Postnatal Depression

By Heather Welford

A sensitive and practical look at all types of postnatal depression and what you can do about it.

There can be many reasons why more than one in ten new mothers experience post natal depression:
• a social and emotional response to becoming a new mother
• a lack of progesterone after birth
• depressive illness which may need prescription of antidepressants

Heather Welford explores, mostly from the sufferer’s position, exactly what PND is, why it occurs and what to do. An essentially practical and sympathetic book with useful case studies of mothers, family and friends throughout.

This is a book to cover each end of the spectrum from loneliness, extreme fatigue, frustration or lack of confidence to post-natal psychosis.

• Language: English
• Publisher: HarperCollins UK
• Release date: Nov 24, 2016
• ISBN: 9780007399697

Book preview

Introduction

Postnatal depression is something that’s likely to touch all our lives.

You, or your partner, might have experienced it. Or your own mother may have done so. Or perhaps you have a friend, a sister, a neighbour who has suffered. You may be in a position to offer help and support to a postnatally-depressed woman. Whatever the situation, this book will help you gain an understanding and an insight into the causes and effects of this condition.

I am especially pleased that this book has been able to look in some detail at the effect postnatal depression has on two other important groups of people – fathers, and the babies themselves. This is newish stuff, and particularly new in a book aimed at non-academic and non-specialist readers. It’s not very comfortable reading, either, but I make no apology for that.

Definitions

My research into postnatal depression has shown me that this is not a comfortable issue. Even the definition of postnatal depression brings its own problem. Is it, I’ve been asked, an illness? Some commentators and supporters, and mothers themselves, call it postnatal illness, as a way (I think) of drawing attention to the fact that it so often needs treatment – and is not a ‘bad mood’, but something far worse – and, importantly, to the fact that classic clinical depression is only one way the condition shows itself.

But calling postnatal depression an illness implies that it’s rather similar to some sort of bodily malfunction that arrives out of nowhere, and that you are just unlucky to ‘catch’ it.

There is an element of sheer misfortune in postnatal depression. And people with it can certainly be desperately ill, especially if they have the more severe forms. But I would never want to ignore the clear social, psychological and emotional factors in its development – so I’ve stuck with the term postnatal depression.

Motherhood is complex, strange and only partly understood. It’s an experience, yet it’s also a state of being. Once pregnant, we have changed … for ever. I think the work of people like Rozsika Parker and Joan Raphael-Leff (see Bibliography), who deliver new insights from a more ‘woman-friendly’ form of psychoanalysis and psychology to the study of mothering, will bring a greater understanding of postnatal depression, and help us see why some women are more likely to experience it. The idea that postnatal depression can be a creative, protective and even necessary response to emotional and social factors was a new one to me.

I have drawn a distinction, based on current clinical consensus, between postnatal depression and puerperal psychosis, and devoted a separate chapter to the latter.

So many people have helped me with this book.

As a journalist and writer in the field of women’s health and family issues for 20 years, I have had contact with dozens of women who have had postnatal depression, and I have interviewed women and health professionals for magazine articles on the topic. By keeping up to date with the academic research and witnessing the way that volunteer support can be so effective, I have gained an insight into postnatal depression. Being an NCT member and breastfeeding counsellor and tutor has made me aware of the pioneering work that the NCT has done in postnatal support, with depressed and non-depressed mothers.

Apart from that background, though, I have interviewed at length 18 women and four men about their own experiences. I can’t name them, as confidentiality was agreed as a condition. The names in Chapter 5 are pseudonyms. Where I have used real names, the owners have already ‘gone public’ in printed interviews.

The frankness and honesty of everyone I spoke to have been very valuable. My thanks to all of them.

Thanks also to Sue Orchard, chair of NCT’s postnatal committee, for her wide-ranging support.

MIDIRS – the Midwives Information and Resource Service – have been their usual efficient and helpful selves in supplying literature searches and research papers.

I should also add a word of praise for New Generation, the NCT’s own quarterly journal. Now I know why I have never thrown a copy away – here was a brilliant source of thoughtful, insightful and honest personal experiences going back 15 years. Any idea about postnatal depression you or anyone else might ever have had, somewhere in New Gen is a letter or a full-length piece giving the mother’s own perspective on it.

I attended a number of meetings about postnatal depression, including an especially useful one organized by MIND and NCT on Working with Postnatal Depression (September 1997). This focused on the way workers and volunteers can offer help and support to women, and it was notable that a broad range of health and social work professionals felt it was within their remit to offer this.

I am fortunate in that I have not experienced postnatal depression myself. I am full of admiration for the women who have suffered in this way, and who have recovered – and women do, nearly always, recover – and who want to spread the word about it, to show there’s no need for fear, or guilt, or shame. We need women like them.

Heather Welford

February 1998

1

Postnatal Depression: What Is It?

‘I wanted someone to look after me…’

After she had her baby, Wendy felt she was inside a ‘bottomless pit’. She saw no way out.

‘Friends and family try to instil hope into your empty soul,’ she says now. ‘They do their best, saying you will feel better, it just takes time. What else can they say? The alternative would be too awful to imagine. But you don’t believe them. You can’t.’

For a substantial number of women, the weeks and months around childbirth are marked by the unhappiness and negative feelings we call postnatal depression.

Just how substantial that number is, is not clear. Textbooks on the topic generally quote studies which put it at between 10 and 15 per cent of all new mothers. However, other studies reveal higher totals of as much as 27 per cent. If you include in your definition of postnatal depression all postchildbirth distress and misery, including the more shortlived forms, it’s probable the majority of mothers recognize many of the symptoms from their own personal experience.

However, a practical definition of postnatal depression is that it’s a depressed mood which lasts, which overwhelms more positive feelings, and which becomes evident in the first weeks and months after childbirth.

Like Other Depressions?

Some medical research and writing holds that depression after childbirth ‘feels’ like depression at any other time of life:

‘Postnatal depression is like other kinds of depression, except that it is brought on by having a baby,’ as MIND’s leaflet on the topic says.

There is another view, though, that postnatal depression has a different symptom profile compared to other forms of depression. Katharina Dalton, a doctor who has worked with many women who have had postnatal depression, says in her book Depression after Childbirth (Oxford University Press, 1996), ‘irritability and violence are also possible symptoms … and because they rarely appear in depression outside the postnatal period, postnatal depression is experienced as a distinct condition.’

It may even be that women are no more at risk of developing depression after childbirth than at other stressful times in their lives. Researcher Sarah Clement, speaking at a major conference held on the topic in 1996, raised this possibility – and it surfaces now and again in other work as well. Until we get a more consistent definition of postnatal depression and a greater understanding of the biological, emotional, social and psychiatric elements of it we can’t be sure.

However, there is contradictory evidence that childbirth is an especially vulnerable time for women and mental health; for example, in one study women were shown to be three times more likely to develop depression in the weeks following childbirth than at any other time. Moreover, as Sarah Clement points out, depression at this particular time may be more difficult for a woman than at any other time, because of the exceptional demands being made upon her as a new mother.

The Different Forms of Postnatal Distress

Postnatal distress affects mothers in one or more of three basic ways.

1. The ‘Blues’

The first, and most common, is simply known as the ‘blues’, sometimes defined as the ‘maternity blues’, ‘postnatal blues’, ‘three-day blues’ or ‘baby blues’. Surprisingly, nobody has yet got their Latin or Greek dictionaries on the term to make it sound any more highfalutin’ or ‘medical’. It’s also called ‘third-day blues’ or ‘fourth-day blues’ because it commonly strikes on these days after the birth.

It affects at least half of all new mothers, at some point in the first week after the birth. The main sign of it is tearfulness, and a feeling of coming down to earth with a bump.

‘On day two I was amazingly pleased with myself at having gone through the birth, producing a beautiful baby. Then on day three the feeding went awry, the baby got a spotty face, my husband was half an hour later than he said he’d be, and my mother said something I thought was stupid on the phone. I cried and cried – pinning the reason for my tears on all the things that had gone wrong, but I knew none of them deserved my over-the-top reaction. I felt touchy and self-pitying, and scared about how I’d cope in the months ahead. Then, the next day I went home and I was okay.’

The blues are so common, and so often lift by themselves, it’s speculated that it’s a physiological – that is, a biological and normal – response to the hormonal after-effects of having a baby. As one obstetrician says, ‘the blues are well-recognized as an almost normal reaction to the earlier elation.’

Precisely why the upsurge of prolactin (the milk-making hormone) should have this effect is not clear. However, all of us have experienced the way any major and life-changing set of events, positive or negative, can sometimes cause tearfulness and confusion as the immediate impact wears off – it’s part of being human.

After all, pregnancy and childbirth are certainly major and life-changing events; for many of us, having a baby is just about the most important thing that happens to us. It would be far more surprising if