Post Natal Depression - It's OK not to be OK
So, here's the thing.
Parenting is one of the most rewarding and at the same time the hardest things we ever do in our lives. We seem to constantly need to question ourselves, as does everyone else to whether we're really doing OK or not.
It's where we do the most learning about who we really are, and why. Where we are going, where we have come from and what we have learned from our own childhood and life journey.
It's not always pretty, sometimes its damn right gross but it's where we can focus on what we truly want for ourselves and our children's future's.
At our highest points our hearts could burst with pride, happiness and fulfillment. But at our lowest point we can be filled with exhaustion, self-doubt and guilt. What we've done is make a miracles, beautiful peaceful children who are filled with love and wonder.
We can be our own greatest cheerleaders but sadly our own worst critics. It's a huge test on our relationship with ourselves and with our life partners, we don't always feel like we get it right all of the time, but we always get it just right enough which is why I'm telling you that we all absolutely rock at this parenting lark. It takes a village to raise a child, and these days our village is so often further away, but we're all in this together, supporting, growing and learning. There are no rights or wrongs, no failures, no rule book. Our good enough's are exactly that.... they are good enough.
You've got this! We've all got this.
In our rural area, I work as a well child/tamariki ora nurse focusing on the infant/child as well as parental health and well-being. I also work as an emergency, practice and paramedic nurse within the ambulance service which means I often deal with parents and their children when they are unwell or injured.
In New Zealand, reports suggest over fifty percent of women up to a few weeks after birth experience feelings known previously as the “baby blues” of anxiety, tearfulness, irritability and feeling overwhelmed, which can often be short lived. Postnatal depression is a depressive illness that occurs in approximately 10-15% of women after having a baby and 8 weeks after birth is present in 4% of fathers, so the impact of having a baby can impact both parents, not just the mother. These ongoing difficulties for the parent can eventuate in negative effects on the children and adverse effects on the marital relationship with less access to quality antenatal and postnatal care. Postnatal depression can range in severity from mild mood disturbances right through to the most severe of forms, postnatal psychosis. Postnatal depression can deeply affect relationships between the mother and baby, partners, and the extended family.
We aim to work in partnership, giving support in the form of information and support for sleep, settling, nutrition and child behaviour and linking mothers into the appropriate community supports. When a woman is experiencing PND it can affect their ability to make critical decisions which can impact on their health status and their infants. On top of experiencing PND they may well be sleep deprived and have other family stressors such as limited support, ethnicity, single parenting, also those affected by family violence. Fatigue is likely to impact parental wellbeing and maternal tiredness is associated with poorer mental and physical health, including symptoms of depression, anxiety, stress, fatigue and energy. The strongest protective factor associated with PND is happiness in partner relationships. There is some evidence examining the correlation between intimate partner violence and PND which made comparison of their findings difficult.
During an acute fear or anxiety episode humans respond in three ways, by fighting (fight), running away (flight) or become immobilised (freeze). Physical symptoms during these anxiety episodes often include the heart to beat faster, adrenal, cortisol levels and blood pressure to rise and shallow breathing, blood leaves certain organs and migrates towards muscles, shaking and sweating can occur, the skin sensation changes with the feeling of hair ‘standing on end’, the gastro intestinal tract is often affected and the mind becomes hyperactive but thoughts are primitive and in survival mode.
“I never know when it’s going to hit me, it feels so irrational but it is very real for me. I often need to isolate myself to remain alone but it is at these times that I need the most support. I always feel as if I’m anxiously waiting for something awful to happen, I truly have no idea why I feel this way but I feel like I’m drowning. My symptoms don’t always involve panic, trembling or hyperventilating, I over analyse things constantly and can’t turn my brain off, particularly at night and it’s so exhausting. This is not an attitude; most people don’t even know I’m feeling this way unless I tell them. I just want to be me and not be defined by this fear and anxiety”.
Rural isolation can impact parenting with reduced socialisation triggering insomnia, anxiety and often leads to lowered immunity, these social stressors often push people’s resilience to their limits. This is a sentiment echoed by the safeguarding children initiative that it takes a village to raise a child therefore our rural communities may struggle more to provide that supportive village for their children to fully reach their potential. There is untold benefit of non-judgmental peer support from each other in our communities which for many is incredibly powerful and the key to normalisation and socialisation. One of the reasons that support groups and social media can be well utilised and popular is because mothers often feel like they need to be heard by people who understand and have been in similar situations which is the true essence and value of the lived experience.
Health implications of PND to the woman and her family with evidence showing that women experiencing PND may have two interactive patterns, intrusiveness or withdrawal. Studies have found that partners often do report symptoms of PND themselves, and felt that the support was directed at the woman only not the family as a whole. The postnatally depressed parent can affect the child’s development in such ways as impaired maternal-infant interactions, it can also lead to attachment insecurity, impaired cognitive and social-emotional development. In the worst-case scenario PND can lead to women taking their own lives, with an obviously profound and long-term impact on the surviving extended family members.
The New Zealand Mental health foundation suggest you “Shrink your worries” for day-to day anxieties by questioning its significance, talking it out with others, writing it down to gain perspective, deep breathing and relaxation techniques or yoga/meditation, allowing themselves only a set time with their particular worry or concern, increase their outdoor activities such as exercising in nature to effectively work through the thought processes, and try to find rationale and balance in their own thoughts.
First line interventions such as enhanced social and psychological support should be considered before prescribing medication for PND especially if the woman has mild symptoms. However, if a woman is suffering from moderate or severe PND then pharmacological treatment may be considered at a first-line treatment. It was found that structured psychological therapies such as CBT and psychosocial interventions, such as peer support and non-directive counselling appear to be effective for reducing symptoms of PND. showing that such psychological interventions can improve the mother's mental health. Community supports such as face-to-face non-directive counselling, peer-to-peer telephone support and group support have a positive effect on a woman’s mental state.
Clinical research trials suggest more diverse therapies and technologies for the long-term management of anxiety disorders such as cognitive behavioural therapy (CBT) are indicated as an effective form of treatment however appear to be more beneficial when used in person as a face to face form of treatment. There are some computerised cognitive behavioural therapies that could either enhance and/or be used independently such as ‘MoodGYM’ and ‘E-couch’ which can benefit those in the rural sector and these techniques can be used in conjunction with a therapist supported through health services. These forms of therapy such as ‘Beating the blues’, ‘COPE’ and ‘Fear fighter’ can be delivered via a computer interface either by telephone or by the internet.
Another variation of cognitive behavioural therapy called ‘Mindfulness’ which focuses on altering the intensity of the relationship between the actual person and their predominant anxieties, as opposed to trying to alter their actual thoughts and feelings. This method is often initiated firstly by medication for mood stabilisation and therapy for reducing physical symptoms to allow them to remain present to experience and react but in a more realistic way.
Support can also be found ‘online’ for example the ‘Online PPMD Support Group’ and ‘mothers helps’ websites offers information, support and assistance to those dealing with postpartum mood disorders. There is help out there for fathers too, a fantastic website is ‘greatfathers.org.nz’ which offers advice and support for fathers that they themselves may be experiencing depression after the birth of their baby and also advice for offering support if their partner has developed PND.
Local support such as ‘Mothers supporting Mothers’, ‘Mothers Matter’, ‘PND Support Groups’, the ‘Plunket Postnatal Adjustment Programme’ and the ‘Mother and Babies Unit’ based at Princess Margaret Hospital in Christchurch. The Mothers Matter Trust came into existence in 2015 and evolved out of the Postnatal Depression Family/Whanau NZ Trust. They provide information for mothers, fathers & families on PND & related conditions, such as anxiety & bipolar disorder.
The Mothers and Babies Unit is a South Island regional specialist service providing psychiatric treatment for pregnant women and parents with babies up to 12 months old (at time of admission). The team provides inpatient and outpatient treatment for women who experience depression and other psychological and psychiatric difficulties during pregnancy and after the birth of their babies and includes CBT groups.
Maori and Pacific models view the wellbeing of the individual as inseparable from the wellbeing of the whanau, hapu, iwi and family in all its dimensions, as do Pacific models, such as Fonofale. Traditional Maori and Pacific perspectives may challenge some commonly-held assumptions in Western psychological and counselling theory, such as the Western focus on developing individuality and self-advocacy. An abundance of literature around PND may be very daunting for them and their family.
“We never talk about it as a society because we are taught that you must always be happy and grateful to be pregnant and have a baby and that those other feelings just aren’t talked about and my only regret is that I didn’t speak up sooner”.
Modern families and modern living preclude why so many mothers are now often left feeling isolated and confused. From an evolutionary perspective, historical parenting had extended families, so recovery was probably easier in a more supportive environment. I think social support is under rated and undervalued, not just for company but to give mothers a platform to offload and unwind. For many medication and therapeutic interventions are the right answer for the acute phase but from a long-term perspective parents particularly mothers need resourceful communities to provide healthy social networks and peer support. To fund, empower and train experienced parents with resources to act as supportive coaches or mentors for new parents could perhaps lesson the need for tertiary mental health services because often the community already has some of the answers.
If you have been feeling any symptoms of perinatal or postnatal distress,depression or anxiety. Please speak to your GP or well child nurse in complete confidence. It's OK not to be OK.
Circle of Security. http://www.circleofsecurity.org/
Mental health foundation. https://www.mentalhealth.org.nz
MIND. Understanding anxiety and panic attacks. https://www.mentalhealth.org.nz
Ministry of Health. Healthy Beginnings: Developing Perinatal and Infant Mental Health Services in New Zealand. Wellington: Ministry of Health.
Mothers Matter. http://www.mothersmatter.co.nz/default.asp
NICE. Computerised cognitive behaviour therapy for depression and anxiety. https://www.nice.org.uk/guidance/TA97/chapter/3-The-technology
New Zealand Guidelines Group. Identification of common mental health disorders & management of depression in primary care. Wellington: NZ Guidelines Group.
Supporting and educating women with experience of depression from Through Blue, http://www.throughblue.org.nz/p/resources.html
PADA - perinatal anxiety and depression aoteroa - www.pada.nz
Nicky Cooper, Well Child Nurse at Murchison Health Centre.
“I am a mother of three little farm boys, twin boys born prematurely at 29wks and 2 ½ years later our third little boy. We own a farm and run an agricultural contracting business. I have been a registered nurse for 23 years and have worked as an early childhood educator. I am currently studying for my Master’s Degree. I started a Facebook page in May 2016 for the parents in our area to provide them with support, electronic resources and a safe virtual village”.