By PANDA (Perinatal Anxiety and Depression Australia)
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It can be hard for a woman to acknowledge that she’s feeling depressed or anxious after the birth of her baby. This can also be a tough time for partners, family and friends. Here’s how to help women who aren’t acknowledging postnatal depression.

The reality of motherhood

Our society makes it difficult for a woman to acknowledge that she might be dealing with postnatal depression (PND). The usual messages are about the joy and bliss of motherhood. These messages rarely address the reality of the challenges motherhood brings to the life of each woman and her partner.

The media often reinforces unrealistic expectations of motherhood. For example, it often shows celebrities who appear to be coping exceptionally well with becoming mothers.

Because of the stigma of depression, PND is often portrayed very negatively and sensationally. A woman who isn’t coping can feel very alone and different from everyone else who seems to be coping.

Reasons why women might not acknowledge postnatal depression

  • Many women and their partners don’t know what postnatal depression (PND) is or how to recognise its signs.
  • The stigma associated with depression prevents women asking for help. A woman’s need to be seen as normal and a good mother is very strong. PND symptoms can be masked with incredible effort, sometimes even from a woman’s partner.
  • It’s hard for a woman with PND to admit she isn’t coping and to ask for help. This involves acknowledging that she can’t manage her feelings and that something is seriously wrong. But denial is the enemy of recovery.
  • Depression itself breaks down a woman’s ability to communicate, make decisions and help herself.
  • It can be too difficult for a woman to find the words to talk about her painful and negative thoughts. This is because she might feel that no-one will understand or others will be horrified by her thoughts.
  • In the early weeks after having a baby, there are many other things happening. A woman might use these to explain how she feels (for example, baby’s sleep, her sleep changes, impact on her partner). She assumes things will get better when everything settles down.
  • A woman might have tried to communicate her feelings or to ask for help from family or services. But her feelings might have been dismissed or not responded to. This leads to an increased sense of failure, inadequacy and guilt, especially if she’s told that she should be happy or that her own mother did it tough and was OK. In this case, the woman might not try again to access help until her depression reduces her capacity to perform everyday tasks.
  • A woman might also blame her partner for how she feels, resulting in significant conflict between the new parents.
  • Women might not trust workers in services with their dark secrets. A woman might deliberately put on a sunny, capable face when seeing her nurse or doctor. This is because she desperately doesn’t want them to know the extent of her bad feelings.
  • A woman might fear being put on antidepressants if she talks about her feelings. She might also be worried about what medication might mean if she’s pregnant or breastfeeding.
  • A woman might fear that the authorities will take her baby away if she has PND and is not coping. She might be worried about being seen to be a bad mother. This fear is reinforced if there’s a difficult partnership breakdown, and she fears her ex-partner will take the baby from her.
  • Even the most skilled health professional can miss PND, especially if the woman isn’t giving clear or honest indications of how she is.
  • A woman might not know what services are available to help her or she might feel that no-one can help her anyway.

When a woman doesn’t acknowledge postnatal depression

Sometimes a woman’s partner, family or friends are the first to pick up that things have changed for her or that she isn’t coping with motherhood. It can be very difficult to observe these changes and know how to address them, especially if the woman isn’t prepared to talk about these concerns or agree to get help.

When a new mother feels things aren’t right, it’s ideal for her to talk to her partner, family, friends and health carers to get it checked out.

But there are women who go to great lengths to avoid discussing and dealing with their mental health issues. Over time these mothers can become quite unwell, and relationships with their babies, children, partners and families can become very strained. Their partners, family and friends can become increasingly concerned.

These women can become angry and defensive if the people who care about them bring up concerns. They can stubbornly refuse to get help or stay involved with services.

Effects on partners, family and friends

If a woman continues refusing to acknowledge her postnatal depression (PND), the costs for the woman’s partner, family and friends increase. Her partner might need to take time off work to help with the baby and provide support. There might be growing concerns for the wellbeing and safety of the woman, the baby and any older children.

The woman might blame her partner, family or friends for everything. Ultimately, she might break ties with her family and friends or tell her partner to leave the relationship. She might feel that her partner is the source of her distress, and if it wasn’t for her partner, she wouldn’t be feeling the way she is. She might focus on aspects of the relationship that have been difficult in the past. She thinks that if her partner leaves, she’ll get better.

Partners in this situation can become very distressed. They know their partner is unwell but she won’t accept any help. This can mean that partners can’t do anything to prevent their families from breaking down completely. In this case, partners can be at risk of depression and anxiety. They face a loss of confidence in themselves and their ability to assess the situation accurately.

The breakdown of a couple’s relationship and the new family is one of the greatest tragedies of unacknowledged and untreated PND.

Strategies to support women with postnatal depression and their partners

Partners, family and friends can use the following strategies to support and get help for a woman with postnatal depression (PND), as well as to take care of themselves.

  • Find out as much as you can about PND. This will help you identify the impact of the illness on your partner’s emotions, behaviour and decisions. Try to keep this separate from what you know about your partner before she became depressed.
  • Get support for yourself. Talk to someone about how you feel and take care of yourself with rest, exercise and time away from caring for your family member.
  • Try to avoid making any significant decisions during this time. You and your partner might not be thinking clearly. Remember that it’s likely that the PND is contributing to her unhappiness in the relationship. If she does seek help and recover, much of the conflict in your relationship is likely to settle.
  • Try to be patient with her. She isn’t her normal self or thinking clearly. You might have to listen to her concerns and provide support, even though she isn’t listening to your concerns or getting help. This is very difficult and frustrating, so sharing this with your family and friends is important.
  • Try to avoid conflict. Your partner might say and do some things that are meant to hurt you or start a fight – she is likely to be feeling very angry and guilty. This can feel very unfair and confusing. Try to walk away or not add to conflict. If this doesn't help or the conflict increases or becomes physical towards you or the children, it's time to get help from family and support services.
  • Trust your instincts and your concern for her. You might need to risk conflict with her in the short term by getting help for her. This is especially if you’re very concerned about her and the baby. You can contact her doctor or child and family health nurse to talk about your concerns and seek their advice. You could also contact mental health crisis services, or go to the local hospital emergency department if you need to.
  • In some cases, child protection services might need to be involved. This might be when women refuse to get help and struggle to care for their baby and older children or if children are exposed to a mother’s unstable mental health, or alcohol and other drugs. The wellbeing of the baby and older children is very important. In this situation, child protection would try to ensure that the woman gets services that will help her recover and help the family stay together.

Encouraging a woman to talk about her feelings

Make it OK to talk
Start by acknowledging the difficulty of the situation. Make it OK for the woman to talk about her difficult feelings. You can do this by identifying the challenges of motherhood for women in general and the challenges specific to this woman’s situation. You could say something like, ‘Adjusting to being a mother is one of the largest changes women ever make, yet we often don’t speak about how difficult it can be’.

Validate and support her
You might feel that she’s not listening to your attempts to support her. Let her know that you understand her feelings are real to her, no matter how bad or unreasonable they sound. Try to avoid telling her how she should feel. Be positive about even the little things she’s doing well. You could say something like, ‘You’re dealing with a lot (for example, lack of sleep, little support, and being away from your family). Anyone in your situation would find it tough’. Or ‘You are doing a really good job’.

Encourage her to talk about her feelings
She might be feeling and thinking many different things as she recovers from the birth and manages lack of sleep and the anxieties of motherhood. Ask her open-ended questions that encourage her to give more than yes or no answers. Try the following:

  • ‘I wouldn’t be surprised if you were feeling that way.’
  • ‘I’m wondering if this might be how you are feeling.’
  • ‘How are you finding motherhood?’
  • ‘How are you really feeling?’

Listen to her
Keep trying to listen to her worries without interruptions, ideas or advice. It can be tempting to try to give her advice and tell her what you think she should do. Just try to let her know that you’re listening.

Give her the power to make decisions for herself
At the same time, you need to encourage her to seek help. Being heard enables a woman to clarify her issues for herself, which is the first step in deciding what to do to address them. Sometimes she’ll benefit from knowing her options. Other times she’ll need you to be more involved in decision-making.

Let her know you believe she’ll recover
Help her to expect to recover by expecting that she’ll come through this (with help). It’s generally hard for her to believe that she’ll ever feel well again. You can hold the light of hope for her, by telling her she’ll recover. In turn, this can support her to make the huge effort to recover.

Look after yourself and your children
Sometimes you might feel like you can’t do anything right. You might have to wait for your partner to open up about her need for support. If you’re concerned about her wellbeing or that of your baby or older children you’ll need to take action and get some help, even if you risk getting into conflict with your partner.

Video Support for you and your baby

If your partner is suffering from PND, there’s no need for your family to cope all by yourselves. If you need to, you can reach out for help.

This short video offers information on the resources that can help parents look after babies and raise children. The video notes that extended family and friends can be a great source of support. Also, a clinical nurse specialist talks about Tresilian, Australia’s largest child and family health organisation. There are many other resources available nationwide that can help you with parenting issues.