A-Z of All Things Baby: P is for Perinatal Depression

Have you heard of Postnatal Depression? I am guessing you have, but have you heard the term Perinatal Depression? What's the difference?

Simply put, "post" means after, so it refers to depression occurring after and as a result of having a baby (I will discuss this shortly). "Peri", on the other hand, refers to the whole period of antenatal and postnatal all together. Although postnatal depression has been recognised for quite some time now, the acceptance of antenatal depression is more recent. Research suggests that around one third of those experiencing antenatal depression will also experience depression after the baby's birth, so it is important to recognise and treat symptoms early.


What causes depression in pregnancy?

Depression is complex, and there is no simple answer. Previously it was thought to be a result of a hormone or chemical imbalance, but this is now disputed. There may be different triggers for different people, but possible causes may include:

- the physical toll of pregnancy: it may be challenging to accept one's body getting bigger, changing size and shape, as well as becoming more difficult to move around and continue everyday activities as before. Sleep can also become more disturbed, especially later in the pregnancy.

- mineral deficiency: depression may be caused in some cases by a deficiency of iron and/or zinc. This may occur more easily as the mother's nutritional needs change during pregnancy.

- emotional factors: having a baby is a huge responsibility, and the parents may be worried that they are not going to be able to cope. There may be worries about the birth itself, or worries about the pregnancy. Perhaps the parents do not have much of a support network nearby.

Those who have suffered with depression in the past are at higher risk of perinatal depression.


What causes postnatal depression?

Again, depression is complex and may have different triggers for different people. You have probably heard of the "baby blues", typically occurring around day 3 when mum's milk tends to 'come in'. As well as hormonal changes, there has been a shift in sleeping patterns, mum may be physically sore from the birth, and everything can be rather overwhelming. However, this tends only to last a few days and doesn't get worse.

It's estimated that around 10-15% of mums will go on to develop postnatal depression (PND). It may develop within the first 6 weeks after birth, or it can take many months before it is apparent. Causes may include a history of depression, lack of support, history of traumatic or highly stressful events, birth trauma, or overwhelm at the absolute life changing nature of becoming a parent. Perhaps the baby cries a lot or there have been feeding difficulties. It's quite likely to a combination of causes.


What are the symptoms?

Symptoms of depression include:

- guilt

- anxiety

- excessive crying

- lethargy

- feelings of isolation

- difficulty bonding with the baby

- worries that one's partner might leave

- hostility towards partner or baby

- excessive irritability or anger

- feelings of worthlessness


What should I do if I or someone I know is showing signs of antenatal depression?

Unfortunately, many people with depression are worried about seeking help. This might be because they do not want to be perceived as weak or unfit to be a parent. However, it is important to seek help so that depression can be treated before getting worse. There are antidepressant medications which are safe to take during pregnancy if needed, and many find talking therapies such as Cognitive Behavioural Therapy (CBT) useful on their own or in combination with medication. So if you need support, try to tell someone who can help you. If someone you know needs support, encourage them to talk to their GP or call a service such as PANDAS (details below). Maybe you could go with them if that would help. If symptoms are severe and you are worried that someone could be harmed, call 999. Self-care including appropriate exercise, such as swimming, walking or pre/postnatal yoga, can help to improve symptoms. If affected by birth trauma, then qualified counselling or 3-step rewind technique may be beneficial. Babywearing and baby massage may help either or both parents to bond more easily with their baby.


What if the affected mother is breastfeeding?

Research tells us that the mothers who want to breastfeed but do not meet their goals are more at risk of postnatal depression than other mothers. Mothers who want to breastfeed and do meet their goals are at the lowest risk. This could be in part due to the elevated levels of oxytocin released when breastfeeding, but we also know that many mothers who do not meet their breastfeeding goals feel strong feelings of failure, guilt, anger or even trauma as a result. Unfortunately in the UK this happens all too often.

However, breastfeeding mothers do suffer with PND as well. Unfortunately they may be advised to stop breastfeeding; not only is this unnecessary for treatment but could make things worse for the reasons described above. Stopping breastfeeding at any stage leads to a hormonal change which can make mothers feel low for a few days (known as "weaning blues"). Many common antidepressants are considered safe when breastfeeding, including sertraline. There is more information in the fact sheet provided below. If you need antidepressants when breastfeeding and are told to stop, please seek a second opinion and contact The Breastfeeding Network Drugs in Breastmilk Information Service.


Is it only the parent who gives birth who can be affected?

No! There has been a big increase in the awareness of men's mental health issues in the last couple of years, and perinatal depression does affect fathers too, as well as partners in same-sex relationships. Studies indicate that around 1 in 5 men experience PND. Causes and symptoms are similar as for the birthing parent, except for the physical implications of pregnancy and birth. However, a traumatic birth may be just as traumatic for the partner as for the birthing parent (if not more so, as the birthing parent may be under anaesthetic or not completely aware of what's going on). He or she may have thought that they would lose their partner or baby, or both. This can affect bonding and self-confidence after the event. Partners are entitled to all of the same support detailed elsewhere in this blog.


Remember!

Having depression does NOT make you a bad person, nor a weak one, nor an unfit parent. It just means that you need some additional support. Talk to your partner or trusted friend or family member and try to seek support, or let them seek support on your behalf. Help is available and you are not alone.


Useful Resources

Why Perinatal Depression Matters, Mia Scotland

PANDAS Foundation http://www.pandasfoundation.org.uk/ (Pre and Post Natal Depression Advice and Support)

PANDAS Foundation Helpline 0808 196 1776

Mind https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/postnatal-and-antenatal-depression/

NHS information on postnatal depression https://www.nhs.uk/conditions/post-natal-depression/

Breastfeeding Network Fact Sheet on Antidepressants and Breastfeeding https://www.breastfeedingnetwork.org.uk/antidepressants/

Traumatic Birth Recovery Practitioners Directory https://www.traumaticbirthrecovery.com/directories/

Birthing Awareness 3 Step Rewind Practitioner Directory http://birthingawarenesstraining.com/team-showcase/certified-mam-3-step-rewind-techniques/


Disclaimer: the author of this blog is not a medical professional, nor should the information in this blog be considered a substitute for professional advice or support. Further information can be found in the above resources. Please contact the author directly in the case of any errors.

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