In this Q & A, Elizabeth Neal, an Inner West Mum and psychologist who specialises in maternal mental health, explains all about postnatal depression (PND): what it is, what it can look like from woman to woman, and what to do if you feel you are not coping with the demands of parenthood.
What is PND?
Postnatal depression refers to mood changes that occur to a woman after having a baby. Women with PND often feel disconnected from their experience of motherhood or from their baby in some way. Women with PND may feel a pervasive sense of hopelessness as well as anxiety and stress. Some women wish to withdraw while others become excessively busy. The feelings of hopelessness, stress and anxiety frequently relate to current and future life circumstances and relationships regarding one’s children, partner and extended family.
What are some of the signs of PND?
The signs of PND vary from woman to woman but are revealed through coping behaviours. These can be expressed by withdrawal and immobilisation, as is the case of some classic depressive symptoms, and a loss of interest in everyday things that used to bring joy or that should seem to be valued in motherhood – like bonding and taking care of a baby.
PND can sometimes be masked by excessive busyness and an inability to wind down. Women with PND tend to push off the idea that they are struggling, and this is in itself part of the mindset embedded within the thinking structure of a woman with PND. For these reasons, PND can go unnoticed until reaching a crisis point or when someone else points it out.
Some of the motherhood hormones make women more sensitive to the environment and this sensitivity is heightened further for women with PND. This can leave women more vulnerable to outbursts of anger or extreme irritation followed by feelings of extreme guilt and floods of tears – which snowballs the emotional and physical exhaustion.
When can it develop?
Official diagnostic criteria specifies that PND develops either during pregnancy or within four weeks of delivery. However, most clinicians working with women experiencing PND would consider any stage where a women experiences depressive symptoms relating to her role as mother as being relevant for treatment and support for PND.
What are some of the risk factors for experiencing PND?
Risk factors include histories of depression and anxiety, complications in reproduction, pregnancy or birth as well as premature or sick babies. Parenting stress and complications within the relationship with a partner are also major predictive factors in PND. In my clinical work, I find most women with PND also report a challenging relationship with their own mother or instability in childhood.
If you feel that you are not coping, what should you do?
Talk about it to someone you can trust whom you can be sure will support you without the fear of being judged. (Women with PND tend to have a higher sensitivity and fear of being judged by others, making it more difficult in taking that first step to reach out for help.) Contact PANDA or your GP for information and referral. Get involved in PND-sensitive Facebook groups or mothers’ groups.
If you feel your partner is not coping, what should you do?
Understand that your partner’s coping behaviours may be challenging for your relationship and for the family, but they are in place in attempt to manage underlying depression and anxiety. Compassion and openness is the first step. Being truly there to hear what’s at the heart of your partner’s challenges without demanding immediate change will not only support your partner but has the potential to bring you closer which may be the very thing they’re in need of. Many partners feel invisible, as though their opinion doesn’t matter, criticised, unfairly picked on, taken for granted and generally second rate after the birth of a baby. These feelings are rarely communicated directly, therefore leaving the partner’s needs suppressed.
If you feel you or your baby is at risk of harm, what should you do?
If a person is concerned they (or someone else) may be at risk of harming themselves or their baby, they can get support from:
A hospital emergency department
A local Mental Health Triage service
Suicide Call Back Service 1300 659 467
Lifeline Australia 13 11 14
PANDA’s National Helpline 1300 726 306
If anyone’s safety is at immediate risk a person should call 000 for an ambulance or the police.
What are some of the treatment options?
As a psychologist, I prioritise working with cognitive, behaviour and interpersonal therapy in a counselling capacity. There is also a range of other treatment options, including medication as prescribed by doctors, alternative and complementary therapies, early parenting centres, support groups, mother and baby units and inpatient programs.
What are some of the things you focus on when working with a client suffering from PND?
Enhancing the relationship between parent and child in my clinical experience translates to more child cooperativeness at home and better organisation at school, etc. We implement strategies for daily struggles, such as resistance, meltdowns, clinginess, aggression, whining, etc., with the focus being a reduction in maternal distress and overwhelm.
Relationship with partner
We focus on supportive communication to deepen understanding of challenging moments or circumstances. I help couples manage conflict better and offer solutions to having disagreements in more constructive ways rather than destructive ways or avoiding them altogether. We also build on the connection and friendship, which is the springboard for managing everything else in the relationship.
The experience of self
Motherhood changes a woman’s identity. Sometimes this is comfortable and easily embraced, but for many women with PND, it can be a struggle. A large part of therapy is to help a woman to deepen her understanding her own thoughts and feelings about herself and her circumstances, where things are getting stuck, and what she needs. We work to identify how true the client feels she is being with her self, what parts of her self she feels are being suppressed in motherhood, and where her sense of purpose lies. I work holistically from a psychological perspective and support each woman in a way that works best for her. Some women identify with Cognitive Behaviour Therapy strategies and others prefer a more psychoanalytical approach. Regardless of the approach, the treatment is tailored to fit the individual’s needs regarding mood, feelings and behaviours.
If your partner has been diagnosed with PND, what are some of the key ways you can offer support?
The best thing any partner can do is to be fully open and emotionally available, to be patient and to help their partner identify their own solutions to problems in their own way, rather than expressing criticism and outward frustration.
Are the risks of experiencing PND with subsequent children higher? What do you suggest to those parents who might be considering having a subsequent child but are fearful of experiencing PND again?
If PND has gone unnoticed and untreated then yes, women will be more at risk of experiencing it with subsequent children, or if subsequent children are particularly more challenging than firstborns, or if there are other challenges co-occuring with the birth of subsequent children.
With subsequent children, the first child or second child will be older – often in the midst of the toddler or preschool years which can be challenging, particularly as an older children adjusts to a new baby. So PND with subsequent children may not only relate to the arrival of a newborn but also with underlying stress and overwhelm with the older first child.
In some cases, the arrival of subsequent children can bring about healing, particularly if PND with a firstborn related to birth trauma, challenges in feeding, or other areas a woman felt she ‘underperformed’ in some way.
Liz is the owner of Elizabeth Neal Psychology in Gladesville. She has recently written an article about worry and motherhood for her website: ‘The Worrying Mind in Motherhood’.
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