Postnatal depression: causes, symptoms & who is at risk

Is it the baby blues or postnatal depression?

The baby blues are particularly prevalent from the third day until about the tenth day after delivery, but this varies. For some women, the symptoms start a few weeks after giving birth or even much later, when they go back to work.

The symptoms usually pass after a couple of weeks. The baby blues become problematic when the depressive mood persists. Headaches, irritability, loss of appetite, crying, and poor sleep should set off your alarm bells.

Please, please, please, if you’re suffering from ongoing symptoms like these, seek help as soon as possible. The sooner you ask for help or treatment, the better. Trust your gut on this; you don’t have to wait months to get the help you need right now.

Causes of postpartum depression

The risk of a woman suffering from depression triples in the first month after delivery, when compared with childless women of the same age. Fluctuating hormones make mothers more vulnerable to depression, but difficult psychosocial conditions also increase susceptibility. Such conditions might be one of the following:

• You have a bad relationship with your own parents.
• You have lost your mother or a key figure in your life.
• Your parents or close family live far away.
• You want to keep everything under control.
• You have very high expectations of yourself and of life in general.
• You have an argument with people in your social circle.
• You have problems at work.
• You have financial difficulties or debts.
• You are in a toxic relationship and/or have experienced domestic violence.
• You have had mental health issues in the past.

The recent increase in the prevalence of postnatal depression is likely, in part, to be related to the increase in psychosocial problems in society. It takes a village to raise a child, but nowadays we don’t have that village. In the past, most mothers could lean on their own mother, who was often at home.

These days, grandmothers often have their own career, or are divorced, or live far away, or sometimes live with a new partner and stepchildren. In some cases, the grandmothers themselves have started a new family or are very busy with their own lives. For any number of reasons, they’re less available to help their daughter and new grandchild.

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The Perfect Mother conspiracy

The new mothers are therefore more dependent on themselves. And then there’s the Perfect Mother Conspiracy. There’s judgment regarding whether or not we choose to nurse, whether we’ve ‘succeeded’ in getting our baby to sleep through the night, and what kind of routine we’ve perfected. And don’t get me started on the pressure to lose the dreaded baby weight.

Mother and baby groups can be immensely helpful, and at their best, life long friendships can be formed, but they can also leave us feeling inadequate, believing that everyone else is doing better than we are.

Postnatal depression & your relationship with your parents

Sometimes, the growing distance to their own parents creates a difficult environment for new mothers. A young mother needs a lot of support. During the post-childbirth period, the search for a reference figure automatically starts: What is motherhood? What makes a woman a good mother? New mothers look back on their own childhood and sometimes relive traumatic childhood experiences. Psychoanalysts refer to this phenomenon as ghosts in the nursery.

This certainly happened to me: I had a rather complicated relationship with my mother and a lot of difficult memories came up after I gave birth to my first child. My postpartum therapist helped me work through it, and I also did EMDR (Eye Movement Desensitization and Reprocessing) to relieve my childhood traumas.

Mothers who were adopted or never knew their biological mother are also more affected by their new role. Sadness and other feelings relating to having never known their biological mother come to the surface intensely when they become mothers themselves. Similarly, women who no longer have a mother miss the enormous support that their mother could have given.

They want to ask questions such as, ‘Mom, how did you do this when I was little?’, ‘Did I cry a lot as a baby?’, ‘What was I like as a toddler?’ I see this regularly with clients in my practice. The lack of their own mother is keenly felt.

Postpartum depression & perfectionism

Postpartum depression is also more prevalent in mothers who have difficulty with role change. Any big role change and life upheaval takes some adjustment. But you might find it particularly difficult if you, like me, developed a lot of insecurities over the years and feel like you need to control everything, and you set the bar very high for yourself. This can get complicated, because a baby isn’t something you can control. Having a baby is essentially a crash course in Letting Go.

Mothers often feel that everything has to go according to the book. Getting help is not a priority. This is a result of today’s society where everything is (apparently) feasible: advertisements show perfect women, perfect relationships, and perfect families. And celebrities who post their blissful photos on Facebook and Instagram don’t make it any easier. A vulnerable new mother sees these photos after childbirth and thinks, Why don’t I feel that way? Why isn’t my stomach flat yet? Why can’t I go outside for a nice walk with my baby? It can push some mothers completely over the edge.

Many new mothers get overwhelmed by all the information they’re meant to remember. A client once told me, ‘I felt like I had to do a test, like in high school, and I always got a D.’ I relate to that, and I see a lot of new moms in my practice who feel this way, too.

ALSO READ: These are the superpowers you get the moment you become a mom (including x-ray vision!)

Signs & symptoms of postpartum depression

If these symptoms last longer than 2 to 4 weeks, ask for help immediately.

• You’re irritable.
• You can barely concentrate.
• You feel dejected.
• You sleep badly, even when your baby is asleep.
• You eat a lot or very little.
• You think about suicide or death.
• You have difficulty concentrating and making decisions.
• You lose interest in the world around you and no longer enjoy the things that used to give you pleasure.
• You feel that everything takes a lot of effort; you don’t want to be asked for anything.
• You feel that you’re outside of life.
• You have negative thoughts and feelings about motherhood.
• You cry a lot and often during the day.
• You’re unreasonable and unkind to people in your immediate environment (family, friends, colleagues, etc.)
• You feel incredibly insecure and you put an enormous amount of pressure on yourself.
• You experience intrusive thoughts. For example: you vividly visualise throwing your baby down the stairs or choking your child.

Prenatal depression

I’ve now started treating pregnant women in my practice because expecting mothers came looking for help through my website and social media channels. Many women suffer from depression during their pregnancy. It’s thought that lack of social support and presence of marital discord may increase the likelihood of this type of depression. Sadly, this is currently a neglected topic, with little research from which to draw guidelines and recommendations. Much more work needs to be done in this area. However, many of the recommendations given to women with postpartum depression are also relevant if you’re suffering from depression before you’ve had your baby. Seek help as soon as possible.

I can’t stress enough how important early intervention is. The sooner you get help, the better, although it’s never too late to get help. Recovery is possible at any stage.

Postnatal depression & intrusive thoughts: functional warnings

Everyone sometimes has thoughts that they really don’t want to have. Maybe you recognise a situation like this: You bend over and admire your sister’s new baby. You fall in love with your new niece immediately. Suddenly a thought flashes through your mind about how you could wrap your hands around this cute baby’s throat and choke her. It’s obviously the last thing in the world you want to do, but the scene in your mind is vivid and it horrifies you. Or you’re at the train station. In the distance, the train is fast approaching. You see yourself walking to the edge of the platform and jumping off. You’re thinking, If I jump in front of the train now, the driver won’t be able to stop in time. The thought fills you with horror. Yet a little devil calls inside, ‘Come on, do it!’

Thoughts about sex with your father-in-law are a more comically horrifying example of an intrusive thought. These types of thought are completely normal, even though they send chills running down your spine. Mothers who are naturally perfectionist are more likely to have these intrusions. Lack of sleep makes the tendency worse, and before you know it, these awful thoughts have taken over completely.

Nadine Rhoen, a child and family psychologist, explains the function of intrusions: ‘An intrusion is a thought that just comes to mind and can be quite bizarre, even frightening. But having an intrusion is actually a way our brain protects us from inattention. Through the intrusive thought, you become aware of the serious consequences that the execution of such a thought would have, and it makes you realise that you should not do this. So it’s
actually a very good protection system made by the brain.’

Further Dutch psychologists Fred Sterk and Sjoerd Swaen confirm that intrusions are an evolutionary warning system designed to protect us from danger and inattention. We’re all wired to be constantly on high alert for possible threats to our children. If you unexpectedly think of strangling a baby, you’re being alerted to the vulnerability of small babies. When it comes to survival, our brain is not subtle; it is purely functional.

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These troubling thoughts stem from the mother’s concern and her enormous sense of responsibility. Your brain wants to point out what could happen to your baby and that you have to stay alert. You absolutely do not have to be ashamed of having such thoughts. Almost everyone has an intrusion on a daily basis. They get startled by it for a minute then continue with their day. If, on the other hand, you take the intrusions seriously, you might start obsessing about the thoughts and what is behind them. Then unimportant intrusions can become annoying and you can develop compulsions or fears.

People think that pregnancy and birth are special, magical periods in a woman’s life. If you have a lot of negative thoughts after you deliver your child, you might feel very sad and anxious, because you think you’re ‘meant’ to be having a special, magical time. Intrusive thoughts can contribute to a feeling of depression because the thoughts can be so stressful to experience – a far cry from a special, magical time.

What usually works best is to notice the thoughts, say to yourself gently, Oh look, I’m having an intrusive thought’, then direct your attention elsewhere. Easier said than done. If you find that intrusions are stopping you doing certain things, seek help from a professional.

Getting professional help for postpartum depression

I can’t overemphasise the importance of getting help. It saved me. I had Cognitive Behaviour Therapy and I did a lot of mindfulness work. My therapist also gave me homework, which I gladly accepted. Anything to get out of the hell of PPD. I saw my therapist on a weekly basis at first, then when I started feeling better, every two weeks, then three, four, etc.

Sometimes I called my therapist if I was feeling really low and couldn’t wait until the next appointment, something I really appreciated being able to do. With good emotional and coaching support and practical help, recovery is absolutely possible.

If you feel well most of the time and only occasionally have milder symptoms of depression, you might prefer to talk to your partner or a good friend. The tips and advice in my book will still help you. But if you feel bad more often than not, or have intrusive thoughts that really upset you, or you’re thinking about running away or killing yourself, it is crucial to get help. I strongly recommend you call your doctor or approach healthcare professionals immediately. Maybe you’ve read about a certain therapist who appealed to you. Please approach him or her and make an appointment as soon as possible.

International research has shown that postpartum depression often goes undetected. This happens because most sufferers don’t talk about it. These mothers feel guilty and ashamed, so they keep their thoughts and feelings to themselves. Because of this, other new mothers often don’t know which signals are associated with this kind of depression. In this way, the cycle continues. Let’s break the cycle!

This is postpartum: free yourself from the perfect mother conspiracy by Tilda Timmers is available for download on Kindle from Amazon. You can follow Tilda on Instagram.