Postnatal depression & anxiety - Mental Health for new Mums

Updated on 1 September 2024.

Mental health wellbeing for new mums and dads

Welcoming a new baby into the family is usually a time of joy, wonder and excitement. However, for a reasonably high proportion of mothers and fathers it can also be a highly challenging time. In this blog we’ll discuss normal postpartum adjustment (let's face it no matter how prepared we are we all feel like we’ve been thrown in the deep end with our first baby), the baby blues, postnatal anxiety and depression or other mental illnesses that can all occur after birth and at any time throughout parenthood. Perinatal mental health illnesses can happen to anyone regardless of socio demographic or cultural backgrounds - we’ll talk through some of the factors that can increase your risk to a postnatal mental health problem, the common signs and symptoms and post importantly when and how to seek health if you or someone close to you is suffering. As you’re reading through this content it’s really important to remember that everyone’s experience of postnatal depression and anxiety is different and while the symptoms may be consistent, your challenges will be unique. The severity of postnatal depression or anxiety depends on the intensity, frequency and type of symptoms you experience - and most importantly how much they interfere with your ability to function in daily life and nurture your baby.

Normal Mental Health Adjustment for Parents

Joy, happiness, apprehension and some degree of worry are all normal for new parents. For the birthing mother, you may be tired following the birth, in pain or coping with your changing body and establishing breastfeeding. Such feelings may increase over the first few weeks. Many non-birthing parents feel helpless and excluded from breastfeeding and struggle to find a connection with their newborn and their partner. For both parents particularly in the first 4 weeks, sleep deprivation is a feature of parenthood - even the most settled babies will feed every 3-4 hours (day and night). Both parents need time to adjust and learn how to be parents and your baby needs time to adjust and learn how to be a baby.

Remember: when your baby is one week old, you are a one-week-old parent.

Everything is going to be a perfectly chaotic mess. Go easy on yourself and be kind to yourself as you all learn together, all this is normal.

The Baby Blues

80-85% of women experience the Baby Blues after birth. Peaking around days 3-5, it usually settles within days to 2 weeks.

Symptoms of Baby Blues include a range of emotional symptoms:

• a sudden onset of tearfulness
• mood swings
• anxiety
• sadness
• irritability
• feeling overwhelmed
• crying
• reduced concentration
• appetite problems or
• trouble sleeping

When may it not be Baby Blues? If the Baby Blues persist beyond 2 weeks, you develop mood changes after the first few weeks and your ability to function is affected, it is possible you may be developing Postnatal Depression (PND), Postnatal Anxiety (PNA) or another illness.

Postnatal Depression

Postnatal Depression (PND) affects up to 1 in 5 mums and up to 1 in 10 dads after birth.

It’s sometimes referred to as postpartum depression and is differentiated from the baby blues because

1. symptoms last longer than 2 weeks.
2. your ability to function is impaired.

Common symptoms of PND include:

• a numb, sad or low mood
• excessive crying
• a loss of interest in enjoyable activities including your baby
• fear of being alone or going out
• having difficulty sleeping (not due to your baby waking) or excessive sleeping
• loss or increased appetite and/or weight loss or gain

Postnatal Anxiety

Postnatal Anxiety (PNA) is thought to be more common than PND. Research has found that like PND 1 in 5 women experience postnatal anxiety.

Common PNA symptoms vary and include:

• Severe anxiety, fear or worry that is difficult to control e.g. about your baby’s health, sleeping or feeding
• feeling irritable, tense, restless, constantly on edge
• Physical symptoms like increased heart rate or breathing, nausea or the shakes
• difficulty falling asleep at night (including when your baby is asleep)
• excessive checking on your baby

Postpartum panic attacks can be experienced in severe cases of postnatal anxiety and are sometimes referred to as postpartum panic disorder. Depression and anxiety symptoms often occur together.

Postpartum Psychosis

A small proportion of mothers 1-2 per 1000 births are affected by the rare but serious illness of Postpartum Psychosis (PPP). It is important to seek help as soon as possible.

Postpartum Psychosis Symptoms include:

• elevated, irritable, or up and down moods
• increased or racing thoughts
• increased amounts of speech
• a reduced need for sleep,
• increase in activity
• disorganisation
• hearing voices and/or having false belief or delusions
• thoughts of harm to yourself or your baby

Anyone can develop postnatal depression or anxiety

Developing postnatal anxiety or depression does not discriminate based on socio demographic or cultural backgrounds - but some parents fall into a hire risk category than others.

My key piece of advice for new parents is that if you have a history of mental health problems you work with your GP and mental health specialists to have a mental health plan ready to go.

 

Risk factors that may increase your risk of PND, PNA or PPP include:

1. A past history of depression, anxiety or Bipolar Disorder
2. A family history of mental illness especially PPP, Bipolar Disorder or other mental illness related to childbirth
3. History of eating disorders
4. Caring for multiple childre
5. Perinatal anxiety during pregnancy.
6. Personality type (a natural worrier)
7. If you experienced your birth as traumatic
8. A lack of supports including from your partner
9. Stressful life events e.g. moving, renovating, changing jobs, a loss of job, the death of a parent or grandparent
10. Fatigue, lack of sleep and poor nutrition

If you think you or someone close to you are suffering from: Postnatal Depression PND, Postnatal Anxiety PNA, Postpartum Psychosis PPP; or if you have thoughts of harm to yourself or your baby the most important things to remember are:

• Seeking help is essential &
• Help is available.

With the right care Postnatal Depression (PND), Postnatal Anxiety (PNA) and Postpartum Psychosis (PPP) can be treated and you can recover.

 

How to go about seeking help?

Speak to your partner, family member or a friend, they can support you to contact your Obstetrician, Maternal Child Health Nurse, General Practitioner or mental health practitioner. They may refer you to a perinatal psychiatrist or psychologist. Many catchments also have some sort of Crisis Assessment & Treatment Team.

2 Other resources supporting postnatal depression Australia include:

• PANDA’s National Hotline 1300 762 306
• The Gidget Foundation National Hotline 1300 851 758

Common reasons parents avoid seeking help for perinatal mental health problems?

1. Asking for help may seem too hard
2. They may not want to be a burden on others
3. Saying they are struggling may feel like admitting they are failing
4. Embarrassed about the stigma around mental health
5. Even trying to think about what they may need may be overwhelming as it is another thing they have to do.

What are the different treatment or therapies for PND/PNA?

1. The first step is often practical support - there are lots of tips and hints below, literally taking the load off can helo
2. Emotional support - this may be from your partner, friends and family, validating your feelings and giving you some time to devote to yourself or the things you know will make you feel good
3. Physical support - ensuring you can get some sleep, eat healthy food, fresh air and light exercise (this is always easier said than done with a newborn, but the emotional and practical support can help facilitate this).

It’s OK if both these don’t work in isolation, they are often not enough to help you to recover, accessing professional treatment for postnatal depression anxiety early is often the most important step towards recovery. Professional treatments with a perinatal psychiatrist or perinatal psychologist and your GP may include: Cognitive behaviour therapy (CBT) or Interpersonal therapy (IPT). Sometimes medications may be needed - you will work with your team of medical professionals on the best treatment for you.

Can I breastfeed if I am on anti-anxiety medication antidepressants?

Like anything you consume as a breastfeeding mother, medications are passed to your baby through your bloodstream and breastmilk. Some medications are safe to use during pregnancy and breastfeeding, but others are not - If you are breastfeeding, it's best to discuss the risks and benefits of medication with your doctor or health care provider and make an informed decision together about what’s best.

How to help someone you love you suspect is struggling with PND or PNA:

Sometime raising these issues can be incredibly difficult to talk about, some ways to start the conversations about postnatal mental health could include:

• “As delightful as they are, having a newborn can be tough…RUOK”?
• “My first few months of parenthood were a struggle too…RUOK”?
• You are doing a great job with her/him, but you still seem tired/flat/stressed…RUOK”?

Schedule in a regular walk and catch-up to encourage them to get out of the house and exercise. If they do not want to talk at that time that is OK, but let them know that you are there if they need and you’ll check back in later in the week. Check in regularly via text or a phone call just to see how they are coping.

One of the best things you can do is offer concrete practical support

1. Cook some meals or organise some meal deliveries
2. Do the grocery shopping
3. Help them with a meal plan for the next couple of weeks
4. Organise a meal train with other friends and family (where everyone takes turns providing food)
5. Hold the baby while they have a shower & wash their hair
6. Clean the house or pay for a cleaner to come in
7. Fold the washing
8. Put away the shopping
9. Walk the dog
10. If there is paperwork or admin to do, offer to help
11. Even things like clearing the kitchen bench…I don’t know about you, but a clear kitchen bench can feel like a breath of fresh air!

Sometimes parents find it hard to ask for these types of practical support one of the things I recommend to friends and family is to send a text with something like: “I’ve got tomorrow afternoon free, can I look after the baby for a couple of hours while you have a shower or go for a walk? I’ll bring dinner for you guys. I’d love you to please pick 2 of the items below I can help with:

• Tidy the house
• Washing/folding/ironing
• Change the sheets on all the beds
• Clean the bathrooms

Can men get postnatal depression?

Yes, anxiety or depressive disorders in new fathers is estimated to be around 1 in 10 but in my experience this is widely underreported. Any parent can suffer from PND/PNA including adoptive parents and non biological parents. In the setting of a highly unsettled baby it’s my experience that nearly all parents suffer at least mild postnatal mental health problems - for more information on unsettled babies please see my colic video.