menu/ POSTNATAL DEPRESSION

postnatal depression may really be lack of sleep

The symptoms of many women thought to have postnatal depression in the first year after their children's birth could simply be the signs of sleep deprivation, an Australian study suggests.

Dr Harriet Hiscock, a pediatrician from the Centre for Community Child Health at the Royal Children's Hospital in Melbourne, found that many women with signs of postnatal depression improved when their babies were encouraged into a more regular sleep pattern.

"To really say that much of the postnatal depression out there is caused by sleep deprivation, you'd have have every woman looked at by a psychiatrist," she said. "But we found a lot of women with significant symptoms of depression out there who are helped by sleeping better."

About one woman out of every 10 who has a baby is likely to have symptoms of postnatal depression, she said. Those include unhappiness, insomnia, tearfulness often every day, an overwhelming sense of responsibility for their child, and not enjoying life any more. About 1 per cent think about harming themselves.

Her study, to be presented in Sydney this week at the annual congress of the Royal Australasian College of Physicians, surveyed 740 mothers of children aged between six and 12 months.

Almost half of them reported that their children's sleep was a problem: many woke frequently at night and many could not go to sleep easily by themselves. Of those 45 per cent of mothers, 22 per cent showed signs of depression. Dr Hiscock said there were some women in the group who appeared to be depressed and whose babies had no sleep problems, but the percentage was much smaller.

The study took 156 mothers who were having problems with their children's sleep: half were given three sessions on how to improve those problems, including instruction on controlled crying and advice about how to wean their babies from remaining night-time feeds. The other half were simply given an advice sheet on these strategies.

The groups were followed up two and four months later. At two months, 70 per cent of the babies whose mothers had been given the advice sessions had no sleep problems, compared with only 47 per cent of the control group. But by four months the difference was negligible, and in fact by then only 64 per cent of the treatment group babies had no sleep problems.

The depression scores of the mothers in the treatment group improved more than those in the control group at two months, but again, the difference at four months was fairly small. Dr Hiscock said many of the control group of mothers - those only given written advice on babies' sleep patterns and not individual attention - went to other sources for help, such as Tresillian nurses or centres [please see below for more information on Tresillian nurses].

The improvements in both the babies' sleeping pattern and their mothers' depression could simply have been a matter of time, she said.

She said her study revealed that a significant burden of postnatal depression in the community was unmanaged.

"Giving new mothers advice about how to help their children sleep through the night clearly helps a lot, so let's do more of it," Dr Hiscock said.

© 2001 Judith Whelan

tresillian centers

Talking through a problem can often make a big difference. Because babies don't keep office hours, our Parents Help Line is open for calls 24 hours a day and night.

So, if you need some urgent advice on looking after your baby, or you just need to talk to someone about how you're feeling, give us a call - even if you're overseas, we will be able to guide you.

Our Parents Help Line staff are all qualified Child and Family Health Nurses who can assist you with your query and advise you on where to go for help in your local area.

international parents' help line

Sydney (612) 9787 5255

Rural NSW & ACT - Free Call 1800 637 357

... or email below for help ...

tresillian@email.cs.nsw.gov.au

tresillian's goals

- To improve the health and well being of families with children under five years of age;

- To help optimise family function by supporting families in the early stages of a child's life;

- To deliver family care services responsive to population needs; and

- To ensure services are delivered in an efficient and effective manner.

tresillian's philosophy

Tresillian believes in the value of the family as a means of establishing individual identity and promoting the development of healthy individuals.

Each family is valued and treated as a unique entity. One of Tresillian's basic beliefs is that the infant and young child have essential needs that are best met in an effectively functioning family.

Tresillian believes in the inherent right of a child to grow within a healthy, nurturing environment and that the family and community are responsible for providing the means for achieving this right.

In order to promote the role of the family and community, Tresillian believes that the organisation exists to provide specialist support and care, when required, to those family and community members regardless of beliefs, social circumstances or culture.

Tresillian is committed to enhancing quality and the continuity of care through networking, liaison and cross referral.

tresillian's role

Tresillian's role is:

- To work towards the promotion of Tresillian as a Centre of Excellence in child (0-5 years) and family health;

- To provide holistic family care within a primary health care framework through a range of services responsive to community needs.

- Primary health care includes specialised nursing care, medical support, social work intervention, family advocacy, health promotion and clinical assessment of growth;

- To provide education and associated resources in child and family health to health professionals and the community; and

- To develop Tresillian's advocacy and research role.

© 2002 Tresillian Centres

the nct book of postnatal depression

Postnatal depression can come at a difficult time in a woman's life. It can have a number of causes. Some women will experience depression because of extreme tiredness, lack of confidence, loneliness or frustration. Others may have depression because of hormonal or other physical causes.

In the following extract from the NCT Book of Postnatal Depression, the three main types of postnatal depression are clearly outlined, supported by the experiences of several sufferers.

postnatal depression: what is it?

"I wanted someone to look after me Ö"

After she had her baby, Wendy felt she was inside a "bottomless pit". She saw no way out: "Friends and family try to instill hope into your empty soul. They do their best, saying, 'You will feel better, it just takes time.' What else can they say? The alternative would be too awful to imagine. But you donít believe them. You canít."

For a substantial number of women, the weeks and months around childbirth are marked by the unhappiness and negative feelings we call postnatal depression. Just how substantial that number is, is not clear.

Textbooks on the topic generally quote studies which put it at between 10 and 15 per cent of all new mothers. However, other studies reveal higher totals of as much as 27 per cent.

If you include in your definition of postnatal depression all postchildbirth distress and misery, including the more short-lived forms, itís probably the majority of mothers recognize many of the symptoms from their own personal experience.

However, a practical definition of postnatal depression is that itís a depressed mood which lasts, which overwhelms more positive feelings, and which becomes evident in the first weeks and months after childbirth.

different forms of postnatal distress

the blues

The first, and most common, is simply known as the "blues", sometimes defined as the "maternity blues", "postnatal blues", "three-day blues" or "baby blues".

Surprisingly, nobody has yet got their Latin or Greek dictionaries on the term to make it sound any more highfalutiní or "medical".

Itís also called "third-day blues" or "fourth-day blues" because it commonly strikes on these days after the birth. It affects at least half of all new mothers, at some point in the first weeks after the birth.

The main sign of it is tearfulness, and a feeling of coming down to earth with a bump, as new mother Suzi relates: "On day two I was amazingly pleased with myself at having gone through the birth, producing a beautiful baby.

Then on day three the feeding went awry, the baby got a spotty face, my husband was late, and my mother said something I thought was stupid on the phone. I cried and cried - pinning the reason for my tears on all the things that had gone wrong, but I knew none of them deserved my over-the-top reaction. I felt touchy and self-pitying, and scared about how Iíd cope in the months ahead. Then, the next day I went home and I was okay."

The blues are so common, and so often lift by themselves, itís speculated that itís a psychological - that is, a biological and normal - response to the hormonal after-effects of having a baby.

As one obstetrician says, "The blues are well-recognized as an almost normal reaction to the earlier elation."

Precisely why the upsurge of prolactin (the milk-making hormone) should have this effect is not clear. However, all of us have experienced the way any major and life-changing set of events, positive or negative, can sometimes cause tearfulness and confusion as the immediate impact wears off - itís part of being human.

postnatal depression

The second form of distress - and the one that will take up the greater part of the discussion in this book - is the form that we tend to know as postnatal depression.

Clinicians diagnose postnatal depression if it shows itself in the weeks or months after childbirth, but this may not be when it begins.

Many of the women I have spoken to trace the start of their feelings to pregnancy, and there are numerous anecdotal accounts of pregnancy or antenatal depression in journals such as New Generation.

An increasing body of research is discovering, even "proving", that it exists, too. It certainly seems that the more womenís own experiences are studied in detail, the more it appears that while womenís symptoms of depression may be reported after childbirth, and they become more obvious to those around them at that time, they may have their origins months earlier.

what are the signs of postnatal depression?

Whatever the precise timing of postnatal depression, it has a wide range of symptoms, and it varies in its severity.

Some women are virtually disabled by it, unable to care for themselves or their baby, while still being in touch with reality (unlike the symptoms of puerperal psychosis, below).

Other womenís symptoms are not so overwhelming, and they manage to struggle along, even hiding how they feel from their friends and family.

Thereís a broad spectrum, and it may be that symptoms differ in intensity according to the level of support a woman has, how easy or how difficult her baby is to care for, and factors such as her physical health and strength.

A mother may show, express or experience a range of emotions, from lethargy to anxiety, confusion to loss of self-esteem, fear of judgment to fear of harming herself or the baby. There may also be disturbed sleep, loss of libido, irritability and tearfulness.

negative feelings

Some examples of these negative feelings include the ones expressed by a mother who spoke to writer Rozsika Parker for her book Torn in Two (Virago, 1995): "I felt so irritated and irritable -I was not a very nice person. I couldnít understand it. Iíd say to myself, 'Youíve got what you wanted - why arenít you satisfied?' 'There were days when I truly felt like smothering the children and taking an overdose myself - not every day was as bad, and I recognized the fact that deep down I didnít want to go as far as this. I managed to cope - it actually helped that I had to go to school with my older child, and collect him at the end of the day. I couldnít do much else apart from that - it felt like too much hassle to arrange any outings."

puerperal psychosis

The third form of depression isnít anything like the usual clinically defined phenomenon of depression. It is puerperal psychosis, a madness (psychosis) that strikes in the weeks after childbirth (the period known as the puerperium).

I once had a letter from a woman who told me she had suffered a "purple" psychosis, and the image that small error inspires seems an accurate picture of this distressing and frightening syndrome.

Puerperal psychosis affects between one and two new mothers in every 1,000. Unlike postnatal depression, it is usually clear to anyone who comes into contact with the mother that she is suffering from a mental disturbance.

It begins soon after childbirth - sometimes in the very first days. The mother cannot hid it, even if she wanted to, and she usually experiences delusions and distortions of reality.

However, there is a range of symptoms, according to the type of psychosis. Some women hallucinate - they see objects or people who arenít there, or bright colours and patterns swirl in front of them.

Some mothers seem to suffer a form of manic depression, or bi-polar illness, though with clinical features that are perhaps more dramatic and distressing.

When the sufferer is high, she is abnormally energetic and excited; when she is low, she can barely talk. A third form is extremely severe, without any highs or shows of energy, and possibly with persistent dark and self-hating thoughts.

Puerperal psychosis always needs medical treatment and almost always admission to hospital.

Note: If you think you may have postnatal depression or any form of postnatal distress:

- Find someone you can trust to talk to - this could be a friend, a relative, your partner, your health visitor, midwife, doctor;

- Accept that nothing you are feeling is your fault;

- Think of ways you can start caring more for yourself;

- Socialize with other people if you can, but at places you feel comfortable;

- Accept that you will get better - but it may not be overnight, and you may need help from other sources.

© 2001 Thorsons

the award-winning pnd progam

This award-winning post natal depression therapy program is the only one of its kind in New South Wales, Australia. Post Natal Depression In 1997, St John of God Services, Burwood, won the Australian Private Hospitals Association Award for Excellence for development of its innovative and specialised post natal depression unit.

This was a ground-breaking development as such specialist facilities were previously non-existent in either the public or private sector in NSW. For the first time, mothers and their babies could remain together during treatment. Partners were also encouraged to stay overnight so that family relationships were not disrupted during the treatment period.

Mothers and their babies now have the comfort and support of knowing they can be treated in a separate unit specialising only in the treatment of post natal illness.

During their treatment program, mothers and their babies are supported by a multidisciplinary team including mothercraft & psychiatric nurses, paediatricians, psychiatrists, psychologists, social workers, welfare worker, registrar and chaplains.

Mothers with post natal depression may experience:

- Being always tired yet canít sleep;

- Feeling sad and crying all the time;

- Not enjoying the baby;

- Mind always racing;

- Having little energy or interest to do anything;

- Lack of confidence;

- Feeling helpless and hopeless;

- Feeling that their partner doesn't understand how they feel Ė and thus feelings of anger;

- Wanting to run away;

- Wishing they were dead / wishing the baby were dead;

- Wondering if is this what motherhood is supposed to be like; and

- Feeling very alone.

Feelings of inadequacy, depression and confusion can be so strong that many women believe no one else has experienced what they are going through.

Post Natal Depression is a mood disorder affecting 10-15 percent of all mothers, with many women experiencing severe depression. It is important for women who are (or think they may be) experiencing such difficulties to receive support and encouragement.

This may be provided by health professionals or a support group where women with similar issues share their thoughts and feelings.

Signs and symptoms Women with a Post Natal Mood Disorder experience feelings that can be quite overwhelming. These may include:

- Sadness;

- Feelings of inadequacy, exhaustion, hopelessness and shame;

- Loss of energy, concentration and confidence;

- Disturbances in appetite and sleep;

- Anxiety and panic;

- Anger and resentment;

- Distressing or unusual thoughts; and

- Inability to care for their baby.

treatment program

St John of God Health Services offers a family-focused treatment program for women experiencing Post Natal Depression.

THE TEAM Highly experienced staff, a comprehensive therapy program and a supportive environment provide mothers, babies and partners with a unique opportunity to gain personal insight, develop new ways of relating, build a sense of confidence, and discover enjoyment in parenting.

THE PROGRAM This includes individual and group counselling focusing on family relationships, infant attachment, sleeping problems, anxiety management, and the use of medication and parent-craft skills.

GROUP THERAPY This facilitates self exploration and develops bonds with other women experiencing similar difficulties.

SUPPORT GROUPS Meeting the specific needs of the mothers, partners and extended family members, support groups play an important role in the treatment program. These groups are offered in the evenings to encourage participation and to facilitate lifestyle needs.

PARTNER SUPPORT The staff recognise that new mothers need their partners' support close at hand. Therefore, overnight accommodation and meals are offered to partners at a reasonable cost. Partners who choose to stay overnight can actively continue their parenting role and receive counselling and skills training while maintaining regular work hours.

THE FACILITIES During their stay, mothers enjoy attractive, comfortable accommodation. Queen size beds and rooms with ensuites add to the comfort. Swimming pool, squash court and gym facilities are available for both day services and hospital clients at the Burwood Campus.

COMPREHENSIVE RANGE OF PND SERVICES St. John of God Health Services can assist people with both in-hospital and outpatient services. In-hospital services are offered by St John of God Health Services, Burwood; outpatient services are available from both the DoŮa Maria Post Natal Support Network and a support group available at St John of God Health Service, Burwood, Miranda Medical Centre and other sites in the near future.

If you would like to fund your own treatment or that of a relative or friend, please contact the Admissions Officer at Burwood or Richmond.

information + referral

A referral from a GP or consultant psychiatrist is necessary.

Enquiries regarding admission or requests to view the facilities, should be directed to the Admissions Officer: Burwood (612) 9747 5611 or Richmond (612) 4588 5088

Email enquiries to webmaster@stjohn.com.au or to www.stjohn.com.au/NSW/rfi.htm

Copyright 1999 Brothers of St. John of God

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