Having a baby can be a wonderful, scary, overwhelming, exciting, joyous, and anxious time. Every emotion can come our way (often multiple times a day). Unfortunately, for some, the overriding emotion we feel is depression. Perinatal depression can be really tough to cope with.
WHAT DOES PERINATAL MEAN?
Perinatal means before, and after birth; antenatal and postnatal. The DSM-5, a manual often used to diagnose, refers to postnatal as four weeks after giving birth. Mind defines postnatal as six weeks after birth.
IS PERINATAL DEPRESSION COMMON?
According to the DSM, 3-6% of people experience major depression either during or post-pregnancy. 50% of these people have symptoms of depression before delivery.
Around 0.1-0.2% of those who have children experience psychotic features alongside depression. This is more likely if we’re pregnant with our first child, have a history of depression or bipolar disorder, or have a family history of bipolar disorder.
WHAT DOES PERINATAL DEPRESSION FEEL LIKE?
We often feel exhausted, restless, persistently sad, hopeless, flat, tearful, or unable to cry. This could start to affect our daily lives, making it difficult to carry out day-to-day tasks.
Despite overwhelming fatigue, we may not be able to sleep. Food can become a struggle. We might have no appetite whatsoever, or rely on comfort eating to get through the day. We might stop enjoying things that we used to like, struggling to motivate ourselves to do anything much at all.
Irritability and frustration can take over. We might find ourselves snapping at loved ones… then feel guilty for doing so. The guilt can become overwhelming. Guilt over not being ‘better’, over not ‘enjoying our pregnancy’, over our unborn child(ren) having us for a parent. Guilt for not being able to help around the house as much as we’re used to, for forgetting things and being totally unable to concentrate. Sometimes, guilt for existing.
Anxiety sometimes ramps up, too, making our depression even more unbearable as each pulls us in a different direction.
HOW MIGHT WE FEEL, PHYSICALLY?
On top of any ‘usual’ bodily changes associated with pregnancy, we may start to have regular, persistent headaches. Unexplained aches, pains, and cramps. Our digestive system can be affected. We might begin to have heart palpitations. All of these things are even more worrying when we’re pregnant. We may worry about how it will affect our unborn child(ren). Frustratingly, that worry can add more fuel to our anxiety, creating a vicious cycle.
BONDING WITH OUR BABY
Bonding with our baby is hard. We’ve all seen those magical movies where a baby is born and a person is immediately in love, but life isn’t always like that. Especially if we’re experiencing depression. We can struggle to feel love for our child(ren), struggle to bond with them, and struggle to see ourselves as a parent.
Talking about these feelings is hard. It can feel shameful. So shameful that we may not want to admit it to ourselves, never mind anyone else.
We end up feeling worthless, hopeless, useless, and possibly as though people would be better off without us.
Recognising and Coping With Perinatal Depression
HOW DO I KNOW WHETHER MY FEELINGS ARE ‘NORMAL’ FOR PREGNANCY?
Many of us are aware that pregnancy can trigger all sorts of emotions, and regularly comes with a variety of physical changes. We also know that post-pregnancy can send our hormones haywire and is often accompanied by many sleepless nights courtesy of our new family member(s). This can make it hard to tell when “normal” pregnancy bits and bobs become something to worry about.
Perinatal depression is usually more intense than “baby blues” and is likely to last longer than the first week or so after birth. It can have a significant impact on our daily life, and our ability to care for both ourselves and our child(ren).
We might find it helpful to keep a mood diary. This can help us to spot any patterns, and can be helpful to refer to when reaching out for support. If we have any worries at all about our mood, then it’s important to speak to someone about it. Our mood might end up improving without any additional support, but that’s okay! Nobody will ‘tell us off’ for sharing our worries, whether they turn out to be “baby blues”, perinatal depression, or something else.
HOW DOES PERINATAL DEPRESSION DIFFER FROM “NORMAL” DEPRESSION?
Many perinatal depression symptoms are very similar to “standard” depression, but some symptoms are more likely to feature as part of perinatal depression. One or two symptoms can be specific to pregnancy, birth, and being a new parent.
Though most new parents have a level of anxiety, when living with perinatal depression, or perinatal anxiety, it can be particularly severe. We may experience panic attacks, have intrusive thoughts, and struggle to leave the house.
As with ‘standard’ depression, some of us may experience some psychotic symptoms, including hallucinations and voices. This can feel scary and unsettling. As with perinatal depression, if we live with any perinatal illnesses – mental or physical – we deserve support.
RISK FACTORS
Risk factors for perinatal depression include poor social support, financial worries, family history, previous mental health problems, pregnancy complications, and a history of trauma. If we experienced depression with psychotic features in a previous pregnancy, then the risk of it happening again is around 30-50%.
These risk factors don’t mean that we definitely will or won’t develop perinatal depression. However, we may want to discuss any concerns we have surrounding the effect of pregnancy and birth on our mental health with our health provider. They will be able to monitor it with us and advise us as needed.
CAN PARTNERS GET PERINATAL DEPRESSION?
We can absolutely experience low mood and anxiety during our partner’s pregnancy and after they’ve given birth. If this is directly related to the pregnancy, then some may say it’s a form of perinatal depression. Others would define it as depression without the perinatal bit, as we’re not the one who was pregnant/has given birth.
Whatever the label, we deserve help and support. Whether we live with our partner or elsewhere, welcoming a new human into our life is a big thing, and it can do all sorts of things with our emotions. We’re often coping with a financial shift, adjustment in household responsibilities, a changing relationship with our partner, lack of sleep, and a big difference in the amount of free time we have. Alongside that, we may be experiencing difficult life events, have cost of living concerns, and find that memories from our past unexpectedly crop up.
Sometimes, our struggles can get lost in the whirlwind of caring for a baby, and our partner’s pregnancy recovery.
At times when everything’s starting to feel a bit much, prioritising self-care and our basic needs (as much as we can) alongside reaching out for support from friends, family, and/or professionals, can all help us to feel a little more ‘okay’ again. If we’re struggling with our mood or anxiety levels then we deserve the support we need to cope with the difficulties we’re facing.
HOW CAN I HELP SOMEONE WHO’S PERINATALLY DEPRESSED?
A good first step is to learn about it. Learn what perinatal depression may look like, and listen to or read accounts of how it may feel. This can help us to spot if a friend or family member is struggling, allowing us to reach in and support them, rather than relying on them to reach out.
Practical things can often be particularly helpful. Ask us what we need. Doing task ‘A’ might be somewhat helpful, but it could be task ‘B’ that we’re finding particularly tricky. Cook for us, so that it’s one less thing for us to think about that day. Support us to find local support. Give us a hand with the mountain of washing (why do tiny humans create quite so much washing?!). Don’t message us constantly, but check in every now and again. Sometimes it’s helpful to include in our message that we don’t expect a reply – otherwise, messages can create another demand that we struggle to meet.
Remember who we were before we became “parent of…”. When we have a child, people often start referring to us as “so-and-so’s parent”. This can be nice, but can also feel like it’s erasing our identity. We can forget who we were outside of our parent role. Bring our favourite film over. Remind us of any anecdotes that come to mind. Refer to us by name, rather than as a parent. Things for a new baby are lovely, but in all the new baby excitement, please don’t forget that we exist.
HOW CAN I HELP MYSELF IF I HAVE PERINATAL DEPRESSION?
When we’re unwell, helping ourselves can feel incredibly difficult, especially if we’re also trying to help a baby that relies on us almost constantly.
Telling others how we feel is such a hard step, but it means that we’re no longer coping alone. Sometimes our loved ones can pick up on a change in our mood before we do. They may also be able to offer practical and/or emotional support, and encourage and support to do things like have a shower or leave the house.
At a “basic needs” level, it’s important to keep eating, and sleeping (when we can). Trying to keep up with basic self-care (roping our partner, family and friends in to help us when needed) gives us the best possible foundation when trying to cope with our low mood.
In terms of professional support, we may find therapy or medication helpful. We will need to speak to our prescriber about any concerns we have in terms of our medication interacting with pregnancy or breastfeeding.
DOES PERINATAL DEPRESSION MEAN I’M A BAD PARENT?
No. Nope. Nah. Nooo. Absolutely not.
Perinatal depression is an illness. It’s not our fault. It is an illness.
Even if symptoms of our depression include thoughts about hurting ourselves or our child – it’s still an illness. It might affect how we parent slightly. It might mean that we have to rely on our partner or close family a little more than planned. We may need to access some professional support.
We may not be able to do all the things we’d always dreamed we would do in the first few weeks of our child’s life, but sometimes things happen. It doesn’t mean that we love them any less, nor that we’re automatically a bad parent. There are plenty of things to feel guilty about in life, especially when it comes to the tricky balance of parenthood, but being unwell is not one of them.
COMING TO TERMS WITH A DIFFERENT STORY
When we think of having a child, many of us have a certain image in mind. Developing perinatal depression probably wasn’t part of that plan.
This can be devastating. Having a child is a really big deal. We may have been trying for a baby for years, yet now we’re pregnant, we can’t summon any excitement. Depression is too busy stifling every positive emotion.
When we have a child, one of the overriding messages we’re given is “this time is something you only get once so make the most of it”, yet we don’t have the energy to make the most of it because depression has sucked it out of us.
In life, things rarely go totally to plan. Pregnancy is something which can be particularly unpredictable. There are so many opportunities for things to veer away from our carefully planned course of action. Depression might take us away from our planned path. When we write our birth plan and dream of what we’ll do with our newborn(s), we probably didn’t do so whilst running on two hours of sleep, only able to use one arm because our baby won’t settle unless we’re holding them. Accepting that and writing a new story – one that’s the right thing for our family and current situation, is hard.
But all any of us can do is our best. Our best will change from day to day (or hour-to-hour) but it is always good enough. We can’t do any more than our best.
WHAT DO I DO IF I HAVE THOUGHTS OF HURTING MYSELF OR MY BABY?
Sometimes, perinatal depression includes thoughts of harming ourselves, or our child(ren). This can range from thoughts of self-harm to thoughts of death and suicide.
These thoughts and feelings are absolutely not our fault and can be incredibly scary. We didn’t just wake up one morning and decide to be suicidal. We’re unwell.
These thoughts and feelings are something that it can be helpful to speak to a healthcare professional about. Telling them doesn’t mean that they will immediately teleport to our house and remove our child(ren) from our care. It should mean that they can help to support us to access the help we need.
One thing that it’s always important to remember, is that if we feel unsafe, totally unable to cope, or we’re struggling not to hurt ourselves or our child(ren), then there is help out there. In the UK, 111, 999, and local A&E are all available for medical emergencies – that includes thoughts like these. We are not alone.
IF I TELL SOMEONE HOW I FEEL, WILL THEY REMOVE MY CHILD?
We can’t say ‘no absolutely not’ because everyone’s circumstances are different.
However, professionals will usually do all they can to work with us to support us, our baby and our loved ones. They don’t want to remove children from people unless they have to.
Having thoughts about hurting ourselves or our baby doesn’t mean that we will carry them out. Struggling to bond with our baby doesn’t mean that we’re an unsuitable parent. Feeling depressed doesn’t mean that we can’t care for our child(ren).
Telling someone how we feel is the first step towards accessing the support that we may need. Accessing the help and support we need can help us to manage our mental health as effectively as possible, which puts us in the best possible position to care for our child(ren) in the way we want to.
WHO CAN I TALK TO ABOUT PERINATAL DEPRESSION?
Our partner, friends, and family are often there to listen to us. Whether we’re ranting, or just need to sit next to someone and watch a film together, they’re often more willing to support us than sneaky depression thoughts make us think.
Sometimes, we attend pregnancy or baby groups and meet others in a similar position to us. If we feel able to talk to other members of these groups, we might find them to be incredibly understanding and reassuring.
We might find speaking to a medical professional helpful. Depending on our stage of pregnancy, we’re likely to be under the care of a midwife or health visitor. These professionals are really experienced when working with all things pregnancy and birth. They will have dealt with many others who have experienced perinatal depression. Often, they’re a good first port-of-call because we know them, they know us, and they’re in a specialised job. They should be able to refer or signpost us to the most appropriate support for our needs and are often incredibly knowledgeable about the support available specifically in our local area.
Some of us may prefer to speak to our GP or another medical professional we see regularly. We could also access our local “Improving Access To Psychological Therapies” team if we’re in England.
Outside of the NHS, there are charities and organisations set up specifically to support those with perinatal depression and other mental illnesses. We might also find support in online communities – because we’re not the only one to have ever felt this way. We are not alone.
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