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Postnatal depression
How can that be?
“My dream has always been to have a baby, but now that he is there, it feels like I want to run away. How can I feel that way? ” Or, "We struggled to get pregnant for so long, but now that my baby is born, I'm constantly overwhelmed."


What is Postnatal Depression?

We often hear these questions when a mother with postnatal depression comes to talk to us in practice. No matter how big the expectation or how much you want a baby, the arrival of a child - especially the first one - is a very big adjustment. As with any other customization, it takes time to get used to your new role and its requirements. Most new moms feel overwhelmed and incompetent at some point. What makes it more difficult is that for some reason women feel that they are not allowed to say it. The isolation of this, and the expectation that everything should be "right", only increases the risk of postnatal depression.

What makes postnatal depression different from “ordinary” depression?

The symptoms of postnatal depression and "common" depression may be very similar, but where another depressive episode may have different triggers are the triggers of postnatal depression around the birth of a baby. In some cases, a woman is already depressed during pregnancy. We will still treat it as postnatal depression, even if it does not happen after birth.

Did you know?
  1. Half of the people who develop postnatal depression begin already before the birth of the baby.
  2. If a woman experiences a depressive episode earlier in her life, her chances of developing postnatal depression are greater.
  3. About 85% of women who give birth experience some type of mood disorder, but only 10-15% will develop noticeable symptoms of depression or anxiety.
  4. Men can also experience postnatal depression!


Who is vulnerable?

There are many factors that can make you vulnerable to depression. Specifically, the following may play a role in post / perinatal depression:

  1. a major depressive episode before pregnancy;
  2. symptoms of anxiety and depression during pregnancy;
  3. recent stressful life events;
  4. poor social support;
  5. problems in marriage or relationship.

What is the difference between “baby blues”And postnatal depression?

"Baby blues"
Most moms initially feel a little emotional, tearful or crying (look through blue glasses). The third to fifth day after birth, one is particularly vulnerable due to the birth and feeding process, as well as hormone changes. It is then normal to feel teary, tired, moody, anxious, irritated and overwhelmed, but as things progress and mommy and baby get used to each other and their new reality, things usually get better. When the “baby blues”After about two weeks to go, the mother is again courageous for the situation.
Postnatal depression (also applies to perinatal depression)
Postnatal depression is more severe than “baby blues”. It can develop at any stage after birth, usually within the first two to three months. The degree of "heavy mood" and the duration of the symptoms differ. When a new mother feels depressed, depressed, sad, and tearful around two weeks after birth (and the symptoms persist for a period of two weeks or longer), it is seen as serious and she should seek professional help as soon as possible.




This happens very little, but there are also some cases where moms develop postnatal psychosis. Only one or two out of every 1 women develop this condition, ie the symptoms worsen to the extent that the mother experiences a break with reality. It usually develops within the first two weeks after birth, but may even be visible within the first 000 hours. This condition requires immediate psychiatric help (ie medication and possible admission to a medical facility).

Signs of postnatal psychosis

Signs of postnatal psychosis

  1. early signs include: restlessness, irritability and insomnia;
  2. a mood that quickly varies between a depressive feeling and aloofness (manifested as a rapidly alternating manic or mixed episode, as seen in bipolar mood disorder)
  3. disorientation or confusion;
  4. erratic or chaotic behavior;
  5. delusions around the baby (believe things that are not true, such as the baby staring at someone in a strange way, or thinking or doing something that is not possible);
  6. auditory hallucinations (eg hearing voices giving instructions to harm the person or the baby).

This is a high-risk disorder that poses a safety risk to the mother and baby. Professional help is urgently needed.

If you or a loved one are showing these signs and you are concerned about the safety of the mother and baby, go to your nearest hospital emergency department immediately.

Who is vulnerable postnatal psychosis?

Who is vulnerable to postnatal psychosis?

The risk of postnatal psychosis (or a depressive episode with psychotic characteristics) is higher for women who:

  1. previously experienced postnatal depression (or mood disorder);
  2. who themselves have a history of depression or bipolar mood disorder (especially bipolar 1);
  3. who has a family history of bipolar mood disorder.
If someone has experienced an episode of postnatal psychosis before, they are 30-50% more likely to experience it again after giving birth again.

Help for postnatal psychosis?

Help for postnatal psychosis?

Women with depression symptoms in the postnatal period also tend to have symptoms of general anxiety en panic attacks to show. If you experience any of these symptoms, consult your clinic sister, family doctor, gynecologist or psychologist.

You can also search the following websites online for a psychologist in your area:

  1. Find help
  2. SA Medical Specialists
  3. Medpages
  4. contact the Wie is ek?-centre.


Symptoms of post / perinatal depression

As with other depression diagnoses, post- / perinatal depression is a diagnosable medical condition of the mood, with a list of symptoms that must be present before a doctor or psychologist can diagnose it.

Postnatal depression is difficult to diagnose because symptoms such as sleep disturbance, fatigue and appetite change can also be associated with caring for a new baby. However, it is important to consider whether the mood symptoms negatively affect the mother's functioning.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), (globally accepted as the most authoritative source) does not describe postnatal depression (PND) as a separate diagnosis, and therefore considers it just as serious as an "ordinary" diagnosis of depression. It is important to identify when the condition has occurred eg. during pregnancy or after birth.

Click here to read more depression symptoms.

Important signs to be aware of:

  1. a depressed / depressed or sad mood
  2. teariness
  3. no longer interested in things that previously provided pleasure
  4. feelings of guilt
  5. feelings of worthlessness and incompetence
  6. fatigue
  7. sleep disorder
  8. change in appetite
  9. struggling to concentrate and remember
  10. suicidal thoughts

Postnatal depression is more commonly known as the symptoms that develop after birth, but one can also develop depression symptoms associated with pregnancy during pregnancy. This is called perinatal depression.

The symptoms and effects of postnatal depression are severe, but it is important to remember that this condition is treatable and the person should seek professional help as soon as possible.


Symptom questionnaire

Please complete the Edinburgh scale for postnatal depression if you suspect you are experiencing symptoms of the condition.

(This scale should only be used as a screening test and only a professional can make a diagnosis.)

Edinburgh scale

If your score is 10 or more, we recommend that you get professional help as soon as possible. You can consider the following:

  1. ask your GP or nearest hospital for a referral;
  2. Visit one of the following websites for the details of a psychologist in your area:
    1. Find help
    2. SA Medical Specialists
    3. Medpages
    4. contact the Wie is ek?-centre
  3. You can also call the South African Depression and Anxiety Group (Sadag) 24-hour helpline on 0800 12 13 14.


What can I do to improve my situation myself?

Of course, there are NO instant solutions. Nor are there two people who will have exactly the same experience. So this is not a "five-step-to-overcome postnatal depression" episode. We simply provide some practical tips to help you better understand your situation and know where to get help, if needed.

The adaptation that comes with nocturnal feeding and meeting the needs of a small baby is physically exhausting. Some babies are restful and sleep a lot, others not. Some moms adjust easily, others find it very difficult. However, it is important to try to get as much rest as possible, especially at the beginning. The tasks in the house (eg dishes) can wait a while. Try to sleep when the baby is asleep. Also, ask your spouse / partner, or someone you trust, to release you so you can spend a few hours of uninterrupted sleep. It is sometimes difficult to give yourself the rest - so discuss practical solutions with your loved one (s) and plan together to share the responsibilities.

Time to get out
Especially in the winter months, it is difficult to go out with a small baby. Long days in the house can have a negative impact on one's mood. Ask your loved one, or someone you trust, to look after the baby regularly so you can get out of the house for at least 20-30 minutes. A quick stroll in your neighborhood (as your physical condition allows), or in a mall (if it suits you better) can work wonders. Then try not to think about baby all the time or worry, rather focus on the world outside.

It is important to note that the woman is not just a machine that can go on as usual after giving birth. Although everyone experiences this process differently, it is a major change and some adjustments will be needed.

To work outdoors or not to work
Practicing a profession is a sensitive matter in this phase of one's life. Some women do not care at all to stop working when they have children. Others want to take maternity leave, but cannot afford it. Some women do take maternity leave and return to work after a few months. One can easily feel guilty or under the impression that society condemns you for the choices you make around this matter. There is not necessarily just one ideal situation. Most importantly, you and your partner / loved one make a choice that you can both live with - and what you feel, in your unique circumstances - is the best option for your family. If you are struggling to talk about this or come to a comparison, call for professional help.

Single mothers' situation is different and there will be unique challenges. Usually this mother will have to work long hours to keep the pot cooking. If possible, it will help a lot if family and close friends can be involved to provide support.

Although postnatal depression is very common, many women feel that they may not admit to struggling emotionally. Maybe it's because we feel within our society that we just have to be strong and cope, or being "weak" when we feel like things are getting too much for us.

However, it is extremely important to talk to someone if you feel that you are not coping with a new baby. Be honest with your partner, loved one, girlfriend or mom. People can't support you if they don't know how you feel. Not everyone can listen, but there is usually a person with whom one can talk openly.

If you feel that you have no one, or that no one understands, you can talk to a psychologist. There are not necessarily easy solutions to your dilemma, but sharing your emotions and experiences in a safe space can bring some relief.

Ask for help
It is not said for nothing "It takes a village to raise a child" no. It is easy to isolate yourself and not make use of the help available. Often there are family and friends who would like to help. You just have to muster up the courage to ask - for example, "Will you please buy me milk?"; "Can you please stop me at the pharmacy?"; or "Can you please look at the baby for half an hour so I can shower?"

However, social support is not equally accessible to everyone, which means one may need to be more creative. There may have been someone in your prenatal class with whom you can forge relationships, maybe someone at the daycare or play school, or ask your clinic sister if there is a group for moms in your area. You might start a support group yourself. A support network can greatly help you manage your situation better.

Professional help - when is it needed?
You don't have to wait for the precipitation to become unbearable before calling for professional help. You can start therapy as an individual or as a relationship partner during pregnancy. The value of this is that someone who is not involved in your situation can listen to you and provide support in a safe space.

However, it is important to ask for help when you experience symptoms of postnatal depression for two weeks, as mentioned above. You can consider the following:

  1. ask your GP or nearest hospital for a referral;
  2. Visit one of the following websites for the details of a psychologist in your area:
    1. Find help
    2. SA Medical Specialists
    3. Medpages
    4. Women's Mental Health
    5. contact the Wie is ek?-centre
  3. You can also call the South African Depression and Anxiety Group (Sadag) 24-hour helpline on 0800 12 13 14.


Advice to loved ones of someone struggling with postnatal depression

Be informed
Once you get to know the symptoms of postnatal depression and realize what it is, it is easier to provide support. A mother (or father) with postnatal depression is not hopeless or lazy, but has a battle with a psychological condition that affects their mood, energy and behavior.

Encourage communication
If you suspect your loved one is experiencing symptoms of postnatal depression, you may want to have an open conversation with him / her in which you can listen with empathy to how the person is experiencing themselves and their situation. Be very careful not to be judgmental, or to communicate the message that he / she is not doing well enough as a parent or is not good enough. It may be something the person is struggling with, which may cause them to be very sensitive to such a message.

Offer practical help
For some moms, the physical demands of taking care of a baby are quite overwhelming. Practical assistance may be most welcome. Once again, one must always ask first and have respect for the person's wishes. You can't just assume they want help.

So, for example, ask if you:

  1. can bring a meal;
  2. can fetch or take away the domestic worker;
  3. wash a few bundles of laundry;
  4. washing the dishes;
  5. can make a few calls to make arrangements;
  6. can go grocery shopping or pick up something from the pharmacy;
  7. can charge the other children (if any) for a play appointment, or help with their transportation arrangements;
  8. can offer - provided you are familiar, and / or comfortable with babies - to look after the baby for an hour or two so the mum can sleep or go for a walk.

Somewhere to be
For many moms, especially those who used to work, it can be difficult to be home for long periods of time. She might appreciate it if she could sit in your house with the baby for a while. You can get on with your activities, but she can come out and see people. Just be very honest with yourself, and with her, about what you can offer and not go beyond what you can handle physically and emotionally.

Encourage the person to consult a professional if needed.
If you notice that a loved one is showing signs of postnatal depression, it is important to reach out to the person and encourage them to seek professional help.

One cannot force the person to seek help. It is also important to be sensitive to his / her emotions, but sometimes the person needs to hear that someone else who loves them supports the possibility of psychological help.

Unfortunately, despite more knowledge and exposure, many people still think there is a stigma attached to consulting a psychologist. Encouraging someone to talk to a psychologist about their emotions and situation can help break down this stigma and help them get the right help.


The role of the man or relationship partner

Men may also experience post / perinatal depression

During pregnancy and childbirth, so much attention is given to the woman and the baby that the husband's experience is sometimes left behind. For many men, there is excitement about the arrival of a baby, but also a lot of uncertainty and losses associated with it. He may feel that he has lost his companion because his wife's attention is more focused on the baby; being uncertain about what his role is, or should be; and that he is not important at all in the whole process. If he struggles to deal with these emotions, it can lead to depression symptoms (see see depression symptoms). In some cases, there may as well anxiety symptoms develop.

The role of the spouse or partner during pregnancy, birth and afterwards is important. Parenting is a major adjustment (see adjustments) that each person experiences differently. It is important for each person to be aware of their own process, because then the person can better adapt to the situation.

Research on postnatal depression in fathers

In JH Goodman's study postnatal depression in fathers occurred in 1,2% to 25,5% of fathers in the community group. Furthermore, between 24% and 50% of fathers whose women experienced postnatal depression also experienced a depressive episode.

In a study done by Ramchandani, Stein, Evans, O'Connor and the ALSAC study team

Sciencedirect it has been found that depression in a father can also have a negative impact on the emotional and behavioral development of the child.

Defining roles
The traditionally male and female roles are no longer as rigidly demarcated as before. Whether the man is the caregiver at home, the breadwinner, or a combination of the two, is something that relationship partners must decide for themselves. Most importantly, there must be communication about this. Everyone should be given the opportunity to articulate his or her needs and decide on the division of responsibilities together.

Even if the man is the breadwinner, the family still needs his input at home. Initially it may be to bathe, soothe, or cook (or buy) dinner. Over time, everyone's contribution is likely to change as they become accustomed to the new role of parenting. Each family is unique, with its own dynamics. Whatever the family dynamics may be, an involved father plays an important role.

The researchers Harris, Furstenberg and Marmer found in a study that the involvement of the fathers with their children has benefits for the children in terms of what they have achieved in educational and economic fields. The psychological well-being of children and teenagers with the affected fathers was lower and they also committed fewer crimes.
For more details


How made if I struggle?

The general belief is that women talk easier than men. Some even say, without being serious, that men got "fewer words" than women! Fortunately, it is becoming increasingly acceptable for men to show their emotional side and talk to someone about their problems.

Friends may offer some welcome distractions, as well as time in nature or in the gym.

If someone feels that they are struggling to cope with the situation before or after the birth of a child, we recommend consulting a professional, such as a doctor or psychologist.

The Wie is ek?experts recommend that you HADS questionnaire, which can provide an indication of possible anxiety and depression symptoms you may have.

If you decide to consult a psychologist, consider the following options:

  1. ask your GP or nearest hospital for a referral; or
  2. Visit one of the following websites for the details of a psychologist in your area:
    1. Find help
    2. SA Medical Specialists
    3. Medpages
    4. contact Wie is ek?
  3. You can call the South African Depression and Anxiety Group (Sadag) 24-hour helpline on 0800 12 13 14.
Research has proven that a combination of psychotherapy and medication is effective treatment for postnatal depression. It is important to decide with a medical doctor about the appropriate medication for your particular condition. Psychologists can then further assist with psychotherapy.


If you or a loved one is struggling with mental health problems, we suggest the following options:
  1. call your GP (if available);
  2. go to your nearest hospital emergency room;
  3. call one of the following emergency numbers: SADAG (the South African Depression and Anxiety Group) 24-hour helpline: 0800 12 13 14 or suicide crisis line: 0800 567 567; or
  4. contact Wie is ek?