Portfolio of Hope

1. What is ‘post-natal depression?’

Post-natal depression is a type of depression that occurs in approximately one in ten mothers following the birth of their child. Although much less common, the mental illness can also impact upon men, though research into male post-natal depression is not very advanced, and therefore this can be a difficult claim to prove.

2. What are the differences between the terms ‘baby blues’ and ‘post-natal depression?’

It is widely regarded as a ‘normality’ for one to experience sadness after giving birth to a baby, so much so that the feelings that so many women report experiencing in the short timeframe following the birth of their child has been given a name, that name being ‘baby blues.’ The difference between ‘baby blues’ and post-natal depression, however, is that the former does not last for more than two weeks after giving birth. Post-natal depression on the other hand can last for months, if not longer. It is not simply a period of feeling down due to hormone imbalances caused by the pregnancy, post-natal depression is a serious mental illness that requires one to seek professional help and support in order for them to recover.

3. What are the possible risk factors for developing post-natal depression?

Whilst it is impossible to highlight just one cause of post-natal depression (it is too complex of an illness for that), there are several factors that can put someone at greater risk of developing the condition.

One risk factor is having a history of mental health problems, such as depression, earlier in life. Having such mental health problems during pregnancy puts someone at an even greater risk of being diagnosed with post-natal depression post pregnancy.

Another risk factor is centred around relationships. Someone who lacks support in the form of family, friends, and/or their partner is more likely to develop post-natal depression in comparison to people who have a strong network of support around them. This is because they might feel isolated, which can in turn lead to them feeling a sense of loneliness, a feeling that can very much intensify after pregnancy.

Going through stressful life events of any type, from the breakdown of relationships to bereavement, can also increase the risk of post-natal depression developing in someone. Pregnancy is an already very stressful and, often, nerve wracking time for people, therefore adding more stress to this already volatile situation can trigger mental health problems arising, with post-natal depression not being an exception to this.

A final risk factor that puts someone at greater risk of developing post-natal depression is if they have also experienced the ‘baby blues.’ Although the ‘baby blues’ are considered to be relatively normal, if the feelings of sadness persist after 2 weeks, they are heading into post-natal depression ‘territory.’ Left untreated, this can quickly escalate into an extremely challenging illness that is incredibly difficult to escape from, especially if adequate support is not provided in the form of loving relationships in one’s personal life.

4. What are the features of puerperal psychosis?

Puerperal psychosis, sometimes referred to as ‘postpartum psychosis’, is a serious mental illness that usually develops in women in the days or weeks after they have given birth. The main symptoms associated with the condition are very similar to those experienced by people with psychosis, those symptoms presenting themselves in hallucinations (hearing, seeing, smelling, or feeling things that are not there), delusions (thoughts/beliefs that are not true), low mood, unwavering sense of suspicion/anxiety, restlessness, confusion, and behaving in a way that is ‘out of character.’ As with all mental illnesses, early intervention is key, and therefore if someone suspects that they may have puerperal psychosis, even if their symptoms do not entirely mirror those which have been listed, they should seek help immediately.

5. What feelings might an individual experiencing post-natal depression have?

Post-natal depression can present itself differently in different people, depending on a wide range of factors. There are however some symptoms that are recognised to occur in large numbers of people diagnosed with the condition. One such symptom is a persistent feeling of sadness. Unlike the ‘baby blues’ that last 2 weeks at the very most, post-natal depression is characterised by a sense of sadness that will not go away. This can cause people effected to lose enjoyment and interest in the activities they used to enjoy, a major indictor suggesting that someone is depressed.

The result of constantly feeling low can cause people to feel overly tired and exhausted, contributing to them feeling as though they are lacking in energy. Despite these feelings of excessive tiredness however, people with post-natal depression often report being unable to get to sleep at night, making them feel even more sleepy during the day. Combined with their low mood, their tiredness and overall lack of energy can, in turn, make them find concentrating and making decisions painfully difficult tasks.

A final commonly reported feeling that people with post-natal depression often experience, is based around intrusive thoughts they may have, such as the thought of them hurting their baby. As such, this can make what should be an enjoyable time of bonding with their baby, incredibly challenging. It can also lead to one feeling anxious, and reluctant to spend time alone with their baby out of fear, and guilt, that they cannot look after their own child and keep them safe.

6. How can post-natal depression affect:

A- The mother?

Post-natal depression, of course, affects the mother, since they are usually the one diagnosed with the illness. Their feelings of anxiety and overall sadness can be overpowering, causing what should be the joyful experience of raising a baby to be quite the opposite.

They might feel a lack of control over their life, since they have essentially been ‘handed’ a baby that they feel completely ‘unqualified’ to look after.

They might also feel as though the constant demands that having a baby entails means that they do not have time to do the things they used to get pleasure out of, the things that used to give them a sense of control, therefore causing them to remain stuck in a cycle of depression. This can cause their social life to suffer, which may, in turn, result in a breakdown of their relationships. At a time when they are likely to be already feeling alone and unsupported, regardless of whether they have support or not, the breakdown of relationships can have a detrimental impact on one’s mental health.

B- Bonding with the baby?

Post-natal depression can lead to feelings of inadequacy and guilt arising in some mothers, whereby they convince themselves that they ‘are not good enough’ to look after their own child. They might feel as though the responsibility is too much, and that if they are left alone with their baby, their baby might subsequently come to some harm. This can cause mothers to find what should be the pleasurable experience of bonding with their baby, an incredibly difficult feat.

C- Others?

The family and friends of someone diagnosed with post-natal depression will also be likely to suffer, albeit indirectly, as a result of the diagnosis. The most obvious example for this can be seen in the father. The father of the baby would have to witness both their partner, and their child, struggling. This might lead to them feeling powerless, not knowing how they can help, and therefore feeling an element of hopelessness and potentially even ‘uselessness.’ Similarly, other family members and friends might also experience such feelings of wanting to help but not knowing how to, which could put a strain on relationships, possibly even leading to the breakdown of said relationships, as well as the breakdown of their own mental health.

7. What are some preparations for birth that may reduce the risk of one experiencing post-natal depression?

Although no one ‘chooses’ to experience post-natal depression, there are certain preventative strategies that people can adopt in the early stages of their pregnancy, to reduce the risk of them developing the condition post-pregnancy.

The most recommended thing that every pregnant woman is encouraged to do, is to ensure that they have a reliable support network around them. This might mean, in some cases, having to seek out a counsellor if they are lacking in support, or it might just mean someone having to consider who in their life they can really trust- who they know will be there for them in their time of need.  

Another thing that all pregnant women should consider doing, prior to giving birth, is to establish some expectations based on what they would like the father of their baby, if ‘on the scene’, to do their ‘fair share’ of. By reducing the workload placed on the mother, they will be less likely to feel overwhelmed and under such immense pressure when their baby is born. Instead, they should feel relatively calm knowing that: not only do they have a support network around them during the pregnancy, but they will also have a support network around them to help after it, too.

Another way in which mothers can access support, aside from talking to their close family and friends, is via support groups. There are loads of free support groups out there, specifically dedicated to helping pregnant women, therefore joining one is a great idea. Whilst the support of family/friends is invaluable, it can be immensely helpful for one to have an opportunity to access support from other likeminded women who either have ‘been there’ or are there. It provides people with a sense of community and togetherness, ensuring that every woman can be comforted by the knowledge that they are not alone in their struggles.

8. What are some self-help measures for post-natal depression?

One of the simplest and, arguably, one of the most effective way to manage post-natal depression is via exercising. Everyone is advised to engage in regular exercise to stay mentally and physically healthy anyway, however for pregnant women, exercise holds even greater importance. A study of over 1000 mothers found that ‘those who found time to exercise before and after the birth of their baby tended to feel better emotionally and were more social than women who didn’t’ (https://www.parents.com/baby/health/postpartum-depression/could-postpartum-depression-happen-to-you/.) This evidence proves how important exercising really is. Even just a short walk amid nature can be of such benefit to people.

Joining a support group is another extremely effective self-help measure that people can take. Engaging with other new parents who can, not only sympathise with you but actually understand what you are going through, provides parents with hope that ‘everything will be okay.’ An example of an ideal support group that might be recommended for people experiencing post-natal depression is a parent-and-baby group. Offered both in person and online, the peer support delivered by such groups functions by encouraging people with similar experiences to share tips to help each other out on the overwhelming path that we call parenthood.

A final self-help measure that I will mention here, though certainly not the last, is ensuring that new mothers actively dedicate time each day for themselves. Having a new baby is a stressful time, therefore it is so important that mothers remember to look after their own health as well as their babies. This might look like having a long relaxing soak in the bath after a stressful day, or it could be sitting down in front of the TV to watch something other than CBeebies. Whatever it is, if it makes them feel good, then it is a great self-help measure (and an excuse to have some ‘me’ time!)

9. What are some treatment options available for post-natal depression?

• Guided self-help is offered to many people experiencing post-natal depression, as it considered to be a relatively ‘unintrusive’ form of therapy. The 9–12-week course involves the sufferer working through a book or an online course in their own time, with occasional input from a therapist if required. This appeals to many people as it allows them to seek help without feeling as though their therapy is interfering with looking after their baby. Such courses typically focus on encouraging one to look at the issues they are facing ‘head on’, seeing them for what they are rather than ‘sugar coating’ them to make them seem more manageable in their head. By gaining insight into their struggles, their said struggles will in fact become more manageable, not less as they feared, since their honesty will enable them to gain practical advice on how to deal with the issues they have raised.

• Many people diagnosed with post-natal depression are subsequently offered antidepressants to help manage their symptoms. Since the symptoms of post-natal depression closely resemble those seen in other types of depression (persistent feelings of sadness, tiredness, irritability etc.), the anti-depressants work in the same way to manage these feelings. They do so by altering the chemicals in the brain so that the individual can function better, in turn allowing them to better cope with their new baby. Some people are reluctant to go down this path however, since there have been some cases in which taking anti-depressants has affected the ‘usability’ and, ultimately, the safety, of breast milk. Because of this, breastfeeding mothers are more likely to opt for psychological treatment in the form of talking therapy, as opposed to medical treatment as suggested here.

10. What local resources are available to an individual experiencing post-natal depression?

• Doncaster PANDAS is a pre- and post-natal support group made exclusively for people suffering with pre- and post-natal depression. The free group is a ‘life saver’ for so many parents, particularly those who lack a support network in the form of a reliable family/partner/friend. The group meets once a week for a two-hour drop-in session, its overarching aim being to ensure that no individual ever feels as if they are alone. Not only do the PANDAS provide help to the individual who is experiencing post-natal depression, they are also sure to offer help and advice to the individuals personal support network, whether that be their family and friends, or their carers and employers. By providing a safe community for people to come together, Doncaster PANDAS is helping to reduce the stigma of such mental illnesses, whilst encouraging anyone struggling to seek help.

• Much like Doncaster PANDAS, Light offers advice delivered from parents who have been there, to parents who are there. Unlike the PANDAS who meet in person every week, Light members communicate with each other via an online forum, which is accessible 24/7. The forum is a place for people to access peer-to-peer support in the form of chats and discussions, either from other Light members, or staff and volunteers from the organisation. It is a very inclusive platform, where everyone is invited, not just the mother, therefore dads and other family members are encouraged to sign up so that they too can have access to support. Alongside their forum which is hugely accessible, available for people to access from all over the world, they have also introduced some virtual groups to their service, allowing for collective discussions to take place whereby people can express how they are feeling to people who will always listen.

11. What resources would someone with puerperal psychosis require?

• APP (Action on Postpartum Psychosis) is a charity offering support for women and families affected by puerperal/postpartum psychosis. Their website is free to access and boasts loads of hugely informative and insightful resources that help people to understand the realities of the often-misunderstood condition. Aside from their blog posts and information surrounding what puerperal psychosis actually is, APP have also created an award-winning nationwide peer to peer support service, connecting women and families to recovered volunteers (people who have been in the same situation and are living proof that you can get through it, however difficult it might seem.) This service can be accessed in several ways, including via APP’s online support forum, one to one email support, face to face meetings, virtual meetings, social groups, and creative workshops. The wide range of services offered means that APP is likely to be of help for everyone.

• As a community mental health service, RDASH offer specialist assessments, advise and, if needed, treatment, to mums and their families living in South Yorkshire. The service exists to help anyone who is planning to have a baby, is already pregnant, or who has given birth in the last 12 months, to access support. With strong connections to ‘Light’, a specialist charity involved in helping women pre and post pregnancy, RDASH collaborate with the organisation to offer peer support groups whereby stories can be shared, and support can be accessed.

12. What treatments would someone with puerperal psychosis require?

• Most people who go to their GP presenting with symptoms of puerperal psychosis will be offered a combination of antidepressant medication and antipsychotic medication. These drugs work together to manage one’s mood and psychotic symptoms, therefore serving to lessen the severity of their illness.

• ECT (Electroconvulsive therapy) is both a psychological treatment and a medical procedure, whereby an electric current is sent through the patient’s brain to self-induce a surge of electrical activity within it. It is performed in a controlled environment and is given under a general anaesthetic; therefore, people are not awake during the treatment. The aim of ECT is to relieve the symptoms of puerperal psychosis when it is unable to be treated by medication and/or talking therapy alone (when greater intervention is required.) The controversial treatment works by administrating a brief seizure that is thought to change one’s brain chemistry, resulting in the reversal of their symptoms.