Forest Trees

Mental Health and Wellbeing
Postpartum ‘baby blues’, postnatal depression, postpartum stress, postpartum psychosis

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Postpartum ‘baby blues’

During the first week after childbirth, instead of feeling happy and elated, you may experience a state of low mood wherein you feel mildly depressed. This is a very common condition known as the ‘baby blues’ which affects up to 80% of women after birth.

The ‘baby blues’ are most likely caused by several contributing factors such as:

  • Sudden hormonal and chemical changes following childbirth.

  • Lack of sleep.

  • Feeling overwhelmed with the responsibilities of parenthood.

Symptoms can include:

  • Feeling emotional and bursting into tears (for no apparent reason).

  • Feeling irritable or touchy.

  • Low mood.

  • Anxiety and restlessness

 

All of these symptoms are normal and usually only last for a few days, and no more than 2 weeks after giving birth. If your symptoms last longer or start later, you may have postnatal depression.

Postnatal depression

Postnatal depression is a common problem, which affects 1 in every 10 women within a year of giving birth. It usually occurs 2 to 8 weeks after birth, though sometimes it can occur up to a year after your baby is born. If left untreated it can persist for months or become a long-term problem. Many women do not realise they have postnatal depression, because it can develop gradually. It can also affect fathers and partners.
 

When you have had a baby, you will experience common postnatal symptoms such as tiredness, irritability, or poor appetite- these are all normal, mild and don't stop you leading a normal life.
 

However, when you have postnatal depression, you may feel increasingly depressed and despondent which makes looking after yourself or your baby become overwhelming.

This can cause emotional and mental symptoms such as:

  • Persistent feeling of sadness and low mood

  • Loss of interest in the baby & difficulty bonding with your baby

  • Feelings of hopelessness

  • Not being able to stop crying

  • Feelings of not being able to cope

  • Not being able to enjoy anything or loss of interest in the wider world

  • Withdrawing from contact with other people

  • Memory loss, being unable to concentrate or make decisions

  • Anxiety in general and excessive anxiety about the baby

  • Loss of appetite

  • Panic attacks

  • Sleeplessness

  • Aches and pains

  • Feeling generally unwell

  • Lack of energy and feeling tired all the time

  • Trouble sleeping at night and feeling sleepy during the day

  • Frightening thoughts – for example, about hurting your baby

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Causes of postnatal depression

 The cause of postnatal depression is not completely clear but there are several factors that may make you more likely to experience postnatal depression such as:

  • Having the ‘baby blues’

  • A history of mental health problems, particularly depression, earlier in life.

  • A history of mental health problems during pregnancy.

  • Having no close family or friends to support you.

  • A difficult relationship with your partner.

  • Recent stressful life events, such as a bereavement.

  • Physical or psychological trauma, such as domestic violence.

 

Adapting to being a new parent is a life-changing event that can take time to adjust to. Looking after a small baby can be stressful and exhausting. So, even if you do not have any of these contributing factors, sometimes parenthood can trigger depression.

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Treatment for postnatal depression

 

Postnatal depression can be lonely, distressing, and frightening, but support and effective treatments are available. Milder cases of postnatal depression can be treated with lifestyle modifications and counselling. This can be given by your health visitor or a therapist. More severe cases often require antidepressants and you may need to see a specialist.

These include:

NB: If you need to take antidepressants and are breastfeeding, it is important to let your GP know so that they can prescribe a type of medication that's suitable while you're breastfeeding.

Getting help for postnatal depression

Postnatal depression can be extremely distressing, and many women suffer in silence.  Their friends, relatives and health professionals don't know how they are feeling.  It's important to seek help as soon as possible if you think you might be depressed, as your symptoms could last months or get worse and have a significant impact on you, your baby and your family. 

 

If you think you have postnatal depression, don't struggle alone. It's not a sign that you're a bad mother or are unable to cope. Postnatal depression is an illness and you need to get help, just as you would if you had the flu or a broken leg.  With the right support you are likely make a full recovery.

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Talk to someone you trust, such as your partner or a friend. Or ask your health visitor to call in and visit you. Many midwives and health visitors have been trained to recognise postnatal depression and have techniques that can help. If they can't help, they will know someone in your area who can.

 

It's also important to see your GP. If you don't feel up to making an appointment, ask someone else to do it for you if you think that you may be depressed.

Remember that:

  • A range of help and support is available, including therapy.

  • Depression is an illness like any other, that needs to be treated.

  • It's not your fault you're depressed - it can happen to anyone.

  • Being depressed does not mean that you're a bad parent.

  • It does not mean that you're going mad.

  • Your baby will not be taken away from you - babies are only taken into care in very exceptional circumstances.

Postnatal post-traumatic stress disorder

Postnatal post-traumatic stress disorder (Postnatal PTSD) is a type of anxiety disorder that is also known as birth trauma. Living with the effects of a traumatic birth can feel very challenging, especially as it can also be accompanied by other postnatal mental health conditions, feelings of guilt and low self-esteem.

Symptoms of post-traumatic stress disorder

The symptoms of postnatal PTSD can occur alone, or in addition to the symptoms of postnatal depression, and usually develop straight after the birth or months afterwards.

 

They can include the following:

  • Physical sensations, such as pain, sweating, feeling sick or trembling

  • Vivid flashbacks (feeling that the trauma is happening right now)

  • Intrusive thoughts and images

  • Nightmares

  • Intense distress at real or symbolic reminders of the trauma

  • Physical sensations such as pain, sweating, nausea or trembling

  • Panicking when reminded of the trauma

  • Being easily upset or angry

  • Extreme alertness, sometimes known as 'hypervigilance'

  • Finding it hard to sleep, even when you have the chance

  • Irritability or aggressive behaviour

  • Finding it hard to concentrate, including on simple or everyday tasks

  • Being jumpy or easily startled

  • Self-destructive or reckless behaviour

  • Other symptoms of anxiety.

 

Postnatal PTSD is often the result of a traumatic birth, such as a long or painful labour, or an emergency or problematic delivery. It can also develop after other types of trauma, such as:

  • A difficult labour with a long and painful delivery

  • An unplanned caesarean section

  • Emergency treatment

  • Other shocking, unexpected, and traumatic experiences during birth.

  • A fear of dying or your baby dying.

  • Life-threatening situations.

Treatments for postnatal PTSD

There are various treatments that you may be offered for postnatal PTSD which usually involves talking therapies. Your doctor should discuss these options with you, so that you can decide together about the best treatment for you:

 

  • Identify your triggers - certain experiences, situations, sensations, or people seem to trigger flashbacks or other symptoms.

  • Confide in a friend, family member, your GP or a trained listener at a helpline.

  • Seek out some peer support to share other peoples experiences e.g. side-by-side.

  • Seek out specialist in advice and support for postnatal PTSD e.g. the Birth Trauma Association.

  • Trauma-focused cognitive behavioural therapy (CBT), which is specifically designed to treat PTSD.

  • Be patient and compassionate with yourself as you recover at your own pace.

  • Look after your health: eat well, do some physical activity, and spend time outdoors.

  • Try to be patient with yourself. Don't judge yourself for needing time and support to recover from postnatal PTSD

  • Eye movement desensitisation and reprocessing (EMDR). 

  • Medication is not normally offered to treat PTSD itself. But there are a few related reasons why your doctor may offer you medication:

  • It is common to also experience anxiety and depression alongside PTSD. Your doctor might offer you medication to treat those symptoms. 

  • Your doctor might offer you medication to help you feel more stable and able to care for your baby. 

  • Sometimes there are long waiting lists for talking therapies in your area. Your doctor may offer you medication to help you while you wait for therapy.

Postpartum psychosis

https://www.nct.org.uk/life-parent/how-you-might-be-feeling/postpartum-psychosis-what-it

 

Postpartum psychosis (sometimes called puerperal psychosis or postnatal psychosis) is a serious mental health illness that can affect a woman soon after having a baby. It affects around 1 in 500 mothers after giving birth.  It is a severe psychiatric illness that can develop within hours of childbirth which should be treated as a serious medical emergency, requiring urgent attention and medical or hospital treatment.

The most severe symptoms tend to last 2 to 12 weeks, and it can take 6 to 12 months or more to

recover completely from the condition. But with treatment and the right support, most people

with postpartum psychosis do make a full recovery.

An episode of postpartum psychosis is sometimes followed by a period of depression, anxiety

and low confidence. It might take a while for you to come to terms with what happened. 

Some mothers have difficulty bonding with their baby after an episode of postpartum psychosis

or feel some sadness at missing out on time with their baby. With support from your partner, family, friends and your mental health team, or talking to others with lived experience, you can overcome these feelings.

Many people who've had postpartum psychosis go on to have more children. Although there is about a 1 in 2 chance you will have another episode after a future pregnancy, you should be able to get help quickly with the right care and the risks can be reduced with appropriate interventions.

Symptoms of postpartum psychosis

Symptoms usually start suddenly within the first 2 weeks after giving birth - often within hours or days of giving birth. More rarely, they can develop several weeks after your baby is born and can include:

  • Restlessness, feeling over-active or energetic.

  • Unable to sleep or feeling as though you do not need to sleep.

  • Manic mood - talking and thinking too much or too quickly, feeling excited, ‘high’ or ‘on top of the world.

  • A low mood - showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety, agitation or trouble sleeping.

  • Severe mood swings - sometimes a mixture of both a manic mood and a low mood - or rapidly changing moods.

  • Loss of inhibitions.

  • Feeling suspicious or fearful.

  • Feeling very confused and disorganised thinking.

  • Behaving in a way that's out of character.

  • Hallucinations - hearing, seeing, smelling, or feeling things that are not there (particularly about your baby).

  • Delusions - thoughts or beliefs that are unlikely to be true.

 

It’s unlikely that you will recognise the symptoms in yourself, so it’s mostly up to your partners, friends, and family to get help for you.

 

If you do suspect a case of postpartum psychosis, it should be treated as a medical emergency:

  • See a GP immediately or call 111.

  • Go to A&E or call 999 if you or someone you know is in imminent danger.

 

You should then receive a referral to a specialist perinatal mental health service for assessment. This should happen within four hours of any symptoms starting suddenly.

 

If you have been assessed as being at high risk of perinatal mental health issues, then you will have a care plan in place. A care plan will let you and your friends and family know how to get help quickly if symptoms appear.

Causes of postpartum psychosis

We're not sure what causes postpartum psychosis, but genes, hormonal changes, disrupted sleep patterns and past mental health status appear to be some of the main causes:

 

  • Hormone level changes.

  • Disrupted sleep patterns.

  • Previous diagnosis of severe mental illness bipolar disorder or schizophrenia.

  • Genetic tendency - a family history of mental health illness, particularly postpartum psychosis, and perinatal mental illness (even if you have no history of mental illness).

  • If you developed postpartum psychosis after a previous pregnancy.

Treatment for postpartum psychosis

Treatment for postpartum psychosis usually happens in hospital. Ideally, this would be with your baby in a specialist mother and baby (MBU) psychiatric unit which can provide you with expert treatment without separating you from your baby. But you may be admitted to a general psychiatric ward until an MBU is available.

With the right support and treatment most women make a complete recovery, although this may take a few weeks or months.

You may be prescribed 1 or more of the following treatments:

  • Antipsychotics medication - to help with manic and psychotic symptoms, such as delusions or hallucinations.

  • Mood stabiliser medication (for example, lithium) - to stabilise your mood and prevent symptoms recurring.

  • Antidepressant medication - to help ease symptoms if you have significant symptoms of depression and may be used alongside a mood stabiliser.

  • Electroconvulsive therapy (ECT) - sometimes recommended if all other treatment options have failed, or when the situation is thought to be life threatening.

  • Psychological therapy - cognitive behavioural therapy (CBT), talking therapy that can help you manage your problems by changing the way you think and behave.

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Support for postpartum psychosis

As you recover it can be hard to come to terms with the experience of postpartum psychosis as it can have a big impact on your life, but support is available.

 

You may find that it helps to speak to others who've had the same condition, or connect with peer support workers or a charity who can help such as:  Action on Postpartum Psychosis (APP) which has a APP forum, where you can connect with others affected by postpartum psychosis, and a series of Postpartum Psychosis Guides covering:

 

  • Recovering after postpartum psychosis

  • Supporting partners

  • Planning pregnancy

  • Parenting after postpartum psychosis

  • Pregnancy for women with bipolar disorder

 

Mind: what is postpartum psychosis?

Royal College of Psychiatrists: postpartum psychosis

 

Reducing the risk of postpartum psychosis

If you're at high risk of developing postpartum psychosis, you should have had specialist care during pregnancy and be seen by a perinatal psychiatrist.  You should have had a pre-birth planning meeting at around 32 weeks of pregnancy with everyone involved in your care. This includes your partner, family or friends, mental health professionals, your midwife, obstetrician, health visitor and GP. 

This is to make sure that everyone is aware of your risk of postpartum psychosis. You should all have agreed on a plan for your care during pregnancy and after you've given birth.

You'll get a written copy of your care plan explaining how you and your family can get help quickly if you become ill, as well as strategies you can use to reduce your risk of becoming ill.  In the first few weeks after your baby is born, you should have regular home visits from a midwife, health visitor and mental health nurse.

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Red flags - when to seek help

It is vital that you take care of yourself and focus some of your attention on your mental health and wellbeing so that you can spot any warning signs and seek medical health when required. 

 

Familiarise yourself with the list below and make sure that you tell your midwife, health visitor or GP immediately if you experience any of these symptoms, as they could indicate a condition that requires further support or immediate treatment.

  • If the ‘baby blues’ symptoms last for more than 2 weeks after birth.

  • If you experience bouts of mania or manic behaviour.

  • If you feel like harming yourself or your baby.

  • If you, or someone in your support network suspect that you have postpartum psychosis.

 

Postpartum psychosis is a serious mental illness that should be treated as a medical emergency. It can get worse rapidly and the illness can risk the safety of you and your baby.  See a GP immediately if you think that you, or someone you know, may have developed symptoms of postpartum psychosis. You should request an urgent assessment on the same day.

You can call 111 if you cannot speak to a GP or do not know what to do next. Your midwife or health visitor may also be able to help you access care.

Call your crisis team if you already have a care plan because you've been assessed as being at high risk of developing postpartum psychosis.

Go to A&E or call 999 if you think that you, or someone you know, may be in danger of imminent harm.  Be aware that if you have postpartum psychosis, you may not realise that you're ill. Your partner, family or friends may spot the signs and must take action on your behalf.

Useful links for further guidance and support

https://www.nhs.uk/conditions/baby/support-and-services/feeling-depressed-after-childbirth/

https://www.nhs.uk/mental-health/conditions/post-natal-depression/overview/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/ptsd-and-birth-trauma/

How you can support your partner

 Women with postpartum baby blues, depression, PTSD or psychosis will need support to help them with their recovery. You can support your partner by ensuring that they are well nourished, well rested, and have the appropriate level of treatment that they need to recover. Below are some ways that you can be supportive:

 

  • Know what the symptoms are and be vigilant of your partners mental health.

  • Ask your partner how you can help and support them.

  • Listen to your partner if they want to talk about their feelings or mental state.

  • Be non-judgemental and considerate towards your partner’s condition.

  • Create opportunities for your partner to focus on their own needs and restoration.

  • Be calm and supportive whilst being vigilant.

  • Help with the housework and cooking.

  • Help with childcare and night-time feeds.

  • Let them get as much sleep as possible.

  • Help with shopping and household chores.

  • Keep the home as calm and quiet as possible.

  • Don’t have too many visitors over.

  • Familiarise yourself with their care plan if they have already been assessed.

  • Encourage your partner to go and see a GP immediately if you think that she may have developed symptoms of postnatal depression, postpartum PTSD or postpartum psychosis.

  • Be prepared to act on your partners behalf and call your GP or 111 if they develop symptoms.

  • Go to A&E or call 999 if your partner, baby, or someone you know is in imminent danger.

  • Postpartum psychosis can be distressing for you as a partner, relative or friend. So, do not be afraid to get help for yourself, by talking to a mental health professional or the charities listed above.

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