How to help the mother who is not acknowledging postnatal depression

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Our society makes it difficult for a woman to acknowledge that she may be dealing with Postnatal Depression (PND), as the usual messages are about the joy and bliss of motherhood. These messages rarely address the reality of the challenges motherhood also brings.

The media often reinforce the unrealistic expectations of motherhood, for example superstars who appear to be coping wonderfully. Due to the stigma of depression, PND is often portrayed very negatively and sensationally.  Other women commonly put up a brave face so that a woman who is not coping can feel very alone and can find it very hard to come to terms with.

Postnatal depression is difficult to identify because:

• many women suffering from PND do not seek help themselves
• many do not know what PND is or how to recognise its signs
• for some the stigma associated with depression prevents them asking for help
• it is hard for a woman with PND to admit she is not coping and to ask for help. Symptoms are consequently masked and the mother may blame other factors for the way she feels (e.g. breastfeeding problems, infection of the caesarean scar, recovery from episiotomy) 
• many women fail to recognise PND in the early weeks because they often have something else to blame for the way they feel, and they assume things will get better
• a woman might also blame herself or her partner for not feeling the way she expected to feel
• furthermore, even the most skilled health professional can miss PND. Many do not know what to look for.

Sometimes a woman’s partner, family or friends become concerned about changes in the woman's mood or personality, or about how she is coping with motherhood. It can be very difficult to get a woman with PND to talk about these concerns or to agree to get help. The following statements are examples of how to encourage a woman who may be experiencing PND to share how she has been feeling.

1. Acknowledge and normalise the difficulty of the situation - shift her self blame by identifying the challenges to motherhood for women in general and the challenges specific to her situation.
   “Adjusting to being a mother is one of the largest transitions women ever make, yet we often don’t speak about how difficult it can be.”
2. Validate and support her - be genuine, if you don’t believe it don’t say it.
   “You are dealing with a lot, (eg the lack of sleep, having little support, and being away from your family) anyone in your situation would find it tough.”
   “You are doing a really good job.”
3. Invite her to share - recovering from the birth, lack of sleep, and anxiety of motherhood can have a woman feeling quite depressed at times.
   “I wouldn’t be surprised if you were feeling that way.”
   “I’m wondering if this might be how you are feeing.”
   “How are you finding motherhood?”
   “How are you really feeling?”

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