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  1. Not just the blues
  2. Vulnerability factors
  3. Die baba doen goed
  4. PND symptoms and feelings
  5. Quick guide to identifying PND

NOT JUST THE BLUES...

When motherhood hurts

When you attended your ante-natal classes, you were probably told that the majority of mothers who have just given birth, become weepy, agitated, and generally emotional a few days afterwards - in fact, you probably expected "The Baby Blues". Typically, this distress lasts only a day or two, at the most, a fortnight, and the new mother then recovers her equilibrium, and is steady enough to cope with the enormous adjustments involved in accepting her new baby into her life.

Certainly, in the early months you will be tired, short of sleep, and will feel that your life is chaotic. It is amazing how such a small person can create such a huge impact. You will have very little time for yourself, or for the baby's father, and it may take quite some time to establish a routine. You may wonder whether you will ever have a life of your own again. It is quite normal to be anxious, to feel more dependent, and to feel incompetent. But basically, as the weeks go by, you ought to feel as though you are learning to manage better and better.

But sometimes things don't work out this way. "The Blues" don't go away; or maybe they do in the beginning, but as the weeks and months go by, slowly you get sucked into a downward spiral, feeling more and more unhappy, or anxious and panicky, and less and less competent. Perhaps you feel numb, or unreasonably angry, or that you are "just going through the motions", or that you are "cut off" from everyone. You know that you are meant to be happy because you have just had a baby; but you don't feel happy. You feel terrible. You may even think you are "going mad". And NOBODY TOLD YOU THAT THIS MIGHT HAPPEN.

In fact, at least 10-15% of all mothers feel like you. They are all over the world, in all kinds of economic situations, from every social class and every nation; and this has been happening for thousands of years. Why did nobody warn you, you may ask? Probably because they did not want to spoil the joy of your pregnancy, or to challenge the myth that the birth of a baby always makes a mother happy. Or maybe the women around you were too ashamed of their own similar feelings of depression to share them. Some experts think that there is "a conspiracy of silence" about Postnatal Depression, perpetrated by older women and doctors!

Or maybe they did tell you, and you did not believe that Postnatal Depression could happen to you, which is what happened to me.

Most women are ashamed, unprepared, unable to ask for help, and feel guilty, unnatural and isolated if they are unhappy after the birth of a baby. Often the women who develop PND are perfectionists, competent, high achievers who are accustomed to being in full control of their lives. Now they seem to have lost the sense of who they were.

PND is probably the result of a combination of biological, social and psychological factors, although there are some who regard it as the result of a hormonal imbalance, or other physical factors.

It is more likely that because the birth of a baby changes a woman's life so dramatically, she experiences a crisis as a result of which she has to rediscover who she is, and what it really means to be a mother. This crisis is very stressful, and some people react to too much stress by becoming depressed, or unbearably anxious and afraid.

To some extent, it has been found that if you have a really good support system you may be less vulnerable to PND. It has to be the right kind of support, though - the kind that makes you feel safe. In a way you may be saying to the people around you, "Help me, but do not make me feel more inadequate.. Help me, but do not take over altogether." But even such support may not be enough to prevent PND altogether.

Less PND has been reported in some primitive tribes, where the extended family is intimately involved with the woman, and where she is treated as "special", and important, and it is understood that she is going through a "rite of passage".

PND occurs in adoptive mothers and in new fathers. So it is not "just hormones"!

For the last few years, I have been collecting information about the women I have known who became depressed in the first year after their baby's birth. Some of them had been depressed for several years before I met them. They had children of four years' old. They had suffered in silence, not knowing what was wrong with them... and their families had suffered too.


VULNERABILITY FACTORS

  • Previous Depressions

  • Depression during Pregnancy

  • Previous PND

  • Stress 

  • Attitude to Labour and Delivery 

  • Lack of Support 

  • Difficult Relationship with Baby’s Father 

  • Personality Factors 

  • Abuse

 


DIE BABA DOEN GOED HOE VOEL JY?

NDOA  

005-295 NPO

Nageboortelike Depressie Ondersteunings Assosiasie

Wie is ons?

Die NDBA (Nageboortelike Depressie Ondersteunings Assosiasie) PNDSA (The Postnatal Depression Support Association) is ‘n nie-profeit assosiasie, gevorm deur ‘n groep vroue wat nageboortelike depressie oorkom het. 

Ons is toegewei om ander vroue wat ook moontlik die selfde ervaring beleef, to ondersteun, en om dit makliker te maak om hulp to kry.

Gevoelens na die Geboorte 

Om vir ‘n nuwe baba te sorg is moeilik, asook onophoudend.  Al het jy goed voorberei en uitgesien, sal dit soms nog steeds moeilik gaan.  Jy sal heelwaarskynlik ‘n groot verskeidenheid gevoelens ervaar, van verjeuging en opgewondenheid, tot frustrasie, veragting, skuldgevoelens en bekommernis.  Dit is alles baie normaal, en u sal ondersteuning en bystand van mense rondom jou nodig kry. 

Maar somtyds word hierdie ongelukkige gevoelens so intens dat jy oorweldig en/of uit kontrole voel.  Sou die gebeur, ly jy moontlik aan ND. 

DIE “BLUES”

Tot en met 80% van alle moeders ondergaan dit kortlike na geboorte.  Jy kan moontlik vir ‘n paar dae gespanne, huilerig, moeg, of geïrriteerd voel.

NAGEBOORTELIKE PSIGOSE

Aan die ander einde van die spektrum,sit die “diepste blues”, wat raar, maar tog ‘n baie ernstige wanorder is; naamlik nageboortelike psigose, wat so een of twee moeders per duisend ervaar. 

Die moder se denke word ernstig versteun, en sy benodig onmiddelik hospitalisasie en behandeling, omdat sy ‘n gevaar vir haarself, en die om haar is. 

NAGEBOORTELIKE DEPRESSIE EN ANGSTIGHEID 

Tussen 10% en 30% van alle moeders, in alle omstandighede, lei aan hierdie middelvlak depressie.  Anders as ander wanorders, is ND minder opvallend, en is identifikasie soms moeilik om te bevestig.  Die kan ook stadig ontwikkel enige tyd gedurende die baba se eerste jaar.  Elke moeder is anders, en kan verskillende simtome wys.  ‘n Moeder may miskien meer geïrriteerd of angstig, as hartseer wees.  Moeders is dikwels bekommered omdat hulle voel hul “mal” word.  Somtyds was die moeder al sedert swangerskap depres, en sal die “blues” nie net verdwyn nie.  Somtyds lyk dit asof ‘n ma goed oor die weg kom, maar dan verander haar gemoed ewe donkerder.

WAT VEROORSAAK ND? 

Daar is nie ‘n enkele oorsaak nie.  Dit is nie net “hormone” nie, omdat vaders, asook aangenome ouers dit ook kan ervaar.  Dit is one siening dat ‘n kombinasie van faktore daartoe dring/lei tot ND, soos: om ‘n  

  • perfeksionis te wees                            

  • onvoldoende bystand

  • ‘n traumatiese geboorte

  • finansiële en ander stresse

  • eensaamheid

  • ‘n onvoldoende verhouding met die kind se pa

  • ‘n vorige geskiedenis van depressie

‘n Vrou is kwesbaar net nadat sy geboorte gegee het, en die kombinasie van tė veel stresfaktore gedurende hierdie tyd, kan lei dat sommige vroue ND ontwikkel. 

BEHANDELING VAN ND

PNDSA (NDOA) beveel drie dinge aan die oorkoming van ND:

  • medikasie

  • psigoterapie

  • en/of individuele of groep terapie

Om met ander moeders te wees wat werklik weet en verstaan hoe jy voel, is baie behulpsaam.  Anti-depressie medikasie kan help om die simtome te beheer.  Psigoterapie is duur, maar tog hulpsaam om onderliggende asook psigologiese moeilikhede te verwerk.

KLINK DIT BEKEND?

  • Ek voel geïrriteerd en deurmekaar
  • Ek voel ek moet huil vir g’n rede Ek voel die heeltyd uitgeput Ek voel hulpeloos, onvoldoende, en voel dat ek nie kan trek hou nie
  • Ek is heeltyd bekommered oor my baba
  • Ek voel soms bang en paniekbevange
  • Ek skaam vir my, en voel skuldig
  • Ek weet nie meer wie ek is nie
  • Ek toon nie belangstelling in enigiets nie
  • Ek kan nie slaap soos voorheen nie
  • Ek eet nie meer soos voorheen nie
  • Ek het nie gevoelens vir die baba nie
  • Ek wil nie meer seks hê nie
  • Ek dink soms daaraan om die baba/myself te beseer


U mag miskien ly aan ND of angstigheid. 

 (Vervaardig deur PNDSA (NDOA) vrywilligers Jacqui Bush Design Studio)

WAT SAL HELP AS JY DEPRES VOEL? 

  • Moenie deur ander mense onderdruk word deur “ruk jou reg” of “jy behoort bly te voel” tipe kommentaar

  • Praat met iemand – jou kliniek suster of dokter, ‘n NDO groep of telefoon groep

  • Praat met jou eggenoot/lewensmaat of ‘n goeie vriend of vriendin

  • Aanvaar dat dit nie jou skuld is nie

  • Vra hulp van ander mense

  • Beplan genoegsame tyd vir rus, asook tyd vir, en met jouself

  • Laat jou standaarde daal; jy kan nie soveel doen as voorheen rondom die huis nie

  • Word deel van ‘n ondersteuningsgroep, waar jy jou ervarings kan deel, en met ander insig kan kry oor hoe jy voel

  • Vat stappie vir stappie

 


Symptoms & Feelings

These unusual symptoms will generally have been present most of the time, for a period of longer than ten days.

  • MOOD SWINGS ARE COMMON

  • MANY WOMEN REPORT FEELING NUMB

1. Depression:

  • Feeling sad; suicidal thinking

  • Feeling overwhelmed with fatigue

  • Feeling hopeless

  • Feeling guilty

  • Feeling lonely, abandoned, unsupported

  • Feeling no love for baby

  • Forgetfulness, indecisiveness

2. Anger:

  • Feeling out of control

  • Feeling angry most of the time

  • Fighting with other people

  • Feeling irritable

  • Feeling frustrated

  • Feeling trapped

3. Anxiety:

  • Feeling anxious most of the time; “knot in my stomach”

  • Fear that she might harm herself, the baby or others

  • Fearfulness: being alone, going out, unbearable, obsessive anxiety over health, her own, baby’s, baby’s father

  • panic attacks, feeling panicky

  • frightening thoughts; that she/the baby/her partner is not safe

4. Loss:

  • Of joy

  • Of motivation

  • Of interest in previous interests

  • Of interest in her own appearance, of taking care of herself

  • Of interest in sex, loss of libido

  • Of self-esteem and self-confidence

  • Of concentration, of the ability to think clearly

  • Of appetite – or control of appetite

5. Physical Symptoms:

  • Loss, or dramatic increase, of appetite – comfort eating, or being unable to eat

  • Weight loss or gain, beyond what is normal after having a baby

  • Insomnia – can’t sleep even when baby is asleep; early waking; sleep disturbances; wants to sleep all the time

  • Agitation, restlessness, or a general physical slowing down

  • Headaches, nausea, vomiting, other unusual physical symptoms

 


QUICK GUIDE TO IDENTIFYING POSTNATAL DEPRESSION 

WHAT TO LOOK FOR...

  • How does the mother look?
  • Is she taking care of herself?
  • Is she very restless?
  • Does she move very slowly?
  • Does she look sad and withdrawn?
  • Is she taking care of the baby properly?
  • How does she hold him/her?
  • Does she look at the baby, talk to him/her?
  • Is the baby thriving?
  • Is she enjoying the baby?
  • Ask her whether she is able to fall asleep, and stay asleep as before?
  • Is she coming to the Clinic too much or too seldom?
  • Is she worrying all the time about imaginary problems in the baby?
  • Does she seem unwilling to go home?
  • How is she managing breast-feeding?
  • Is she enjoying it? Have you asked her?
  • What support does she have? Can she get a break?
  • How is she getting along with the baby’s father?
  • Is her own mother available? If not, is there an older woman who can support her?
  • Has she a "best friend" in whom she can confide?
  • Is she very anxious?

*Remember these are only Guidelines. If you are worried about the woman, please refer her for a professional assessment.

©Liz Mills