Perinatal Depression and Anxiety; A Midwife’s Advice

Screen Shot 2016-05-10 at 12.06.08by Hannah Horne

Becoming a Mother is an all consuming, life changing event. Any such event can trigger emotional highs and lows, add to that the hormonal and physical changes of pregnancy, childbirth and postnatal period it can be a very challenging time. Lindsay has asked me to give a Midwife’s perspective on postnatal depression. I hope that writing this blog will provide anyone who is struggling with perinatal depression or anxiety with information to assist them to access help and support.

The World Health Organization estimate 10% of pregnant women and 13% of postnatal women are affected by a mental health disorder worldwide, and in developed countries these rates may be 15.6% in pregnancy and 19.8% postnatally (WHO, 2016). Additionally, 85% of women will experience the ‘baby blues’, a brief period of emotional instability/tearfulness within the first couple of weeks following birth which usually lasts a few days before resolving (Mind, 2013). If symptoms of sadness or tearfulness, feeling down or numb, feeling hostile or indifferent towards others, feeling very anxious or guilty, hopeless or worthless, being unable to cope or concentrate, or difficulty with sleeping are persisting beyond two weeks, then it is possible you are experiencing a perinatal mental health disorder.
Firstly, if you are a Mum-to-be or New Mum who is experiencing difficulties in coping with pregnancy and the postnatal period please be aware that you are most definitely NOT alone. Secondly, I want any  woman experiencing this that no matter how bad you feel right now how you are feeling will not last forever and you will get better, with appropriate treatment, help and support. I would say that any woman who is questioning herself as to whether she has a perinatal depression or anxiety probably has got it to some degree. Here are some of my ideas to help you seek support and start on your road to recovery.
  • Admitting you have a problem to yourself
The first step to recovery is admitting you have a problem. At a time when a woman
‘should be’ happy and content it is incredibly difficult to concede that you are feeling exactly the opposite. When experiencing symptoms of depression it is very difficult to think rationally, you may feel guilty for not being happy or content, which in turn makes you feel worse. Once this cycle of thought takes hold it is very difficult to break. It is not your fault. Once you recognise that you are not feeling yourself and you are not coping then you can take steps to move on. If this takes some time for you to identify, or come to terms with, that is OK.
  •  Deciding who to speak to
Each woman is an individual, as is her experience, therefore it is an individual choice who you choose to tell. There is no ‘right’ person. It is who you feel you can talk to. For some it will be a partner, friend or relative because it feels easier to speak to someone close who you feel will understand and be able to support you to seek professional help. For others it will be a Midwife Doctor or Health Visitor. Their objectivity may make it easier for some to admit their problems to before having the additional emotional ties of talking to family and friends. It really doesn’t matter who you choose to speak to first, as long as you seek some help.
  •  Telling People

This is a massive step and you will probably feel terrified/overwhelmed/upset so try not to worry too much about what you’re going to say. Say how you are feeling, say you are not coping, say “I have depression”. Say whatever feels right. Whatever you say the point is that you are asking for help. As long as you get your message across say whatever feels right. If you feel it will help you might want to write down what you want to say to take with you. Don’t be frightened of being judged. Midwives,  Health Visitors or GPs will be supportive, they will feel for you and want to help you. Family and friends will probably have noticed that you are not yourself and will be relieved that they can do something to help you. Once you have told one person you need then you can move on to telling other people.. It may feel overwhelming but the first time you talk about how you are feeling is the worse, and after that it does gradually become easier. If it is a healthcare professional you have spoken to first they may be able to provide you support in telling family and friends. You may find that writing/emailing/texting is easier than actually talking about what you are experiencing. If this is the case then do  it. If talking face to face seems the best option for you then do that. Just make sure you are doing what you can cope with. If you have told a family member or friend first then they can come to see your Midwife/GP/Health Visitor with you for support and may be able to speak up for you. One appointment with a GP may not be enough; you may not be able to take in information about recovery or medication, or you might walk away without saying what you wanted or asking certain questions. Make further appointments if you feel you need them and possibly write down how you are feeling or any questions so you can discuss this at your appointment.

  • Don’t be afraid of medication
If you are experiencing anxiety or depression medication can and will help. When you feel hopeless then needing medication can seem like another stick to beat yourself with. If your bone was broken you would take pain relief. If your thyroid wasn’t working you would take thyroxine. You wouldn’t think it was your fault that you were unwell so you should be able to cope without medication. Try to think of medication for anxiety or depression in this context. If you are pregnant or breastfeeding there are medications which you can take. Your GP can take advice from mental health services if need be to find the appropriate medication for your individual circumstances.
  • Thoughts are only thoughts
When you are anxious or depressed it can feel like negative  thoughts or worries are out of your control. Often they are. However, when this happens try to remember thoughts are only thoughts and thoughts and not actions. If you start to feel out of control try counting back from 500, reciting favourite song lyrics or a poem. The brain cannot focus on the negative thoughts as well as the task you chose it to think about so this can help you take back control of the negative thought cycle.
  • Setting up a Support Network
You will need a support network to help you recover. One person will not be enough for you to seek help from, and they will  need support too. You may decide that a small core group of  a few people would be enough for you to seek help from without feeling overwhelmed, or you may decide telling everyone will help you to be understood and therefore cope better. Some people need to talk to others about their feelings. Others find practical help is more useful. Tell people what you need; whether that’s someone to have a cry with over a cup of tea, or someone to take the baby for a walk while you sleep or have your hair cut or  nails done. Any one who cares about you will want to help you feel better so will be happy to help in any way they can, but may not know what to do or say for the best. If you tell them what will help you then it will be useful for everyone. Whatever it is you need to feel better, don’t feel guilty about it. There are support groups, counselling and talking therapies, such as Cognitive Behavioural Therapy. Try whichever you think will suit you, or try them all the decide which helps you most and focus on that. There are also online support groups which may help if you find talking face-to-face difficult.
  •  Be Kind to yourself
Try not to add pressure on yourself. Forget the jobs mounting up and the ‘to do’ list. Just focus on what you can cope with and forget the rest. Prioritise yourself and your baby. Take time to do what makes you feel better. Try some activities that help you connect with your baby; baby massage, baby yoga, swimming classes or just talking or reading books to your baby. Additionally, getting out and mixing with other Mums will help you, identifying with their transitions to motherhood and sharing tips on how to cope.
  •  Just keep on going
When you feel out of control, down, depressed or numb every day tasks can seem overwhelming but try to keep just going through the motions. Put one foot in front of the other. Focus on the moment and not the rest of the day, the week or the year. Alongside, medication and talking therapies you will eventually stop just ‘going through the motions’ and you will start ‘feeling’ and living again, with time.

WHO (2016) Maternal Mental Health (02/05/16)

Mind (2013) Postnatal Depression (02/05/16)

Online Support

Recommended Reading:
Dalfen, A (2009) When Baby Brings the Blues. Canada; Wiley and sons

One thought on “Perinatal Depression and Anxiety; A Midwife’s Advice”

  1. Well done Hannah! This is a fabulous article which will help so very many women – some of whom struggle to accept that they need help. Recognising that they are not alone is a huge step towards recovery and having life back on track.

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