Men and Postnatal Depression

A considerable amount of work and research has been done on how men also can suffer from Postnatal Depression.

Like the reasons for women, it is multifactorial. Caring and supporting a partner through labour and birth can be extremely difficult for men who don’t like to see their partners suffering and in pain. They often feel helpless and try to ‘fix it’. But labour and birth are not like that. Men have their own release of male hormones in response to this. Adrenaline, testosterone to name a couple.

After the birth, there is exhaustion for them too, coupled with broken nights, worry about work, the future, guilt at watching their partners struggle with breast feeding, plus healing from the birth, all contributing to a lowering of mood in the days and weeks that follow.
The treatment for this is of course, first recognising the depression and for help with this there is a self-assessment tool on the NHS website, NHS choices. www.nhs.uk.
The National Childbirth Trust also have a lot of useful information on their website too. www.nct.org.uk
Talking Therapies is another great way of getting back on track as well as having a discussion with a General Practitioner (GP) who may prescribe a short course of anti-depressants if necessary.
The main thing is owning the sad feelings and not feeling guilty that you too (men) could be suffering from postnatal depression.

Beyond Birth Counselling offers services for partners as well.

Postnatal Depression

I was watching an interesting programme on BBC 2 last night, ‘The Baby has landed’. It was a documentary following six very different couples, during the later stages of pregnancy, the birth and then the time following the birth which as commonly known as the postnatal period.

It was striking to note how the different couples on the programme were coping and adapting to having a new baby and a new addition to a family.

My heart went out to all of them but the one couple that struck me the most was the couple having their first baby after a long labour resulting in a caesarean section for the birth. As is the norm now, they were home after a couple of days and settling back into life with a loving extended family.

Initially, as is fairly common, all was well. As time went on however, the baby became unsettled. Mum and dad became increasingly tired with broken nights sleep and then a downward spiral into the mum feeling that she was failing because she could not settle the baby. The grandmother was supportive and the partner was trying to be but he too was beginning to feel that he was doing it wrong and all this against a backdrop of advice, from well- meaning relatives.

The mum was doing all the right things, but it was easy to see that she was becoming too hard on herself and forgetting that not only had she been through labour, but had, had a major operation for the birth. I think women underestimate just how difficult those early weeks can be.

The Mother now had another life to care for as well as herself.

The baby is growing even after day 1 and will be demanding more food but also, babies cry for all kinds of other reasons such as loneliness and need reassurance. They have been so used to being in the womb for 9 months and now they are having to adapt to a new environment.
That is why skin to skin contact is so important. It actually physically affects the baby’s heart rate and breathing. It calms and soothes the baby and they are a perfect temperature close to your body. You don’t have to be breast feeding to do this and Dads can do it too.

Another couple had just had their fifth baby handled it well. Mum and Dad were back running guides and scouts after a week after the birth. It made me feel tired just watching the activity within the household. I was also a bit sad because every woman is different post birth and yet they measure their progress alongside, other women who make it look so easy. The women who make it look easy tend to be in the minority, but the woman with her fifth baby said that she liked to keep busy to stop her wanting to have another baby! This could be a trick played by the levels of Oxytocinon (necessary for bonding) in the body. The levels are so high for some women after giving birth, that they can make you believe that having another baby would be a good idea.

Also, it is this cocktail of hormones or lack of them, in particular Progesterone and emotions post birth that can contribute to some women developing post-natal depression.

Postnatal depression (PND) is the most common perinatal mental health disorder women experience in the first year after having a baby. Between 10% and 20% of women have depression and anxiety in pregnancy and after birth. PND is an illness and will get better in time. The reasons for this are multifactorial and the symptoms are many and varied.

There are lots of excellent websites that explain PND and perinatal health disorders. One being the NCT.org.uk/ and the NHS website who have a self- assessment depression screening tool that you can complete if you are not sure that this is what you are suffering from.

New mothers need to care for themselves as well as their baby and it is common sense to delegate as many of the household chores as is possible and use a good 2 weeks to rest and recuperate.

In the old days (not so long ago) the 2 weeks following the birth was known as the ‘lying in period’. Women were kept in bed and only allowed to look after the baby and themselves. This of course, contributed to a higher risk of developing a thrombosis (blood clot) or chest infection because the clotting factors in the blood become thicker and it takes a while for the blood to return to pre-pregnancy state.

Nowadays, postnatal exercises are encouraged including gentle walking and if there are any other risk factors for a blood clot, then medication and anti-embolic stockings (like flight socks) are advised.

Anxiety in Pregnancy

You will probably remember from my last post that evidence has shown that one in four women experience some form of mental illness during the perinatal period (this relates to the period of time before and after the birth) (Howard et al, 2018).
Most common mental health disorders are depression (11%) and anxiety (15%), but eating disorders, obsessive-compulsive disorder and post-traumatic stress are also seen.

These figures, though, do not always accurately reflect the true number of women who suffer, because a great number of mental ill health cases still do not get reported by the women themselves due to the stigma attached to them and the fear that women will be judged as being poor mothers who are unable to cope.

So, what exactly is anxiety?

Anxiety is a normal reaction to an unknown situation and many psychologists believe it is to be expected to be anxious about the unknown. However, it is the persons reaction to the stress response that needs to be addressed in order that it does not become all-consuming and colours an experience which otherwise should be an exciting and joyful time.
In other words, it is a feeling most people experience at various points in their lives but when it is constant and overwhelming and out of proportion to the situation then something needs to be done to address the anxiety.

Anxiety is a feeling of unease…

…like a worry or fear, that can be mild or severe. Everyone feels anxious from time to time and it usually passes once the situation is over. Anxiety can also cause a myriad of physical and mental symptoms although not everyone will experience all of the symptoms all of the time. I do not intend to list all the symptoms here or how to manage your anxiety. There are plenty of web sites where you can do this, for example…

Useful websites for symptoms of anxiety and how to help your self are:
http://www.nhs.uk/ and http://www.mind.org.uk/

Talking therapies such as counselling are beneficial.  Talking through your concerns with a counsellor and therapist will help you cope with whatever is causing you to have anxious thoughts.

Pregnancy and childbirth is a time of great anxiety for some women and some of the anxiety can be expected. Your body is in an altered state physiologically so its common sense to expect your emotions and psychological health to be altered. Every woman is different and will have a different anxiety relating to herself, the baby, the labour, how they will cope and so on.

I remember one of my pregnancies feeling terrified that every time the post person delivered a letter or a parcel that it was a bomb! (This being in the 1970’s when the IRA were setting off bombs in England). Why they would want to blow me up I don’t know, but all that I do know is that I had the fear. Fortunately, I was able to tell myself that it was because I was pregnant and feeling protective of my unborn baby.

I have counselled a number of pregnant women in the past who have presented to me, saying that they are just frightened, and they could not articulate the reason why.

One woman in particular, was however able to explain that there was no way that she could give birth to her baby – the very thought of it made her physically vomit. She displayed all the signs and symptoms of sheer panic at the thought of going through labour and childbirth.

After further discussion and talking to her we decided, together, that she had a mental health condition called Tokophobia .  A rare specific phobia with an overwhelming, debilitating fear of childbirth. So much so that in some instances (not in this case) women have been known to request a termination, avoid getting pregnant or as in this case opt for a caesarean section for the birth. This mental health condition can be managed if identified and as in this case a lot of work was done with myself, the clinical psychology team and the obstetrician who supported her request for a caesarean section. Other plans were put into place to support the woman, who was able to have a positive birth experience with a good outcome.

Rosemary A Harris.

Child Birth and Mental Health

According to the literature and articles written on mental health in Pregnancy and Childbearing, it is very common for women to experience mental ill health for the first time. This is due to many reasons, but mainly it is because women feel vulnerable and anxious about what changes the pregnancy is having on them physically as well as emotionally.

Just the very physiological changes in how your body functions when pregnant is enormous and not to be taken lightly or dismissed. Therefore, it follows that some alteration in mental health follows for some women.

When I had my children in the 1970’s and early 1980’s, you weren’t allowed to display any signs of being depressed or anxious and if you did, then the thoughts that you tried to express would be very quickly dismissed with comments such as:
“Nonsense, rubbish, what’s wrong with you – you should be happy you’re not ill, you’re just having a baby etc. etc.”

As for trying to talk through your birth experience then,that too,was another big taboo.

I remember trying to explain to a dear Aunt who was a Health Visitor and Midwife, how traumatized and shell shocked I felt after giving birth to my third child. Which incidentally, was classed as a ’normal vaginal birth’ with no intervention, but to me felt like I had been run over by a bus. I also felt overawed by the whole experience, even though I had given birth twice before. When I tried to express this to my Aunt her words were:
“Never mind. It’s over. Don’t think about it any- more. Read a book and take a couple of Codeine!’

Women were also afraid to express that they might be depressed because of the fear of having the baby removed from their care or judged as being poor mothers or simply not coping with the demands of motherhood.

When I read these words back, I feel that I could almost write a thesis, un-picking how powerfully negative they are and how unhelpful it is for women to have to hear these Kafkaesque phrases trotted out by well-meaning people including some health professionals.

Just the very hormonal changes in a woman’s body alone is enough to upset the equilibrium. Add to the mix recovering from being pregnant, the labour and birth and then a few weeks of broken nights and constant demands being made, it is no wonder that some women may feel ‘down or depressed’ following the birth.

Thank goodness attitudes are now shifting to mental health.
Midwives and other health professionals over the past decade have really moved the subject into the public arena and there is much more openness about the subject than there ever was before.

In the past, the emphasis had always been on ensuring that women and babies survived child-bearing which is of course the primary concern. But when you consider that maternal suicide is the fifth most common cause of women’s deaths during pregnancy and remains the leading cause of death in the first year after birth (MBRRACE, 2018) then the care and support for women with mental ill health in pregnancy and afterwards is essential and not an optional extra.

It is also essential that we continue to talk to each other and share our feelings and not be frightened to say to your doctor, health visitor, midwife or family when you are struggling with anxiety, depression or negative thoughts about your birth experience.

Remember it’s OK to not be OK and there is an abundance of help and support out there.

Rosemary A Harris.

Watch this space for further articles.