Postnatal Depression

I decided to address this issue now, because for the past few weeks, I’ve been reading articles about mothers harming their children and/or themselves almost on daily basis. 

Every time, I read another of these horrific stories, I feel incredibly sad for the lives lost, angry for the injustice of it all, afraid that it could happen closer to home, appalled that the women did not have the support they needed for this to be prevented. 

Every time you read deeper into their stories, you find that they were struggling with mental health for many months if not years and as a society we have failed them and we have failed the children, whose lives were cut short.

It is only too easy to say those women are monsters, to shame them and blame them for the horrors they inflicted on their own families and communities, but the truth is, it could happen to any of us. Postpartum psychosis is the extreme end of baby blues. Although, there are often some predispositions, it can literally happen to anyone. Simple chemical imbalance, coupled with chronic exhaustion and perpetual low mood, can lead to catastrophic ends. 

Post Natal Depression in some form is not inevitable, but way too common place in today’s world, especially in the Western society. PND is on a spectrum, it goes from feeling moody and ‘not oneself’ to going through a psychotic event on the extreme end. The basis of the cause are three elements: Exhaustion through lack of sleep, Hormones adjusting and uterus shrinking while the body recovers and Trauma (past or from the birth experience). Lack of appropriate support often exacerbates any symptoms the new mother might be experiencing. Additional aggravating factors are identity crisis, previous poor mental health, unstable relationships (partner and/or family), addictions (especially alcohol or drug use) and lack of safety (lack of accommodation, food or money, also war or domestic abuse). Although the list is not exhaustive, it does cover most of the world’s population for one reason or another. If the mother is already caring for young children and/or has given birth to multiples, it makes recovery from birth even more challenging, especially without adequate support.

Many cultures have systems in place for at least the first six weeks, whereby the new mother is completely taken care of by her family and community, so she can entirely focus on her new baby and her recovery. By six weeks most women fully recover physically from birth , even after c-section. Their uterus is back to normal, the hormones are settled and even the baby tends to fall into more of a routine. The mother adjusts to new sleeping patterns and is starting to be able to expand her activities beyond just sleeping and breastfeeding. This is the natural process when the mother is given the opportunity to rest properly by care givers, who feed her, keep her home clean and safe and look after her baby for brief periods so she can take care of herself and have some uninterrupted sleep. Sadly, many mothers in the ‘modern’ world are not afforded such care unless they literally pay for it in forms of nannies, cleaners and night nurses. Too many women are forced back to work almost immediately after giving birth. As prolonged separation of mother and baby in the first year is often very traumatic for both mother and baby, it can in itself lead to PPD or PPA. As breastfeeding on demand has been shown to prevent or at least lessen the symptoms of PND, anything that disrupts the process poses a risk to the mother’s mental health if she is not adequately supported.

The lack of supportive community is particularly sensitive point for women as our bodies have evolved to be a part of extended family, to be surrounded and held by women of all generations. To watch mothering, births and breastfeeding as part of our daily lives, so knowing what to do was in our bones. We’ve lost that. The fear of the unknown and the burden of having to learn ‘on the job’ is partly why many women struggle with labour and PPD. This is compounded by the lack of practical support that used to be there. The community would have taken care of all the chores, of cooking, of older children, of the mother’s sleep and wellbeing, giving her time to adjust and recover. No wonder, that one of things that women complain about the most in postpartum period is loneliness despite having babies be their side and often partners and older children.

The symptoms of PPD are pretty varied. A persistent feeling of sadness and low mood, lack of enjoyment and loss of interest in the wider world, lack of energy and feeling tired all the time, trouble sleeping at night and feeling sleepy during the day, difficulty bonding with your baby, withdrawing from contact with other people, problems concentrating and making decisions and frightening thoughts – for example about hurting your baby (intrusive thoughts) are just the most common ones and some of these can be easily dismissed as ‘normal’ baby blues.

As you can see the net of PPD that traps new mothers (and some fathers) is pretty wide, so what can we do to lessen the impact or even prevent it all together? Actually fair deal can be done, but sadly not all of these actions can be taken by everyone as they are simply not always accesible. However, there are few things that anyone can do, no matter what their situation and I shall start with those.

Wherever you are on your motherhood journey (weeks or years after birth, pregnant or just thinking of having kids), stop and take an honest stock of your mental health. If you struggle to gain clarity, try journaling your feelings three times a day for a couple of weeks. It is ok to have a low mood or feelings of anger every so often, but if these are the prevalent feelings most of the time, something is clearly amiss. Once you know where you are at, how you feel and what you think most of the time, the next step is to realise that you are not your feelings and thoughts, that these are just passing through and they are not permanent unless you keep hold of them. Mindfulness and meditation are great tools for managing unruly thoughts and feelings and there are plenty of free resources out there, online and in person through countless charities. 

Our bodies are great messengers, so tuning in and listening to what they are telling us, can be really crucial to combating PPD. Exhaustion is one of the obvious causes and I’ll tackle that shortly, but there also other possible issues to be aware of like hidden inner bleeding, infection, unusual hormonal imbalances, the uterus not retracting and digestive issues to point out just a few. These issues when not addressed in time, can lead to serious complications in some cases. The symptoms can be easily overlooked in the early days and weeks postpartum. They may cause PPD directly or indirectly through the associated trauma and fatigue. Therefore it is crucial for a new mum to regularly check in with her body, feel beyond the tiredness and report anything remotely suspicious to her midwife, GP or health visitor. Effective way to tune into your body is to do (or follow a recording of) a full body scan meditation, or tapping gently on every part while in the shower or bath or to simply make a list and go through it one item at a time.

When it comes to exhaustion and sleep deprivation itself, it can easily slip into PPD, so learning how to rest effectively is really important. I’ve already posted a stand alone blog about rest on my website and plenty of additional information and resources on my social media, but the gist of it is that sleep is not the only way to rest and active/wakeful rest is incredibly important for physical and mental health. You don’t need any resources to practice active rest, just a discipline to prioritise it.

Conscious breathing is a great way to rest your body and mind, to reset your mood, to calm or energise you, to bring you to the present moment and to connect with yourself. Whenever you stop and focus on your breath, you are practicing conscious breathing. It is as simple as that and research show that it greatly reduces stress and its negative effects, especially if practised regularly. Make an effort to practice conscious breathing as often as you can, but if you struggle, tie it to another activity like going to the toilet, having a cup of tea, walking the dog or having a shower. Once  a day for half a minute is better than nothing.

These techniques are available to virtually anyone, but here are few that require various degrees of privilege and if you are lucky enough to have access to any of these ways to prevent or help PND, I urge you to use them.

Ask for help. However, when asking,  be specific in what you need help with (maybe a friend wants to help by holding baby, while you’d prefer them to cook you a meal), if you can afford it, a lot of the day to say stuff can be outsourced to a paid professional, it is entirely up to you what kind of assistance you’ll find more helpful. Maybe you enjoy cleaning and cooking and nanny spending time with your baby, giving you time to clean your home, might be actually restful and therapeutic. Perhaps what you need as a good cleaner twice a week, who does not mind doing the laundry and holding the baby for ten minutes while you have a shower. If you have a partner, ideally discuss division of responsibility before the baby arrives into the world. If you have someone helping you by looking after your baby, try and ensure that they follow your parenting style and are respectful of your values otherwise such help can cause more stress than good.

Great activities for recharging batteries are walking in nature, napping with the baby, breastfeeding (if you are able to), cuddles with pets, cuddles with a partner, gardening, art, swimming, yoga, singing, dance and so much more. Many of these things can be done with a baby in tow, in the carrier or pushchair. You can sing to your baby, dance around the kitchen, take baby out to the park or just catch up on your sleep when baby sleeps.

If, despite trying everything you can think of, you still feel low and struggle with your mental well being, contact a therapist. The sooner you catch it, the easier it is to get out of it and the less trauma will be caused all around. When you are not well, those closest to you, especially children, will suffer with you. This is one of those ‘put your oxygen mask on first’ moments, where in order to be able to look after others, you must take care of yourself first. I am not talking of having luxurious baths, massages and having your nails done (although there is no harm in that), taking care of your mental and physical health, when it comes to postpartum period, can literally be a matter of life and death.

Fortunately, nowadays there are lot of sources of help and support even if you feel all alone, so don’t hesitate to reach out. We all have the capacity to enjoy motherhood, we’ve just never meant to do it without a community to hold us. So lets create our own community, our own ‘village’ that it takes to raise a child.