Depression and Birth Trauma

ANTENATAL DEPRESSION

At least one in ten women will suffer depression and/or anxiety in pregnancy. However studies show that teenagers and women in their early twenties are more vulnerable to this than their older counterparts.  One third of women who suffer depression in pregnancy will go on to suffer post natal depression.  Pregnancy is expected to be a time of joy and wonder, so it can come as quite a shock to feel otherwise.

 

Antenatal depression should be taken seriously as it has been linked to low birth weight and preterm birthFeeling weepy or experiencing mood swings is quite normal during pregnancy but not if you are unable to function well, highly stressed, and/or experiencing suicidal thoughts, or thoughts of harming yourself. Stress and anxiety may also be passed onto the developing baby through increased levels of stress hormones such as cortisol.

If you are suffering, seek help immediately from your GP and midwife who will discuss a plan of action with you which could involve a course of antidepressants and/or counselling. Talking to a counsellor, family and/or friends will help you to air your feelings and any fears you have around your pregnancy. Homeopathy and acupuncture are also helpful for establishing equilibrium between mind and body and balancing hormones.  Above all take it easy, and don’t feel guilty for not getting the day to day jobs done – they can wait.  You are far more important.

If you are feeling depressed during your first trimester, then this will be compounded by morning sickness and fatigue.  So it really is vital to stop and look after your self.  Take time off work if you need to – it is unlawful for your employer to treat days off sick whilst you are pregnant as a disciplinary issue.

 

Physical causes and risk factors for antenatal depression …..

  • Hormonal changes – Opinion was that the sudden increase in pregnancy hormones oestogen and progesterone, protected against depression and created a sense of well being.  Experts now believe that the hormonal surge affects brain chemistry leading to depression. It can also be caused by a lack of hormones – in particular, if the placenta is not producing enough progesterone.
  • Vitamin Deficiency – Lack of iron, zinc and B vitamins, in particular, B6 and B12 have all been linked to depression.
  • Acute sickness – Hyperemesis gravidarum
  • Personal and/or family history of depression
  • Past history of abuse (verbal, physical, sexual)Pregnancy can evoke painful memories of abuse from the past as you start to think about becoming a parent yourself.  The loss of control over your growing body can reflect the loss of control you felt when you were abused.
  • Underlying Anxieties – For example, fear of birth, fear of losing a much wanted baby, something’s wrong with the baby, fears about becoming a parent …..
  • If you have already suffered the loss of a baby through miscarriage, still birth or neonatal death (see above)
  • Undergone fertility treatment(s)
  • Problematic or high risk pregnancy
  • Excessive weight gainEmotional Impact of the physical change in pregnancy on body image
  • Unplanned pregnancy, and/or single motherhood

POST NATAL DEPRESSION (PND)

With the fluctuation in hormones after birth, and when the breasts begin to produce milk, it’s very common to feel low and teary.  This is referred to as the ‘baby blues’ and happens 2-4 days after birth.  This only lasts for a short period – usually a few days.  Being in a hospital environment can also be conducive to low mood.


Post natal depression can develop any time over the first year particularly around the time the baby is four to six months old. One in ten women will develop this illness which isn’t surprising given the often overwhelming adjustment to motherhood; the responsibility of looking after a baby 24/7, lack of sleep, the change in your relationship with your partner. All these can be further compounded by anxiety over your baby’s well being and doubting your parenting skills.

Older mothers tend to breastfeed their infants the hormones of which help to protect against depression.  However, if you have a long and successful career behind you and/or have been very in control of your life for many years, the initial shock of adjusting to mother hood and suddenly feeling out of control might tip the balance into depression.  You might experience some kind of identity crisis as you adjust to life as a new parent.

Personal history must not be underestimated.  Birth and parenthood can unleash lots of forgotten memories from the past some of which may be painful.  It might be difficult to process the emotional impact of this while looking after a baby, leading to depression.  Talking to someone confidentially can help to come to terms with whatever happened in your childhood and move on.

 


One in a 1000 women will develop a rare form of depression called puerperal psychosis. It usually develops a few weeks after the birth, and symptoms include severe depression, mania, delusions and hallucinations.

If you think you are suffering from depression speak to your GP, midwife and health visitor.  Treatment usually involves a combination of practical support and advice, counselling or psychotherapy and if necessary, antidepressants.  Complementary therapies which act on the ‘whole person’, such as homeopathy, reflexology, acupuncture and cranial osteopathy, can also help balance hormone levels and improve sense of well being.

There are a number of things you can do whilst you are pregnant to lesson the chances of depression after the birth;

  • During pregnancy start a self care program of gentle exercise and relaxation e.g. yoga, walking, swimming and meditation. Once the baby arrives, it will be hard to find time for yourself so you could use feeding times as an opportunity to meditate and go for walks with the baby in a pram or sling.
  • Good diet, as there is evidence to show a link between certain nutrients and depression – make sure to include omega 3 oils (found in oily fish, seeds and nuts), magnesium (leafy green vegetables and seeds) and zinc (seeds and nuts).  Also take a vitamin supplement.
  • Talk to your partner about who is going to be responsible for which jobs when the baby arrives and how you are going to take care of your relationship.
  • Build a support network of people – friends, therapist, and if they live near, family, who can help look after the baby and give you some rest.
  • Mothers from any antenatal group you join can offer invaluable support during the first year.
  • If you can afford it, enlist the help of a maternity nurse or post natal doula for the first month or so after the birth.

BIRTH TRAUMA

Thousands of women in the UK suffer from a form of post-traumatic stress disorder (PTSD) after a difficult and painful labour.  This often goes misdiagnosed as it can look like post natal depression.  You might feel angry at the way your midwives or doctors handled your labour, and feel very upset your birth didn’t go the way you had planned.  Perhaps you had hoped for a natural water birth only to end up having an unplanned cesarean section.


Birth itself is a huge shock on the body, and baby. Well meaning people might tell you to forget about the birth and focus on your beautiful new baby so you end up sidelining your feelings.  The demands of a new baby also make it difficult to attend to your emotions.  When feelings around your birth experience aren’t processed they can result in trauma symptoms like flashbacks and nightmares.

emotional numbing, anger, relationship difficulties and difficulty in bonding with your baby.  You might also feel depressed.  Negative birth experience can lead to fear or childbirth (tokophobia) and difficulties with intimacy and sexual problems (vaginismus).  Symptoms may not surface until months after the birth.

If you are suffering from post traumatic stress disorder (PTSD) after a difficult childbirth then you should be treated for trauma.  Treatment can depend on the severity of symptoms.  Speak to your GP if you have been experiencing your symptoms for over a month (they can disappear within this time) or if you just can’t cope.  You may have antidepressants prescribed if you are additionally experiencing depression.

If you feel your symptoms are mild then simply talking to a counsellor may help alleviate symptoms. I have included a number of organisations that offer specific support for birth trauma. If you feel your symptoms are severe or won’t go away after talking to a counsellor, then there are two types of therapy recommended by NICE (National Institute for Health and Clinical Excellence) which are proven to be very effective for the treatment of trauma – your GP should know about both;

  • Trauma focused cognitive behavioural therapy (CBT)
  • EMDR (eye movement desensitisation and reprocessing)

SYMPTOMS OF DEPRESSION AND POST TRAUMATIC STRESS DISORDER (PTSD) – you might experience one or more of the following ….

 

Depression

  • Feeling low and tearful
  • Thoughts of death and self harm
  • Unable to cope with everyday tasks
  • Unable to concentrate or make decisions
  • Feelings of guilt
  • Irritable and angry
  • Hostility towards others
  • Loss of appetite or over eating
  • Sleeping difficulties
  • Loss of interest in sex
  • Anxiety and panic
  • Obsessive fear about the baby’s well being
PTSD

  • Vivid flashbacks and nightmares
  • Intrusive thoughts
  • Keeping busy
  • Avoiding situations which remind of the trauma
  • Repressing memories of the event
  • Emotionally cut off, numb or detached
  • Unable to express affection
  • Sleeping difficulties
  • Angry and aggressive
  • Extreme alertness
  • Panic response and easily startled