Identifying postnatal and antenatal depression and finding help

Many parents, predominantly mothers, had either been diagnosed with or self-identified as experiencing antenatal or postnatal depression or anxiety. Several others experienced significant distress but were unsure if this could be considered antenatal or postnatal depression. Parents talked about the ‘symptoms’ of distress, anxiety or depression during the perinatal period; the difficulty for some of distinguishing between perinatal depression and ‘normal’ emotions in pregnancy or early parenthood; and whether they or someone else had identified there was a ‘problem’.

Fathers and mothers described a broad range of ‘signs’ indicating that things were ‘not right’ during pregnancy or early parenthood. Physical signs included vomiting, loss of appetite, sweating, a dry mouth, lack of interest in personal grooming, and sleeplessness. A new migrant from Sri Lanka, Chandrika described feeling ‘depressed’ after her daughter was born and said when her mother visited from overseas: ‘she was surprised because my hair was tangled, tangled. I haven’t time to even brush my hair’.

Anna who experienced postnatal depression said the first indications were physical.

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For other parents, a change in their relationships or interaction with others was a ‘signal’ that something was ‘wrong’. Some people reported experiencing tensions with a partner, becoming impatient with or indifferent to an older child, isolating themselves, or feeling uncomfortable in social situations. Tony experienced depression related to his ex-partner’s ill-health after his daughter’s birth and said: ‘I’ve had times when I don’t want to get out of bed or I don’t want to answer the phone … days where I’ll just sit and watch TV the whole day because I just can’t be bothered doing anything’.

When he realised he was ‘yelling’ at his children, Andrew thought he might have ‘a bit of depression’ and took steps to have it ‘addressed’.

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A few mothers talked about feeling ‘unattached’ to or having ‘negative’ feelings for their babies. Melissa who experienced postnatal depression after her second child described feeling ‘resentment’ towards her son: ‘I started to have these feelings … like it was all his fault. Everything was his fault.’ (See Parents’ experiences of meeting and bonding with their babies).

In addition to physical signs, parents described a broad range of emotional or psychological signs of antenatal or postnatal depression or anxiety. These included feeling ‘robotic’, ‘mechanical’ or ‘disconnected’. Several people who mentioned these feelings said they felt ‘suicidal’, such as Deb when she experienced postnatal depression after her second child: ‘I became a robot – the larger part of me felt nothing. And that it would be easier if I committed suicide – not in a really graphic way, but just rather that if I was dead’.

Maree talked about feeling ‘numb’ while pregnant with her second child and as though her family would be ‘better off’ without her.

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Other emotional ‘signs’ of depression, anxiety or distress during the perinatal period mentioned included feeling anxious, crying often or being ‘teary’, feeling ‘sensitive’, ‘overwhelmed’, ‘unmotivated’, ‘angry’, being ‘unfocussed’ or ‘scattered’, and feeling ‘suffocated’ or ‘trapped’. A few people also remembered thinking they had ‘made a mistake’ in having a baby, and some described distressing experiences of intrusive thoughts about harming their babies.

When her baby was six months old, Chelsea described feeling ‘suffocated’ and escaping to the beach one day when ‘it all became too much’.

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Zara experienced intrusive thoughts after her daughter’s birth, not knowing that these could be a ‘characteristic’ of postnatal depression.

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For a few mothers, the distinction between ‘normal emotions’ in pregnancy or early parenthood and perinatal depression was unclear. Some women described themselves as ‘borderline’, others retrospectively identified their experiences as depression, and a few weren’t sure. Not having a clear idea of what to expect during this period of their lives made it difficult to work out what a ‘normal baseline’ was (see Expectations of early parenthood). Georgia said she asked herself when she was struggling during first-time parenthood: ‘Is it this goddam hard for everybody? Is it because I thought I was career-orientated and this is not working the way I wanted it to? Or have I got postnatal?’

For Susanne, the line between ‘coping’ with a new baby and experiencing postnatal depression was ‘very grey’.

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Looking back on the first few months of parenthood caring for a restless baby with reflux, Sara L wondered if she had experienced postnatal depression.

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Some women were also reluctant to consider they might be experiencing postnatal depression as felt mental health problems were ‘stigmatised’.

Elizabeth, a mother of two, found it hard to make an appointment with her GP to talk about how she was feeling due to uncertainty about what was ‘normal’ as well as a sense that postnatal depression was a ‘personal failing’.

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Most parents identified themselves that something was ‘amiss’ and that they needed help, often referring to a distinct ‘turning point’ that made them realise there was a problem. Zara experienced ‘intrusive thoughts’ and described the moment she realised she needed help: ‘one night when I had to give [my daughter] a bath and I was talking to her and saying, “Oh sorry, your mummy’s sick, something’s wrong with your mum”. And so I put her into the cot and I think that’s when I realised – I’ve got to work something out here, I’ve got to talk to someone.’

Several parents said it was another person who identified they were experiencing depression, distress or anxiety, including a partner, parent, friend or health professional. The Edinburgh Postnatal Depression Scale (EPDS), used to screen for postnatal depression, was mentioned by several mothers. A few were critical of the scale or said they had ‘lied’ or modified their answers as had not wanted to confront the possibility of postnatal depression. Other women who received a ‘high score’ on the EPDS said this led to diagnosis and treatment for perinatal depression.

Georgia’s Edinburgh Postnatal Depression Scale score was ‘borderline’ after each of her children but she was more open to the possibility of being diagnosed with postnatal depression the second time.

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Although looking back, Elly thought she was depressed during early parenthood, she described the Edinburgh Postnatal Depression Scale as ‘silly’.

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Most people who experienced postnatal depression, anxiety or emotional distress were able to access help once they asked for it. Parents described contacting health professionals (GPs, psychologists, midwives, maternal and child health nurses, and psychiatrists), helplines (PANDA, beyondblue, Nurse-on-call, Healthdirect), or obtaining support through their own social networks (partners, parents, friends, other family members).

Melissa rang a maternal and child health hotline about her baby’s unsettledness and the nurse she spoke to asked her if she had postnatal depression.

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See

* Experiences with health professionals for antenatal and postnatal depression
* Social support during antenatal and postnatal depression