Postnatal Depression is often called "the thief that steals motherhood". Devastatingly sad, but true all the same. In mining communities, where women are often isolated and far from face-to-face medical support, the issue is particularly pertinent. Here, Flinders Medical Centre Perinatal Mental Health Clinical Practice Consultant (CPC) Jane Woolmer answers our questions...
Q: How widespread is Post Natal Depression (PND) in Australia?
A: Fifty to eighty per cent of women will experience the baby blues within three days of giving birth, which results in the mother's mood lowering and she becomes tearful. This is normal and should have resolved within the first week of childbirth. PND affects 16 per cent of women during the perinatal period (conception to the first year of the baby’s life). PND might develop during or after pregnancy and can also be accompanied by perinatal anxiety. It might develop over a short period or over a longer time. PND not only affects the mother but also her partner and baby. PND is called "The thief that steals motherhood" for a reason.
Q: What are the symptoms (i.e. how can people recognize it in themselves and others?)
A: Symptoms of PND include:
- Depressed or low mood
- Feeling numb (even towards the pregnancy or baby)
- Diminished pleasure, or interest in usual activities
- Sleep disturbance
- Appetite changes
- Loss of energy and motivation
- Feeling guilty or worthless
- Diminished concentration or indecisiveness
- Frequent thoughts of death, suicide or harming the baby
Unfortunately, some of these are also a part of pregnancy and motherhood. Women with PND also describe:
- Sleep disturbance unrelated to baby
- Appetite disturbance unrelated to pregnancy
- Crying inside and out
- Inability to cope
- Irritability with baby and family
- Anxiety and restlessness
- Negative intrusive thought
- Fear of being alone (sometimes with their baby)
- Feeling inadequate, low-esteem, lacking confidence in being a new mother
- Feeling disconnected from the pregnancy or baby
Q: Are some people more susceptible than others?
A: There are particular risk factors for women becoming depressed during or after pregnancy, accumulative stress is a big factor others include:
- A family history of depression or anxiety
- A past personal history of depression and anxiety
- Social isolation/lack of social supports
- Financial stressors
- Current drug or alcohol use
- History of child abuse (physical, emotional, sexual)
- Traumatic and stressful life events such as bereavement, relationship stressors or domestic violence or a difficult pregnancy or birth experience
Q: Lots of mining mums raise kids in remote areas, away from strong support networks, or in DIDO/FIFO relationships where their partner works away for extended periods of time. Could this make them more susceptible?
A: Social isolation, which is common to mining families, is one of the psychosocial risk factors for PND. Being near to support systems and family networks can be a resilience factor to help pregnant women and new mothers cope with the physical, emotional and social changes of pregnancy and motherhood. Other issues such as not knowing about local health and social support resources or having to birth in a specialist obstetric centre hundreds of kilometres away because of a high-risk pregnancy may also pre-dispose a woman to PND.
Q: What should people do if they think they’re suffering from PND – or know someone else who might be?
A: We know the perinatal period is an ideal opportunity for women to address some of their health issues, both physically and emotionally. If a pregnant women or a new mother feels depressed or has the symptoms of depression it is important that she doesn’t blame herself. She should not feel ashamed or frightened, but try to see this as an opportunity to get the right support and to enjoy her pregnancy and baby. The GP/midwife, obstetrician or maternal child health nurse might be their first port of call, as a number of health professionals are now screening women for postnatal depression. Here the woman’s emotional health issues can be assessed and a plan put in place to access appropriate support and treatment. This can be difficult for women who are new to country areas and may not be aware of local services. There may be Visiting Specialist Professionals who also FIFO on a regular basis. There are also telephone and internet support services for women with postnatal depression (listed at the end of this article).
Q: What are the treatment options for women with postnatal depression?
A: Treatment s available includes therapeutic/talking therapy, either face to face or by phone. There are now also internet programs which allow women to gain psycho-education without leaving their home. Some states also have links with metro-based mental health professionals via teleconferencing. Other options include medication such as antidepressants. Some pregnant women and breast-feeding women worry about taking medication because of possible side effects. This should be discussed with their treating doctor and women on antidepressants should not just stop taking them without the support of their doctor. There's a national helpline providing info on medications in pregnancy, and that can be accessed by members of the public and professionals. (Again, it can be found at the end of this article.) For many women, finding a way to manage some of the symptoms of depression (and indeed of being pregnant and a new mother) such as sleep disturbance can be helped through the use of basic problem-solving techniques, meditation and relaxation and breathing techniques, as well as making sure they eat and drink properly - something that new mums often forget to do.
Q: What is your main message to women in remote areas?
A: To realize that they are not on their own, don’t feel embarrassed or ashamed and to get help and support.
Q: Anything else you’d like to add?
A: Pregnancy and birth can be a wonderful experience, but in the western world we idealize and over-emphasize the positive aspects of pregnancy and motherhood. Most pregnant women and new mums have worries about harm befalling their baby. While most people recognize that children and adults have emotional and social health, few people realize that babies do too. Having a mother who is suffering from untreated depression may make some of the emotional and social developmental tasks of the infant more difficult to achieve.
- PANDA (Post and Ante Natal Depression Association): 1300 726 306
- Beyond Blue: 1300 22 4636
- Lifeline: 13 11 14
- Teddy Love Club, for parents bereaved by miscarriage or stillbirth: 1800 824 240
- Kids Helpline: 1800 55 1800
- Pregnancy and birth helpline: 1800 882 436
- Medication in pregnancy and lactation: www.otispregnancy.org
- Royal Women’s Hospital Medicine Information Service: 03 8345 3190
- Moodgym (mental health training program online)