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What can be done to help?
A great deal, but first the Post Natal Depression must be recognised.
Many depressed mothers don't realise what is wrong with them, and are
ashamed to admit that they are less than thrilled by new motherhood.
They may think that if they say how they feel the baby may be taken
away (it won't be). Some doctors and Health Visitors are good at spotting
PND, because they know about it and look out for it, but others overlook
or ignore it, or say, wrongly 'Oh, that's just the Baby Blues'.
Now that there is a greater awareness of depression in general, PND
should be missed less often. A questionnaire with only 10 questions
is now widely used and is helping Health Visitors and GPs to spot the
disorder - it's called the Edinburgh Scale.
Once the condition is suspected, the mother is encouraged to say how
she has really felt since she had the baby. If she says that she has
felt miserable, irritable, incompetent, frightened and not all that
keen on her baby this is accepted with compassion and understanding,
not alarm and reproaches.
It helps many a mother to be told 'You've got PND'. At last she knows
her enemy. She can be reassured that she is not a freak or a bad mother,
and that many others are in the same boat. PND is very common and anyone
can get it (like flu). She can then be told that she will get better,
but it may take time, and that arrangements will be made to see that
she is supported until she has recovered.
It is now important to bring the partner into the picture, so that he
can understand what has been going on (he, too, has been suffering from
PND!) and be helped to be helpful. He is usually best placed to give
support, provided that he has goodwill and gets a bit of support himself.
If this is the first baby he may have been feeling pushed aside by the
new arrival. If he then feels resentful without grasping how much his
partner needs his support and encouragement, he may withdraw and add
to her problems. He too may be hugely relieved by the diagnosis and
guidance about what to do. Practical help with the baby, sympathetic
listening, patience, affection and being positive will go a long way:
they will be much appreciated even when at last the depression is over.
What about 'talking treatments'
The opportunity to 'off-load' to a sympathetic, understanding, uncritical
listener - who could be a friend, a relative, a volunteer or a professional
- can be a great relief and release. Many general practices now have
a counsellor, and trained Health Visitors have been shown to be helpful
to groups of depressed mothers.
More specialised psychological treatments, such as psychotherapy ('Let's
try to understand this depression in terms of what has happened to you
in the past') and cognitive therapy ('We're going to help you to feel
more positive about yourself') are sometimes appropriate, and may be
arranged through the GP with, say, community psychiatric nurses, psychologists
or psychiatrists.
What about tablets?
Doctors don't always dismiss their patients who have emotional problems
with a prescription! However, sometimes the nature of the depression
is such that one of the antidepressant drugs will help a lot. These
drugs:
· are not tranquillisers or pep pills
· are not addictive
· take two weeks or more to work
· need not stop breast-feeding; an antidepressant can usually
be found which does not get into your milk, so that the baby will not
be affected in any way
· need to be continued for six months after the depression has
lifted to reduce the risk of relapse
Hormones appeal to many women more than antidepressants, because they
seem more 'natural'. However, the evidence that they work is less impressive,
and they are not necessarily harmless, eg if there is a previous history
of blood clots.Progesterone is best as a suppository, while oestrogen
is now sometimes applied in skin patches. There is no doubt that many
women feel that they have benefited greatly from hormone treatments,
but it has yet to be shown that this is more than a 'placebo' effect
- that is produced by hope rather than the treatment itself.What
is the outlook if postnatal depression is not treated? Most women
will get better anyway, after weeks, months or even a year or two. However,
this means a great deal of suffering. PND gets the experience of new
motherhood off to a bad start, and strains the relationship with the
baby's father. So the shorter it lasts, the better. It is very important
to diagnose and treat PND as soon as possible.Can it be prevented?
Yes. There are three kinds of prevention: stopping it happening
in the first place; nipping it in the bud; and stopping things from
getting worse. This leaflet has been mainly concerned with the second
form: spotting PND and treating it quickly.We don't know enough yet
about PND to prevent it in the first place, but certain principles make
sense:
DON'T try to be a superwoman: having a baby may be a full-time
occupation, so try to reduce commitments during your pregnancy. (If
you are at work, make sure you get regular and sufficient nourishment
and put your feet up in the lunch hour);
DON'T move house (if you can help it) while you are pregnant
or until the baby is six months old;
DO make friends with other couples who are expecting or have
just had a baby; among other things, this could lead to a baby-sitting
circle;
DO identify someone to whom you can confide, it helps so much
to have a close friend you can turn to. (If you can't easily find someone,
try the National Childbirth Trust or MAMA - their local groups are very
supportive before and after childbirth);
DO go to ante-natal classes - and take your partner with you!
If you have suffered PND before, that doesn't mean that you will do
so again. However, it is only sensible to keep in touch with your GP
(and, after the birth, your Health Visitor) so that should there be
any signs of recurrence, treatment can start at once.After the baby
has arrived:
DO take every opportunity to get your head down. Try to learn
the knack of cat-napping. Your partner can give the baby a bottle-feed
at night, using your own expressed breast milk if you like.
DO get enough nourishment. Healthy foods like salads, fresh vegetables,
fruit, fruit juices, milk and cereals are all nice, packed with vitamins
and don't need much cooking.
DO find time to have fun with your partner. Try to find a baby
sitter and get out together for a meal, a show, to see friends or just
a visit to the pub;
DO let yourself and your partner be intimate, even if you don't
yet feel like sex: at least kiss and cuddle, stroke and fondle. This
will comfort you both and lead all the sooner to the return of full
sexual feeling.
DON'T blame yourself or him: life is tough at this time, and
tiredness and irritability on both sides can lead to quarrels. But 'having
a go' at each other may weaken your relationship when it needs to be
at its strongest;
DON'T be afraid to ask for help when you need it. It may be up
to doctors and Health Visitors and midwives to diagnose PND, rather
than the mothers themselves. But those who have learnt about it from
ante-natal classes (and leaflets like this) could help by asking themselves,
their partners and the professionals whether they could be depressed.
FINALLY even if the PND is well established by the time it is
recognised, support, counselling and medication will often make a big
difference and will speed eventual recovery: it's never too late!
Organisations that can help:
Association for Post-Natal Illness (APNI): 25 Jerdan Place, London SW6
1BE. Tel: 0171 386 0868.
Can put you in touch with other mothers who have come through PND.
BCM CRY-SIS: London WC1N 3XX. Tel: 0171 404 5011
For help and support with a crying baby.
Meet-A-Mum-Association (MAMA): Tel: 0181 771 5595
Self-help groups for mothers with small children.
National Childbirth Trust: Alexandra House, Oldham Terrace, Acton, London
W3 6NH. Tel: 0181 992 8637 between 9.30am and 4.30pm, Mon to Fri. Information
and support in pregnancy, childbirth and early parenthood.
The Samaritans: 10 The Grove, Slough, Berks SL1 1QP. Tel: 01753 532
713. National helpline: 0345 90 90 90
National organisation offering support to those in distress who feel
suicidal or despairing and need someone to talk to. They have 204 branches
around the country open 24 hours a day, every day of the year. The telephone
number of your local branch can be found in the telephone directory.Books
Banish Baby Blues
by A. M. Sapsted. Thorsons Mail Order, Harper Collins, Westerhill Road,
Bishopbrigg, Glasgow G64 2QT. £5.99, inc. P&P
Down with Gloom!
by Brice Pitt, drawings by Mel Calman. Gaskell Press, The Royal College
of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. £5.00,
inc. P&P
Coping with Postnatal Depression
by Fiona Marshall, Sheldon Press, SPCK Mail Order, 36 Steep Hill, Lincoln
LN2 1LU. £5.99, plus £1.00 P&P
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