Coping with Postnatal Depression
By Dr Sandra L. Wheatley - a Sheldon Press Book

Postnatal depression affects between 10 and 20 per cent of women who have had babies, causing distress at a time of life when there is every reason for happiness. For some, symptoms can be relatively mild, but other women suffer from very serious, continuing bouts of depression.

In this book, Dr Sandra L. Wheatley offers sympathetic advice and support to those who have postnatal depression, and their families.

• The topics covered include:
• symptoms
• causes
• treatment, including drugs and therapies
• staying well, including emotional support, relaxation and complementary therapies
• work worries, relationship issues and other worries, including the ways in which depression may affect the baby and other children
• further resources

The message is, don't despair — with support and treatment, postnatal depression will pass and leave you free to enjoy your baby and your life.

Contents 

• Introduction
• How do I know if I am depressed?
• Why me?
• Getting well
• How you can help yourself to get well
• Staying well
• Supporting the depressed mother: how to help
• Useful Addresses
• Further Reading
• Index

You've recently had a baby and this is probably the last way you expected to feel — weepy, vulnerable, isolated, and perhaps scared to talk to anybody. Now is supposed to be a time for celebration and new life. What could have gone wrong? If you're not feeling as happy as you expected, don't worry — you are not alone. Some one in ten women develop postnatal depression or feelings of sadness and despair after the birth of a baby.

Meet Helen. She took part in the research that formed part of my PhD, and I interviewed her twice, once three months after her son was born and again when he was one year old. Her account of having her son and how her life was changed during this time is in the book Nine Women, Nine Months, Nine Lives, the details of which can be found in Further Reading at the back of this book.

Helen was 30 years old when she accidentally became pregnant. She and her husband Richard had been married for six months and had known each other since they were at school. She experienced a great deal of internal conflict about her decision to go ahead with having the baby, having seriously considered a termination well into the first few months of pregnancy, as she had never really seen herself having children. Her husband had always thought he would be a father.

It wasn't until her son was a year old that she confided in me that she thought she had been depressed after Will was born. She described how she had felt trapped at home with the baby and couldn't wait to get back to work. The unrewarding (to her), repetitive tasks involved in caring for a young baby frustrated, irritated and ground her down so much that her confidence in her ability to hold even a simple conversation with other adults took a nosedive. She told me that she had been horrified to realize that she would frequently not speak to her son from the moment he woke up in the morning until well into the afternoon — she just hadn't felt it necessary to interact with him at all. She had to make a conscious effort to speak to him and take an interest in his development.

Before she had Will she thought she was incapable of being a mother. When he was born all the evidence of her own behavior confirmed to her that that was the case. She did want to be a good mother but felt she didn't even know how to be a good enough mother. From the conversation I had with her three months after Will was born I knew that she wanted to return to work as soon as she could. She emphasized that this was for financial reasons. But underneath what she felt it was acceptable to say even to me, as a psychologist, was the real reason: she really felt it would be for Will's and her own benefit to be apart.

The good news was that this allowed her to retain as much of her sense of self as she could and to be the best mother she could be. Going back to work had helped her to recover from her depression. Naturally I encouraged her to continue getting support from the people she felt she could turn to and soon she was well on the way to feeling better.

The most important thing you can do at the moment, and throughout this very difficult time, is to believe that you will get better. Just like Helen, you really must seek and accept help. Don't delay. Helen regretted not getting help sooner, and felt that she had missed out on an important part of her son's life, one that could never be repeated or replaced.

Many people find it difficult to ask others for help, but it is very important that you do. It is unlikely that your depression will just get better on its own, no matter how much you wish that it would. Please don't feel ashamed of how you are feeling. You are not alone. Always remember that one in ten women who have had a baby feel the way you do. The sooner you get help, the sooner you will be well again. Let that thought give you courage.

Having a baby and becoming a parent is a major event in the lives of women and men. Becoming a parent is usually accompanied by changes to your home life, social life and relationships. Whether this is your first, second or third baby, the first few weeks of parenthood are daunting and demanding, both physically and emotionally.

Popular images of motherhood are often misleading. They suggest that mothers are radiant and energetic, living in perfect homes with supportive partners and happy well-behaved babies and children. Mothering is often believed to be a natural ability that all 'good' women have. You may have expected to love your baby immediately, but this can take a while and it is not always instinctive. Not loving your baby straight away does not mean that you are not a 'good woman' or a 'natural mother'. Becoming a mother can feel like an overwhelming responsibility and it is very easy to feel inadequate when other mothers around you seem to be coping well.

In reality, becoming and being a mother means constantly experiencing new events and carrying out tasks we are not sure we can manage. A new set of skills to cope with these situations have to be learnt, so don't be too hard on yourself. We all learn to be a mother when we actually have a baby, not before. Women do not automatically know how to be a mother. Men do not automatically know how to be a father.

Each woman's experience of having a baby and being a mother is unique. It is likely that during the first few weeks and months of motherhood you will feel a mixture of emotions. Some women feel sad more often than they feel happy. Sometimes this sadness can develop into depression. Women who find the weeks and months after childbirth difficult often imagine that they are the only ones who are not coping. This is simply not true.

If you think you are depressed after your baby is born, please do not despair. In all the years I have been helping women through this difficult time I have never yet met a woman who, after having sought and accepted help, did not recover.

By reading this book you are seeking and accepting help, so I would say that means that you will recover. It will take time and effort, but you will recover. Please believe me.

Postnatal mood changes
Before I go any further I will outline some facts about the mood changes a woman can experience at this time. There are three mood changes that can develop after the birth of a baby: the baby blues, postnatal depression and puerperal psychosis.

The baby blues
The baby blues tend to occur in the first week after delivery and affect as many as eight out of ten of all new mothers. In fact, it is considered usual to experience the blues, even if only for a short while. A woman may burst into tears for no obvious reason, or feel on top of the world one minute and miserable the next. It is quite usual to feel anxious or tense, be lacking in confidence or feel worried.

Postnatal depression
Postnatal depression affects one in ten women following the birth of a baby. This illness usually begins in the first six months after childbirth, although for some women the depression begins in pregnancy. It is important to know that postnatal depression can occur at any time within the first year after the birth of a baby, and can last for longer than a year if help is not sought and received. Untreated postnatal depression can lead to the breakdown of relationships with partners and children.

On an optimistic note, early diagnosis and treatment of postnatal depression will result in a faster recovery. Quite often a close family friend or perhaps the partner of the woman recognizes that she is unwell before the mother realizes it herself.

Puerperal psychosis
Puerperal psychosis is a much rarer and serious mood change, affecting about one in 500 new mothers. The symptoms will appear suddenly, often within the first two weeks following the birth of the baby. Women with a family history of mental illness or who have suffered from puerperal psychosis in the past are at a higher risk of developing this illness.

Symptoms include hallucinations (seeing or hearing things that others cannot), delusions (incredible beliefs such as thinking she can save the world) and mania (extremely energetic and bizarre activity like cleaning the house in the middle of the night). The symptoms can be severe and sometimes very frightening for the woman, her partner and her family. In fact her partner may be the first to realize that she is unwell. So it is important that her partner, or someone close to her, knows the symptoms to look out for.

Medical help should be sought immediately from her GP or from the emergency services. Seeking help quickly will make sure that she is well again quickly. Women with this illness are often treated in hospital and will usually make a full recovery.

The focus of this book
From this point forward I am going to assume that the reader of this book is a woman who has, or thinks she may have, postnatal depression. I will talk to you directly. The main aim of this book is to help you, a woman who has postnatal depression, become well again as quickly as possible. I would also like for you to feel stronger, as an individual, as a result of having survived postnatal depression. This book is here to help you achieve that. One in ten women who have had a baby has had postnatal depression. Fact. This means that you are not alone. It means that one in ten of the women that you know who have children will understand what you are feeling because they have been depressed too. One in ten of the women at the health visitor's clinic. One in ten of the women at playgroup. One in ten of the women with children in the supermarket. And perhaps most important to remember, as so many of them are women, one in ten of midwives and health visitors who have children. There is no 'us' and 'them' with postnatal depression. It happens to women from all walks of life, regardless of race, culture and social class. One in ten women really means one in ten women.

Talk to someone you can trust about how you are feeling, like your partner, your mum, a friend, or your midwife or health visitor. It can help a lot just to confide in someone else. Once they know how you are feeling they will be able to give you the support you feel you want or need.

Postnatal depression is an illness. It is not your fault you feel the way you do. Please don't be ashamed of how you are feeling. Your midwife, health visitor and GP are all trained to help you. One in ten of them will have personal experience of how you are feeling. They want to help you. So let them try.

You may get on better with one or other of the health professionals involved in your care. Speak to the one you feel you can trust the most. For example, it doesn't matter if now that you have had your baby you don't get on as well with your health visitor as you did with your midwife — if you feel you can be more honest with your midwife then speak to her rather than your health visitor. You will not offend your health visitor. She will be very glad that you have told someone how you feel.

The most important thing you can do is to believe that you will get better, and to seek and accept help. If you haven't already, and you think you are depressed, talk to your midwife, health visitor or GP as soon as you can. By combining their help and this book you really are speeding up your recovery.

Many people find it difficult to ask others for help, but it is very important that you do. It is unlikely that your depression will just get better on its own, no matter how much you wish that it would. You would not expect a broken leg to get better without the help of health professionals. Don't expect your feelings to get better without their help either.

You are only human — you are not perfect. You have limits to what you can do. Each of us can cope with different amounts and types of stress in our lives. You may find yourself asking why you, who previously could cope with working, running a home and having a social life, can no longer seem to cope when working is swapped for motherhood. Simple. Motherhood is a role that contains different types and different amounts of stress. Those differences have led, in part, to your suffering from postnatal depression.

Lack of concentration is a problem for people with depression. And lack of time is a problem for women with young babies and children. This means that a book about postnatal depression needs to be written as simply and concisely as possible. This book is intended to give you information about the emotional changes that can happen after having a baby. This information should help you decide if the emotions you are experiencing after having your baby are usual. If they are not usual then you may want to try some of the suggestions in this book to get you and keep you well. They have worked for many women and so they should work for you too.

This book aims to inform but not overwhelm you. Within each chapter there are several headings so that you can dip in and out of it as you wish. I would recommend starting at the beginning as each chapter builds upon the last, but it has been written so that you will be able to jump between chapters if you want to.

The first couple of chapters focus upon what postnatal depression is, what the symptoms are, which symptoms you have and what the possible causes of your postnatal depression are. Chapters 3 to 6 are for when you can start taking control of your life again. They outline, with simple, practical suggestions, what you can do to help yourself get well, and how you, with help from your partner (if you have one), family and friends, can keep yourself well.

At the back of this book is a list of other books you may like to read and some support groups and organisations for parents, which you might like to contact.

That you are reading this book tells me you want to recover from this illness. You have noticed you have changed and are wondering whether that change has been a good or a bad one. Please don't feel guilt about that change. There seems to be no rhyme or reason why some people get depressed and others don't. The fact is that you are and you want to do something about it. And that is fantastic. Welcome to the road to recovery.

About the author
DR Sandra L. Wheatley BSc PhD CPsychol has over a decade's experience developing and assessing innovative interventions to prevent and treat antenatal and postnatal depression. Her first book, Nine Months, Nine Women, Nine Lives (Potent 2001), recorded the lives of nine women over the course of their first pregnancy and their child's first year of life.

She also has over five years' experience in training professionals and non-professional volunteers in what antenatal and postnatal depression are and how women can best be helped to become well again. Her most recently published training programme, Helping New Mothers to Help Themselves (Potent 2004). represents the accumulation of her knowledge and experience in a format that can be easily and effectively shared with others working with women to achieve the aim of reducing the impact of antenatal and/or postnatal depression upon women's lives.

In her role as a Media Consultant for the British Psychological Society, Dr Wheatley is regularly asked to contribute to television and radio articles in the field of parenthood and psychology. She has been commissioned to develop an educational DVD for women about the emotions they may experience after having a baby (Orlando, for release in 2005).