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.

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 does not produce 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 gain – Emotional Impact of the physical change in pregnancy on body image
• Unplanned pregnancy, and/or single

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.

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.

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 that 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.

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 experiencing depression as well.

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 ….