Post-natal depression affects many mothers

Press, 8 October 1987, Page 8

Post-natal depression affects many mothers

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MAVIS AIREY

Philip Watson is a general practitioner with a particular interest in postnatal depression. He experienced it in his own family after the children were born, and his professional interest in obstetrics and paediatrics has brought him into contact with many sufferers in his 14 years in a semi-rural practice near Christchurch.

“After two or three years I began to see a pattern in families,” he explains. He believes this type of depression takes three forms.

Most common is the socalled “baby blues,” generally experienced at the maternity home a few days after delivery. It affects 80 per cent of mothers.

The woman usually feels weepy and inadequate and detached from both the baby and herself. With support and reassurance from her family a:.d the staff, this usually passes fairly quickly. True post-partum psychosis is the rarest and most severe. Affecting one or two mothers in 1000, it is a psychiatric disturbance akin to a psychotic condition. It generally, requires a psychiatrist’s help, and may involve hospital treatment. Post-partum depression falls in between the baby blues and post-partum psychosis and affects 10 to 15 per cent of mothers. In most cases, it comes on in the first two or three months after the birth, but it may go unrecognised for a year or even two.

One sign Dr Watson has learned to recognise Is when a mother comes frequently to see him with minor complaints affecting her or her baby. Most commonly, it shows itself in women experiencing prolonged feelings of baby blues, but it may occur for the first time, with feelings of extreme tiredness, lethargy, irritability, and inability to cope.

The woman often feels inadequate as a mother, and believes she is letting her housekeeping standards slip. Her marriage may be suffering. • ; . “ L Dr Watson acknowledges that there is a debate in medical circles as to whether post-partum depression is an illness or a reaction to a new situation. “No-one has the answer," he confesses. "Is it caused by hormonal changes? Are some types of personality more vulnerable than others? Are hereditary factors involved? Or is it a matter of lifestyle changes?” He tends to emphasise the latter, “because those are what you can do most about”

The stress of the new baby and the responsibility put on the new parent certainly contribute. So

does the amount of support available from friends, neighbours and relatives, especially the woman’s mother. “When a new mother has previously been working in a busy, intellectually stimulating environment and now finds herself isolated at home with an infant it can be totally shattering,” he says. "She may not feel the effects in the first two to

three months, blit once the excitement of the new baby wears off, visitors are no longer dropping in and her husband has gone back to work, the humdrum sets in.

“It’s also the time when breastfeeding ties her to the baby, but the baby does not give much feedback in the first few months before it starts to smile and recognise its mother.

“The lack of a consistent input of social activity and recreation means she soon exhausts her mental fund of experience.”

A woman’s experience of pregnancy and birth also seems to have an important effect If the pregnancy was unplanned or troublesome, or the birth has not gone as expected, it can contribute to a lot of difficulties later, Dr Watson believes.

"Particularly if a woman has high expectations of a'natural delivery but ends' up needing forceps or a Caesarian, she often feels a failure. If she thsn has difficulties breastfeeding, that, can exacerbate the feeling of failure.”

Treatment starts by recognising the situation and explaining it to the woman, emphasising that it is not uncommon — and that she is going to get better. It may take several appointments to get all her feelings out into the open and make sure the diagnosis is correct, Dr Watson says.

Then he feels it is important to get her husband or partner along to explain the situation to him and get him to fill in any gaps the woman may have left, perhaps by underestimating her condi-

tion. He can then suggest ways in which they can help each other. “One of the most important things is for the woman to have the understanding support of her husband,” he insists. It may not be easy for the man. !

“Perhaps he’s never heard anyone describe feelings of depression before, let along felt it himself.”

Some phrases do not go down well, Dr Watson warns. “You’ll get over it” and “Pul! your socks up” not only wash right over a depressed person, but sometimes hurt because they indicate a lack of understanding.

The man’s attitude to sexuality needs to be equally sensitive. “Sometimes the woman needs to have increased sexual relations to show she is needed and loved, but more often, she is less interested in sex,” Dr Watson says.

Both husband and wife often need counselling. Most G.P.s can handle this, but when the problem is not being resolved, people can be referred to trained counsellors.

Coming to terms with lifestyle changes may be as significant for the husband as for the woman.

“Often, the woman has made a big sacrifice, but the man has not He has kept his evenings at the pub and his sports activities. Somehwere in the new lifestyle it is important for the mother to have time out for herself, too.”

It is Important to find new social groups because the old work-based groups are no longer appropriate: for a woman at home with a baby needs friends who live close by and share the same lifestyle. Through the Post-Natal Depression Support Group sufferers can meet with other women who have had these feelings and be reassured that you do get better.

Medication has a part to play where the depression is more severe. Particularly if the patient is unable to feel any improvement despite a lot of effort, Dr Watson says. Anti-depressants can help her get over this hurdle, as well as helping her sleep — often a problem in post-partum depression. Medication normally lasts six months. The chances of a relapse depend on how much the people involved have learned about themselves in the process, and how much they have been able to change their lifestyles, he believes. “The majority of women recover to be confident, capable parents, but a few will need ongoing support and assistance.”

Although many sufferers claim the medical profession has — in the past at least — been reluctant to take post-natal depression seriously, Dr Watson believes the condition is nothing new. “Post-partum depression has always been there. Our parents had unrecognised post-partum depression, but society did not allow them to express it,” he believes. Karitane units used to admit women and babies with difficulties, and rest homes for women were set up by the Women’s Division of Federated Farmers, he says.

Today, pressures to be superwoman may exacerbate the problem. "Modem expectations of being a mother and the reality are perhaps wider now than in the past. The liberation of women hasn’t included the expectation of taking time out to be a mother and homemaker,” Philip Watson believes.

"Both husband and wife often need counselling’