As part of the Clinical Psychology unit I am currently studying, we have done a fair bit on parental mental health. This week I thought I would talk about depression, addressing what antenatal and postnatal depression is. I hope this is useful for you and sheds light on new things you may not have considered before.
The Frugal Frenchie
Symptoms for antenatal depression
According to the diagnosis criteria (DSM-5)…
- Chronic anxiety
- Incessant crying
- Lack of energy- which lack of sleep doesn’t help
- Relationship worries- will my partner leave once the baby is born?
- Conflict with parents
- Isolation – from friends, or due to not feeling the same as other mums
- Fear to seek help – will my baby be taken away if I speak out?
Causes of antenatal depression
There are many physical changes during pregnancy. For some, body changes can be distressing: weight gain, swollen breasts, dizziness, nausea, exhaustion, heartburn, fainting etc. It can lower self-esteem and make normal, mundane activities suddenly seem unachievable or difficult, which can lead to isolation or feelings on inadequacy.
Hormonal changes and tiredness can also impact mental health – in fact, Ohayon & Roth (2003) found over 40% of participants reported symptoms of insomnia before developing a mood disorder, including depression and bipolar disorder. This was supported by findings showing that treating insomnia symptoms can be beneficial towards reducing/preventing depression (Londborg, et al, 2000).
Pregnant women will experience mood swings, worries about being “doing everything right,” or struggle with a change of identity (I’ve heard so many people talking about this and now only being known as a mum and having to give up things that were part of them).
Another thing that’s important to bare in mind is previous pregnancy difficulties that may have occurred. Complications during pregnancy or difficult labours can also cause maternal PTSD, and cause severe anxiety in the next pregnancy. Risk factors could include emergency caesarean, instrumental delivery, inadequate care and even just the sheer pain experienced during labour (Anderson, et al, 2012).
First of all, I’d just like to talk about the “position” of antenatal depression in society. It is not a new thing. It has been around forever, it was just previously very taboo. Despite it still not being spoken about enough, it is now being shown in the media more. When Stacey suffered from issues in Eastenders or when it’s been shown on Call the Midwife – these episodes were produced with the advice and support of psychologists and those with experience, to try and portray it as clear as possible.
Social causes can be related to family, society, work and money. Families support, especially in a young or first-time mum, is extremely important. When they feel excluded, have been rejected or leave far away so don’t have support, it can be hard, especially due to the exhaustion, worries and obstacles that can come from pregnancy and postnatally.
There are many expectations in society: to provide with the best prams, to have everything sorted, to enjoy the pregnancy, to have a good support network and a perfect partner to help… there are so many more examples I could give; especially with parent bloggers or YouTubers, who may not necessarily show the hardships that can come from pregnancy.
Another expectation or pressure from society is within work and finance. With an ever-existing gender wage gap, women may feel pressured to stay at work for as long as possible, however, may be treated differently or discriminated due to being seen as less capable or “non-maternal.” A study in 2007 by Hebl et al, found that pregnant women were met with benevolence when entering traditional roles, but were treated with hostility when seeking nontraditional roles. I found this interesting as it would seem that they were rewarded or punished based on whether they met gender norms or not. For somebody who may be in this situation, this may lead to them withdrawing from work, feeling isolated and becoming depressed; especially if there is a financial strain added in the picture.
All these causes are often pregnancy-specific. There are of course other factors that can cause or influence postnatal depression, however only 1/3 will develop postnatal depression after antenatal depression.
Postnatal depression vs baby blues
Baby blues is common and normal; it affects up to 75% of mums!
For those who didn’t know, baby blues is a feeling of sadness, anxiety or guilt following a few days after birth. It’s due to excessive hormones (pregnancy and new-mums need different hormones), body changes, difficulty in sleeping and just feeling overwhelmed. It is why you may experience bursting into tears for no reason, or experience negative thoughts such as questioning maternal skills with no necessary triggers.
What differs this from postnatal depression is the length of time mums endure this. Baby blues may last up to a week, if not normally between 2-4 days after birth. If it persists, it may develop into postnatal depression, however, this normally develops independently. Alongside this, postnatal depression has to start within the first-month post-birth; this is what distinguishes it to normal depression.
Symptoms of postnatal depression
According to the diagnosis criteria (DSM-5)…
- Depressed mood
- Diminished, or no interest in all/almost all activities
- Significant weight loss or decrease/increase in appetite
- Insomnia or hypersomnia (sleeping too much)
- Observable agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive/inappropriate guilt
- Diminished ability to think or concentrate, indecisiveness
- Recurrent thoughts of death, suicidal ideation, planning or attempts
This actually affects 10% of new mums, whereas baby blues affects up to 75% of mums. Although they say it must start within 4 weeks post-birth, many are trying to change this to months or a year afterwards. This is because anyone who develops depression related to child-rearing should be put into this classification. Time onset shouldn’t matter, as triggers or causes could be the same. 4 weeks is hardly anytime, it can take that long just to adjust!
Another sad statistic is that 50% of those diagnosed with postnatal depression were too afraid to tell health professionals about it. Fears about their child being taken away from social services, or being viewed by friends, family and society as incapable or a bad mother.
Alongside some overlapping causes from antenatal depression, there are these too:
- The shock of being a mother
No matter how many books you prepare, the classes you take, or videos you watch, it’s impossible to be 100% prepared. For some women, they feel unprepared for the physical impact of childbirth and the new skills and responsibility can seem overwhelming and daunting.
The lack of communication and cries of an infant can make some women feel like a bad mother or feel like they’re not sure how to help. The emotions that can come from this, feelings of being overwhelmed, hopelessness, self-doubt, can easily contribute to the development of postnatal depression.
Alternatively, some may be overly paranoid and worried about if what they’re doing is right or whether their baby’s behaviour is normal. In some cases, mother’s may be worried if they don’t hear crying and may watch over their baby all night to make sure everything is ok. This, of course, doesn’t help their exhaustion.
As mentioned before, hormones play a big role in a woman’s pregnancy and time as a new mum. Oestrogen and progesterone affect emotions greatly; during pregnancy progesterone levels rocked, but decrease very suddenly after birth.
Hormones are very influential in baby blues especially but can’t account for postnatal depression entirely.
I shall talk about the potential impact of postnatal depression in another post (as it’s linked to my dissertation), but for now, I’ll quickly go through the treatments.
Pharmacological treatment available is antidepressants. Naturally, they have a huge amount of positives, but also some uncertainties associated with them. Positives include that it can help alleviate symptoms quickly and can allow basic functioning. It is also an option whilst awaiting a diagnosis or treatment. Negatives are that depending on the drug, it could potentially be unsafe for a mother whilst breastfeeding or during pregnancy. Furthermore, if there is no improvement, it may be deemed unsafe to continue, in case a tolerance or addiction is formed. Always check with a GP or psychiatrist first.
The second option is the psychological therapy treatment CBT (this is one of the most common therapies, however, there are others available). CBT stands for cognitive behavioural therapy and aims to address irrational or faulty thoughts and beliefs, whilst also addressing some behavioural aspects. It can be done in groups or individuals, however, either way, it can take a while to get to the top of the waiting list.
If you have comments, want to share your experiences or have suggestions for other posts, please leave them below in the comments.