Chapter 6: When the Low Mood Stays

From the Diary

Week 6. Everyone said the baby blues would be over by now, and they are. So I do not understand why I feel this way. It is not the sudden crying of the first days. It is more like a grey blanket over everything. Our daughter gave me her first real smile this week, and I wrote it down so that I would remember it. Today she smiled at me again, and I smiled back, and inside I felt almost nothing. I told myself that I am tired, that every new mother is tired. My mother visited on the weekend and said I looked pale, and I said it was only the nights. Yesterday I wrote a page in this diary and then tore it out and threw it away, because it sounded too sad to keep.

Week 8. I sleep when she sleeps, the way everyone tells me to, but often I just lie there awake with the same thoughts going round and round. I am not hungry, and I forget to eat until my husband puts a plate in front of me. When my friend from the parents' class sends a message at night, I do not answer, and then I feel guilty for not answering. I see other mothers in the park laughing with their babies, and I think they are doing something I cannot do. Sometimes I think our daughter would be better off with a different mother, one who feels what a mother is supposed to feel. I have not told anyone that. I am afraid that if I say it out loud, it will become true, or that people will look at me differently.

Week 9. Tonight, after our daughter was asleep, my husband sat down next to me and said, very gently, that he was worried about me. He said I seemed far away, that I had stopped laughing, that he missed me. My first feeling was anger, because I was trying so hard. My second feeling was relief, because someone had seen it. I cried for a long time, and my husband did not try to fix anything. He just stayed. Before we went to bed, we agreed that I would tell the midwife at the next visit, and that he would come with me if I needed to see the doctor.

Week 10. I told the midwife everything, even the sentence about a different mother, and she did not look shocked. She said that what I described is common after a baby, that it has a name, that it is nobody's fault and that it can get better with help. She helped me make an appointment with the doctor, and my husband came with me two days later. We left with a plan, a date for the next appointment and the number to call if things get worse before then. I do not feel better yet, and the doctor said that getting better takes time. But tonight, for the first time in weeks, I feel that I am not alone in this.

What Postnatal Depression Is

Postnatal depression is a low mood, together with other changes in feelings, thoughts and the body, that comes after having a baby and stays. Some people call it postpartum depression; the meaning is the same. The baby blues, which Chapter 3 describes, usually begin a few days after the birth and fade within about two weeks. Postnatal depression is different: it does not simply pass on its own after a short time, and it can become deeper if nobody notices it. It can begin at any time in the first year, in the first weeks, as for the mother in the diary, or months later, when life seems to have settled down.

Postnatal depression is common, and it can happen to anyone. It can happen to a mother who had an easy birth or a hard one, to a mother who longed for this baby, to a mother who has never had a low mood before and to a mother who has. It is not caused by anything a mother did or did not do. It is not a sign of weakness, of not loving the baby or of being a bad parent. Many things can play a part together: the great changes in the body after the birth, broken sleep, a difficult birth, feeding worries, loneliness, money worries, low moods in the past, and the very large change that a first baby brings to a person's life.

Depression is not something a parent can end by trying harder, being more grateful or thinking more positively. Many parents with postnatal depression tell themselves that they have a healthy baby and no reason to feel this way, and then feel even worse for not being able to feel better. Like the mother in the diary, they may hide the signs, even from the people closest to them, because they are ashamed or afraid of being judged. Depression is a real health problem, in the same way that a slow-healing wound is a real health problem. It deserves care, not blame, and it is not a test of how much you love your baby.

It is important to know that the other parent can also have depression after a baby arrives. A partner may become quiet, irritable or withdrawn, or may start working much more, and these can be signs of a low mood too; Chapter 9 explains this. Depression also often comes together with anxiety, a constant worry and a racing mind that will not rest, which Chapter 7 describes. Many parents feel both at once. A partner who is struggling deserves the same kindness and the same help as a mother who is struggling. Whatever shape these feelings take in your family, the steps toward help are the same.

The most hopeful thing to know about postnatal depression is that it can be helped. With support and the right care, parents can and do feel like themselves again. Getting better is often slow, with good days and bad days mixed together, and the mother in the diary did not feel better on the day she spoke to the midwife. Many parents do not. But the first conversation is where getting better begins, and each step after it counts. You do not have to wait until you feel very bad before you ask. The earlier help starts, the sooner the heavy days can begin to lift.

Signs Worth Telling Someone About

Every new parent has hard days, tired days and tearful days. What makes postnatal depression different is that the signs are there most days, for more than a couple of weeks, and that they make ordinary life feel much harder than it should. The signs differ from person to person, and nobody has all of them. Reading about them is not a test that you pass or fail. It is a way to find words for something that is often hard to name, so that you can say it to someone who can help.

Some signs show in the feelings. A parent may feel sad or heavy most of the time, or empty and numb, as the mother in the diary felt when her baby smiled. A parent may lose interest or joy in things that used to matter, or feel cut off from the baby, as if caring for the baby were only a list of tasks. Many parents feel guilty, worthless or like a failure, or become irritable, angry or tearful much more easily than before. Worry that will not stop is common too. Many parents with depression also feel a deep shame about these feelings, and that shame can make it even harder to speak.

Some signs show in the body and in daily life. A parent may have trouble sleeping even when the baby is asleep and someone else is caring for the baby, or may sleep far more than usual. Appetite may change, so that a parent eats much less or much more than before. Energy may be very low. It may be hard to think clearly, to concentrate or to make simple decisions. A parent may pull away from friends and family, stop answering messages and not want to go out. Some of these, like tiredness, are part of every new parent's life, which is why depression is easy to miss. The difference often lies in how deep the change goes and how long it lasts.

Some signs show in the thoughts. A parent may think that things will never get better, that they are a burden, or that the baby or the family would be better off without them or with someone else, as the mother in the diary once thought. Some parents have thoughts of harming themselves. Thoughts like these are a sign that the depression is serious and that help is needed now, not later; the last part of this chapter explains exactly what to do. Having such a thought does not make you a bad person or a bad parent. It makes you a person who needs care, and that care exists.

Sometimes the person with depression does not see the signs, because depression changes the way a person sees themselves and their life. The people around them may notice first: a partner, a parent, a friend, the midwife or the nurse. Like the husband in the diary, they may see that a mother seems far away, has stopped laughing or no longer answers her friends. If someone close to you says that they are worried about you, try to listen, even if your first feeling is anger or a wish to say that you are fine. They are telling you because they care about you.

Taking the First Step

The first step is to talk to a doctor, midwife or nurse. You do not need to be sure that what you feel is depression, and you do not need to find perfect words. You can simply say, "I have not felt like myself for a while, and I am worried." Doctors, midwives and nurses who care for new families hear this often, and they know how much courage it takes to say it. Many parents fear that if they admit how low they feel, others will think they cannot care for their baby. In fact, asking for help is what caring parents do, and health workers are there to support you and your baby together. If the first person you speak to does not seem to understand, try again with someone else; your feelings are worth being heard.

It can help to prepare a little before the appointment. Write down what you have noticed: how your mood has been, how you sleep and eat, which thoughts worry you and how long this has been going on. Bring someone with you if that makes it easier, as the mother in the diary did. Be as honest as you can, including about the thoughts that feel too dark to say aloud. Like the midwife in the diary, a doctor, midwife or nurse has heard such thoughts before, and saying them is what allows the right help to begin.

The doctor, midwife or nurse can explain the kinds of help that exist where you live and which of them may suit you. Help often includes talking regularly with a trained person, such as a counsellor or a therapist; more frequent visits or calls from the midwife, nurse or doctor; practical support at home; and groups where parents with similar feelings meet and talk. For some parents the doctor will also explain other kinds of treatment and talk them through with you. If you are breastfeeding, tell the doctor, so that this is part of the conversation. Help is chosen together with you, and it can be changed if it does not suit you. If the first kind of help does not seem to work, say so at the next appointment; there is often another way to try.

Partners, family and friends can help a great deal, often in simple ways. They can notice, and say gently what they notice, as the husband in the diary did. They can listen without rushing to fix everything and without telling the mother to cheer up. They can take on practical tasks: a night feed, the shopping, a meal, a few hours with the baby so that the mother can sleep or go for a walk. They can go with her to appointments, help her keep them, and remind her that the low mood is not her fault and is not who she really is. And they can look after themselves too, because supporting someone through depression is tiring.

If you are raising your baby alone, building a small team matters even more. Think of one or two people you could tell honestly how you feel: a friend, a family member, a neighbour or another parent. Let your doctor, midwife or nurse know that you are on your own, so that they can think with you about extra support. In many places there are groups and services for parents who are raising a child alone, and the official contact points where you live, such as the local public health office, can tell you what exists. Asking for help when you are on your own is not a sign that you cannot manage. It is part of managing well.

When Help Is Needed at Once

Some situations need help straight away, not at the next appointment. If you have thoughts of harming yourself or your baby, or if you feel that you cannot go on, get help now. Call the emergency number, a crisis line or your doctor now, or tell someone close to you at once and ask that person to stay with you. You do not have to explain everything well. You only have to say that you need help now. This is not a moment to wait until tomorrow or to see whether the feeling passes on its own.

If you are the partner, a family member or a friend, and someone tells you that they are thinking of harming themselves or that they cannot go on, take it seriously, even if it is said quietly or with a small laugh. Stay calm and stay with that person. Thank them for telling you, because saying it took courage. Then help them get help now: make the call together to the emergency number, a crisis line or the doctor, or call for them. Do not leave that person alone until help is there, and if a baby is in their care, make sure someone else is caring for the baby too.

Asking for help in that moment is one of the strongest and most caring things a parent can do. It protects you, it protects your baby, and it is the start of the care that helps you get better. Thoughts like these come from the depression, not from who you are, and they can ease with help. If you can, keep the emergency number and the number of a crisis line written somewhere easy to find, so that you or someone close to you can use them without having to search.

There is also a different situation, much less common, that everyone around a new mother should know about. Very sudden, unusual changes in a mother in the first weeks after the birth need emergency help at once. These changes can include confusion, seeing or hearing things that other people do not, strange beliefs that seem completely real to her, very unusual behaviour, or a mood that swings suddenly to extremes, and they can appear quickly. The mother herself may not realise that anything is wrong. If you notice changes like these in a mother after a birth, call the emergency number or get emergency medical help at once, and stay with her until help arrives.

Partners and family members sometimes hesitate in these moments, because they do not want to overreact or to upset the mother. It is always better to call and be told that all is well than to wait. Emergency workers, doctors and crisis lines are there for exactly these moments of doubt, and they would much rather hear from you early. Calling for help for someone you love is not a betrayal of that person. It is a way of keeping the mother and the baby safe until she can feel like herself again.

A Checklist of Things to Prepare

The emergency number, a crisis line and your doctor's number, written on one card in a place everyone in the home knows. In a hard moment, nobody should have to search.

A short note of how you have been feeling, to bring to your next check-up or appointment: your mood, your sleep, your appetite and any thoughts that worry you. It makes the first sentence easier.

One person you agree to be honest with, who knows that you might call or send a message on a grey day. Tell that person what to do if they are worried about you.

A plan for small breaks: who can hold the baby for an hour so that you can sleep, eat, take a shower or walk outside. Write down the names and ask before you need it.

A sentence for your partner or the people close to you: "If you are worried about me, please tell me, even if I seem annoyed." Saying it on a calm day makes it easier to hear later.

Your next appointment with the doctor, midwife or nurse, written on the calendar, with a reminder for the person who is coming with you. Going on the days when you do not feel like it is part of getting better.

A list of small things that helped, even a little: a walk in daylight, a warm shower, a message from a friend, a smile from the baby written in the diary. On a hard day, choose one.

A few kind words for the people who help you, written down or said aloud when you can. Letting your partner, family or friends know what helped makes it easier for them to keep helping.