Dealing with the urge to walk away

Many parents experience the baby blues, but what happens if the depression refuses to go away?

THE SAFE arrival of a new baby should be a magical time for a couple, to be celebrated with outpourings of love and fluffy toys.

With the physical challenges of pregnancy and labour behind them, relieved women expect to relish the early days of motherhood. But every “bundle of joy” should carry the warning that childbirth can damage your mental health.

Life with a baby is not all happy gurgles and cute smiles; nobody tells you there may be days when you just want to walk away.

Women are at greater risk of depression in the weeks and months after giving birth than at any other time. Lack of sleep and the stress of caring for the baby erode their defences.

It is a vulnerable time for women, for reasons that range from psychological, biological to hormonal and relationships, says Dr Anthony McCarthy, consultant perinatal psychiatrist at the National Maternity Hospital in Dublin. “For every mother, every issue in their life is up for grabs.”

A woman is 19 times more likely to be admitted to a psychiatric hospital in the first six weeks after delivery than at any other six-week period in her lifetime. Yet in the Republic there is nowhere she can have her baby with her if she needs in-patient psychiatric treatment.

Those are the most severe cases – puerperal psychosis occurs in approximately one to two per 1,000 women after childbirth. The vast majority of the estimated 13 per cent of women who suffer from depression at this time do not require hospitalisation. Support of family and friends can be enough to pull them through, while others need professional counselling and/or antidepressant medication.

But it is vital for a woman or her partner to recognise the warning signs and seek help before she is caught in a negative downward spiral. “Baby blues”, which most mothers experience within days of delivery, should not persist beyond a fortnight.

Symptoms of postnatal depression range from fatigue and sleeplessness, loss of appetite and anger to panic attacks, low self-esteem and being unable to carry out simple tasks. A woman is often very reluctant to admit she is finding it difficult to cope or bond with her baby, believing she is the only one who feels that way and to talk about it would be revealing herself as a “bad mother”.

Fathers are not immune to postnatal depression either, despite a common misconception that fluctuating female hormones are the sole cause. Risk factors include a traumatic birth, lack of support, bereavement, financial problems and a pre-disposition to depression. Assisted reproduction is also linked to a higher incidence.

An extensive study published last month by the Medical Research Council in the UK found that 3 per cent of fathers had been depressed in the first year of their child’s life. This rose to 10 per cent by the time their child was four.

“When I see a man or a woman struggling after the birth of a baby, I am not looking for a thing called postnatal depression, I am looking for what is going on,” explains McCarthy. “If they are depressed, why?”

It is unlikely that the birth on its own, or becoming a father on its own, is going to be the key thing. It may be an adjustment problem that needs support, psychotherapy counselling or, if it has developed into a clinical condition, may need antidepressants.

The adjustment required when a baby comes into the house should not be underestimated and is one of the reasons postnatal depression affects adoptive parents too. As more couples delay parenthood, a man and woman may have lived together for a decade before starting a family.

“Having had a certain kind of relationship, suddenly this bombshell lands in the middle,” says Dr Harry Barry, a GP in Drogheda and a director of the depression support organisation Aware. “The whole relationship gets thrown up in the air and the man begins to feel isolated. Up to 10 per cent of men will develop postnatal depression and this is never talked about. The man becomes invisible.”

The biggest single problem in treating women for postnatal depression, he says, is convincing them to take medication when normal measures, such as getting rest and getting help, are not enough.

“They feel that means they are a failure, instead of accepting it as part of a package to get better,” says Barry, whose latest book, Flagging the Therapy: Pathways out of Depression (Liberties Press), outlines medical, psychological and complementary treatment options for depression.

Whenever a parent develops depression after birth or when the children are older, it has a huge impact on the family. For a start, somebody who feels worthless inside is likely to push away his or her partner.

The problem is the partner feels rejected and starts reacting, which makes the depressed person feel worse because this kind of confirms what they already feel, says Barry. But if a partner understands the world of depression, he or she can move in and help.

The Parents’ Advice Centre in Belfast offers a six-week programme entitled Sink or Swim: Parenting with Depression. “It is for parents who have mild to moderate mental health issues,” says its education manager, Jackie Valentine. “Even though they are dealing with their mental health, often they don’t think about the effect it is having on their children.”

Parents may think they are hiding it and doing the right thing by not telling the children what is wrong with them, but that can make things worse. One parent said it was only after doing the programme that she spoke to her son – and his immediate reaction was one of relief. “I thought you had cancer,” he told her, having observed frequent visits to the doctor and taking of medication.

Parents generally will try to shield any illness from their children, says consultant psychiatrist Siobhán Barry of Cluain Mhuire Community Mental Health Service in Blackrock, Co Dublin. “I am not entirely sure that it is often helpful for parents, whether it is physical or mental illness, to talk to their children about being ill.”

However, children are perceptive and any questions they ask should be answered truthfully, in an age-appropriate manner.

“It is not helpful to hoodwink them but I think they need a sense of security and protection,” she says.

Among adults, though, Dr Harry Barry would like to see more frankness about depression. He says friends or family should bring up the topic of suicide with someone who is depressed – to find out if they are contemplating such an action.

“That is what’s wrong at the moment. We are all afraid, instead of saying we must open up this subject.” Often a depressed person is relieved to get the chance to talk about it, he stresses.

“It might be the one chance you get to ask the question, so remember that, before something else happens.”

THE LONELINESS: 'THEY ARE JUST NOT EXPECTING IT'

FIONA REA resented having the “postnatal” label attached to the depression she suffered after the birth of her second child. “I did not want Megan taking the blame for this. She was a brilliant baby.” She was happily breastfeeding, which has been shown to lower the risk of depression – although, if it goes badly, can cause it.

Almost certainly it was the loss of Rea’s own mother, when she was five months pregnant with Megan, which triggered the depression. Looking back, the months after the birth are all a bit of a blur. But by the time Megan was eight or nine months old, Rea was at breaking point as it became increasingly difficult to keep up the pretence that life was wonderful.

“You get to the point where you can’t play the game anymore. The gloss had gone off the world.”

Luckily, her GP had expertise in treating postnatal depression. “It is not something you tend to discuss with your pals that much. Obviously, your very close friends know you are upset and different to how you have been in the past. But nobody else would put a label on it, except your GP or a health professional.”

Rea was very reluctant to take her GP’s advice to go onto antidepressant medication. “He explained in no uncertain terms if I broke my leg he would be giving me painkillers. Once I got my head around the fact that it wasn’t for ever . . . it was probably the best thing I ever did.” She was on medication a year before she started to wean herself off. “I knew when I was ready to come off it. It took me two or three weeks and I suffered from vertigo.”

Now the mother of four children aged 12 to two, Rea did not develop depression after the other two births since Megan’s. There were times when she started to feel low but was able to deal with those without going back on medication. “I know the signs of when I need support and help.”

Rea is willing to talk about her experiences because she sees the prevalence of postnatal depression, particularly among older first-time mothers. “They have had their career; they are just not expecting the loneliness that comes with it.”

It is a topic she concentrates on in the antenatal classes she leads for the North Wicklow branch of Cuidiú, the Irish Childbirth Trust. She urges partners to be vigilant. “If they feel things aren’t right, they should have a word with her and if that is not working, talk to the GP or public health nurse and get other people involved.”

In her own case, her husband knew something was amiss “but like a typical man, was waiting to be told what was wrong for a long time. Once I started talking about it, he was very supportive. Everybody was”.

She encourages parents to form a support group within an antenatal class, so they are embedded in a network before the baby is born – not just for postnatal depression, but for all aspects of first-time parenthood.

Look for help early, she stresses. “There is no need to be that unhappy – there is help out there. Unfortunately a lot of the time, people only realise the help available when they are better.”

US health psychologist Dr Kathleen Kendall-Tackett will address a one-day conference on depression in new mothers, hosted by Cuidiú on Friday, October 29th at the Alexander Hotel in Dublin. To register, see cuidiu.com

PERFECT MOTHERHOOD: LETTING THE MASK SLIP

The reluctance of women to let the mask of “perfect motherhood” slip means talking about feeling miserable at what is supposed to be one of the happiest times of your life which can still seem taboo.

"Nobody should have to suffer in silence," writes Madge Fogarty in a new book, Recovering from Postnatal Depression, which she has co-authored with Bernie Kealey. Both of them experienced very bad depression after giving birth two decades ago and became involved in support groups to try to help other women in similar circumstances.

Fogarty has single-handedly kept Postnatal Depression Ireland going, with the help of volunteers, since she founded it in Cork in 1992. Her “greatest wish” is that every city in Ireland have a dedicated support group. The book is not only an easy-to-read guide to postnatal depression, looking at risk factors, symptoms and the roads to recovery, but also gives a voice to women who have gone through it.

Recovering from Postnatal Depressionis published by Ashville Media

WHERE TO GO FOR HELP

Anybody who suspects they, or someone close to them, might be suffering from postnatal depression should seek medical help from a GP or public health nurse. While medication and counselling may be required, becoming involved in a support network is also an important step to recovery.

* Post Natal Depression Ireland is based in Cork and organises monthly support meetings in the city. But women anywhere can make contact with each other through the discussion forum on its website, pnd.ie. Its helpline is 021 4923162 or you can e-mail support@pnd.ie.

* Cuidiú – Irish Childbirth Trust not only has a network of branches that offers postnatal support but also runs an “experience register” through which you can contact somebody else who has suffered depression. See cuidiu.com or phone 01 8724501.

* Parentline volunteers are specifically trained in postnatal depression, operating the helpline, 1890 927 277, on weekdays. Its website, parentline.ie, has a section on postnatal depression.

* Parents Advice Centre in Belfast runs “parenting with depression” programmes. See parentsadvicecentre.org.

* Parenting websites such as rollercoaster.ie and magicmum.com have dedicated threads dealing with depression in their discussion forums where people share experiences anonymously. Mumstown.ie not only offers such a thread but also organises and promotes events which offer parents “real-life” contact – a vital tool when fighting depression.

* Aware runs depression support groups, a helpline on 1890 303 302 and aware.ie has extensive information.

* The Samaritans offer emotional support at any time of day or night on 1850 60 90 90.