What is Post-natal Illness

• What Is Post Natal Illness?
• The Baby Blues
• Puerperal Psychosis
• Post Natal Depression
• Why Does It Happen
• How To Get Help
• Help For Someone Else
• The Importance of Getting Help
• Online Support

WHAT IS POST NATAL ILLNESS?

I am not a professional in this field so what follows is only my opinion and what I have learnt from experiencing the illness, counseling others with it and researching as much as I could find out about it. I have taken a lot of this information from other web sites, at times whole chunks and I am especially grateful to those have gone before me.

As far as I can work out Post Natal-illness covers all illnesses which 'appear' to have a psychological basis and or psychological symptoms,which might happen to women after they have given birth and as long as 4 to 5 years afterwards

I said 'appear' because it is not at all certain what the cause is. It could very well have hormonal or another physical roots in the process of carrying a child and giving birth ,or be an entirely psychological function of pregnancy, childbirth and perhaps breast feeding or a mixture of all. No one really knows.

These illnesses are divided by medical professionals into types, The Baby Blues, Puerperal Psychosis and Post Natal Depression.

I think it is important to point out that Post Natal Depression and the Baby Blues are not the same . Both these conditions can be distressing and affect the whole family.

However after many years of listening to women suffering PNI I feel that these distinction between types of Post Natal Illness can not really be made as hard and fast distinctions. Many women experience symptoms from all 'types' of PNI. Often a women will feel she has the baby blues but then feels better for a time and later realizes she has PNI. While Puerperal Psychosis for some women comes on very swiftly after a birth and is very severe, many women with moderate to severe PNI will experience some of the some symptoms and women with Puerperal Psychosis will have some of the mainstream PNI symptom,s and feelings

Therefore I do not think the three illnesses above are exclusive.

Personally over the years I have begun to think it is possible to have a mixture of them. My own experience also confirmed this. I actually heard voices about 3 days after I gave birth and then was reasonably OK until about 6 months later, when I got full blown PND and some delusions indicative of Puerperal Psychosis such as waking up one day after a particularly bad storm in the night and being convinced that the world had ended, myself and my baby were the last people left on earth. I then went to work as usual and said things in a meeting such as ' it was such a bad storm last night I was convinced it was the end of the world' needless to say everyone thought I was joking! I would have episodes such as this and then be all right for another few weeks, although I still very much had PND.

Therefore from my own experience and from the nest 10 years of listening to women with PHI I am convinced one can have symptoms of PP, BB and PND all at once, all to a greater and lesser degree.

However below is the standard/accepted explanation of the different forms of PNI.

BABY BLUES Back to Top

About one in every two women who has a baby will suffer from the baby blues. Often about the third or fourth day after childbirth and so it usually happens while women are still in hospital. The new mother often feels like crying all day, and gets anxious about many things both small and large.

This can range from despairing about getting breast-feeding going, to anger that a particular friend hasn't rung up or perhaps to thinking her partner won't want her any more, or worrying about how your baby looks or their health. These feelings usually last around a day or so, and if family and friends and staff are patient and listen, no other treatment is usually required.

For one in every ten women, however, (which is a big percentage of the women who have babies), either of the following can happen - the blues never go and the situation develops into a Post-natal depression which is more severe and long-lasting, or symptoms of depression develop a few weeks or months after childbirth, even after the blues have long gone away. This condition is really very common and can interfere with how a woman gets on as a mother for a long time.

PUERPERAL PSYCHOSIS Back to Top

This is a set of psychological symptoms that can develop after childbirth, namely puerperal psychosis. This is the most severe mental illness that can happen to a woman after birth, and it happens to one woman in every five hundred. It usually comes on in the first few days after childbirth, although I have known women for whom it came on later. My cousin who had it with two babies was fine both times until about the 5th week. Women who have had depression before and women who have had bipolar mood disorders (manic depression or BPAD) are those people who are at risk.

Quite often women do not know they are at risk until after their first baby, although there may be a family history of BPAD. Sufferers can get a wide range of symptoms, from hearing voices or believing unusual things (delusions) to being so confused they can't care for their babies at all. Their mood may be very changeable and life quickly becomes chaos for everyone. These people usually need treatment in hospital, and it is best to go to hospital with the baby if at all possible. That is, if there are mother and baby facilities in your area. The alternative is to be treated as a day patient if you have enough support at home to stay there. This illness is very treatable and often quite quickly.

I believe that for a while I had this but there were no mother and baby units where I live in Cornwall, so I did not seek treatment and did not allow my partner to do so, as I did not want to be parted from my child. If you or your family think you have this. Do not do what I did but seek help from the professionals as I am assured that things have now moved on.

POST NATAL DEPRESSION Back to Top

How will you know if you've got it? Common symptoms include the following things:

* crying a lot, or crying about small upsets

* getting angry or irritable over 'nothing'

*bizarre, obsessive and disturbing thoughts

* thoughts and fear you may harm your baby

* fear you may sexually or physically abuse your baby or another child

*chanting thoughts or voices

*having panic attacks

*feeling generally physically unwell

* obsessive or disturbing thoughts about your physical health or that of your baby, other children of partner.

* Having 'what if' thoughts you can not control

* feeling scared all the time for no real reason

* hating yourself - low self esteem

* being scared you might harm your baby either accidentally of deliberately

* hating your baby

*hating your partner

*lacking confidence, and or self esteem

*having uncontrollable temper tantrums

* feeling very uncertain of your skills as a mother

*feeling you are a' bad' mother and or a 'bad' person

* sleeping poorly even when your baby is asleep

* being terrified of being alone

* not feeling any sex-drive (libido)

* just feeling you can't cope with anything, e.g. housework

* feeling very anxious and uncertain about a whole range of things, e.g. going out shopping, seeing friends, etc.

Any woman who has had a baby is quite likely to feel some of the things on that list some of the time. However, if you have PND you are likely to feel awful all of the time, even when your baby is on best behavior. There are many other symptoms you may have too. For instance, tension and anger often lead to friction with other people, especially a partner or other close family members.

WHY DOES PNI/PND HAPPEN? Back to Top

The cause of PNI/PND hasn't been proven and most people who work in the field believe it is likely to be due to a whole range of things. These include:

* the hormonal changes at the end of pregnancy, affecting women whose brain chemistry is vulnerable

*birth trauma such as a cesarean and or lack of control during the birth

* a baby who is irritable and sleeps very little

* lacking in self-confidence generally

* not having enough support from people around you, e.g. partner, extended family

* having had a difficult upbringing yourself - all those troubled memories of how NOT to be a parent come flooding into mind

* being a perfectionist - setting unreal expectations - having a baby is often reported in idealistic terms, until you have one you do not realize the harsh realities of it all - and nowadays, for many women, this means trying to keep going with a job and be a perfect mother as well.

* past history of depression for any reason

* physical problems of your own - recovering from difficult birth, breast problems, tiredness

* premature baby or baby with particular health problems.

The list goes on and on, and it is not really surprising that one in every ten women get this problem. Recognizing there is a problem and accepting you need to do something about it is the first gigantic step. For many women, this will be the first time they have had to seek help of any sort, and if you were expecting everything to go smoothly, let alone perfectly, you might feel very ashamed at admitting that all is not well.

Society seems to have an investment in portraying child bearing and motherhood as an idilic occurrence. Yet even for a mother who is well, it more often than not involves both physical and mental pain and at its best is physically and mentally challenging. It is also physically very hard work and not at all idilic when one has to deal with, nappys, extra cleaning and vomit. For all women their own body changes at best need adjustment and at worse - if you put on extra weight, get stretch marks etc. - be distressing. It is my experience that most, even other mothers, do not want to discuss the down side of it all. This is especially distressing when you have Post Natal Illness and need to be reassured that you are not alone in finding a negative side of being a mother of a young baby or toddler.

HOW CAN I GET HELP Back to Top

Next, you may have to decide whether this is a problem you and your family can sort out, or whether you need to get professional help? If you have a partner, talking it over with him might help you to make that decision. Some women don't have partners or might think that their partner is not really 'into' feelings and might not understand. In that case, you could talk it over with your mother or a friend. Because of shame or isolation, some women may want to turn straight to a professional, and nowadays, most professional people know that PND exists, or know how to get information about it. Places you could get information include:

*Advice and Information Lines

*The web - I found newsgroups quite helpful

* Your health visitor

* Your GP

* Your health center

If you do go to see your doctor, she or he may, as well as asking you a number of questions, want to do a physical examination or some blood tests, and may want to prescribe some medication.

Usually an antidepressant is suggested if the symptoms are severe, and the type prescribed depends on many factors. Some are relatively safe with breast-feeding, e.g. Prothiaden, Nortabs, or others called Tricyclics, while newer medications like Prozac and other SSRIs) Zoloft, Aropax and Aurorix all have their place in other circumstances. By the time you read this there are probably safer drugs available with even fewer side affects. Another therapy that some have tried with some success is natural progesterone therapy. A female British Harley Street doctor called Katharina Dalton ( see my book list) recommends this. Recently the opposite natural hormone, oestrogen have recently been used in patches as a cure. I will try to get further information on both to update this page.

Ask your doctor to explain anything you don't understand or don't feel happy about. Sometimes, referral to a psychiatrist or the psychiatric nurse team is suggested, and this can be very helpful.

In addition to medical help, you might want to seek counseling and be lucky enough to have a counseling service or therapy center nearby, or find that your doctors surgery is able to offer this. Otherwise you could find a private counselor. The last of course will cost but counselors, at least good ones, usually negotiate with their clients a fee they can afford. I had to opt for the private counselor as my doctor could not offer counseling and the health service in the area only offered short term cognitive therapy, due to cost. However my counselors, I had two in the time I had PND, did negotiate the fee.

Telephone counseling through The Association for Post Natal Illness is available by women who have all been sufferers themselves, so they are in a good position to understand.

Helpful things include:

*going to a mother and baby /toddler group can help some. For me it added to my stress but you can chose for yourself.

*go to a PNI support group if you are lucky enough to have one in your area

* getting a few good nights sleep - let someone else care for your baby overnight

* tell someone you trust how bad you feel,

* stop being so tough on yourself about your expectations

* go out and do something fun - go shopping, go to the movies, take a walk in the park, ring a friend and have a chat, put your feet up and read a book, get your hair done

There are also many good books on the subject of PND/PNI and I have put them on my book page.

CAN YOU HELP SOMEONE ELSE, OR KNOW SOMEONE WHO MIGHT NEED HELP? Back to Top

Do not try to help another mother on your own if you still have the illness yourself and you think it will put to much stress on yourself. You need support for your own needs, but you can advise on where to go for help. By all means do some voluntary work in a different area if this helps. I did this, I fund raised for a local village hall and it was useful for my self esteem.

However, perhaps you have now recovered from PNI/ PND and are reading this out of interest or perhaps you know someone who has recently had a baby and does not seem to be quite herself, or is obviously very unhappy. What can you do to help?

If you are a mother who has recovered you could volunteer to do telephone or other counseling with mothers who are currently depressed.

In the case of a person you know who you think has PNI, if she is someone you know very well and you think she and you would be able to cope with you bringing up her unhappiness in conversation, this may be helpful. Try not to be shocked by anything the person might tell you. They might need to express their distress and what they say could be unsettling. However while depressed mothers can have quite frightening and sometimes even violent thoughts, very few actually act on them. Anyhow, suppressing this will not do any good either so just try to keep calm, listen and reassure. DO NOT JUDGE.

It is often very difficult for a partner or a close family member or friend to listen like this, after all it is your child too and you have both peoples welfare as your concern. If you feel to involved and can not cope, seek help, rather than trying to pretend it is not happening, or reject what they are saying.

Sometimes, though, being there for her is what she really needs. This is often in terms of offering practical help. Looking after a baby, especially a first baby, can be exhausting (even if it is rewarding some of the time). Offering to clean a bathroom, do the ironing, bring a meal over, or baby- sit while the "new" mother goes to the supermarket or hairdresser, can be a wonderful gesture of friendship. Many Asian cultures have the custom of the mother's mother or mother-in-law moving in for the first 40 days after birth and doing all the housework so that mother can just learn to look after her baby. This custom has a lot going for it, even for people who value their independence, but, Grandma, remember, not too much advice-giving please!

THE IMPORTANCE OF GETTING HELP Back to Top

There can be several unfortunate consequences of not treating PNI/PND, whether it is mainly medical or another treatment which is needed. Problems range from unnecessary ongoing suffering, sometimes with the possibility of self-harm (suicide), to big strains on a relationship often leading to breakup, to possible effects of the baby.

I am sure many of us can name incidences of the results of untreated PNI/ PND. I have worked as a youth worker with depressed young mothers who had to go on the 'at risk' register. My cousin jumped out of a window with her baby in her arms - thankfully they both survived. A woman in my village committed suicide because of post natal depression. Her child was about 8 months younger than mine. I once came across her pushing her child aimlessly about an empty village street. I recognized how she was feeling and said you are doing this because you are scared to go home. We talked and I helped her briefly that day, but was unable to do anything in the long run as I was too depressed myself at the time. However it is ironic that the only person who recognized the degree of her suffering was some one who was also depressed and too ill to help. This is why it is important that if you know someone in this position you try to get professional help for them - and why it is so important that the 'professionals' recognize PND/PNI quickly and know what to do about it.

However the fact is that many women with PNI get through it without any drastic consequences noticeable from the outside and with out treatment or support. However why should anyone suffer this awful thing along if their is support out there and treatment that at least can make having PNI more bearable and possibly lead to a swifter recovery so you can get on with enjoying your family.

There should be no reason for any women who suspects they have PNI to hide it of 'grin and bear' it. The sooner a women with PNI gets support and treatment the sooner she will be able to get back to enjoying life and the less having had PNI will affect future family life.

Babies learn many things in the first 12 months of life. They learn more when their mothers have energy and time for them, and when the quality of the relationship (usually known as the attachment) is strong. Obviously, therefore, if Mum is depressed, her baby may suffer consequences Young babies are very adaptable, and if mother has been depressed for a while but then gets treatment, she and her baby can make up for 'lost time'. But the sooner you get treatment, the better. However, babies do also recognize the quality of love, so despite being depressed they can pick up on the fact that you love them and I believe this affords some protection to the damage of your depression.

So, finally, do remember, POST NATAL DEPRESSION is common, treatable, not due to anyone's "fault" or just not "pulling themselves together"

1998 Updated 2002

NOW is a good time to start to do something about it!

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