depression; anxiety; post; natal; puerperal; psychosis; postnatal; languages; multicultural; beyondblue;
Pregnancy, birth and early parenthood are times of great change. Having a baby can be the biggest life change that you will ever have. It may be difficult to adjust to the day-to-day stress of caring for a new baby.
Depression and anxiety can occur at any time in your life, and can often come to the surface with a major event like pregnancy or having a baby. The risk is higher if you have been depressed in the past.
- Some women experience depression during pregnancy - antenatal depression. Around 12 per cent of pregnant women in Australia experience antenatal depression.
- Postnatal depression (PND) is depression that a woman experiences in the months after the birth of her baby. Postnatal depression affects almost 1 in 6 women in Australia (15%).
If you are concerned that you, or someone you know, has symptoms of depression talk with a doctor or health professional. It is important to seek help – the sooner the better.
Support and treatment are important. If antidepressant medication is needed, there are medications which are relatively safe and effective even for mothers who are breastfeeding.
Women who come to Australia from other countries may be isolated and even more at risk of postnatal depression. The Beyondblue website has information about postnatal depression in many different languages.
Signs and symptoms
After the birth of a child.
- Two out of every 3 women who have a baby will have the 'baby blues' – a wide range of feelings including tearfulness and anxiety. These very normal feelings usually happen on about the third or fourth day after childbirth and last for a day or two. For more information, have a look at the topic 'The baby blues'.
- For some women the blues may never go and the situation develops into postnatal depression (PND).
- Symptoms of depression may develop a few weeks or months after childbirth, perhaps long after the blues have gone away.
- More rarely a mother might develop a severe illness called puerperal psychosis.
PND has the same signs and symptoms as depression experienced by men and by women who have not just become mothers, except that having a baby makes things different.
Common symptoms of PND include:
- crying a lot, or crying about small upsets
- feeling very uncertain of your skills as a mother
- sleeping poorly even when your baby is asleep
- being very frightened of being alone
- feeling you are a bad mother
- irritability with other people around you such as your partner, your toddler or other family members
- perhaps hating yourself and your baby
- not feeling any sex-drive (libido)
- just feeling you can't cope with anything, for example, housework
- feeling very anxious and uncertain about a whole range of things – such as going out shopping or seeing friends.
- an increase in wanting things in order or the complete opposite - not caring at all about how things look
- obsessional thoughts which are sometimes about harming yourself.
Any woman who has had a baby is quite likely to feel some of these things some of the time. After all, who feels like cooking tea when you've been looking after a fretful baby all day, or about making love at night when your baby has been crying for hours and has just been sick all over you?
But if you have PND you are likely to feel depressed much of the time, even when your baby is on her best behaviour.
There are many other symptoms you may have too. For instance, tension and anger often lead to friction with other people, especially a partner or other close family members.
In fact, this can be a time of great tension between partners. Sometimes the father may understandably feel you are giving more time to your baby than to him - this is usually quite true! So if your sex drive drops off (a very common symptom) it won't be a surprise that you and he have to deal with lots of changes in your lives and that often causes problems.
What can you do about it?
With any condition, recognising that it is there, and accepting that you need to do something about it is the first gigantic step. For many women this will be the first time they have had to seek help about their feelings.
If you were expecting everything to go smoothly, let alone perfectly, you might feel very ashamed at admitting that all is not well. Next, you may have to decide whether this is a problem you and your family can sort out, or whether you need to get professional help.
If you have a partner, talking it over with him might help you to make that decision. But some women don't have partners or might think that their partner is not really into feelings and might not understand. In that case, you could talk it over with your mother or a friend. Some women may have a professional person to whom they can turn, and may choose to do this instead, or perhaps will do so if she and her partner have discussed it, and think this is a good pathway.
People you could ask include:
- Child and family health nurse
- Family doctor (GP)
- Community health centre
There are quite a lot of places you can get specialised help.
In South Australia these include:
- Helen Mayo House - Phone 08 8303 1183 or 1800 182 232.
- General Practice Perinatal Shared Care Workers who have lists of local resources in the city and country - Phone 8303 1451 or 8305 1532 during office hours
- Parent Helpline - Phone 1300 364 100. The Helpline is a 24-hour line run by the Women's and Children's Health Network.
You and your doctor must work out together which is the best pathway for you.
- It is a good idea to have someone else with you when you talk these things over with your doctor, to help you make a decision and to discuss it all as time goes on.
- Ask your doctor to explain anything you don't understand or don't feel happy about.
- Sometimes, your doctor may suggest referring you to a psychiatrist or psychologist, and this can be very helpful.
Your doctor may suggest you try some medication. This is most likely to be an antidepressant if your symptoms are severe.
- If you are breastfeeding, you and your doctor need to weigh up the risks of your baby getting some of the drug through your breast milk (some small amounts do go through) against the risks of you staying depressed and unable to manage the things you want to do with your baby. Sometimes a mother's depression can affect her baby, which is why the risks and benefits need to be worked out together.
- Some medications are believed to be safe when mothers are breast feeding.
In addition to professional help, it is good to speak to other women who may have had similar problems. In South Australia the staff at Helen Mayo House (telephone 8303 1183) may be able to put you in touch with community groups.
Why is treatment and positive action so important?
There can be several problems if PND is not treated.
- A mother may have unnecessary on-going suffering, and worst of all, there is the possibility of self-harm (even suicide).
- Depression often causes big strains on a relationship, which can lead to break-up.
- Many studies also show that there may be effects of a mother’s depression on her baby.
- Babies learn many things in the first 12 months of life.
- They learn more when their mothers have energy and time for them, and when the quality of the relationship (known as the attachment) is strong.
- It takes a lot of energy to tune into your baby all the time - even well mothers can’t tune in ALL the time – no one is a perfect mother.
- But young babies are very adaptable, and if their mother has been depressed for a while but then improves, she and her baby may make up for lost time. But the sooner you get treatment, the better it is likely to be.
So, finally, do remember …
- Postnatal depression is common, and it is treatable.
- It is not the fault of the woman, and has not happened because she can’t "pull herself together".
Everyone tries the best they can and mothers want to do the right thing by their babies, but depression may stop them doing so.
How fathers can support their partner
Postnatal depression is not something you or your partner caused, and her being angry and irritable with you is part of the illness.
Things that you can do that may help include:
- try to understand her feelings. Even though it does not seem reasonable to you, it is real for her at the time.
- don’t take her irritation or anger with you personally
- let your family and friends know what is happening. Support from those close to you will be a big help at this time.
- accept help from family and friends even if this goes against the grain
- give her practical support and spend time with your baby but do not take over her role unless she really can’t cope
- if she is getting help be patient with her while she gets better.
Things that probably won't help your partner are telling her:
- to pull herself together
- to be grateful that she has a lovely baby
- that she will get through it, everyone feels bad sometimes
- to relax and she will feel better.
If your partner is suffering we know it can be very hard for partners to keep coming home to an unhappy house but it is important to hang in there - getting better will take time.
Fathers adjusting to parenthood
When a baby comes along it can turn your world upside down. It is wonderful and exciting to have a baby but also a lot of extra work.
- Your relationship with your partner has changed and the routine you had before is now not possible.
- You may feel inadequate about knowing how to care for the baby and support your partner.
- Getting enough sleep may be difficult for you and your partner and this can lead to tension.
- Your finances may be an issue now with only one income coming in and more expenses.
- If you were not sure that you really wanted a baby at this time you may be feeling left out.
- You may feel a great pressure to do lots at home and also do well at work.
Whatever you feel we know that you need support in becoming a father.
Where do you get your support from? It is good to talk to family or friends about how you are going but most important is to talk with your partner. Hopefully she will be your main support just the same as you are for her.
Some fathers may suffer depression after the birth of their baby
You will probably have highs and lows as a new father. However we know that up to 10% of fathers suffer depression ater the birth of their baby but often do not seek help. Some of the things you might feel if you have depression include:
- a lack of energy
- increase in anxiety
- loss of all enjoyment
- feeling miserable, grumpy or sad
- not able to enjoy the baby
- feeling left out and alone
- your friends or work mates might notice you are low
It is tough for many fathers to ask for help because they think they should be able to cope. However it shows great strength to recognise when you have a problem and get help rather than ignore it. So if you are feeling low and not coping with things over a period of more than 2 weeks you should see your GP and talk to your partner and other supports.
Helping other people with PND
Perhaps you know someone who has recently had a baby and doesn't seem to be quite herself, or is obviously very unhappy. What can you do about it?
- If she is someone you know well and you think she would be able to cope with you bringing up her unhappiness in conversation, this may be helpful.
- Sometimes, though, being there for her is what she really needs.
- This is often in terms of offering practical help. Looking after a baby, especially a first baby, can be exhausting (even if it is rewarding some of the time). Offering to clean a bathroom, bring a casserole over, or baby-sit while the new mother goes to the supermarket or hairdresser, can be a wonderful gesture of friendship.
Puerperal psychosis is a severe mental illness which can happen to about one woman in every 500 after birth. It begins in the first few days after childbirth, and women who have had bipolar mood disorders (manic depression) have a higher chance of developing puerperal psychosis - so taking medications to greatly lower this risk can be important. Quite often, women do not know they are at risk until after the birth of their first baby, although there may be a family history of bipolar mood disorder.
A person can get a wide range of symptoms, from hearing voices or believing unusual things (delusions) to being so confused she can't care for her baby at all. Her mood may be very changeable and life quickly becomes chaos for everyone.
These people usually need treatment in hospital, and it is best to go to hospital with the baby. Hospitals may be able to take mothers and small babies.
In South Australia Helen Mayo House specialises in caring for women with this condition.
Resources and further reading
- Parent Helpline 1300 364 100.
- Helen Mayo House - telephone 08 8303 1183
- runs inpatient and day patient services
- telephone helpline
- sends out reading material
- advises about other available services eg postnatal depression groups in the community
- Your family doctor.
- Women's Healthline 1300 882 880
- Lifeline 13 11 14
- PANDA - Post and Antenatal Depression Association Support line 1300 726 306 (9am to 7pm AEST)
- beyondblue info line 1300 224 636
- Rural Mental Health Information and Referral Line 1800 13 11 14
Books for children
- Louis, Andrea, "Robby Rose and Monkey".
- Sved Williams, Anne, "Jake's Dinosaurs".
Both available from Helen Mayo House for $15.00 each. Phone: 08 8303 1183.
Information in other languages
There is information in many languages on the website of the NSW Multicultural Health Communication Service.
Beyondblue 'Postnatal depression'
Ellis P M & Smith D A R, "Treating depression: The beyondblue guidelines for treating depression in primary care." Medical Journal of Australia 2002
Brockington I, ''Postpartum psychiatric disorders'' The Lancet Vol 363, January 24 2004, p303-310
Beyond Blue Resources
Depression in men
Fathers and PND
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.