Q&A on postnatal and antenatal depression with therapists Annabelle Hird and Elizabeth Hill - answers back

[SorchaMumsnet]

Hello

It's Mental Health Awareness Week and we're pleased to announce a Q&A with two therapists specialising in PND (postnatal depression) and AND (antenatal depression).

Annabelle Hird is a BACP registered Gestalt counsellor, who trained at London’s Tavistock and Portman and qualified at The Gestalt Centre. She works with postnatal depression charity, Cocoon Family Support.

Instead of Dr Rima Lamba, Elizabeth Hill will be answering some of your questions. She is an integrative counsellor (means the relationship between the client and therapist is at the centre of her work), mainly focusing on family relationships (inc. parenting and loss), ante/post-natal support, life transitions and work-related stress (particularly teaching and medical professions).

Welldoing.org is the UK’s leading therapist matching service for in-person and online therapy, matching people with verified therapists and counsellors since 2014. They have over 800 therapist members and an extensive library of articles and resources on mental health, self-development and wellbeing. Their mission is to improve mental wellbeing support for all, through better access, understanding and efficiency.

Please post your questions on PND or AND by noon Thursday 23 May. We'll collect and send over to the therapists and post the responses on here on Friday 31 May.

Do bear in mind our webchat guidelines (though this won’t be a live webchat!)

Thanks
MNHQ

I had pnd with my daughter (shes 2 now). I had feelings of harm towards her and after one particularly bad night where I had to place her down very carefully and ask my husband to take over or I was actually going to throw her against a wall I saw my gp and was put on sertraline and introduced to the perinatal mental health team. They were amazing (gp &my nurses), I was terrified I would be vilified and have my daughter removed. What actually happened was daily calls from the gp, daily visits from the nurses (while I needed it) and problem solving to see if they could support me more practically than just meds.
My daughter was conceived via ivf, and while we've always wanted several children I keep putting off treatment as I'm so worried about it happening again. Is this likely and can anything be done to help before pnd sets in?
Secondly- I have no problem sharing my story with people as I want to reduce the stigma of pnd, especially wrt feelings of harm towards the baby. However I do often get people questioning how 'normal' this is- and I've had a couple of people try to tell me I brought it upon myself! Are there any facts I can throw their way to help them understand that pnd isnt the mothers fault and that pnd comes in many forms- not just feeling sad? I was rarely sad! I was stressed, hyper, indecisive, angry, irritable and full of guilt.
Many thanks for reading my essay!

Why are gp’s so poorly trained on tackling possible symptoms of pnd?

I was told to go swimming. That was it.
Told to go swimming.

It had taken all of my strength and many months of suffering to finally get the courage up to go.

Swimming.

Why are GPs so lacking in awareness? I went to mine, I knew I had ante natal depression. She told me " some people would love to be expecting a baby" . Well I had actually struggled to conceive and this was a much wanted baby, but I still had antenatal and post natal depression.

Also, shouldn't all women who suffer from hyperemesis gravidarum be monitored for AND/PND as the links as so clear.

And finally.. I had PTSD /PND as a result of a traumatic birth caused by sever staff shortages (I was left entirely alone). I suspect investing in more midwives would hugely reduce the drugs bill for post natal care, do you agree?

What can be done to improve training for professionals? I had a traumatic birth and nearly lost my newborn due to hospital negligence. I have found processing these events, the guilt, shame and fear difficult. There was very little support and when I did start to open up to MWs and HVs my feelings were minimised with 'but baby's ok now isn't she'. I was having periods of intense low mood, feelings of self harm, flashbacks, sleeping issues and intense nightmares. Also why is everything post baby labelled as PND? I continue to experience PTSD symptoms 9 months on but was advised from my GP that whilst it may turn in to a PTSD diagnosis they are reluctant label MH issues as anything other than PND/PNA in that postnatal period which I find really shocking and I fear is quite unhelpful in finding effective treatment.

Lastly, what are your top tips for speaking to your friends and family about PND/PNA?

Reading a thread the other day about sleep routines, a few posters commented that they believed the safe sleep guidelines (in particular, always being in the same room that baby is sleeping in) may be contributing to higher levels of PND. I can’t find the thread now but I think their reasoning was that mothers don’t then get any break from their DC (“me time”) and it leads to more sleep deprivation as they feel they need to respond to every little peep the baby makes. Do you think there’s a link?

I suffered with pnd when I had my daughter, she's nearly three now, when I think back to that time I feel incredibly sad and so so so guilty for the feelings I had. I've sat and felt disgusted with myself and cried because I feel so bad for having felt these things even though in my rational mind I know I wasn't well and I wasn't myself. I guess I still beat myself up. Although I'm better now and don't have such thoughts or feelings anymore the guilt remains, so my question is this, do you think pnd can cause ptsd? or do you think perhaps I'm not a 100% recovered yet? In all info I've read it says pnd is from birth -1yr?

Perfect! I've been worrying about my friend this week as she has tried so long for a baby and is now past the 6 month point of pregnancy using her last round of IVF and everything is looking well, I'm concerned that she will expect to be the last person to experience postnatal depression as she will have everything she's ever wanted, but may be more likely to because she's going to be terrified of not having eyes on her daughter at all times in case something happens which will be hard enough anyway but worse because she won't want to sleep so will be sleep deprived

I can't just come out with it because she will think I'm mad, as explained above, so how can I help to prevent this and keep an eye on behaviour that may suggest she is starting to go down that path?

I'm hoping beyond hope that she doesn't struggle with this, but I do think the chances are high and she would think it impossible (she'll have everything she ever wanted) which makes it harder for her to understand/accept if it does

I love my baby and feel very bonded. In myself though I feel completely flat. I feel constantly on the verge of tears and always so tired. I never had the PND questionnaire as I was always told "I was doing well". If I am bonded with my baby could it be PND? Or am I just tired?

I was diagnosed with ‘situational’ depression once i returned to work full time. I was very lucky that my gp was supportive and that I was able to have 10 psychotherapy sessions on the NHS which saved me.

I think that it’s just as important to talk about the mental health fall out of women being expected to work as if they did not have children and to mother as if they did not work, as it is to talk about perinatal mental health.

What can Mothers do to look after their mental health when returning to work?

How long would you expect untreated PND to last? Does it go away in its own? And if it doesn’t, is it still PND, or would it get a different diagnosis?
And is there a link between prem birth and PND?

My youngest child is 17 months and I have terrible intrusive thoughts.. I have not been to the dr about this but feel quite anxious at times. Will this ease off naturally.. what can I do to help this ?
Thanks

Hello. I had terrible PND for the first six months of my baby’s life, with no bond at all, and me feeling suicidal. He’s older now and I know that the depression is lifting and I’m so feel a bond with him. However, frustratingly, a still have a lot of anxiety around this bonding- I constantly worry that I don’t love him as much as ‘normal’ mothers for example, and worry that I’m don’t love him enough (even though I know that I do love him!) I know it is just a symptom of anxiety- that my greatest fear is not loving my child as much as he deserves. Do you have any advice on coping with this? I think my problem comes from this media portrayal as love for your child as like a ‘rush’ and I’ve not had that yet. But is this unrealistic?

Hi Annabelle and Rima, thanks for this chat. I have long-standing issues with anxiety and low mood but in the year I was on mat leave they really ramped up. I felt utterly hopeless, as if I could never feel joy again.

Looking back I think I might have benefited from access to the perinatal mental health team but I was told I didn’t have PND because of my history. This made me feel very ashamed- like normal women, good mothers get PND whereas I was already a crap person. My family also said there was no point in ‘labelling’ how I was feeling as PND. But I do feel like it was different to how I have normally been. What are your thoughts on depressive symptoms in a mother who already has issues with her MH? Is it PND? Should it be addressed as such? I know every case is different.

So I have always struggled with undiagnosed anxiety etc. Which got worse as my pregnancy progressed. I have bonded with my baby and I love him more than anything in the world. Some days all I want to do is cry for no particular reason. I feel flat and the only reason I need to keep going is for my little boy. I have a partner and he helps out as much as he can with everything but it doesn't always help the way I feel. My little boy is almost 5 months and I thought these feelings would just pass on there own. But they haven't, these 'bad' days seem to be happening more often. My HV wanted me to change my contraception method as she feels this could be affecting my moods but the nurses didn't seem as keen. Is it worth talking to my HV again regarding how I am feeling, could I be PND or is this normal. Any advice is appreciated. Thank you

Hi all

Thanks for your questions and apologies for the slight delay in posting the answers - we'll be putting them up asap.

Just to let you know that unfortunately one of the therapists (Dr Rima Lamba) was unable to take part in the Q&A. In her place, we have Elizabeth Hill - you can see her profile here: welldoing.org/counsellors/elizabeth-hill-integrative-counsellor-s10

If you do need any more information or want to talk to others who are going through similar experiences, check out our advice page on symptoms, support and treatment of postnatal depression or head to our Talk forum.

@Queenfreak

I had pnd with my daughter (shes 2 now). I had feelings of harm towards her and after one particularly bad night where I had to place her down very carefully and ask my husband to take over or I was actually going to throw her against a wall I saw my gp and was put on sertraline and introduced to the perinatal mental health team. They were amazing (gp &my nurses), I was terrified I would be vilified and have my daughter removed. What actually happened was daily calls from the gp, daily visits from the nurses (while I needed it) and problem solving to see if they could support me more practically than just meds. My daughter was conceived via ivf, and while we've always wanted several children I keep putting off treatment as I'm so worried about it happening again. Is this likely and can anything be done to help before pnd sets in? Secondly- I have no problem sharing my story with people as I want to reduce the stigma of pnd, especially wrt feelings of harm towards the baby. However I do often get people questioning how 'normal' this is- and I've had a couple of people try to tell me I brought it upon myself! Are there any facts I can throw their way to help them understand that pnd isnt the mothers fault and that pnd comes in many forms- not just feeling sad? I was rarely sad! I was stressed, hyper, indecisive, angry, irritable and full of guilt. Many thanks for reading my essay!

Never mind thanking me for reading your essay, thank you for writing it. You raise some important issues that I am sure many people will benefit from exploring. I am so sorry you had such a difficult experience and so glad that you received the support you needed. I also feel it is important to let you know that one of the things that struck me in what you wrote was your bravery. Despite your fears you were able to do what was best for your child and seek help. What a wonderful mother your daughter has.

The first question you raise is about preventative measures. I can fully understand that given your experience there must be all sorts of anxieties around having a second child. There’s a lot of research that flies around about pre-dispositions that must be adding to your concerns but in my experience, no two pregnancies are the same. This said, you will already know that one of the toughest parts of PND is the bit before you are aware of what is going on and are given the help you need, so if you become pregnant again I would advise you to raise your concerns with your midwife and ask to be referred to the perinatal mental health team. If possible, you could also seek some therapy privately to support you with any concerns you might have during pregnancy. Do what you can to put in place help that will be there if you need it but, and the ‘but’ is very important, remain open to the fact that you might not need it at all. Think of it as taking an umbrella out with you on a day when rain is possible, it’s a precaution and nothing more, but why would you risk getting soaked through?

Your second question saddens me. I am so sorry that you have been having to explain yourself, but I commend your desire to share and to educate. I wonder if the following article I have written can help at all? welldoing.org/article/maternal-isolation-post-natal-depression

You are right that PND presents in many forms, the APNI website talks about various presentations but I would also like to share with you something I was once told by a colleague while in training - that ‘anger is sadness’s bodyguard’. Sometimes the presentation of our emotions may not be the actual root of it all. Certainly I find myself snappy and irritable when anxious. I have never once calmly asked my child to come down off a wall he is walking on or step away from a ledge – it is always barked at him, but at the root of that bark is fear. Emotions are rarely straightforward.

@crosser62

Why are gp’s so poorly trained on tackling possible symptoms of pnd?

I was told to go swimming. That was it.
Told to go swimming.

It had taken all of my strength and many months of suffering to finally get the courage up to go.

Swimming.

What an awful experience you had with your GP. I can only imagine the courage it would have taken to ask for help, let alone the strength needed to leave the house. There are gaps in the training that are being addressed as we get the results of extremely important research being conducted but the truth of the matter is that GPs are human beings and some of them are more able to be of use when it comes to mental health issues than others. I am so sorry that the GP you saw lacked in the understanding required to see that you needed more than directions to the local pool. I know that the following advice will not be of much comfort to you given that this horrid encounter has already happened, but I would advise taking a trusted friend of family member with you when visiting a GP about PND. Ten minutes can feel like a very short amount of time and it can be hard to make yourself heard when you are feeling fragile. The extra voice can help your GP understand that action needs to be taken. You may want to get another opinion. Sadly, it could take a few attempts to get the right help and those who really need the help rarely have the fight in them to keep attempting. A friend or family member may feel more able to do so, this person can play the role of a birthing partner, a sort of post-birth partner, and be your advocate.

I do hope you are feeling better now? If not please do contact APNI or Cocoon Family support who should be able to signpost you.

@NeverTwerkNaked

Why are GPs so lacking in awareness? I went to mine, I knew I had ante natal depression. She told me " some people would love to be expecting a baby" . Well I had actually struggled to conceive and this was a much wanted baby, but I still had antenatal and post natal depression.

Also, shouldn't all women who suffer from hyperemesis gravidarum be monitored for AND/PND as the links as so clear.

And finally.. I had PTSD /PND as a result of a traumatic birth caused by sever staff shortages (I was left entirely alone). I suspect investing in more midwives would hugely reduce the drugs bill for post natal care, do you agree?

I am so sorry, your GP's comment was unhelpful and unkind. As I said in my previous response, there may well be gaps in the training but there are also some GPs that are better than others. Many do a fantastic job, it seems yours was not able to give you the support you needed when you asked and that must have been a horrible experience.

No woman should be left alone to birth their child, it is awful that this happened to you and not a surprise to me that you have suffered with PTSD as a result. With this information it is even more shocking that your GP was not more supportive.

You raise a very interesting point about precursors, our understanding of them and our responses to them when you talk about difficulties in pregnancy (hyperemesis gravidarum) and labour. It is, as you suggest, most likely a question of money. My wish would be that as we come to understand more about this we can be thinking in terms of cost, not financially, but to the wellbeing of mothers and children. It is my belief that supporting mothers is at the root of the prevention of so many physical and mental health issues.

@blackcat86

What can be done to improve training for professionals? I had a traumatic birth and nearly lost my newborn due to hospital negligence. I have found processing these events, the guilt, shame and fear difficult. There was very little support and when I did start to open up to MWs and HVs my feelings were minimised with 'but baby's ok now isn't she'. I was having periods of intense low mood, feelings of self harm, flashbacks, sleeping issues and intense nightmares. Also why is everything post baby labelled as PND? I continue to experience PTSD symptoms 9 months on but was advised from my GP that whilst it may turn in to a PTSD diagnosis they are reluctant label MH issues as anything other than PND/PNA in that postnatal period which I find really shocking and I fear is quite unhelpful in finding effective treatment.

Lastly, what are your top tips for speaking to your friends and family about PND/PNA?

You have really had a rough ride of it. It seems that in childbirth you did not receive the care that you should have received and in the months following the birth of your child your needs were not met by those whose job it was to look after you.

I am afraid I can’t comment as to why your GP is preferring to label your difficulties in the way they have. It could well be for a whole list of reasons. Certainly, when I work with women in the postnatal period I try to stay away from these sorts of labels and work with the client’s presenting issues and their experience, but then I do not have to justify prescriptions or deal with funding allocations. It may well be that your GP is doing their best to make sure you have the care you need. Birth trauma very definitely falls under a postnatal illness, but as you say it is very different to depression. Do you feel that the PND label is preventing you from receiving the right treatment? If so, it might be worth having another conversation with your GP to explain that you do not feel that your diagnosis is right.

@NotANewUser2

Reading a thread the other day about sleep routines, a few posters commented that they believed the safe sleep guidelines (in particular, always being in the same room that baby is sleeping in) may be contributing to higher levels of PND. I can’t find the thread now but I think their reasoning was that mothers don’t then get any break from their DC (“me time”) and it leads to more sleep deprivation as they feel they need to respond to every little peep the baby makes. Do you think there’s a link?

I have little doubt that there is a link between sleep deprivation and mental health issues. I don’t advise going against sleep safe guidelines though. It is extremely important to follow advice that keeps your child safe.

Babies are dependent on their caregivers, there is no denying that; the feeling of responsibility for any new parent can be overwhelming, and the impact on sleep is brutal. My advice would be to ditch all your non-essential non-baby related responsibilities. Let the house be messy, accept offerings of being made food, only do the bare minimum when it comes to chores and obligations. This is often a lot easier said than done, particularly if you have other children but if you can prioritise and delegate, the early days will be more bearable. Rest as much as you can but do follow the sleep safe guidelines, they are as they are as a result of detailed research.

@thecheshirecatcanfuckoff

I suffered with pnd when I had my daughter, she's nearly three now, when I think back to that time I feel incredibly sad and so so so guilty for the feelings I had. I've sat and felt disgusted with myself and cried because I feel so bad for having felt these things even though in my rational mind I know I wasn't well and I wasn't myself. I guess I still beat myself up. Although I'm better now and don't have such thoughts or feelings anymore the guilt remains, so my question is this, do you think pnd can cause ptsd? or do you think perhaps I'm not a 100% recovered yet? In all info I've read it says pnd is from birth -1yr?

You are really not alone in the feelings you describe. How many of us look back on a day that has not been as we had hoped it to be and felt sad? Many parents report watching their child sleep and wanting them to wake up so that they can apologise. This is in no way to diminish your experience, but rather to help you understand that it may be that what you are experiencing is to do with loss, a sort of rather complicated grief. It is hard for me to entirely understand your experience without being able to ask a little more, but I think you have suffered a loss, the loss of your ideal new-parenthood. It really might be worth seeking some therapy to help you come to terms with all the feelings associated with this loss so that you are not burdened with them in the way you seem to be at the moment. A counsellor could help you embody what your rational mind is telling you. You have been very unwell, it is sad, very sad, but not your fault. It is clear that you have come a long way along the path to recovery, which is no mean feat. Perhaps you could also do with the space to acknowledge that strength and celebrate it?

@TellMeItsNotTrue

Perfect! I've been worrying about my friend this week as she has tried so long for a baby and is now past the 6 month point of pregnancy using her last round of IVF and everything is looking well, I'm concerned that she will expect to be the last person to experience postnatal depression as she will have everything she's ever wanted, but may be more likely to because she's going to be terrified of not having eyes on her daughter at all times in case something happens which will be hard enough anyway but worse because she won't want to sleep so will be sleep deprived

I can't just come out with it because she will think I'm mad, as explained above, so how can I help to prevent this and keep an eye on behaviour that may suggest she is starting to go down that path?

I'm hoping beyond hope that she doesn't struggle with this, but I do think the chances are high and she would think it impossible (she'll have everything she ever wanted) which makes it harder for her to understand/accept if it does

You are extremely concerned about your friend. It seems that her pregnancy is really worrying you and for this reason I think you will probably not like my advice. I am afraid that I think that the best thing to do is nothing. Your friend is clearly excited about becoming a mother and yes, she may not have thought about some of the harder parts of the transition into parenthood or taken into consideration that she could suffer with PND. You describe some factors that could make her more likely to suffer with PND but there is also a chance she may not struggle at all, why give her something to be anxious about when it may not be necessary? It can be so hard to witness someone we love make themselves vulnerable to experiences we understand to be painful, but this is her experience and all that you can do is be there for her. This means sharing in her joy and excitement as much as it means sitting in her sadness (if it comes). It might be useful to look at what Brene Brown has to say about ‘dress rehearsing tragedy’ and foreboding joy; Brown can also be really useful when it comes to her tips on supporting our friends: .

@RoseWrites

I love my baby and feel very bonded. In myself though I feel completely flat. I feel constantly on the verge of tears and always so tired. I never had the PND questionnaire as I was always told "I was doing well". If I am bonded with my baby could it be PND? Or am I just tired?

The flatness you describe sounds like depression. It is not uncommon to bond with your baby and still present with some symptoms of PND. However you say that you are also tired and I am wondering how much you are attending to your own self-care, this includes sleep, healthy eating and accessing support networks like friends and family. It may be helpful for you to seek out some counselling to help you reflect on your mood, a counsellor may be able to help you unpack some of the feelings you are experiencing and provide you with some coping mechanisms. It's also important to visit your GP and look at other possible causes, you may have a vitamin or iron deficiency (very common after birth) which could be addressed easily.

@verybookish

I was diagnosed with ‘situational’ depression once i returned to work full time. I was very lucky that my gp was supportive and that I was able to have 10 psychotherapy sessions on the NHS which saved me.

I think that it’s just as important to talk about the mental health fall out of women being expected to work as if they did not have children and to mother as if they did not work, as it is to talk about perinatal mental health.

What can Mothers do to look after their mental health when returning to work?

I’m glad that counselling worked for you. I agree that the mental health fall-out of women returning to work after maternity leave is a neglected area of support. In my experience with clients who struggle going back to work, the biggest issue is their feeling that they should be able to cope. They can be overwhelmed by the pressure to be good at everything (which is impossible!).

Many of the women I have worked with have benefitted from an honest conversation with their employer about what their return to work will look like and where to go when they are feeling stressed or unable to cope; employers have a duty of care to address this properly. I also encourage them to find a network of people with whom they can have an honest conversation about their experiences, often it helps to find other women who are struggling with the same issues so that you don’t feel as alone. It is important that the right support is in place for the mother to go back to work and not feel as if she has to do everything when she returns home; this includes finding the right childcare for her baby, friends and family pitching in and an honest conversation with a partner about household responsibilities.

Finally, sometimes becoming a parent changes our priorities and experience of life to the point when we no longer recognise who we are or what we want. This can be overwhelming. The job we once loved can suddenly be a place we dread going and struggle to get to everyday. Some of my clients have found becoming a parent to be a moment of change and have used it as a springboard to discover new directions. An honest conversation with a counsellor about all these issues may help sort out what is really happening and develop strategies and plans to have a more meaningful and balanced life as you move forward.

@DrDiva

How long would you expect untreated PND to last? Does it go away in its own? And if it doesn’t, is it still PND, or would it get a different diagnosis? And is there a link between prem birth and PND?

Postnatal depression usually develops at four to six weeks after the birth of your baby and can last for up to two years. PND can go on its own but I would urge people to try and get access to some support either through your GP or a counselling service. A counsellor will reflect with you about the thoughts and feelings you are experiencing. They will be able to help you access some coping mechanisms and provide a safe space for you to explore parenthood and all its ups and downs. It is helpful if your GP knows what you are experiencing during this time, they may be able to refer you to a specific service for parents and might prescribe antidepressants as a way of helping you cope. If your PND lasts for longer than two years you may go on to receive a different diagnosis, however, it is likely that the mechanisms of support will be the same.

There is no specific link between PND and premature births, but it is not uncommon for the stress and trauma that parents experience with a prem birth will create a host of symptoms, some of which will be PND. There is also likely to be some PTSD (Post Traumatic Stress Disorder) attached to a prem birth. This has different symptoms to PND but can be just as crippling. It is important that if you think you are suffering from this, you talk to your GP or Health Visitor so they can help you access the right support.