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Mama, you are not alone. For too long misconception and stigma has surrounded perinatal anxiety and depression (PAD). This post is to help women recognise the signs & symptoms & know how to get help, but also to spell it out clearly what PAD is NOT!
‘Perinatal’ means during pregnancy or the first 12 months after having bub, and so includes postnatal depression. PAD can be crippling, frightening, confusing, overwhelming, and so much more. It can feel like you are in the darkest depths of nowhere, utterly lost, with no one to save you. Everything can be a blur. If you have some or all of the following symptoms, you may be experiencing PAD.
Signs & Symptoms
- Worry or anxiety that is persistent and ongoing, often related to fears for baby’s wellbeing.
- Constant sadness
- Teariness – so much crying! Crying for no reason, crying out of the blue, constantly feeling like you are about to cry but don’t know why.
- Irritability, anger or sensitivity to touch/sound – do you find yourself feeling constantly cranky, jumping when your husband comes anywhere near you, noise sounding like a deafening marching band in your head?
- Not recognising yourself – who is this woman? Where has the real me gone, and how do I get her back? Will our marriage ever be the same?
- Feeling numb
- Lack of emotional connection, or loss of interest in activities, day to day life, friends and family
- Withdrawal from others
- Increased alcohol or drug use
- Appetite changes
- Thoughts of harm to self, baby, others or thoughts of suicide & death
- Fear of being alone with your baby
- Brain fog – memory difficulties or just a general lack of concentration
- Low self-esteem, or confidence in yourself as a parent
- Obsessive compulsive behaviours
- Panic attacks. These aren’t always obvious. They may present as shortness of breath, heart palpitations, a feeling of dissociation, or a feeling of impending doom.
- Extreme lethargy – feeling physically or emotionally overwhelmed and unable to cope with day to day life.
- Difficulty leaving the house
- Abrupt mood swings
- Feeling constantly ‘on the edge’, nervous, or panicked
- Feeling like you’re ‘going crazy’
- Wanting to escape
If you’ve read this far, you’re probably here because you feel you may have PAD, have had it in the past but didn’t realise, or think someone you love has it. Although it feels incredibly lonely and isolating, the statistics are shocking. Globally, the rates of postnatal depression are in the tens to hundrends of millions annually. In Australia 1:7 women and 1:10 men experience postnatal PAD, and in America those stats are even higher!
“We drove to the shopping centre, my husband and 7 month old son with me. We parked the car, and I cried. Bawled my eyes out. I don’t know why – there was no trigger. But I knew these tears had been a lump in my throat for weeks, and had finally escaped. I finally broke.”
Triggers & Contributing Factors
When we become pregnant, our brain’s neuroplasticity increases. That means the nerve cells in your brain are more able to change their activity in response to new situations and changes in environment. A really amazing Midwife once explained it like this to me – from birth, our brains wire up like an electrical system. When we are pregnant and birth a baby, those wires get cut, and the brain has to rewire itself.
There’s contributing factors that can hinder that ‘re-wiring’ and make women more vulnerable to perinatal anxiety and depression – see below. But there’s also ways that the re-wiring can be supported (see our post on having a positive fourth trimester).
Sometimes, there are no answers though. You may be reading this and feel like you don’t tick any of the boxes described below. That’s because PAD is non-discriminatory. You could be financially stable, in a loving, supportive relationship, having a very much planned for baby with an incredible amount of support around you, yet still experience PAD.
Remember, you are not broken. You are not crazy. There is nothing wrong with you and you’ve done nothing wrong. You are unwell, and you can get well again.
- History or family history of anxiety, depression or mental illness
- Relationship stress
- Financial concerns
- Sleep deprivation
- Pre-existing physical illness
- Birth trauma or premature/unwell baby
- Feeding or settling challenges
- Difficult pregnancy
- Previous loss – miscarriage, stillbirth, termination, or death of a baby
- Fertility challenges
“Breastfeeding, and the importance of breastmilk for my baby, literally saved my life. In my darkest hour, I truly believed the only reason I had to stay alive was because my baby needs breastmilk. He needs it to thrive. Not once did I think ‘he needs his Mummy’ or that my husband needed me around. I valued a fluid my body produced over my own self worth. It sounds crazy, but that’s what it does to you.”
Perinatal anxiety and depression is not ‘the baby blues’. We’re talking about a whole other ball game here. Generally, the baby blues occur in the first week or two after giving birth. Mothers may be very teary, anxious or irritable, or experiencing insomnia and brain fog, but the symptoms don’t last long, no more than a couple of weeks. PAD can worsen and begin to affect day to day functioning.
If I were to ask friends what they know about postnatal depression, most would say “isn’t that when you want to hurt your baby?”. This is a HUGE (and awful) misconception about PAD. Not all women, in fact I’d estimate less than half, develop thoughts of harming their child. I’ve even known women who have developed extreme anxiety that they would hurt their baby after being diagnosed with postnatal depression, purely because that’s what they thought the illness is.
For women who suffer from PAD, the unspoken supposed to’s of pregnancy and motherhood can be crippling. You’re supposed to enjoy pregnancy – supposed to enjoy having a gorgeous new baby – supposed to be one of the happiest times of your life. I’m not saying this isn’t the case, for many it is. But not for all.
For some, pregnancy is hard to the point of unenjoyable, or new parenthood is so overwhelming it is far from joyous. This doesn’t mean these mothers aren’t grateful to be pregnant or have a healthy child – it doesn’t mean they love their baby any less. These are huge misconceptions that can mean the difference between a mother being supported through overcoming PAD by understanding friends/family, or suffering alone.
“I’m such a bitch, I’d tell myself. I knew I was. I would hear words coming out of my mouth and immediately think ‘who is this person, listen to yourself!’ My husband suffered too, and it’s because I couldn’t be happy or kind, and I couldn’t care less about trying. I’d jump if my body sensed he may possibly be about to touch me.”
What We Don’t Want to Hear
“It’s probably just the baby blues” – as a society we tend to minimise mental illness because it makes us uncomfortable. Dismissing or minimising PAD does nothing but leave a Mama feeling alone and even more confused.
“You need to get help” – Well meaning loved ones often take the tough love approach. Don’t. If you think a Mama needs help, there’s so many better ways to voice your concern than instructing them on what they should be doing. If this phrase is all you can come up with, you’re probably not telling her anything she doesn’t know.
“I think you’re just exhausted, and it’s taken its toll”
“At least you can have a baby/get pregnant” – I don’t think I even need to explain why this is wrong on so many levels.
“You have a healthy baby, that’s all that matters” – This is a common one following birth trauma. Dismissing a Mama’s feelings, or trying to find a silver lining, does not make her feel better. But it does add to her feelings of guilt.
If you ever have the privilege of a woman confiding in you to process her negative birth experience, hold her. Hold the space for her. Tell her you’re sorry. Tell her she’s amazing. Empower her with gentle words of love and recognise her as her own person – a separate entity to a healthy baby.
Perinatal Anxiety and Depression Support Services:
Australia: PANDA panda.org.au