Perinatal depression occurs during pregnancy and affects between 10% and 20% of women. It can begin at any stage in the pregnancy. Although some women develop perinatal depression during just one of their pregnancies, others may experience repeated episodes throughout the period of pregnancy.
During pregnancy it is common for a mum-to-be to feel tired, have trouble sleeping, and not feel themselves emotionally. Women can suffer with perinatal depression without even realising it. Symptoms of perinatal depression can include:
- Frequent tearfulness without any identifiable reason
- Trouble sleeping (unrelated to frequent urination)
- Daily fatigue or low energy
- Mood changes
- Changes in appetite
- A loss of enjoyment in once pleasurable activities
- Withdrawal from friends and family members
- A pervasive sense of fear or anxiety without a known trigger
- Trouble feeling connected to the developing baby (sometimes referred to as poor foetal attachment)
- A fear of not loving the baby when he or she arrives.
What causes perinatal depression?
If you have experienced depression prior to your pregnancy, then your symptoms may be more significant during pregnancy than they were. Although, this is not to say that women who have experienced depression will invariably develop perinatal depression. Other causes of perinatal depression include:
- The pregnancy is unexpected or undesired
- A difficult relationship with the baby’s father
- Stress during pregnancy such as financial worries, bereavement or housing problems
- Age (approximately 50% of teenage mums-to-be experience perinatal depression)
- Limited support from a partner, friends or family members
- A ‘high-risk’ pregnancy or concerns about the baby’s health
- A history of depression, panic disorder, anxiety or premenstrual tension (PMT)
- A family history of perinatal depression
- A history of depression when using hormonal contraceptives such as birth control pills
- A history of trauma or abuse during childhood or adolescence.
What can help if you have perinatal depression?
If you have a history of mental health issues such as bipolar disorder, depression or anxiety and are planning for a baby, speak to your GP for advice. If you’re currently on medication for your mental health, it’s important that you don’t stop without seeking medical advice. Your doctor can arrange for you to be monitored appropriately when you become pregnant, throughout your pregnancy, and after your baby arrives. This is not to say that your doctor will see you as ‘high risk’ but that there will be certain types of support from which you will benefit.
Regardless of whether or not you have a history of mental health issues, it’s crucial that you let your doctor know if you start to develop symptoms of emotional distress while pregnant, or you feel you’re not coping as well as you would like.
Prenatal care isn’t just about keeping your baby healthy – it’s about maintaining your wellbeing too. Make sure that you attend all of your prenatal appointments, and let your doctor know if you’re feeling unwell, either emotionally or physically. The earlier you get help, the better for both you and your baby.
It’s also really important to eat well throughout your pregnancy. A balanced diet will benefit both your wellbeing and that of your baby.
Treatments for perinatal depression
Don’t attempt to treat perinatal depression without the advice and support of your GP. They will be able to advise you on the best course of action, and also rule out other possible causes for how you’re feeling. You might be offered medication of a type which is safe for pregnant women, or therapy such as talking therapy or cognitive behavioural therapy (CBT). Your GP may also suggest local support groups, appointments with the surgery’s nurse practitioner, the assistance of your health visitor, or other types of help.
The baby blues
About 80% of new mums will experience the baby blues. Although it’s not easy, it’s absolutely normal and symptoms will usually recede within 14 days of giving birth. Signs that a new mum is experiencing the baby blues start within the first few days of giving birth, and can include:
- Feeling generally emotional, sad, irrational or overwhelmed
- Impatience and irritability
- Low-level anxiety without a specific trigger
- Unexpected tearfulness without a known reason
- Changes in mood
- Insomnia even when the baby is sleeping
- Poor concentration
- Forgetfulness or ’brain fog’
- Changes in appetite.
Most women who experience the baby blues report that their symptoms don’t occur 24 hours a day and that they have times when they feel their usual self. The majority of women report feeling ‘back to normal’ within ten days to two weeks postpartum.
What causes the baby blues?
Carrying a baby and giving birth is one of the most demanding physical experiences a human being can go through – not to mention the many emotional changes that occur both during and after pregnancy. Although the exact cause of the baby blues is unknown, it’s thought to be caused by a number of factors, including the hormonal changes experienced during pregnancy and after birth, and the enormous physical and emotional adjustments needed for the new arrival.
As any parent can attest, when a new baby arrives, life as you knew it changes completely. Sleep is often negatively affected, daily routines need to be re-navigated, and worries over money and housing can play a part in feeling overwhelmed. It’s also important to note that some women may not experience the baby blues at all after the arrival of their first or second baby but may find it develops with subsequent births.
What can help if you have the baby blues?
- Let your health visitor know if you’re struggling. There is nothing to feel ashamed about – having the baby blues doesn’t mean that you’re not a great mum! It just means that you’re adjusting to a brand new life which can take a little bit of time. Your health visitor or GP will also be able to offer you guidance and advice on how to cope.
- While sleep might be at a premium, make sure that you get enough of it. Napping when the baby is asleep can help you to catch up on much needed rest. If you’re supporting your partner after the birth, aside from offering to help with household chores such as cleaning and cooking, remember that sometimes a new mum just wants someone to ask her show she’s feeling, and a reminder that she’s doing a great job.
- Make sure that you eat well and regularly. Even if you’re not breastfeeding, you still need to eat healthily. Don’t rely on sugar and caffeine to deal with fatigue – it will only make you anxious (and low when the effect wears off). Feeling too tired to cook can also mean that you rely on too many simple carbohydrates, but these can make you feel low, sluggish and moody. Make sure you get your five a day and ask your health visitor if you should consider taking any nutritional supplements.
- Although many new mums feel under pressure to get back to their pre-baby fitness level within days of giving birth, this isn’t possible and it’s certainly not fair! Pressure from the media can cause new mums to worry about our looks and shape, when what we really should be focusing on is looking after ourselves and our baby. Get outside every day – even for a short walk – and feel good about the action you’re taking. You might also want to have a look at the NHS Fitness Studio which offers easy to follow exercise videos you can do at home, at your own pace and in line with your own fitness level.
- Women who have recently given birth as well as those who are breastfeeding require a balanced diet to meet the demands their bodies are facing.
- Don’t expect perfection in the first few weeks. Give yourself time to adjust and be kind to yourself.
Postnatal depression (PND)
Also sometimes referred to as postpartum depression or antenatal depression, about 10% of new mums will experience PND. Symptoms can start at any time within the first year of giving birth and are more severe and long-lasting than those associated with the baby blues. PND can have a significant impact on you and your family, and left untreated, it can become worse over time. However, with the right support, a full and lasting recovery is possible.
In addition to the symptoms listed for the baby blues, women with PND may also experience:
- A persistent, day-to-day feeling of sadness, emptiness or low mood
- A lack of enjoyment in the things they usually like to do
- Withdrawal from family and friends
- Daily fatigue
- Difficulty physically or emotionally bonding with their baby
- A feeling that they don’t love their baby
- A pervasive fear that they’re ‘a bad mum’
- In some cases, women report having distressing thoughts about wanting to hurt or abandon their baby.
What causes PND?
There appears to be many causes for PND, which can include:
- A history of mental health problems, particularly depression, earlier in life
- A history of substance misuse, or current misuse of alcohol or drugs
- A history of mental health problems during pregnancy
- A lack of close family or friends to lean on for support
- A poor relationship with your partner
- Domestic abuse or other difficulties in a relationship
- Recent stressful life events, such as housing problems, bereavement or financial worries.
What can you and your partner do if you have PND?
- It’s critical to speak to your health visitor or GP if you’re experiencing any symptoms associated with PND. Many women don’t even realise that they have PND because symptoms can come on very gradually. Health professionals know that PND is not a reflection on your ability as a parent – it’s an illness and with the right kind of support, it can be treated. But remember – PND won’t go away by itself. Seek help as soon as you notice any changes in your wellbeing.
- Lifestyle changes can really help manage symptoms of PND so ensure that you’re eating well, getting enough rest, and letting your loved ones know when you need help both practically and emotionally.
Treatments for postnatal depression
Postnatal depression can be lonely and distressing, but support and effective treatments are available. Depending on your situation and history, your GP might recommend:
- Talking therapy
- Medication which is safe to take while breastfeeding (if your depression is more severe or other treatments have not helped).
Other helpful resources
Pre and postnatal mental health
Pre and Postnatal Depression Advice and Support (PANDAS) provides expert guidance, advice, signposting and downloadable information. You can also access online support from other people experiencing pregnancy-related depression.
The Maternal Mental Health Alliance offers a range of services including a national directory of organisations which offer support and guidance.