Depression after childbirth falls into four categories:
- Baby-blues, which usually occur around day three or four, customarily when your milk comes in. After the emotional 'high' of the birth itself, baby-blues are reckoned to be due to an abrupt change in your hormonal levels.
- Mild depression which may be a quite natural reaction to the emotional intensity of giving birth and becoming a mother, combined with hormonal changes, and feeling tired and bruised after the birth and lack of sleep. This may only last a short time or be easily resolved with a little more rest and recovery.
- Severe depression: a clinical depression that may come from nowhere or result from a worsening of mild depression. Approximately one in 10 mothers experiences postnatal depression of this type, and for many this goes unrecognised, misdiagnosed as tiredness or anaemia or some other physical problem that we can put a face to and treat.
- Puerperal psychosis: an acute psychiatric illness that occurs within a few days of delivery. It is easily identified and needs prompt treatment. It is also relatively unusual, affecting about one woman in every 1,000.
Unfortunately it isn't possible to identify the women who will get postnatal depression, only to be alert to the signs and to seek help if necessary. Becoming a mother is such a life-change that it would be surprising if there weren't a strong reaction to the reality of this new life with a small baby and all the unheaval it involves. All other relationships, with your husband or partner, parents, siblings, friends, workmates, etc. change to some degree. If this change is suppressed rather than acknowledged and integrated, depressed feelings can sometimes escalate.
We spend so much of pregnancy dwelling on the physical, rather than the emotional impact of having a baby, when it happens we can be emotionally 'caught short'. If time isn't given to addressing these changes and how we feel about them, it can easily contribute to depression.
Nowadays the average length of a hospital stay after giving birth is two days, whereas in the past it was 10 days, which enforced a period of rest on a new mother. Both have their merits and drawbacks. It's good to get home as soon as possible, but only if you can rest and recuperate there, too. Some suggestions for living with the ups and downs of the early days include:
- rest, recover and focus on your new baby;
- however busy your routine seems, try to eat regularly and well, and keep your fluid levels up if you are establishing breastfeeding;
- don't over-do the visitors. Have your husband, partner, mother or friend tell people if you are resting and not to be disturbed;
- suggest to friends that they will be very welcome if they make their own tea, or bring a ready-cooked meal around, or want to wash the kitchen floor, or babysit while you take the yourself and/or your older children out for an hour;
- talk through your delivery with your husband or partner, or midwife or friend, especially if there were aspects of it you were unhappy about;
- however brilliant you are feeling, take it easy and don't be surprised if you inadvertently overdo it one day and feel exhausted the next;
- take some gentle exercise, it will keep you going and increase your energy levels;
- take some time out just for you: go to the hairdressers, take a walk, visit a friend, have an aromatherapy massage or reflexology session;
- see a cranial osteopath for a postnatal check and treatment, and take your baby for a check-up too.
Avoiding depression isn't always possible, and it may be part of the process of adapting to parenthood. However, even if this is the case, support and help are necessary. If things seem overwhelming, and you feel you can't cope any longer, it is important to get professional help. This needn't be in the form of any sort of medication, but some sort of short-term counselling might be appropriate. In France women are entitled to much more postnatal support - and this includes a year's free counselling - than we receive here. Try your health visitor and doctor first; there may be a postnatal support group and counsellor attached to your GP practice or health centre.
It isn't a sign of failure to seek help, but more a case of recognising what an important job parenting your child is, for which we all need help sometimes.
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