What can I do if I think I have postnatal depression and anxiety?

Having a baby can be happy and exciting, however, it can also be difficult for many women. Sometimes depression and anxiety can start during pregnancy, let’s face it, you’re not only going through a major life event, but you also have hormonal changes to cope with, body changes, maybe financial changes, and adjustment to a whole new way of life…your life will never be the same again!


Baby Blues
Firstly, let’s talk about the baby blues, this is common, happens to about 85% of women and should not be mistaken for postnatal depression. What you may notice in the first few days after having a baby is feeling very emotional, crying for no apparent reason, and feeling anxious and exhausted. This is normal and usually goes after a couple of days. This is thought to happen because of hormonal changes, and many women throughout their lives have changing emotions influenced by their hormones, unfortunately, this can be a normal part of being a woman.


Postnatal Depression
Secondly, let’s talk about postnatal depression, for some women the postnatal period can be overwhelming and it’s difficult to cope, and about 10 to 15 % of women will develop symptoms of postnatal depression after having a baby. You may find yourself crying, feeling sad, worthless, guilty, experiencing loss of interest or enjoyment in things that used to bring some pleasure, worried, irritable or angry. You may even feel you have negative or no feelings towards your baby. It’s a tricky time for many women, not only do you now have this tiny person that you are responsible for, they wake you up several times a night, and need your attention almost constantly. On top of this, you have physical changes to deal with, hormonal changes, emotional changes and social changes. It can be difficult to carry on with your social life too. Whilst, once you may have popped out to meet a friend for coffee, now with junior in tow, a trip out to meet a friend, or go to the supermarket, can turn into a military operation, with huge amounts of equipment needed, just in case! It’s no surprise it seems like a major hassle – because it is a hassle.


Social Pressure
Thirdly, let’s talk about some of the myths surrounding pregnancy. The media is flooded with information about pregnancy and childbirth. Celebrities are doing photoshoots with their new baby, looking glamorous, immaculate, slim and happy, in their perfect house, with their perfect partner. And then we have social media to navigate, not only do celebrities have perfect, fun-filled lives, so do our friends, allegedly, according to FB, Instagram, etc.! Sometimes women have very fixed ideas of how the birth of their baby will be and do everything possible to prepare for the birth, from antenatal classes, pregnancy yoga, hypnobirth, etc. If the birth and postnatal time doesn’t go to plan, for example, you end up needing medical interventions, or maybe breastfeeding is difficult and you decide the best option is to formula feed your baby, then often women can feel as though they have failed and compare themselves to friends and family members who have not had similar complications.


What can help
Talk about how you feel, to your partner, a friend, a family member, your midwife, health visitor or GP.
Don’t try and be the ‘perfect housewife’ or the ‘perfect mum’ remember good enough is good enough, you’ve just had a baby and nobody is going to judge you if your house doesn’t look immaculate.
Try not to isolate yourself, try and meet with friends, join some mum and baby groups or support groups, your health visitor will be able to put you in touch with groups. It’s helpful to know you’re not alone.
If someone offers you practical help, take it. If it’s making a meal for you, looking after the baby for a couple of hours while you catch up on sleep, or running the vacuum cleaner around. Don’t be proud, accept the help.


Get as much rest as possible, try and sleep when the baby sleeps, this is a natural thing for mothers to do, try not to use that time to catch up on jobs, you’re a new mum, your job is to rest and look after yourself as well as the baby. Don’t neglect this, rest is important and you’re important.
Eat a healthy diet and try and get some gentle exercise. Don’t go crazy though, the aim of this is to help your mental and physical wellbeing, not so you can get back into your pre-pregnancy jeans!


Changing your behaviour
When people are depressed their motivation reduces and people then can end up doing very little, isolating themselves and having negative thoughts. Get a weekly planner and write down some activities that you can do each day, try and aim for a mixture of activities that involve some social contact with others, some low-key exercise and some rest time for yourself. When you’ve finished each activity markdown which activities have given you enjoyment, which have made you feel a sense of achievement and which have given you a sense of closeness or connectedness to other people. All these are really important in terms of how you feel, and once you’ve identified which of the planned activities are most helpful in achieving enjoyment, sense of achievement and closeness to others, planning your week should get easier, and you will see your mood improve.


Challenging negative thoughts
Depression also can bring unhelpful negative thoughts. To try and address these you can use the ABC approach. A is the event, B is your thoughts about it and C is your feelings about it. When you start to experience negative thoughts and feelings you can use this approach. Make a note of the event that triggered the thoughts and feelings, then write down how it made you feel and the automatic thoughts that pop into your head. Next is the important part, write down more balanced thoughts, pretend you are a lawyer in court and you’re putting forward evidence that will contradict the negative thoughts.

Example:

Event – the health visitor is due to visit and the house is messy
Feelings – worried, inadequate, hopeless
Thoughts - she’ll think I’m not a good mum, she’ll report me to social services, she’ll judge me
More balanced view – she visits lots of women whose houses are probably messy, she’s not going to judge me. I’m doing my best, she’s been several times before and had no concerns, but I am worried about this I can ask her. I like to keep my house clean and tidy, but this is my home as well, and homes with new babies can get messy.

Challenging anxious thoughts
Anxiety and depression often happen together. If you find you are having lots of thoughts starting with ‘what if…’ then it can be helpful to stop and ask yourself exactly what you are worried about. Before your “what if…’ thoughts snowball and before you know it they have prompted another, more catastrophic thought, then another even more catastrophic thought, and so it continues. As soon as one of those ‘what if…’ thoughts pops into your mind ‘nip it in the bud’. Stop the process and change the focus of attention onto something else that will draw you away. A worry thought that starts with ‘what if…’ is a hypothetical worry, not a real worry, don’t give it the time of day!


Some worrisome thoughts, however, are real problems, and if this is the case, you can ask yourself is this something I can deal with now? If so, make a list of possible solutions, take action, carry out the plan and then change your focus of attention. If this is a problem that you are unable to take action on at the moment, then plan to readdress it when you are in a position to act on it, then change your focus of attention, you’ve done as much as you can at the moment, worrying about it won’t solve the problem. 


Psychotherapy
It may be that seeing a psychotherapist may be helpful to you. Cognitive behavioural therapy (CBT) can be particularly helpful for dealing with symptoms of depression and can help you to explore how your thoughts, feelings, physical feelings and behaviours all affect the other. Sometimes breaking negative cycles can be difficult to do on your own and CBT can help you to make changes in a structured way.
The main thing to remember is, you’re a new mum, not superwoman, you’re human, pregnancy and birth is an amazing achievement, you’re doing your best and that IS GOOD ENOUGH!

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