The arrival of a new baby is expected to be one of the happiest times in a woman's life. But becoming a mother has a huge physical, social and psychological impact. Hormonal changes mean that most new mothers experience the 'baby blues' in the first week after childbirth, but for 15 per cent of the 669,000 who give birth in the UK each year, this develops into postnatal depression. A shocking new report from industry analysts, Datamonitor, show that more than 75 per cent of those affected are left undiagnosed and untreated.
The sooner postnatal or postpartum depression (PND) is diagnosed the better. As many sufferers will be reluctant to seek help from GPs, it is vital that secondary care workers, such as midwives and health visitors, and those who are in contact with new mothers like nursery staff should be aware of the symptoms and how to help.
Datamonitor attributes the alarming low diagnosis rate primarily to patients' belief that they will get better naturally and to the lack of research into the safety of using antidepressants during pregnancy and while breast-feeding, which deters GPs from prescribing them.
PND needs to become a more acceptable and treatable illness. For this to happen, the report calls for:
* drug companies to clarify the effectiveness of antidepressants as well as safety issues
* better healthcare systems to put into place guidelines to ensure both that screening for PND is more regular and that treatment lasts for a minimum of six months, not six weeks.
Iris Gibbs, parent-child psychotherapist at the Anna Freud Centre, a leading child therapy centre in north London, says, 'Society idealises childbirth and motherhood, and this puts women under pressure when their experience does not match their expectations. Many women suffer from the baby blues, but often the expectation among family and friends is that it will pass. When it doesn't, a mother may feel even more overwhelmed by her feelings. Proper help and support is needed to help these women and the families that are affected.'
Effect on the baby
The parent infant project at the Anna Freud Centre has helped many mothers overcome their postnatal depression and restore their relationship with their child.
Project manager Tessa Baradon says that newborn babies' development is strongly dependent on the primary relationship in their lives, usually with their mother, and interactions with their mother, including feeding, smiling, playing and comforting.
She says, 'If a mother is suffering from PND, this cuts across these interactions. The mother is often preoccupied with her own mental state, not with her baby. This means that the usual display of spontaneous warmth, attention, interest and love is not conveyed to the infant.'
In this situation, the baby faces two main responses from the mother - withdrawal or intrusiveness. If withdrawn, the mother is unresponsive to her baby's activities. An intrusive mother may overstimulate the baby or show irritability, anger or negativity. However, it is important to understand that the mother adopts neither of these behaviours intentionally.
Babies need their mothers to help them to feel emotionally secure. When PND is involved, a mother struggles to provide stability, as her own mental state is so fragile. The effect on the baby can vary. Lynne Murray, professor of developmental psychology at Reading University, says, 'Postnatal depression does not make a poor relationship with the baby inevitable. But it does raise the risk of finding it difficult to respond to the infant.'
Other people play a vital role at this crucial stage of infancy. If the baby has regular contact with another adult, then this can help minimise the impact on their development. The difficulties with their mother will still need to be addressed, but they have someone else to support them. If the mother is the baby's primary carer, it will be more difficult for the baby to get their emotional needs met. This can affect the baby's attitude and expectations of others, and if they have been met with blankness or anger at home they will expect to find this from other people. These expectations can carry on until the child reaches nursery, where their lack of emotional development may become apparent.
Nursery workers can play a very important role at this stage. Tessa Baradon says, 'A third person can be very helpful for both the infant and the mother as they can recognise the parent's state of mind and offer support.
It is very important to sympathise and empathise and help ease the feelings of guilt that they probably have. Parents often provide information through their behaviour that could be indicative of a problem, for example, if a mother seems very weighed down or on the verge of tears or quick to anger.
'Nursery workers can also support the child and help them to understand the situation that they are in. They can introduce positive interaction to try to recover their development and also explain to them that their mother is not well and that it is not their fault.'
Babies can also display signs of a troubled relationship with their mothers, for example, if a baby does not look at the mother when talking to her, or is staring away her when being fed. This is in contrast to a mother and baby who have a strong bond, who will spontaneously interact by smiling and looking at each other a lot.
What to do
It is very important for nursery staff not to be critical of a mother with PND. Experts suggest approaching the mother in a non-judgemental environment, allowing them to just talk about how they are feeling. Be patient, and give them time. Talk to the mother about her daily routine.
This can give clues about their interactions during their time spent together. If there does appear to be a problem, assist them in getting help from their GP, health visitor or support groups.
Although not much is known about the causes of PND, progress has been made in its treatment. But it has to be diagnosed first. It is important that PND is recognised and treated as an illness by the patient and those around her. Catching it early is the best way of helping. The shorter it lasts, the less impact it will have.
Case study: a major life event triggers PND
Ruth was a single woman who worked full time and, when she discovered she was pregnant, chose to keep her baby although she did not want a relationship with the father. She was close to her own family, but her mother died of cancer during her pregnancy. Ruth fell apart. She could not cope with trying to mourn her own mother while trying to become one herself, and became depressed and stopped working. Eventually Ruth went to her doctor and got help. They discussed antidepressants and her GP was ready to prescribe, but Ruth opted for therapy instead. She was referred for parent-infant psychotherapy, which helped her to discuss her relationship with her own mother. After the birth, Ruth carried on with the counselling, which was adapted to include the baby. This allowed the interactions between Ruth and her baby to be observed and discussed to help her improve the relationship. Both mother and baby showed significant improvement and soon Ruth was able to cope on her own.
Organisations that can help
* Association for Postnatal Illness, www.apni.org.uk
* National Childbirth Trust, www.nct-online.org
* Meet-A-Mum-Association (MAMA), Postnatal depression helpline (Mon-Fri, 7pm-10pm), 020 8768 0123, www.mama.org.uk
* Anna Freud Centre, www.anna freudcentre.org
Case study: a lack of social support
Susan was a young mother with her first baby. She was married with a successful career and comfortable home life, but just before the birth she and her husband moved to a new part of London where they didn't know anyone. The couple had supportive parents but they didn't live locally so Susan was on her own with the baby. She began sleeping later and later, and although breast-feeding was fine, other contact with the baby was too much for her to handle.
She went to her GP, who was very responsive and organised visits from a health visitor. She also received parent-infant psychotherapy where it became clear that she felt tremendous guilt for the negative thoughts she kept having about the baby, for example, imagining using a cushion to stop her crying. Susan started to take antidepressants, after weaning the baby, as well as continuing the therapy and joining a local support group.
Gradually both she and the baby started to improve. The baby went from a sombre little girl to a happy, playful infant. When the couple decided to have a second child, Susan's family, counsellor, GP and health visitor were better prepared to offer greater support.
Noa-9
