AIMS IrelandPostnatal Period
NICE Guidelines: Routine Postnatal care of women and their babies
‘The NICE clinical guideline on postnatal care covers the core care that every healthy woman and healthy baby should be offered during the first 6-8 weeks after the birth. Although for most women and babies the postnatal period is uncomplicated, care during this period needs to address any deviation …’
Read the full guideline here.
Post Natal Depression (PND) and other Postpartum Mental Health Issues
Helpful resources if you think you are suffering from post-natal depression include:
Post-Natal Depression Ireland
Tel: 021-492-2083
Aware
Tel: 1890-303-302
Parentline
Tel: 01 873 3500 or lo-call 1890 927 277
You can also contact your GP or maternity care provider. Many maternity units offer their support and counselling services for women. Find their contact details here.
Alternatively, contact AIMS Ireland at support@aimsireland.com or info@aimsireland.com.
Aware lecture on Postnatal Depression – Rosemary O’Callaghan
Post Natal Depression
Rosemary O’Callaghan,
Development Officer for Women’s Health, HSE
October 2008 – AWARE Lecture Series
(reproduced with permission)
Rosemary was previously a midwife, and when she was working in that area ten years ago, she realised that she had had no idea how common PND was and how many mothers suffer from it. As she had some experience in counselling she decided to use her skills to research this area and do something to help.
Perinatal Depression
Postnatal Depression is now called Perinatal Depression because it is recognised that many women experience depression during pregnancy as well as after the birth of their child. Perinatal refers to the period during pregnancy and one year after birth.
Rosemary hoped the lecture would help people to understand it, to recognise it and also to learn how to support a mum who may be going through it. About 10-15% of all mothers experience a depression either antenatally (before birth) or postnatally (after birth) although experts suspect the real figure may be higher. For 3% of mothers the experience is quite severe and they may need more intensive support.
Mothers who experience perinatal depression may not realise they are depressed: they may feel that they are just not coping, where everyone else is. They may think that they’re a bad mother or that they’re going mad. It can cause problems with the bonding process, so it is vital that mothers get help and support at an early stage.
Up to 50% of partners also become depressed: because they don’t recognise that depression is a factor for their partner, they may feel that there is no time for them and may experience hostility and, as we are prone to do where there is hostility, they may retreat from their partners.
There is a very poor detection rate during routine care despite all the contact the mother has with the services (e.g. GP, midwife and gynaecologist) during and after the pregnancy. Without help 30% of mums with PND are still unwell after one year.
PND can happen to anyone, but there are groups who are at particular risk. The single biggest risk factor in developing PND is a previous history of depression. Other risk factors include:
- Poor social support
- Lack of a confiding relationship
- Additional life events
- Early loss of own mother
- Concern for own health or baby’s health
- Early and/or severe blues
- Perceived difficulty with the delivery
Between 55% and 75% of new mums experience The Baby Blues, where she will feel tearful, very tired and very emotional. In fact, this is so common that it is considered normal and it only lasts a matter of days. Only between 1-2 in 1000 mothers experience psychosis, where they lose touch with reality and this requires urgent professional care. Rates for Antenatal Depression (during pregnancy) are similar to those of Postnatal Depression i.e. 10-15%. Two thirds of those who are diagnosed with depression after birth were actually already depressed before the birth. So this means that about one third of mothers-to-be who experience depression will find it lifts around the time of the birth, and one-third of mothers who are postnatally depressed will have become depressed after the birth.
Depression: The Impact
- Motivation: lack of interest, loss of energy, things seem meaningless, hopeless.
- Emotional: depressed mood, feelings of emptiness, anger or resentment, anxiety, shame, guilt.
- Cognitive: poor concentration; negative ideas about self, the world and the future.
- Biological: sleep disturbance, loss of appetite, changes in hormones and brain chemicals.
We don’t know what precisely causes depression but there are a number of different perspectives which argue different causes:
Genetic – Depression is 50 – 50 caused by genetics and life experiences
Medical – Hormones cause depression: there is some evidence that the sharp drop in progesterone after the birth can be a factor in the baby blues and also in psychosis
Feminist – Mum alone at home, caring for the baby
Biopsychological – How much social support you’ve got and how you are physically and psychologically.
Cultural – In some cultures more mothers present with physical symptoms rather then the regular symptoms of depression, so they need to be looked out for.
What to look for
For PND to be present a mum must be experiencing AT LEAST a lack of interest OR sadness AND crying, irritability, extreme tiredness, anxiety, panic attacks, obsessive behaviour, fear, guilt, sleep disturbance, sense of hopelessness.
Other things which may indicate PND are an excessive concern for the baby e.g. how it’s feeding, sleeping etc, avoiding contact with friends, relationship problems, hypochondriasis, agoraphobia and panic. The baby may show poor eye contact, be fussy, colic, early weaning and have constipation, poor motor control or irritability (of course these things can occur in babies where the mother is not depressed, but do be mindful of them).
What else could it be?
Anxiety disorder, which is very common and may occur in the absence of depression or may contribute to PND.
The difference between depression and anxiety
Depression:
- At least: Sadness OR Loss of pleasure, interest
- Sleep disturbance
- Appetite disturbance
- Agitation
- Retardation
- Extreme tiredness
- Negative feelings about self
- Poor concentration
- Suicidal thoughts
Anxiety:
- Excessive worry
- Sleep disturbance
- Restlessness
- Feeling on edge
- Easily fatigued
- Irritable
- Poor concentration
- Mind goes blank
For depression a person has to experience five of these symptoms including at least either 1) sadness or 2) Loss of pleasure/interest. Suicide is never a factor in anxiety alone.
Two screening questions:
The World Health Organisation recommends that all community personnel have a working knowledge of depression, since it is so common, and that they should ask these two questions to screen for the condition:
During the past two weeks have you ever been bothered by –
Having little interest or pleasure in doing things?
Feeling down, depressed or hopeless?
If the person answers positively on at least one of these a third question is then posed:
Is that something you need or want help with?
The Edinburgh PND Scale recommended as part of the screening process:
- 10 item self-report questionnaire
- Simple and brief
- Gives permission to talk about feelings
- Gets it right two-thirds of the time
- Raises awareness when everyone is being screened
What works:
- Cognitive Behavioural Counselling – which deals with unhelpful faulty thinking e.g. ‘I’m a bad mother’
- Counselling
- Guided self help
- Listening – if no treatment received, 1/3 get well. If listened to, 2/3 get well.
- Talking to an empathetic, understanding friend
- Exercise
- Support groups
- Anti-depressants: work for 7 out of 10. Sometimes needed in order to get the person well enough to engage with talking therapies.
How to cope
- Know that it’s normal and very common
- Get rest, sleep as much as you can
- Eat small meals or hot sweet drinks regularly, even if you don’t feel like it
- Talk over any worries and anxieties with someone close
- Accept practical help from others
- Involve your partner in looking after the baby
- Get fresh air and exercise, every day
- Take a break at least once a week; visit a friend, the hairdresser etc
- Avoid extra pressures
- Avoid upsetting situations or people
- Learn to deal with panic
- Take control of your day
- Don’t try to be ‘superwoman’
- Learn how to recognize your own needs and to ask for help
- Have regular breaks from the baby
- Know that things will get better
For relatives
- Find out all you can about PND
- Try to understand the mothers’ distress, listen to her
- Never blame the mum for being depressed, it’s not her fault
- Tell her she’s ok and just needs help
- Provide practical and emotional support
- Don’t try to cope alone, accept any offers of help
- Talk about your own feelings
Experiencing depression can be very difficult for the mother and it can rob her of some precious times with her child, so it is imperative to seek help early for what is a very treatable condition.
Please talk to your caregivers (GP, PHN, SECM, Obstetrician) if you think you are suffering from Perinatal Depression.
You can also contact the AWARE helpline on 1890 303 302 or email aware@iol.ie. For more information from AWARE see www.aware.ie/information.php