Valerie Gommon Midwife’s Blog

Postnatal Depression

Posted on: March 4, 2009

I am probably not going to be able to do this subject justice in a short blog posting, but the subject was being discussed this afternoon on Radio 4 – “Am I Normal?” presented by Vivienne Parry www.bbc.co.uk/radio4/science/.

The programme debated many interesting issues, for example the increase in the diagnosis of postnatal depression and the changing role of women in society.

I apologise that the information below is perhaps written in a slightly “academic” or technical style as it is taken from an essay I submitted on my degree programme, however I think the information is largely valuable – if you feel you would like to discuss anything I have written do feel free to contact me info@3shiresmidwife.co.uk or telephone 01908 511247.

I also feel very strongly that women are often given inadequate support in the postnatal period.  Indeed many women are reporting receiving only two or three postnatal visits from NHS midwives (and then it is not always a trained midwife who visits) and Health Visiting services are also very stretched.  As an Independent Midwife I am able to offer far more support postnatally and this is something that I believe all women deserve.

If you are struggling DO speak to your midwife, health visitor or GP – make a nuisance of yourself!  Self-help groups and lay groups like the National Childbirth Trust (NCT) www.nct.org.uk, La Leche League (LLL) www.laleche.org.uk Meet A Mum Association (MAMA) www.mama.co.uk and Association for Post Natal Illness (APNI) www.apni.org can all be very supportive.

Postnatal Depression

It can be predicted that the early days, months and even years after childbirth are a time of stress for the woman and her family.  Indeed there are also the major physiological changes from the pregnant state into lactation and the return to the usual non-pregnant state of monthly menstruation cycles.  These changes are normal physiological reactions to the changes undergone by the woman (Stables, 1999), often women as said to experience “baby blues” at this time.  Some women, however, go on to experience stronger reactions that may be described as “postnatal depression” or occasionally “puerperal psychosis” (Sweet, 1997).  A few women will be so traumatised by their experience that they develop “post traumatic stress disorder”.

Baby blues” is considered by many to be a normal phenomenon that happens around three or four days postpartum, and is associated with the rapid physiological and psychological changes taking place.  Many women experience a degree of transient emotional lability and changes or mood that is self-limiting and usually resolves quickly.  (Ball, 1996).

Postnatal depression (PND) is more severe.  Cox, 1986 suggests that 10% of all mothers develop clinical depression following childbirth and that a further 10% exhibit considerable emotional distress.  The onset is gradual and may last for 3-6 months (or longer).  PND is a reactive illness and can be associated with other stress factors (i.e. moving house, marital tension and low self-esteem).  Women suffering PND are usually able to sleep, but continue to feel tired and exhausted, often feeling worse as the day progresses.  PND can cause disruption to family life, and can affect mother-child relationships.  (Ball, 1996).

In recent years Health Visitors have been encouraged to use the Edinburgh Postnatal Depression Scale (developed by Cox et al, 1987) as a tool to detect postnatal depression.  Some authors have suggested that midwives should use the Edinburgh Postnatal Depression Scale (EPDS), (Sweet, 1997 and Clements, 1995) but the tool is not foolproof.   Postnatal women are asked to identify and report on their feelings and they may choose not to disclose feelings.  Feedback suggests that the scale is a useful tool, and can enable further discussion to ensue.  If indicated, the woman may then be offered “listening visits” when the Health Visitor will set aside time to talk on a one-to-one basis with the woman.  Some women may also be helped by medication and the Health Visitor will liaise with the General Practitioner and indeed the wider mental health team if it is thought appropriate.  It is thought that early treatment is most effective, midwives and health visitors should therefore be alert for early symptoms such as excessive anxiety and depression.  (Church and Scanlan, 2002, Bryant et al, 1999).

There has, however, been criticism of The Edinburgh Postnatal Depression Scale.  Robinson, 1998, suggests that it is ineffective because of indiscriminate usage, whilst Ballard et al, 1995 suggest that women often score highly on the EPDS and receive inappropriate treatment.

Puerperal psychosis is a severe form of mental illness that will affect approximately one or two mothers in 1000.  The onset is rapid and usually occurs within the first few days after delivery.  The condition presents as a depressive psychosis, manic illness and in some cases schizophrenia.  Primiparae are most often affected.  Women affected in this way need prompt admission to a psychiatric unit.  (Ball, 1996).

Women can experience Post Traumatic Stress following childbirth, this phenomenon has only been documented in the literature in recent years.  Indeed an extensive literature and internet search did not reveal any mention of post traumatic stress following childbirth until 1994 (Ralph and Alexander, 1994).

During the 1990s there were several articles discussing the merits of offering “debriefing” to postnatal women.  (Charles & Curtis, 1994, Jones, 1996, Westley, 1997, Robinson, 1998).  Interest in labour debriefing revealed that some women experience severe adverse reactions to their birth experience and it was suggested that a small number of women may experience post traumatic stress symptoms following childbirth.  The prevalence of post traumatic stress following childbirth has been estimated at between 1.5 per cent (Ayers & Pickering, 2001) and 1.7 per cent (Wijma et al, 1997), although Laing, 2001 argues that this is probably an underestimation of the problem.

I am very happy to offer a birth debrief to women within my catchment area, please see my website www.3shiresmidwife.co.uk for details.

Lastly, I should add that serious Postnatal Depression only affects a small number of women, but it is important that it is spoken about and that you seek help if you need it.

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3 Responses to "Postnatal Depression"

Thanks for this blog it is very useful and interesting. I feel post-natal depression is most effectively dealt with through social support. There is an excellent support network here if mothers would like to check it out http://my.bounty.com/Forums/Subject/145/1/1/Post-natal-depression.htm I also feel we need to raise public awareness of this disorder, which is more common thab i think you allude to!

Personally I think there’s a fear where depression (after childbirth) is concerned. I always suffered terribly both before and after I had children and was terrified to talk about it incase social services got involved and my children were taken away. I don’t actually know how likely that is to happen but it seems like you always hear of these horror stories of mothers asking for help with depression and the next thing you know their kids are being carted off to foster carers…

My biggest fear, even in the deep dark depths of depression, was that my children would be taken away if I asked for help. I think something really needs to be done about that fear… I’m not sure what COULD be done about it – but I know from personal experience and from talking to other Mothers that THIS fear is what keeps many women from asking for help or talking about it. Many put on a “face” when infront of midwives/health visitors/GPs, or are in complete denial as to why they feel so low.

I am a huge fan of counselling.

Counselling may be obtained free of charge via your GP – if you are concerned about speaking to a “health professional” you could consider private counselling. I appeciate that there is a cost to this, but I do know of trainee counsellors (who are often very good) who may be willing to help without charge.

Do contact me if you’d like contact details.

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