Postnatal Depression (PND) – Educating Dads

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Written by Tim Barnes-Clay

We often hear all about the physical effects on mums during pregnancy and after birth, but their mental health is just as important and dads can play a vital role in keeping them safe.

Recent news stories have highlighted the need for better care and more awareness surrounding mental health issues. Tragedies, such as that of Charlotte Bevan in December, demonstrate the huge importance of dads being aware of what to look out for, where to seek help for their partners and how to act immediately.

Postnatal Depression

Post-partum or Postnatal Depression (PND) has become more widely known, but there is still plenty of misinformation. Around 85% of women suffer ‘baby blues’ in the first few weeks after giving birth and this is normal. Symptoms are likely to be anxiety, tearfulness, strong mood changes and irritability rather than just sadness. These feelings tend to peak around the fifth day after birth and, whilst unpleasant, they should not interfere with her ability to function. If they do, or if feelings last longer than two weeks, then she needs to be seen by a doctor to rule out a more serious problem.

PND can actually begin in pregnancy and symptoms include feeling depressed or sad, loss of interest in usual activities, feelings of hopelessness, being overly self-critical, significant changes in appetite or ability to sleep and suicidal thoughts. Diagnosis is tricky as many of the symptoms can occur in well women for a short time, especially after birth, as a result of sleep deprivation and the dramatic life changes.

Spotting the signs

It can also be difficult for your partner to recognise the symptoms in herself, so if you’re worried, make sure you let her know gently what you have noticed and that you care. Trust your instincts, if you feel something isn’t right then encourage her to seek help or if she feels unable to, then notify her doctor or health visitor.

Although many women start suffering from PND during pregnancy or straight after birth, the onset can happen months after and in many cases lasts for two years or more. It can be easy to forget the psychological impact on your partner once into the swing of having a baby, so make sure you keep an eye out. If you notice a change in her emotional state any time during the first year then treat it seriously.

Anxiety or Obsessive Compulsive Disorder can occur post-partum and these may be in conjunction with depressive symptoms or alone. Symptoms of anxiety can include panic attacks, hypochondriasis (severe but unfounded anxiety that the person is suffering from a severe illness) and inability to leave the house.

OCD may also feature around cleanliness, completing irrational rituals (e.g. knocking the cot a certain number of times before picking up the baby) that they feel will keep them or their loved ones safe from harm. This may also consist of repetitive and intrusive thoughts about harming the baby; although these are almost never carried out, it’s important that help is sought and received. Again, you need to speak to your partner and a healthcare professional must be notified.

The most severe and sudden of all post-partum illnesses is Post-partum Psychosis, which can begin as early as 48 hours after delivery and usually the onset is in the first two weeks. Psychosis is a loss of touch with reality and most often Post-partum Psychosis is a severe manic or mixed episode of Bipolar Disorder. Mums can become delusional and experience hallucinations. Both of these symptoms are often centred on the baby, so mums could believe their child is special in some way, or hear voices telling them to harm the baby.

Early symptoms include restlessness, irritability and insomnia. Your partner may be disorientated or confused, display erratic or strange behaviour, make odd comments or seem paranoid and suffer from an extreme mood. In mania, this mood can be elation so don’t brush away concerns because she seems overly happy.

Risk factors

Risk of harm, or even death, to mother and baby are very high with Post-partum Psychosis so you need to act immediately if you notice the signs. Never leave your partner alone, and if you are still in hospital notify staff straight away or if you’re at home phone an ambulance. This form of Psychosis can get worse very rapidly and needs immediate treatment, those suffering with it are unlikely to be aware at the time and may even vehemently disagree that they are unwell.

All women can suffer mental health problems during pregnancy or the Post-partum period, however, your partner is more at risk if she:

– Has had an episode previously

– Has a history of Depression or Bipolar Disorder (or related illnesses)

– Has had recent stressful life events including marital problems

– Lacks a good support network (dads can be helpful here!)

– Has not had adequate healthcare during pregnancy

Using your instincts

If unwell, your partner should see Perinatal Services – specialists in mental health care throughout pregnancy and the postnatal period – although care isn’t available across the country (your Antenatal Clinic can inform you about help in your area). Currently, 75% of mothers do not have access to the care they need, something you can help change here.

Depending on the severity of the illness, your partner may be treated as an outpatient or in some cases, need to be transferred to an inpatient mother and baby unit where she can receive around the clock care whilst remaining with your baby. This separation might be difficult for dads, but there is strong evidence to support your partner remaining with the baby and forming the bond they need.

Your partner is likely to need medication if unwell and this must be managed by a perinatal specialist. Depending on the severity and type of illness, your partner may be able to continue (or start) breastfeeding, although several factors can influence this and it can be a hindrance; adequate sleep is so important for stabilising mental health and breastfeeding mothers cannot share night feeds with dads. It’s crucial you support your partner in the decision she needs to make based on advice given and her own feelings.

You will know best, if you feel something is wrong or are worried about a partner/loved one then don’t be afraid to fight for immediate and appropriate treatment. If your partner is under mental health care already then you should have a plan ready for emergencies, but don’t be afraid to contact their psychiatrist if you’re finding emergency doctors unhelpful.

Ways you can make a vital difference to your partner staying healthy are:

Showing interest and support through the pregnancy and getting involved when your baby arrives.

Reducing her stress levels, both during pregnancy (as this is strongly linked to causing a Post-partum episode) and straight after birth.

Sharing night duties so she can get some sleep.

Making sure she doesn’t feel isolated or cut-off from people.

Helping her to get enough nutrients and encouraging exercise for wellbeing when appropriate (yoga or a simple walk can be helpful).

Being encouraging and offering a listening ear and a shoulder to cry on if necessary.

Learning the symptoms and being vigilant for signs she might be unwell.

Making sure she gets help immediately if she seems unwell, particularly in Post-partum Psychosis.

Helping her remember any medication during pregnancy and especially in the early postnatal period, where lack of sleep and big changes can make it easy to forget.

If you need help or more information please call Pandas Foundation on 0843 28 98 401 or contact a local mother and baby unit here.