Postnatal depression
Introduction
This leaflet is aimed at
- the partners, friends and relatives of a woman with Postnatal
Depression (PND) who provide continuing help, support, without
payment;
- the psychiatrists and other members of the mental health team
involved in the care and treatment of the woman at this time.
It suggests ways of improving communication and partnerships
between a women, her carers and mental health professionals.
For the carer
About PND
Over half of all women feel very emotional in the first week
after giving birth (baby blues) and this usually passes in a few
days. If these feelings continue or get worise, the woman may have
PND. This illness affects 1 in 10 mothers and usually begins within
a month of birth, but can start six months later. If untreated, it
can last for months and sometimes longer.
Less common is puerperal psychosis. This affects 1 in 500
mothers after childbirth. It is a serious mental illness that
usually comes on within days or weeks of birth. Women may
experience rapid and extreme changes in mood, withdrawal or
overactivity, severe sleeplessness, false beliefs or unusual
experiences. A woman is most likely to be affected if she has
already experienced such an illness, or if she has already
experienced such an illness, or if someone in her family has
suffered a serious mental illness.
Although PND and puerperal psychosis are completely different
illnesses, both respond well to treatment. It is important for the
woman to receive help as early as possible.
Some of the most common symptoms of PND are:
- low mood and despondency
- tearfulness
- guilt about not coping
- unusual irritability
- withdrawal and avoiding contact with other mothers, family or
professionals
- changes in appetite
- problems sleeping
- anxiety, panic and/or clinging behaviour
- excessive fears about the baby's health
- thoughts of death
- indifference to the baby
- inability to enjoy anything, including sex
- sometimes thoughts of harming herself or worries about harming
the baby
These signs must be taken very seriously, and it is important to
discuss them as soon as possible with the professionals who care
for the woman.
Making a diagnosis of
PND
In some women, PND is one of a number of episodes of depression;
in others the depression may only occur after giving birth. A
diagnosis will normally be made by talking to the person, their
partner, or other close relatives or friends to get an
understanding of the person's history, as well as considering all
other possible causes of the symptoms. Sometimes a health visitor,
GP, or mental health professional will use a questionnaire such as
the Edinburgh Postnatal Depression Scale.
Treatments
For many women, increased support and counselling with the
health visitor and GP is sufficient. Some women will need to be
treated with antidepressant medication. Psychiatrists can prescribe
medication to women even when they are breastfeeding. Occasionally
a woman will need hospital admission. In some regions, there are
specialist Mother and Baby inpatient units.
As a carer and/or partner you may feel:
- shocked at, disappointed or angry with your partner
- frustrated and helpless
- scared and/or ashamed about admitting there is a problem, and
seeking help - will they take the baby away?
- worried about the effect of the illness on the baby
- blame the baby
- worried about the responsibility of caring for the woman and/or
baby, and scared to leave them alone
- exhausted by caring for the woman and other children
- resentful that your needs have been pushed to one side.
Tips for carers
In partnership with your doctor and the health care
team
Good communication between a doctor, members of the health care
team, a woman with PND and her partner or carer is important, but
takes time and effort. Forming a positive relationship with staff
and doctors is especially important if the condition is
long-term.
After making a diagnosis, the GP may refer the woman to a
specialist. The specialists you are likely to come across include:
psychiatrists, community psychiatric nurses, counsellors,
psychologists, social workers and other members of the community
mental health team or perinatal psychiatry team.
Questions to ask the
doctor
|
|
|
What does
the diagnosis mean? |
|
|
|
Can
you explain it in a way that I will understand? |
|
|
|
Are there any treatments?
|
|
|
|
Are
there other things we can do to help ourselves? |
|
|
|
What can
we expect in the near future and over time? |
|
|
|
How
often should we come and see you? |
|
|
|
What is
the woman's care plan? |
|
|
|
What
is the carer's care plan? |
|
|
|
Do you
have any written material on the condition? If not, who
does? |
|
|
|
Is
there anything that we can change at home to make things easier or
safer? |
|
|
|
Are there
any organisations or community services that can
help? |
|
|
|
Which
health service worker is our main contact for guidance and
advice? |
|
|
|
Will this
affect the baby? |
|
|
|
Does
this mean we should not have another baby? |
|
|
|
Can you
give me an 'out-of-hours' emergency telephone number? |
- If the woman needs another appointment, remember to
arrange this before you leave. Regular, well prepared visits to the
doctor will help to get the best care for both of you, and the
baby.
The following advice may help you prepare for follow-up
visits.
Before your visit
- Keep track of changes in the woman's behaviour and reactions to
medication in a notebook, along with any concerns or questions that
have arisen since your last visit.
- It may be helpful to sit together and decide what concerns you
both want to discuss with the doctor. Writing down this information
means that you do not have to worry about remembering it, and you
can be sure to talk about the things that matter most.
- For example, these may include questions about:
- changes in symptoms or behaviour
- side-effects of medications
- general health
- your own health and that of the baby
- help needed.
During your visit
- If you do not understand something, ask questions until you do.
Don't be afraid to speak up.
- Take notes during the visit. At the end, look over your notes
and tell the doctor what you understood. This gives the doctor a
chance to correct any information or repeat something that has been
missed.
Tips for carers - dealing with
doctors
Doctors can be reluctant to discuss a woman's diagnosis with
their partner and/or carer as there is a duty of confidentiality
between a doctor and the patient. However, if the woman is ill and
unable to understand what is happening, doctors usually appreciate
the need to involve the carer to obtain information and discuss
treatment plans.
Although many professionals will be happy to see you together,
it may be important for a woman to be seen alone also. She may put
on a brave face in front of a carer and feel more able to discuss
her feelings about the illness, the relationship and the baby if
alone with her doctor.
If the doctor is still unwilling to involve your as a
partner/carer, there are a number of things you can
do:
- ask the woman if you can stay with her for part of the
appointment with the doctor
- talk with other partners/carers of women with PND for helpful
suggestions
- try to talk to other health professionals.
Don't forget to look after yourself as
well:
- Don't be afraid to ask for help.
- Explain to your employer why you may need extra time
off.
- As the depression lifts, if possible, try to have fun with your
partner. Get a baby-sitter or go out together.
- Share your worries with trusted friends or family members.
- Look after your own health, and go and see your doctor if
you are exhausted or depressed.
For the professional
As a professional working with women with PND and their carers,
we hope that the following is a helpful guide to good practice.
Remember that partners and/or carers may be physically and
emotionally exhausted and they will know more about the patient
when well than anyone else.
| |
|
When making an assessment, do
you? |
|
|
Try to see the woman and the
partner/carer separately, as well as together
|
|
|
|
Try to see
them at home - their environment could be important |
| |
|
Do you allow yourself enough time
to? |
|
|
|
Listen, ask,
listen |
|
|
|
Obtain a life
history |
|
|
Ask about any losses, or orther traumatic life events,
especially previous miscarriages or stillbirths |
|
|
|
Leave time
for questions and discussion |
|
|
|
Explain how
you arrived at the diagnosis |
|
|
|
Talk about
the prognosis |
| |
|
In the management of the illness,
do you? |
|
|
|
Discuss
possible treatments |
|
|
|
Talk about
the possible side-effects of drugs |
|
|
|
Spend time asking about the partner's/carer’s health – physical
and emotional |
|
|
|
Discuss how to meet the health needs of both the woman, and the
partner/carer |
Points to
remember
- Everyone needs some respite - use family for baby-sitting,
consider nursery placement, either through social services or
privately.
- Make it clear that you will be happy to talk to any other
members of the family, with the mother's consent.
- Tell everyone you see about voluntary organisations which can
offer information and support.
- Give a telephone number where you can be reached.
- Make sure that there is a named professional person whom the
family can contact at any time.
- When you write to the GP or specialist, consider sending copies
to the partner and carer.
- Try talking to the GP as well as writing.
Further help
Association for Postnatal
Depression
Provides support to women suffering
from Postnatal Depression.Tel: 0207 386 0868.
Our office hours are :- Monday to
Friday - 10.00 a.m. - 2.00 p.m. If you are outside of the UK - you
can contact Postpartum Support International
(PSI).
Netmums
A website offering support and information on pregnancy and
parenting. There is a specific section on offering support. There
is also information on local resources and support groups.
Pandas Foundation
Helpline: 0843 28 98 401. An organisation that helps individuals
and their families with pre- and postnatal depression advice and
support.
Carers' Trust
Carers Trust is a new charity which was formed by the merger of
The Princess Royal Trust for Carers and Crossroads Care in April
2012. Carers Trust works to improve support, services and
recognition for anyone living with the challenges of caring,
unpaid, for a family member or friend who is ill, frail, disabled
or has mental health or addiction problems. With our Network
Partners, we aim to ensure that information, advice and practical
support are available to all carers across the UK.
One of the aims of the Partners in Care campaign was to show
that if all those involved in the care of people with mental health
problems or learning disabilities can work together, a trusting
partnership can be developed between carers, patients and
professionals which will be of benefit to all.
Original authors: Dr Kristina Hofberg and Dr Roch Cantwell
Editor: Dr Philip Timms, chair, Royal College of Psychiatrists'
Public Education Editorial Board.
© July 2012. Review date: July 2014.
Royal College of Psychiatrists. This leaflet
may be downloaded, printed out, photocopied and distributed free of
charge as long as the Royal College of Psychiatrists is properly
credited and no profit is gained from its use. Permission to
reproduce it in any other way must be obtained from the Head of
Publications. The College does not allow reposting of its
leaflets on other sites, but allows them to be linked to
directly.
The Royal College of Psychiatrists is a charity registered in
England and Wales (228636) and in Scotland (SC03869).
Please note that we are unable to offer advice on individual cases. Please see our
FAQ for
advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about the
statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
every item.
Did you look at this leaflet because you are a (maximum of 2 categories please):
Age group (please tick correct box)