Beyond the Baby Blues

by Aida Santory

It’s meant to be the happiest time of your life. But instead of celebrating the birth of your beautiful baby, you’re looking for the nearest exit. You’d run away, but you’re too tired, too teary and you can’t even find your keys. Surely this can’t be normal? 

It actually is. Around half of all new mothers experience a period of mild depression called the Baby Blues, which are considered a routine part of early motherhood and usually go away within 10 days of delivery. Many of us are so overwhelmed with the birth of our child that this period passes without us giving it much thought. Yes, we are crying for no reason, but it’s OK. We just need a bit of sleep, right? 

The expected tiredness following the birth of a new baby can blur the range of emotions and physical changes a new mother is experiencing and the onset of a more serious depression may be difficult to identify. 

Post Natal Depression (PND) may start off as "The Blues" that do not go away after a couple of weeks. But it can also develop any time during the first year or so after the birth of your baby. 

SIGN, the Scottish organization that develops national clinical practice guidelines, defines PND as any non-psychotic depressive illness of mild to moderate severity occurring in the first post-natal year.  

However, for a significant proportion of women the illness may have its onset in the antenatal period. And while the common belief is that PND is caused by hormonal changes, it is now widely accepted that a range of psychological and social factors can increase the risk. 

The demands and responsibilities of being a mother are overwhelming at the best of times but the pressures on mums today are enough to tip anyone over the edge. We set what seem like reasonable goals for a healthy pregnancy, the ideal childbirth and the perfect child. So why doesn’t it work out as smoothly as the books say it will? Why is it that I can manage my career, but I can’t figure out breastfeeding? I have done everything the “baby whisperer” says, but my baby still won’t sleep through the night!  

Among the non-biological factors associated with PND are: 

A poor relationship with your partner

Difficulties at work and fear of the change in your career 

Financial problems 

Changes in your body image both during and after pregnancy 

A difficult pregnancy 

A difficult or traumatic labour 

Poor relationship with your own mother or no mother at all 

A colicky baby 

Fear of failure 

Difficulties breastfeeding and related feelings of inadequacy 

Living in isolation or far from a community and activities 

Causes and symptoms can vary greatly between women, but it is important to identify a change in normal character and behaviour. You should look out for a number of the following symptoms:

Feelings of guilt or inadequacy 

Disturbed sleep, fatigue 

Reduced self-confidence 

Agitation 

Poor concentration 

Feelings of worthlessness 

Loss in appetite 

Reduced self-esteem 

Obsessing about own health and baby’s health 

Anxiety 

Lack of enjoyment 

Lack of interest in sex  

Feelings of self-harm

These are all powerful emotions and can be scary for many mums. So what should you do if you are worried about being depressed? The first step is to talk to someone about how you feel. Speak to your GP or health visitor. They will be sympathetic to your needs and anti-depressants are not the only solution. In some cases cognitive behaviour therapy, which is often prescribed for anxiety, has shown it can make a difference.  

We spoke to health visitors and midwives on the frontlines of PND and we have put together their suggestions for treatment  

1) Involve your partner

– you made this baby together and you should face the challenges together. Have him come with you to the GP so he can understand what you are going through. 

2) Make friends

– breastfeeding groups, toddler groups, PND support groups. Don’t wait to join – the sooner you are around other mums facing similar challenges the better.  

3) Bond with your baby

– classes such as baby massage have proven to be helpful. The skin-to-skin contact improves the relationship between mother and baby. 

4) Take a good antenatal course

- one that covers more than just the basics. The benefits include knowledge, confidence, bonding with your partner and making new friends that can carry you through pregnancy and beyond. The National Childcare Trust (NCT) runs classes all over the country, visit www.nct.org.uk/local/classes for your nearest one. The NCT runs intensive weekend classes as well as eight-week courses with trained antenatal teachers and usually include comprehensive breast-feeding consultation. 

5) Keep your expectations for pregnancy, childbirth, and parenthood realistic

- It doesn’t always go as planned. Be prepared to change your birth plan, call the lactation consultant and scrap the good baby books. It may all go smoothly, but if it doesn’t it’s ok, you can cope. 

6) Stop trying to be “super mum”

- You can let the housework go a bit and take a nap in the middle of the day. You have earned it! A few extra pounds aren’t going to kill you and baby doesn’t need homemade organic food for every meal. Take a deep breath and try to chill out.  

7) If you plan on breast-feeding, do your research

- find a lactation consultant or an organisation you feel comfortable with before you give birth. Contact NCT on 0870 444 8708, La Leche League on 0845 120 2918, or the Breastfeeding Network on 0870 900 8787. You can find breastfeeding support groups at www.breastfeed.scot.nhs.uk/breastfeedinggroups.htm 

8) Don’t be afraid to ask for help

– you can’t do this alone! Ask family or friends to drop off some ready-made meals to keep you going during those first couple of weeks. Draw up a list of chores and tasks and tell them you would rather have help than a pile of gifts.  

9) Take time out with your partner

– it’s ok to leave baby for an hour or two with someone you trust so you can take time out with your partner. The chances are he’s also feeling a bit neglected, as everyone’s attention is focused on the new arrival. 

10) Stick to a healthy diet

– you need energy to meet the physical demands of caring for a new baby. Eat a balanced diet, with a focus on eating wholegrains and cereals, fresh fruits and vegetables, and foods that provide plenty of protein, calcium and iron. 

11) Exercise

– this has been proven to improve your mood and to raise your self-esteem. It may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve symptoms of depression. However, as little as 10 to 15 minutes at a time have been shown to improve mood in the short term. 

Some mothers find it helpful to talk to a mother who has experienced and recovered from PND. Sometimes what is needed most is a reassuring voice and there are a number of excellent organisations which offer phone support as well as drop-in services and support groups.  

The Church of Scotland Post Natal Depression Project
0131 538 7288 

The Association of Post-Natal Illness 0207 386 0868 

Home Start 0800 686 368 

Perinatal Illness UK 01654 713 833 (phone and email support, message board and online chat ) 

KNOW THE DIFFERENCE

Puerperal psychosis

This is a rare, but severe, form of depression which affects 1 in 500 mothers. This should not be confused with PND or the Baby Blues.The onset is more sudden and dramatic and usually requires urgent treatment. Some of the symptoms are irrational behaviour, confusion, suicidal thoughts. In some cases there is danger the mother may harm herself and her baby. It is most likely to occur in mothers who have previously had an episode of serious mental illness or in those who had a strong family history of serious mental illness. 

There are two Mother and Baby Units staffed with specialist perinatal mental health teams with the knowledge, skills and experience, to provide care for women at risk of or suffering from serious postpartum mental health illness. 

The Southern General Hospital in Glasgow is Scotland's First Mother and Baby Mental Health Unit. The six-bedded facility enables mothers to stay with their babies as they undergo treatment.  
St John's Hospital in West Lothian has a six bedded unit and is joint initiative between five health boards and will serve women from Tayside, Borders, Fife and Highland as well as Lothian.  

* Referrals to these units are accepted from a wide range of health professionals including GPs, health visitors and midwives