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Common maternal mental health questions answered

Q. I had my first baby six months ago, and after the birth I started to feel incredibly overwhelmed & anxious. I feel trapped inside our home and unable to go out. Before the baby I felt like I could do anything, now I don’t feel confident at all. Could I have post-natal depression? 

A. The arrival of a first baby is a time of enormous change and upheaval. You are likely dealing with a whole range of challenges, including recovering physically from the birth, ongoing sleep deprivation, changes to your financial independence, and strain on your relationship. It is really not that surprising that the accumulation of stresses can lead to feeling overwhelmed. Sometimes the stress and strain can tip people over into an episode of depression and this is quite common in the years after having a baby. 

In fact, our research found that 1 in 3 women experienced depression in the first four years after birth. Symptoms of depression in the postnatal period may include persistent sadness or crying, loss of confidence, withdrawal from friends and family, anxiety, constant worrying, irritability or anger, and thoughts about harming yourself.
 
If you find symptoms like these are causing you a lot of distress, or are negatively impacting your day to day life, it is a good idea to talk to someone about how you are feeling. Sometimes it can be hard to ask for help. There is still stigma about ‘postnatal depression’ as there remains a misconception that experiencing depression after birth means you are somehow not happy about becoming a mother, or that you don’t love your new baby. This is far from the truth. Speaking with a trusted GP or Maternal and Child Health Nurse is a good place to start. Fortunately, there are a range of effective treatments for maternal depression.

These include strategies to reduce stress in your life, increase how much sleep you are getting, the possibility of talking to a psychologist about ways to manage stress, exploring other avenues for support, or taking prescribed medication. All of these strategies can significantly reduce the anxiety and distress you are experiencing, and help you function at your best. 

Q. I am worried about my partner. Our first child has just turned 1, and I feel she may not be coping. She just doesn’t seem like herself, and is always angry and irritated. Any time I try to talk about it, she tells me that she is fine, and to leave her alone. What can I do to help her?

A. The arrival of a new baby brings about enormous changes for women (or for whoever is acting as the primary care-giver). Essentially, they are taking on a new job 24-7, and one for which they have very little training! They may be dealing with leaving the workforce, having less financial independence, and coming to terms with the reduced adult contact in their life. These challenges don’t pass in the first few months either. The risk for women experiencing things like extreme fatigue, back pain, sleep deprivation, anxiety, and depression are heightened for many years after birth.
 
There are some practical things you can do that may really help your partner. Both emotional and practical support have been found to increase women’s wellbeing after birth. Giving your partner an opportunity to talk about how she is feeling, and share what her day to day life is like may help her to open up. When someone we love is in pain, we have a tendency to want to ‘fix’ the problem, or to make them feel better. However, just being there and listening, without judgement or advice, is more likely to be helpful. Show her you are interested, and let her talk about how hard things can be, without trying to change how she is feeling.
 
We also know that making sure women get regular, frequent time out from the demands of caring for young children protects women’s mental health. In a large study of over 1500 new mothers, we found that women who did not get regular time out in the first six months after birth had three times the prevalence of depression when compared to women who had time out once a week or more. So you can help your partner by providing ongoing  practical support. Offer to take the baby out for a few hours, so that she can put her feet up, go for a walk, or catch up with a friend. Encourage her to take an hour or two each week (at least) to do something for herself, that she enjoys. 

Q. I am due to have my first baby in 3 months. I have a history of depression, and I feel worried that I might get post-natal depression. What can I do to try and prevent it?

A. Having a prior history of depression is a risk factor for developing depression after birth, so it is great that you are being proactive and thinking about how to look after yourself. There are certainly things you can do now to try to reduce your risk of developing mental health problems after your baby arrives.

The most valuable thing that will protect your mental health is trying to engage and accept as much social support from those around you as possible. Talk to the important people in your life (partner, family, close friends) about how they might help you out in practical ways when the baby arrives. Talk to them about the fact that you will need to have time out, at least once a week, to have a break from the demands of caring for the baby – this is something which research has shown protects women mental health in the first six months after birth.
 
It may also be helpful to think about exploring mindfulness meditation. We are currently developing a study to explore this in more detail. Based on promising  pilot data, we are planning to evaluate the impact of a mindfulness intervention in pregnancy on women’s mental health. Mindfulness is a strategy which has been shown to reduce the risk of relapse of depression in general populations. Setting aside 10 minutes each day, to focus your attention on your breath, or on what you can hear or feel in the present moment is a strategy that will promote and strengthen your mental resilience. There are many self-help books available which can describe mindfulness in detail, and help you to start your own practice. Some examples are Mindful Motherhood, by Cassandra Vieten and Mindful Birthing by Nancy Bardacke.

Q. I have heard from friends who have children that having a baby can be pretty hard on your relationship with your partner. What can I do to make sure we stay strong?

Without doubt, the many changes that a new baby brings can put strain on intimate relationships. In a study of over 1500 new mothers, we have found that women report a drop in their emotional and physical satisfaction in relationships after the birth of a first baby, which can continue for a considerable time. The first thing to remember is, this is quite normal. It makes sense that dealing with chronic sleep deprivation, changes to your roles in the relationship, and possible financial strain will leave couples not at their best.
 
In the Maternal Health Study, we conducted in-depth interviews with a sub-sample of 30 women in the study about their experiences in intimate relationships after the birth of their first baby. Some of the challenges they reported was the impact of pain and tiredness on their sex lives, a loss of libido after birth, and the impact of changing roles on intimacy with their partner. Many women reported that it took much longer than they expected to ‘get back to normal’.

But, it is not all bad news! Some women reported that sex and intimacy improved for them after birth. And there were also some strategies that seemed to help couples in making the transition to parenthood a bit smoother. Teamwork between partners was extremely helpful, as was sharing the emotional and practical demands of caring for a newborn baby as equitably as possible. Getting time out to be together as a couple, away from children was helpful (but challenging), and talking as much as possible with each other about the changes and demands you are dealing with, and what are your current priorities as a couple was also helpful.
 
You can access the resource produced by this study here.

Q. My baby has been having a lot of trouble sleeping, and I don’t feel like I am coping. I feel like crying all the time, and I’m really exhausted. Could I have postnatal depression, or am I just sleep-deprived?

A. There is a strong relationship between not getting enough sleep, feeling exhausted, and depressive symptoms. It can be difficult to figure out what comes first, as there is definitely a ‘chicken or the egg’ relationship at play. For example, when people are experiencing an episode of depression, they are likely to feel tired and lethargic, as this is one of the key symptoms of depression. Likewise, if you are sleep deprived, this will cause changes to your mood, and will no doubt leave you feeling more emotional and stressed.

I would suggest talking to your GP about how you are feeling. It may be that working on some strategies to make sure you are getting some more sleep will help to improve your mood. For example, if it’s possible, you may want to engage the help of someone else to be in charge of the night-time wakenings for a few nights (such as your partner or another trusted family member). Early parenting centres – sometimes called ‘sleep schools’ - are another possible avenue of support. They can help you with strategies to manage sleep problem, and support you in looking after yourself as well. There are also private sleep consultants who can visit you at home to help you to improve your child’s sleeping.

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