Postpartum or post natal depression occurs mostly in the Mother and sometimes in the Father following the birth of a child. It effects about 1 in 7 woman and is thought to be caused mainly by difficulty in adjusting to parenthood. The degrees of severity will vary and can be measured by asking the Mother targeted questions or asking her to do the Edinburgh post natal depression scale and then scoring the result.
It is better to seek help for the problem early so that you can enjoy parenthood and be the best parent possible.
Many specialist Mother/ Baby Parenting Units offer postnatal depression groups which are a strength based group, usually run by a Clinical Psychologist involving 8 weeks of weekly group sessions.
During the group they introduce a range of strategies to manage the condition mainly based on Cognitive Behaviour Therapy. The groups perform an important function in that they allow the Mothers to network and form supportive friendships, sometimes lifelong.
In my experience as a Health Service Manager of a Mother/Baby Unit the networking is important. Often the Mothers have had Corporate careers and have left having children until around the age of 38-45.
Their professional lives have run smoothly, they often have a house and usually a partner, and when they take the baby home from Hospital they find that they have no control over the routine and control is what they are used to having. Things fall apart without some support.
Often their parents are dead or too old to be of any help and they find that they don’t have anyone to support them except their partner who is working long hours and needs his sleep. The best thing that we can do for these women is to help them to get the baby into a good settling pattern, and this sometimes requires a Residential Stay.
Dr. Howard Chilton a Neonatal Paediatrician writes extensively about the Parental Attachment Theory in his book ‘Baby on Board’. His lectures to new Mothers are legendary and attended by the parent prior to discharge from Hospital. He explains that human babies are born too soon and in the animal world would be in the womb for another few months and then come out less dependent.
He then goes on to say that when you go home from the hospital keep your baby at home for the first 4-6 weeks and keep the room semi darkened. During that time feed and sleep the baby with as few visitors as possible.
The important thing to remember is that Postpartum Depression is a temporary condition and it can be treated.
Often when the Mother leaves Hospital she is followed up in the community by a specialized home visiting team of nurses who can keep track of her condition and see how the baby is progressing.
Volunteers especially trained in supporting Mothers and babies can be very helpful in this situation and often forge strong links with the family.
Sometimes depressed Mothers are unable to play with their babies and the child begins to suffer from his/her own adjustment issues. Play therapy may be useful in this situation where weekly controlled play is given in a therapeutic session, and the Mothers progress is observed.
Children of a depressed Mother tend to become withdrawn and unable to relate to other people and will ultimately fail to thrive and become, in extreme cases mal nourished. This trait was seen in Bosnian orphanages of the neglected children after the Bosnian War in 1992 to 1995.
The problem with play therapy is that it needs to be continued for about six months in order to be effective and to get the Mother into a routine.
Other ways to treat Postpartum Depression is for the Mother to continue with weekly counselling sessions. She can take the baby in the pram and continue for the first twelve months with the sessions becoming fortnightly towards the end of this time. Psychologists report that this is very helpful to the client, although not always cost effective.
Secure attachment is a loving, emotional relationship between parents and the baby. Even one consistent caregiver as in, single mothers, is enough and if this relationship is not present for the babies later life development of the brain will be affected. The quality of our early relationship with our parents and our caregivers in the early years influences the rest of our lives.
The attachment theory is a psychological theory underpinning a child’s development. Our early experiences will determine how we respond to others later, and a ‘secure attachment’ is what we are aiming for. The fact that this attachment can be disrupted by the Mother being depressed is ‘key’ to our work in promoting a secure attachment and treating any kind of maternal depression.
You will notice that during your child’s development at between about 1-3 years they will not want to separate from you. Once we have built that secure attachment between the ages of 3-3.5 years, you will find that the child will be able to go away and play and then return to you without becoming anxious.
This is not hard to do with a loving ‘present’ mother, but will not happen if the Mother is depressed. It is not recommended that children are removed from their Mother under the age of 3, even if the Mother goes to prison they try to send the child with her. This presents a new range of problems.
Conclusion, on problems that may arise from Postpartum depression
it is extremely important that large amounts of funding are poured into Early Intervention programs to support Families and children.
In many countries specialized Early Intervention Centres are in place and they help to identify problems that may impede the child later in life. One of the problems identified has been autism, and if found early enough a lot can be done to help the child. Other disabilities are also identified.
Poverty is also a big problem as people who are depressed can’t always work. Many single parent children grow up in families that live with incomes below the poverty line, poverty is growing and due to lack of work or substance abuse, or other factors the parent is unable to work.
These children often grow up disadvantaged, and where the problem may have started off as poor attachment related to substance abuse, the problem grows, and the pattern is often repeated. We owe our children safety, food and a good education this takes money and many charities work towards raising this. In most countries millions of people live below the poverty line. In recent years 2 US Policies to address child poverty have been supported by evidence: These are Early Intervention and Employment based Financial incentives, they have not eliminated poverty but will help to support low income families.
The US has high poverty rates about 20-22% and there is high income inequality. This means that families where a Mother or Father suffers from Postpartum Depression are ‘held back’ in making ends meet so it is doubly important that they get the help that they need to become productive again as soon as possible. People with mental health problems are also over represented in the homeless population, and every child needs a safe home to grow up in.