• So You're Expecting A Baby!
• Types Of Postnatal Mood Disorders
•Postnatal Mood Disorder Affects the Whole Family
• Who Is At Risk?
• Can Postnatal Mood Disorders Be Prevented?
• If You Think You Have a Postnatal Mood Disorder
  You Can...

So You're Expecting A Baby!

Having a baby can be a wonderful time, but it can also be stressful.  Parenting is like no other job you've  taken on.  The responsibilities can seem overwhelming at times.  Having a baby is a major life change for first time parents, as well as for families with children.

Many women and families have unrealistic expectations about what it will be like to have and care for a new baby.  Putting pressure on yourself to be a super mom can set you up for failure.  Adjusting to becoming a parent, when you are tired, sore, and trying to care for a crying baby, is hard at the best of times.  No one can do everything!

The prenatal period is a good time to plan for your new baby.  Talk to your partner, family, and friends about how they can help now, and after your baby arrives.  Arrange for help with meals, housework, and child care for a week or two after your baby is born.  You will need all the rest you can get, as well as time for learning how to feed, care for, and enjoy your new baby.

During pregnancy, your body and mind have to deal with fluctuating hormone levels, physical changes, new roles and responsibilities, changing relationships, and decisions about career and lifestyle.  It may take time for you to feel the pregnancy is real, and to accept that you are going to be a parent.  It is normal to feel unsure and to have fears about your baby's health, your ability to parent, finances, giving birth, and changes in your way of life. 

On a day-to-day, or even hour-to-hour basis, your emotions can range from joy to doubt and sadness.  Mood swings are normal, but if you are feeling down all the time, you may be experiencing a mood disorder which can begin during pregnancy.  If you become depressed during pregnancy, there is a 40-50% chance you will remain depressed postnatally, after the birth of your baby.

Types of Postnatal Mood Disorders:

Postpartum "Blues"or "Baby Blues" are common.  Approximately 80% of women have the blues starting three to four days after their baby is born.  They may feel weepy, sad, tired, irritable, sensitive, anxious, overwhelmed, or confused.   With good physical care, emotional support, and information, these symptoms usually subside within two weeks.  If after two weeks these symptoms continue or worsen, it may be a more serious problem.

Postpartum Depression occurs in approximately 30% of women who have a baby.  Depression may develop any time in the first year, but more often appears two to four months after a baby is born.  Women with depression may have symptoms similar to the blues, but they last longer, are stronger, and interfere with their ability to carry out day-to-day activities.  They may also:

• feel out of touch or not themselves;
• have persistent aches and pains;
• feel worried, guilty, overwhelmed, hopeless, panicky, or trapped;
• have difficulty sleeping or relaxing;
• eat more or less than usual;
• lose interest in doing things or seeing people they once enjoyed;
• become easily frustrated, irritated, or moody;
• have problems concentrating and completing tasks;
• have difficulty, or not enjoy, caring for their babies; and 
• even have thoughts of harming themselves or their babies.

Postpartum Psychosis is rare, occuring in .01-.02% of births.  It usually begins within a few hours or days after delivery, but can occur later.  A woman with postpartum psychosis loses touch with reality, becomes suspicious, and may have strange and frightening thoughts.  She may be unable to sleep or eat, slow down, or relax.  Her judgment may be impaired, and she should not be left alone with her baby.  She needs immediate medical attention, and often, hospitalization and medication. 

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A Postnatal Mood Disorder Affects the Whole Family

For partners, the symptoms of a postnatal mood disorder may be frightening and difficult to understand.  A family's ability to carry out day-to-day activities is affected and may lead to denial, anger, or despair.  Women, devastated by feelings of shame and guilt, often blame themselves.  The development of the new baby and other children may be affected if the disorder goes untreated.  It is important for all family members to understand and be involved in treatment.  Don't suffer in silence.  The whole family is affected by postnatal mood disorders.

Who is at Risk?

Anyone can develop a postnatal mood disorder.  It is not known for certain what causes these conditions, but there are factors that increase the risk:

• depression which develops during pregnancy;
• personal or family history of depression, or other emotional problems (e.g. anxiety or eating disorders);
• severe premenstrual syndrome (PMS);
• thyroid disease;
• history of physical, sexual, or emotional abuse;
• difficulties in a woman's relationship with her mother or father;
• use of drugs or alcohol to cope with problems;
• not having enough or the right kind of support after a birth;
• personality traits, such as having high expectations of yourself and others, a sad or pessimistic outlook, or low self esteem;
• recent losses (e.g. death of a loved one, loss of job, miscarriage, moving, or loss of freedom);
• history of infertility, high risk pregnancy, or difficult delivery; and
• stressful life events (e.g. money or relationship problems; a sick, fussy, or colicky baby; an unplanned pregnancy).

Can Postnatal Mood Disorders be Prevented?

Prepare yourself before your baby arrives.  Go to prenatal classes, learn about baby care and breastfeeding, and get supplies together - that's a good start.  It is also important to prepare yourself emotionally.  Talk to your doctor or a public health nurse about normal adjustment to parenting, signs of trouble, and where to get help.
 

Talk with your partner realistically about what life will be like after your baby is born.  Be clear about how your partner can help.  Difficulties in relationships often become worse with the stress of a new baby.  Try to deal with problems before your baby arrives.

Don't be afraid to ask for support from others.   Make plans for someone to help with meals and housework for a few days, or even a few weeks.

Have friends and family delay visiting until you are feeling up to it.  Plan to have people around you who you feel are supportive.  Avoid  people who are negative or overly critical until you are feeling emotionally stronger.

Find someone to talk to about your worries, fears and feelings.  Talk to your family doctor or midwife, public health nurse, or other support person.
 

Being prepared is the best prevention.

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If You Think You Have a Postnatal Mood Disorder, You Can ...

Get help!  Talk to someone about how you are feeling so they can help.  It is important for you and your family to know the signs and symptoms of postnatal mood disorders.  Often you may not recognize the symptoms or may deny them.  Postponing treatment can delay recovery for months, or even years. 

Talk to your doctor or health care provider.  If this is not helpful, or you feel they don't take your concerns seriously, keep trying; see someone else.  If you are not able to see your doctor, and you feel it is urgent, go to the Hospital Emergency Department. 

Consult a Public Health Nurse (PHN).  A  PHN will listen, tell you about resources in the community, and provide information to help you choose a treatment which is right for you.  The treatment you choose will depend on how severe your symptoms are, your preferences, and previous experiences. 

Take good care of yourself.  Eating well, sleeping, resting, and daily exercise can reduce stress and help you recover.  Don't criticize yourself.  A postnatal mood disorder is an illness, and is not something you can wish away.  Be positive and realistic about what you can and can't do.
 

Delay major decisions until you are feeling better.  A mood disorder affects your concentration and ability to think through problems.

Avoid alcohol and non-prescribed drugs, as these can make depression worse.

Ask for support from family, friends, and support groups.  You may need help caring for yourself and your baby, doing housework, and making meals, for as long as ittakes to rebuild your energy.  You will need people who will listen without judging, and who are patient and caring.  You may be surprised to find that a close friend or relative has had a postnatal mood disorder in the past.

Get counselling.  Psychologists, social workers, psychiatrists, and other qualified professionals offer one-to-one, couples, or group sessions, depending on what is best for you.

Consider antidepressant medication.  Antidepressants are not addictive and there are many to choose from.  Talk to your health care provider about which medication is best for you.  Always take your medication as prescribed, even if at first you don't think it is helping.  Medication may take two to six weeks to start working, and improvement is gradual.  Side effects usually lessen in the first week or so.  If one medication doesn't work for you, there are many others your doctor can try.

Keep follow-up appointments with your doctor or counsellor.  Your health care provider needs to know how you are feeling, if your symptoms are changing, or if you are having side effects to medications.
 

Which treatment will work best varies from individual to individual.  Often the combination of support, medication, and professional counselling is the most effective approach.

Talk to your doctor, health care provider, or a Public Health Nurse.

For more information about  Postnatal Mood Disorders, call the Family HEALTHline at 743-1000