Postnatal blues, depression, psychosis, anxiety and PTSD
Do you know the difference between postnatal depression, postnatal blues, postnatal psychosis, anxiety or postnatal post-traumatic stress disorder? Along with who to go to for support and help if you feel yourself or a loved one is in need of support.
During the weeks and months after childbirth, it can be a really challenging time for some mothers and fathers. Bringing a new baby into the world is a hugely physical and emotional time, it is no wonder a lot of parents get overwhelmed and have some wobbly moments. If there has been a traumatic birth, or complications in pregnancy or if there is a history of mental health illness then these mothers may need some extra care and support.
Mums often worry or feel guilty that they shouldn’t be depressed or low, they have this wonderful new baby that they have been so excited about and longed for, but they just can’t stop crying, or don’t immediately fall madly and deeply in love with them. This can be very normal and there is no reason to feel guilty for these feelings. Talking through your feelings with your partner can help so they know what you are experiencing and can help. Talking to friends and family can be useful so they can offer help and support. If these feelings last longer than a week or so speak with your health visitor or doctor who will be able to talk through your feelings and offer the most suitable help and support for you. That is the biggest single action you can do to help yourself, let someone know how you are feeling, ask for support and don’t suffer in silence.
Postnatal blues / baby blues
Postnatal blues / baby blues is very common, up to 80% of mothers get the baby blues! Up to 80% that is a huge amount of new mums yet it’s not really taken very seriously and is often laughed off. This is fine for some mums, others can feel guilty or more upset, so mums do need a bit of grace and compassion during these early weeks.
Mums have this lovely, wonderful bundle of joy yet are upset, emotional, tearful and have mood swings, this is difficult to understand and frustrating for some, but as about 80% of mums can experience some sort of symptom they aren’t doing it to be frustrating or emotional, it is normal and it will subside over the first week or so.
Baby blues typically begins after the first couple of days after giving birth and can last up to a couple of weeks.
This is what differentiates the blues from depression the onset and length.
Baby blues symptoms can commonly include:-
Mood swings
Crying spells
Anxiety
Difficulty sleeping
The exact cause of baby blues is not known, however, there is a compounding effect on your whole mind and body of giving birth and bringing a new baby into the world, such as:-
Hormonal changes
Lack of sleep
Physical exhaustion
Pain, either from birth from rips and tears or a c-section
The new huge weight of responsibility of bringing a baby into the world
Your milk coming in
Trying to learn how to breastfeed
Coming down from the chemical high of giving birth
And just an overall feeling of being overwhelmed.
There are many changes once you have given birth. With so many physical and emotional changes to your body, it is not a surprise that there will be tearful moments and feelings of being overwhelmed and anxious. But rest assured these feelings do subside and you do settle into your new life with your baby.
It is okay to admit that you are feeling wobbly, and have a little cry, however, if you feel increasingly depressed and despondent, you may have postnatal depression. If you think you have postnatal depression, or think your partner may have it, then speak with your doctor, midwife or health visitor who will be able to offer more advice, support and treatment.
Postnatal depression
10-20% of mothers may get postnatal depression. Postnatal depression is a much deeper and longer-term depression than the baby blues. This usually develops within six weeks of giving birth however, can be anytime within the first year and it can be gradual or sudden. It can range from mild to very severe.
There isn’t one main cause of postnatal depression, there are risk factors that can mean some mothers are more susceptible than others. If you have had complications getting pregnant, or complications in your pregnancy this can be a compounding factor. If you have a history of depression or anxiety or if there is a history in your family, this can also be a risk factor. Along with everyday social factors including, work or family stress, poor relationships or poor support from family, being a single parent or having an unplanned pregnancy can all add to the risk of getting postnatal depression. So it is important to recognise these factors and try and plan ahead so you have some help and support once your baby is here.
If you or someone you know are showing signs of postnatal depression then it is important to speak with your doctor, midwife or health visitor so you can get support. It is important to remember that there is support there, depression is like any other illness, it doesn’t make you a bad parent and it is not your fault you are depressed, it can happen to anyone. Your baby won’t be taken away from you, mothers and babies are always tried to be kept together. Even with severe depression or psychosis, there are specialist mother and baby centres that can ensure mum and baby are kept together.
There are different treatments for postnatal depression, speak with your doctor to get the best one for you. For mums worried about taking medication, this doesn’t always have to happen. There are other options such as talking therapies and social support. So don’t think your doctor will automatically put you on antidepressants, there will be times when these are best and needed, but speak with your doctor about all the options available and best for you.
If you feel you have any of the following feelings it is best to speak with your doctor, midwife or health visitor, however, if you are feeling any of the last three, then you need to get help and support as soon as possible.
Symptoms of postnatal depression can include:-
Physical
Headaches
Difficulty breathing
Palpitations
Poor concentration
Insomnia / excessive sleeping
Fatigue
Loss of appetite / overeating
Stomach ache or nausea
Agitation / shakiness
Poor concentration
Emotional
Low mood
Feelings of inadequacy
Overwhelming sense of sadness
Constant exhaustion
Inability to cope
Feelings of guilt or shame
Feelings of anger or being overwhelmed
Overwhelming anxiety
Isolation relationship difficulties with your partner
Lack of self-esteem or confidence
Overall irritability / oversensitive
Social withdrawal from family and friends
Crying for no reason
Helplessness / hopelessness / worthlessness
Intrusive thoughts
Thoughts of suicide / self harm
Thoughts of harming your baby
Postnatal Psychosis
Postnatal psychosis is a serious condition, although rare it can affect one or two women in every 1000 births. Postnatal psychosis is a serious mental illness that should be treated as a medical emergency. It can get worse rapidly and the illness can risk the safety of the mother and baby. Be aware that if you have postnatal psychosis, you may not realise you are ill. Your partner, family or friends may spot the signs and have to take action. You should call your doctor immediately for advice, if you cannot get hold of your doctor then 111 will be able to tell you what to do next. If you feel the mother or baby are at risk then call 999.
Postnatal psychosis needs to be treated in hospital, usually in a specialist mother and baby ward, so mums and babies can be kept together.
The cause is unknown, however if you have bipolar or schizophrenia you are more at risk, along with if you have a family history of mental illness or postnatal psychosis, or if you have had postnatal psychosis after a previous pregnancy.
Symptoms of psychosis are:-
Feeling out of touch with reality
Hallucinations and delusions
Confused or disturbed thoughts
Mania or hyperactivity
Loss of appetite
Feelings of suicide
Thought of harming the baby
Trouble sleeping
Severe depression
Can Dads suffer postnatal depression too?
Yes, Dads can suffer from postnatal depression. The peak time for postnatal depression in men is three to six months after the birth.
As with postnatal depression in mums, it often goes undiagnosed. The symptoms can look a lot like the everyday stresses of having a newborn.
Symptoms can include:-
Irritability, frustration, cynicism and anger
Anxiety
Sleeping difficulties
A loss of humour
Tendencies to withdraw from people, adding to stress levels at work and creating tension in the relationship
Fear, confusion, helplessness and uncertainty about the future
Indecisiveness
Marital conflict
Partner violence
Negative parenting behaviours
Alcohol and drug use
Physical symptoms like indigestion, changes in appetite and weight, diarrhoea, constipation, headaches, toothaches and nausea.
Dads have a huge life changing event too when they become a father. They haven’t had the pregnancy, birth and hormonal changes, however, they do have huge new changes and responsibilities, the household finances usually change with one parent on maternity pay and then nappies and baby supplies needed which are added costs. Lack of sleep and then still trying to do their day job. Relationship dynamics change and the want of being a good parent, these are all huge life changing events affecting both parents.
If you have concerns about your own or your partner’s mental health, do seek help from your doctor who can help you. It’s important to talk to someone if you feel like you’re not coping, or you often feel angry or stressed. You can talk to friends, family, your doctor or health visitor. The health visitors are there for you as well as your partner.
Postnatal Anxiety
You will already have heard of postnatal depression, where you can become depressed post birth. Postnatal anxiety is also common and has become more recognised in recent years.
Having anxious thoughts is very normal for everyone, and especially in the early weeks of parenthood, you may worry that something will happen to your baby, are they feeding enough, what if you do something wrong? These feelings do tend to ease and become less over the first weeks and months.
Postnatal anxiety is different in that it is more persistent, it won’t go away and it can be more distressing. Dads and partners can develop anxiety during their partner’s pregnancy, or post birth too.
If you already have anxiety you will be more likely to have persistent or excessive thoughts and physical symptoms post birth, such as the inability to relax or get panic attacks. Some symptoms of anxiety are similar to common new parent worries such as trouble sleeping or concentrating, so postnatal anxiety can sometimes be hard to spot. Other types of anxiety conditions like panic attacks or post-traumatic stress disorder can develop especially if there has been a traumatic birth, or the baby has been very unwell.
It is important to remember that everyone feels anxious at times, new parents may feel they cannot talk about their negative thoughts as they are under pressure to be happy and so in love with this new little baby they have. They feel under pressure to be happy and that everyone else is coping, or family and friends have always been fine beforehand, so they have to be okay now.
Postnatal anxiety is common and needs non-judgemental emotional support, talking to friends or family can sometimes help in getting support for you, take the offer of someone holding the baby whilst you have a shower. Or if guests come round, get them to bring the coffee and cake so you don’t have to worry about having anything suitable in for them!
If you have anxiety, you may also feel:
Anxious all or most of the time and not be able to control it
Restless or worried
A sense of dread
Irritable
Constantly on edge.
Anxiety can also affect your behaviour. For example, you might avoid certain places, doing certain things or even denying certain feelings because they feel threatening. You may be overly careful or asking for reassurance again and again from loved ones or healthcare professionals.
Some people who have anxiety can also have panic attacks. These can come on very quickly and for no apparent reason. Most panic attacks last for between 5 and 20 minutes. They can be very frightening, but they are not dangerous as anxiety is a normal emotion. During a panic attack, you get a rush of intense mental and physical symptoms.
Symptoms of a panic attack can include:
A racing heartbeat
A feeling of dread or fear of dying
Chest pain
Shortness of breath
Dizziness.
Anxiety UK says that if you can answer yes to most of the following questions you may be affected by postnatal anxiety:
Have you found yourself overly worrying that your baby is in danger?
Have you found yourself imagining your baby coming to harm?
Have you found your concerns over your baby’s safety are affecting your daily life?
Have you experienced repeated panic attacks?
If you feel your anxiety is having an impact on your wellbeing and is excessive it is important to speak with your doctor or health visitor.
The main treatments for mental health difficulties such as postnatal anxiety are talking therapies, self-help, medication or a combination of these. What you are offered will depend partly on what your symptoms are, how severe they are and what services are available locally.
Most new parents will feel some anxiety during the first few weeks. But if this anxiety becomes constant and affects your daily life, you may need some help.
Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is different from postpartum depression, although both can happen at the same time, they require different treatments. Some cases of postpartum depression can be managed by your doctor, but postnatal post-traumatic stress disorder (PTSD) more commonly requires a specialist maternal mental health referral. Research shows that up to 25% of people who have PTSD could remain undetected because they are also experiencing postnatal depression, so the PTSD goes undiagnosed therefore untreated.
One third of women experience giving birth as traumatic, and consequently 3-6% of all women giving birth develop PTSD, with many going undiagnosed. It is only recently that it has become recognised that PTSD can develop post birth. Recognising early responses to a traumatic birth and providing advice and support can reduce the risk of PTSD developing. Symptoms of trauma can happen quite soon after your baby has been born. PTSD can be diagnosed from four to six weeks after the traumatic experience if particular symptoms are not going away. Sometimes, symptoms of PTSD can start later on, months or even years after what has happened to you.
Dads and birthing partners can also be affected by the childbirth experience. Unexpected events during pregnancy and childbirth can cause a rollercoaster of emotions. Witnessing a traumatic birth can cause partners to feel out of control of the situation, fearful of what is happening, they are not able to do anything to help and may see a lot of blood, medical procedures and having their loved one and or baby at risk is highly stressful.
There is little research although as many as 5% of partners can develop trauma symptoms having been present during the birth.
When you experience trauma symptoms, it’s as if you’re still stuck in the middle of the trauma. You feel on high alert as if something terrible is going to happen. A smell or a noise takes you right back to the moment of the trauma, and you relive it all over again. It’s less like a memory and more like an event that is still happening.
While some of these symptoms are very normal following giving birth, if they continue for weeks and months afterwards, you should consult your doctor or health visitor.
Possible reasons for individuals to develop PTSD can come from experiencing a number of complications and traumatic situations pre-pregnancy and or during pregnancy and labour. Research has shown people who have experienced traumatic events previously are more likely to exhibit symptoms of PTSD after childbirth compared to those who have not. Prior exposure to trauma predisposed individuals to postnatal PTSD.
The likelihood of developing PTSD following childbirth was found to be increased for people who:-
Had undergone multiple traumatic events
Had a history of sexual trauma
Experienced trauma during childhood
Had suffered childhood maltreatment
PTSD isn’t necessarily caused by a single dramatic event during childbirth or pregnancy but a complicated mix of factors such as:
You had a very lengthy labour
You had a very painful labour
You had an assisted birth with ventouse or forceps
You had an emergency caesarean section
Your baby was born with a disability
Your baby spent time in special care
You feared for your, or your baby’s life or health, during or after the birth
You felt powerless during the birth.
Your medical carers were unsupportive or unsympathetic.
You’ve had a traumatic event in your past
You felt you were not in control
There were high levels of medical intervention
You felt you were not being listened to
You felt a lack of information or explanation
You felt a lack of privacy and dignity
Your baby was stillborn
You experienced poor postnatal care
The birth had to be induced
PTSD from a traumatic childbirth has some specific symptoms such as:-
Revisiting images of labour and birth
Vivid flashbacks (feeling that the trauma is happening right now)
Intrusive thoughts and images
Nightmares
Intense distress at real or symbolic reminders of the trauma
Panicking when reminded of the trauma
Being easily upset or angry
Extreme alertness, sometimes known as 'hypervigilance'
Finding it hard to sleep, even when you have the chance
Physical sensations such as pain, sweating, nausea or trembling.
Fear of and avoidance of giving birth in the future
Poor self-image and feeling inadequate
Relationship difficulties
Feeling like nobody understands
Blaming yourself for what happened
Overwhelming feelings of anger, sadness, guilt or shame.
Difficulty with bonding with your baby, and guilt as a result
Isolation and loneliness
Postnatal depression (PND)
Avoidance of medical treatments like smear tests
As one of the characteristics of PTSD is persistent re-experiencing of a trauma, for some Postnatal PTSD sufferers, the new baby could be a reminder of the traumatic birth and trigger flashbacks. A parent may seek to avoid their baby because of their association with the traumatic birth.
If you feel yourself or your partner is suffering from PTSD then speak with your doctor or health visitor who will be able to find the right support for you. There are talking therapies, birth rewinds and other peer support groups that can help, along with medication for some. It is important to speak to a medical professional who can assess your individual circumstances and offer you the best support for your situation.
Who to go to for help and support
Firstly talk to your partner explain how you are feeling and let them know you are struggling. This won’t necessarily solve the problem but having them understand how you are feeling can help in a small way. Sometimes that small step is enough other times you will need more help and support.
Friends and family may be good support for you if they can bring round a dinner, or hold the baby whilst you have a shower, they could run the hoover around whilst you are feeding. If you want them to have the baby whilst you have a nap, some friends or family would love to do this. If you don’t want to leave your baby with anyone this is okay too, just having an adult conversation is sometimes nice in that postnatal bubble of feeds and nappies.
Your midwife in the first couple of weeks post birth is there for help and support. Once you have been discharged from the midwife team you will be transferred to the health visitor team, who are there to offer help and support until your child is 5. They often do a house visit about two weeks post birth to check everything is going okay. After your two week check, there are normally drop in clinics or their contact details will be in your babies ‘Red Book’. Your health visitor will be able to offer some help and support and be able to signpost you to different groups and classes in the area that may help.
Your doctor is there for you too. You and your baby will have a 6 week check to make sure everything is healing well, baby is growing well and to see how you are feeling. If you need any help or support before or after this visit then they are there for you. Often waits can be long to get doctors appointments, however I have always found post birth, doctors are very good at seeing mothers and babies as they know this can be a very stressful and worrying time for many. So don’t feel there is no point calling as you won’t get an appointment for weeks, if you are struggling then stress you need to speak to a doctor as soon as possible. Many doctors are getting better at postnatal support, however, if you do have one who is not as supportive as you need, then ask for a second opinion and speak with another. Sometimes, it isn’t right, but you do have to demand to be taken seriously and push until you find the right person.
The charities below offer help and support to families affected by postnatal depression, anxiety, PTSD or any other postnatal mental health difficulty yourself or partner may be experiencing.
https://pandasfoundation.org.uk - Postnatal depression awareness and support
https://apni.org - Association of postnatal illnesses
https://www.birthtraumaassociation.org/peer-support - Birth trauma association helps mothers, fathers and birthing partners who have experienced birth trauma.