in energy, reduced sleep, accompanied by changes in behaviour such as irritability, hostility or erratic behaviour. The individual may experience elation in a euphoric (pleasant emotions)or dysphoric way (unpleasant, pent up emotions).

Bipolar 11

Marked episodes of depression and mild episodes of elation. Elation is often described as a negative, distressing experience and may be confused with depression. However anti- depressant medication may make symptoms worse.

Stress vulnerability

The stress vulnerability model is based on the concept that as human beings we all have different capacities for dealing with stress. Our capacity is influenced by genetics, biology, learned coping skills and supports. A bucket is used to represent this capacity. As we experience stress it is similar to water being poured into the bucket. When the bucket overflows,- when we experience more stress than we have the capacity to deal with we begin to experience illness. For some people this may happen sooner than it will for others. It is also evident that when too many stressors occur at the same time our capacity to cope with them is also overwhelmed. 

If we really take a look at all the potential stressors that occur post-natally it is hard to imagine why we all don’t experience depression, mood disturbance or psychosis. It is widely accepted that approximately 10% of women do and a recent study in the UK that was conducted among 4000 women concluded that that figure may be closer to 20%. 

Stressors/ possible triggers

Baby- demands of a new baby, difficulty coping, lack of sleep lack of routine. Experience often doesn’t meet images and expectations. Women are bombarded with perfect images of motherhood and the reality of those first few weeks can be shocking.  The baby may experience Colic, sickness or complications caused by the birth that also cause additional stressors

Partner- The roles within our relationship may have changed as we adjust to life with a new baby. Each partner will have to deal with their new role and responsibility for another person’s life. One or other partner may feel a little forgotten about or unsupported. It is often difficult to have time for intimate moments or our sexual relationship.

Self- The mother may have difficulty adjusting to her new role. Many mothers describe feeling like public property around the time of giving birth, not merely because some of our most intimate body parts have been on show to a number of professionals but also because people tend to invade normal social boundaries when a baby is involved. Unexpected/ sometimes uninvited visitors, people touching our tummy when we are pregnant  etc

Many women also have difficulty dealing with changes to their body and their body image may become much more negative because of stretch marks increased weight, shape changes and physical trauma during birth. Some women fear rejection.

Lack of sleep can be a huge contributing factor to the development of depression that can never be underestimated. Many women are extremely sleep deprived at this time.

It is also of note that many women who have had traumatic births may find themselves reliving or having nightmares about the birth. 

Some women may have experienced damage to pelvis or back and continue to have pain post -natally.

“Unspeakable”- Shame Based Stressors

There are also many stressors that are often experienced by women as “unspeakable’s”- they feel that it is impossible to discuss them due to the strong feelings of shame attached to them:

• Vaginal tearing is a stressor that can be associated with a lot of shame and in some cases women have experienced incontinence from their bladder or bowel. 
• Some Mothers harbour negative thoughts or feelings towards their baby, irritability, anger resentment jealousy and may feel very guilty or ashamed because it doesn’t measure up to their expectations about what a “good mother” should think and feeling. The reality is that many of our thoughts are automatic reactions to our circumstances and are not always a true reflection of what we really think or want. Its very important to discuss negative thoughts or feeling towards your baby.and often helps to resolve them..
• Underlying fears or self- doubt may rise to the surface as often happens when we are on a steep learning curve or are feeling vulnerable. Believes around- not being good enough or being a bad mother can be very difficult to deal with and can generate a lot of shame that renders them difficult to talk about
• Unresolved past traumas may also become a focus, such as bereavement, past experiences of abuse or difficult relationships with our own parents.

The Road to Recovery

• Beginning to talk is one of the first things that anybody with depression can do to begin the process of recovery. Talking helps us to share our inner world with others and provides an opportunity to develop an alternative view or more objectivity. It also helps us to connect with another human being and begin to put our experiences into perspective. It can be very reassuring to discover that contrary to how it is portrayed on the TV, lots of people have difficulty coping after having a baby. This is crucial.
• Talk to your partner or Close friend. 
• Choose a friend who is supportive and always has your best interests at heart. It is important to be able to speak honestly and not feel that you are in competition or have to pretend to be coping better than you are. 
• Contact your GP or Public Health Nurse for additional support or advice.
• There are also a range of psychological treatments that may be helpful such as cognitive psychotherapy and compassion-focussed therapy. Talk to your GP for further advice.

Support & Information Service

The Support & Information Service is a telephone and email service staffed by experienced mental health nurses 9-5 Monday to Friday with an answering and call-back facility outside hours. You can contact the Support & Information service by calling 01 249 3333, or if you would like to email your query to info@stpatsmail.com we will endeavour to get back to you within these hours.