It is Perinatal Depression and Anxiety Week from November 13th to 19th 2017
Here is an Op-Ed I wrote for Fairfax Media in 2013.
I get a bit frustrated that we have not made more headway into these conditions in all the years I have been talking about it.
Hopefully, this will change with more social media attention #bePNDAaware
Anyway here it is again:
We have known for a long time that up to one in 10 Australian women will experience depression during pregnancy and that this increases to one in seven in the year following birth.
Plus research is now telling us that anxiety during pregnancy and the postnatal period is even more common than this.
So why are these still conditions that many women feel they have to suffer in silence?
Especially when early warning signs of these conditions are recognizable and help is readily available.
Here are some reasons why women still aren’t getting early identification and treatment for PND.
- Women don’t seek help. Many women still don’t know what these conditions are and how to recognise them because they are either too busy or don’t have access to good quality childbirth education.
- Women can be very good at masking their depression and anxiety. Because of the social stigma around “not coping” as a new Mum, women can feel too ashamed to ask for help and admit they are not finding the experience of motherhood as full filling as it is “supposed to” be. They can also be worried that their babies might be taken away from them if they admit they aren’t coping.
- Women, their partners, and even health professionals don’t recognise the early warning signs because they put it down to tiredness, low iron or just having to adapt to a new baby. So couples can go on for weeks hoping things will get better soon.
Causes of PND
There can be many factors that contribute to Postnatal Depression (PND) such as the birthing experiences, but biological, social and psychological factors all play a role.
For many women, it is a difficult or unexpected birthing experience that may trigger PND.
Nature really wants us to succeed at mothering. The hormones of labour and birth are meant to flood our bodies after birth; giving us feelings of well-being and love towards are new born babies. We are supposed to feel like Wonder Woman – ready to take on anything. And women who do feel like this after birth can still feel like this after 5 months. This is such a different picture of a woman who is scared, shocked or even just disappointed after her birth. She is far more likely to be feeling overwhelmed, shocked and tired in 5 months time.
Unfortunately,many women don’t understand how important it is not to interrupt the flow of their own hormones during birth.
Other women do know about this and want a calm, natural and fulfilling birth. However, in today’s highly medicalised birthing environments, Australian women are now more likely than not to have an intervention during their first birth. This can leave many women feeling less than a good mother, as well as having to cope with the emotional and physical scars from their birthing experience.
Some women are just biologically and genetically predisposed to PND. These are women who have a previous experience of PND, a family or personal history of mental health conditions such as depression, bipolar disorder or schizophrenia.
Others experience PND because of relationship difficulties with a partner or parents/in-law; traumatic or abusive childhood, particularly sexual abuse or certain personality types such as perfectionist or controlling.
Still more contributing factor are a lack of family and community; social isolation; financial hardship; lack of close friends, particularly with children; relocation interstate or into a new area; age or stressful life events such as a death in the family or loss of a job.
Once a woman has PND there can be a devastating effect on the whole family.
Partners can often feel confused, overwhelmed and helpless and are at risk of developing depression themselves.
Prolonged periods of PND, particularly if left untreated, can affect the mother-baby interaction which can negatively impact the baby’s development leading to increased fussiness or withdrawal: and compromised brain pathways development, cognitive and social skills.
And in the long term, children of mothers with untreated PND can have impaired cognitive and language development; reduced social competence; behavioural and parenting difficulties.
Fortunately, early identification and treatment can shorten the duration and severity of PND and there are ways of preventing it.
Good quality prenatal education is the first step as it provides a valuable opportunity to raise awareness of mood changes related to childbirth and educate couples about PND. It can also help de-stigmatise PDN by dispelling the myths and misconceptions around it. Furthermore, it can inform couples about the warn signs and symptoms of PND and also teaching them where to get help. This dramatically helps with early intervention plus it encourages the woman to take control over her own mental health.
Unfortunately many women with PND and their partners say that their antenatal classes did not prepare them for the possibility of PND.
Many complain that their classes emphasised preparation for delivery rather than preparation for parenthood.
So it really is important to seek out good quality childbirth education.
Signs and Symptoms of PND
It is important to seek help if you are experiencing some of the following for two weeks or more, low mood and/or feeling numb
- feeling inadequate, like a failure, or feeling guilty, ashamed, worthless, hopeless, helpless, empty or sad
- often feeling close to tears
- feeling angry, irritable or resentful (e.g. feeling easily irritated by your other children or your partner)
- fear for the baby and/or fear of being alone with the baby or the baby being unsettled
- fear of being alone or going out
- loss of interest in things that you would normally enjoy
- insomnia (being unable to fall asleep or get back to sleep after night feeds) or sleeping excessively, having nightmares
- appetite changes (not eating or over-eating)
- feeling unmotivated and unable to cope with the daily routine
- withdrawing from social contact and/or not looking after yourself properly
- decreased energy and feeling exhausted
- having trouble thinking clearly or making decisions, lack of concentration and poor memory
- having thoughts about harming yourself or the baby, ending your life, or wanting to escape or get away from everything.
Pip Wynn Owen has been a midwife and childbirth educator for 13 years and owns the independent childbirth education service Birth Savvy