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  1. Depression, Anxiety and Childbirth
  2. Recommended books and articles on PND
  3. Book Reviews

Depression, Anxiety and Childbirth

DEPRESSION, ANXIETY & CHILDBIRTH 

WHY DO WE CARE?

  • Relatively high prevalence of PND (>1 in 10)

  • Long duration of many episodes

  • Long-lasting negative effects on infant, mother & family

  • “Conspiracy of silence”

Affective disorders associated with childbearing have been described since the time of Hippocrates.  More recently, in 1838, the French physician, Jean Etienne Dominique Esquirol1, documented cases of mental illness in childbearing women.  He divided them into illnesses that arose during pregnancy, soon after childbearing, and weeks or even longer after delivery.  Louis Victor Marcé1, also a French physician having a particular interest in psychiatric disorders in postpartum women, in 1858, wrote Traité de la folie des femmes enceintes, a treatise about emotional disorders during pregnancy and after delivery.  Modern interest in the subject was revived in the late 1960s, with the publication of the works of James Alexander Hamilton (1962)1 and Bryce Pitt (1968)2, amongst others.  While this continued, concurrently during the 1980s, in several parts of the world, the efficacy of self-help and or support groups was being confirmed as assisting postnatal depressed women in their recovery.

Little is known about developments in South Africa, prior to 1987, when the author was involved in the establishment of a facilitated support group for women who were struggling to adjust to their new roles as mothers.  These first support groups were set up at The Parent Centre, a project of Child Welfare in Cape Town.  Intuiting that the problems of these mothers might, in fact, be a manifestation of Postnatal Depression (PND), the author began to use the Edinburgh Postnatal Depression Scale as a “measuring instrument”, and to refer, where appropriate, for medication and individual psychotherapy.  By educating and informing health care professionals and the public about PND and our services, the author, with the Parent Centre, was able, slowly, to reach women and families who were suffering from the effects of postnatal depression (PND).  The support groups became therapy groups, and through referrals and word of mouth, the numbers grew.  The author undertook several research projects, one of which was published in the SAMJ3.

The author made contact with and joined Postpartum Support International (PSI), and the Marcé Society, and is, at time of writing, a member of the Executives of both these international organizations, which have a practical and academic interest in affective disorders, associated with childbirth.  Having been a delegate and presenter at conferences presented by PSI and the Marcé Society, it became clear to the author that Southern Africa needed a support service focusing specifically on women who were experiencing clinically diagnosed anxiety and depression, during pregnancy and post partum.

The Postnatal Depression Support Association of South Africa, (PNDSA), was established as a registered non-profit organization in 1997.   Its 230 members include psychiatrists, psychologists, paediatricians, general practitioners, childbirth educators, midwives, and obstetricians, nursing sisters, academics, recovered “survivors” and volunteers.  Funding is either by donation from the private sector and individuals, or from membership fees.  PNDSA has effectively given support and assistance in many parts of Southern and Sub-Saharan Africa, especially in the Western Cape. By February 2000, the organization had distributed 27 500 pamphlets, and had had direct personal or telephonic contact with more than 1791 depressed mothers.  In addition, our volunteers have visited 4210 newly delivered mothers in maternity hospitals.  In the Cape Town area alone, more than 3000 support group sessions have been held since 1997.

The author has recently conducted a large research project examining postnatal depression in the broader context of the woman’s life.  (It is intended to submit a summary of the, as yet unpublished, findings to this Journal.)  There is an urgent need for further community-based support services, and for random controlled research trials to be extended into the less educated and less affluent communities in Southern Africa.  Financial stress, poverty and lack of social and instrumental support are known to be risk factors for PND.  We are uncertain as to how PND presents and is interpreted by our many different cultural groups.

This is a time when “women’s issues” are “politically correct”.  To some extent, lip service is paid to this, particularly in respect of the rights and needs of new mothers.  Having a baby requires more recognition than maternity leave, as every parent knows.  To be allowed to be at home with her baby does not ensure the mother’s emotional health.  To motivate changes in societal attitudes will take time and the co-operation of the academic, medical, corporate and general communities.  By encouraging research and education at all levels, we hope to achieve this.  The prevalence figures are internationally consistent:  At least 1 in 10 mothers in all levels of society, and regardless of socio-economic conditions, experience clinical depression and/or anxiety before, and up to a year, after childbirth.  Without sounding too much like a feminist, this raises the question of what would happen if, every time a child was born, one in ten men became clinically depressed! 

References:

Hamilton James Alexander, and Harberger Patrician Neel. (Eds.).  Postpartum Psychiatric Illness.  A picture puzzle.  University of Pennsylvania Press, Philadelphia 1992: 5-13.

Pitt B. ‘Atypical’ depression following childbirth. Br. J. Psychiatry 114: 1325-1335.

Mills E.P., Finchilescu G., Lea S.L. Postnatal depression – an examination of psychosocial factors. S.A. Med. J.1995; 85(2): 99-105. 

AUTHOR:

E.P. Mills - Founder President PNDSA


Recommended Books on PND & Related Topics 

  • Atkinson, Dr Holly: Women & Fatigue (Papermac, London, 1988).  Deals with Depression in relation to Fatigue.  Practical.
  • Ball, Jean A:  Reactions to Motherhood.  The role of postnatal care.  (Books for Midwives Press, Cheshire UK. 1994)  Research by a midwife on the effects that psychological and social factors, and care given by midwives, might have on the emotional state of the new mother.  Interesting, especially for midwives, childbirth educators and obstetricians.
  • Barnett, Dr Bryanne: Coping with Postnatal Depression. (Lothian Books, Port Melbourne, Victoria, Australia. 1991)  An excellent, understandable explanation.
  • Baumel, Syd: Dealing with Depression Naturally. (Keats Publishing, Connecticut, USA. 1995)  Offers “natural ways” to treat depression – vitamins, homeopathy, exercise, visualization, etc.  May have some appeal.
  • Bloomfield, Dr Harold H. & McWilliams, Peter: How to Heal Depression. (Thorsons, London. 1995)  Simple-to-follow explanation of depression, and suggestions of how to find healing.
  • Blackie, Penny: Becoming a Mother After Thirty.  (Basil Blackwell, Oxford, UK. 1986)  Practical suggestions from actual experience.  Helpful.
  • Blumfield Wendy: Life after Birth. (Element Books, Shaftesbury, Dorset, UK. 1992.)  Focus on reality of pregnancy, birth and what happens later, including a section on PND.  Good.
  • Breen, Dana:  Talking with Mothers. (Free Association Books, London.1989.  The reader joins a mother and shares her experience of pregnancy, birth and afterwards – her fears, fantasies and reflections at this time of change.  Recommended.
  • Buist, Anne. Psychiatric Disorders associated with Childbirth - A Guide to Management. (McGraw-Hill, Australia, 1996)   Excellent, serious, academic. 
  • Burns, David D. M.D.: Feeling Good.  (Signet Books, New York, 1981)  A practical, cognitive approach  - self-help treatment for depression.
  • Burns, David D. M.D.: The Feeling Good Handbook. (Plume Books, Penguin Books, Middlesex, England. 1990)  See above.  Exercises.
  • Comport, Maggie: Towards Happy Motherhood. (Corgi Books, London. 1987)  A self-help book, offering sound and sympathetic advice on managing PND.
  • Copeland, Mary Ellen. Living Without Depression & Manic Depression. New Harbinger Publications, Oakland, California. 1995)  Work Book for maintaining mood stability.  Practical.
  • Cox, John & Holden, Jeni: Perinatal Psychiatry.  Use and Misuse of the Edinburgh Postnatal Depression Scale.  (Gaskell, Royal College of Psychiatrists, London, 1994)  Research-based, academic, and excellent.
  • Cox, John L.:  A Guide for Health Professionals.  Postnatal Depression. (Churchill Livingstone, Longman, Edinburgh, 1986)  Classic.
  • Coyne, James C. (Ed.): Essential Papers on Depression. (New York University Press, 1985).  Exactly what it claims to be.
  • Cozad, Sheryl & Craig: Mam’s Voyage. (Willow Pond Arts, Norman OK, USA, 1999).  Beautifully illustrated graphic representation of PND.  Art.
  • Dalton, Katharina: Depression after Childbirth. (Oxford University Press, 1985)  Classic.  Exponent of hormonal treatment for PND.
  • Dalton, Katharina with Holton, Wendy M.: Depression after Childbirth. (Oxford Paperbacks, 1996)  See above revised 3rd edition.
  • DePaulo, J. Raymond, MD & Ablow, Keith Russell, MD: How to Cope with Depression. (Fawcett Crest, New York. 1989).  Guide to general Depression.
  • Dominian, Jack. Depression.  What is it?  How do we cope? (Fontana, Glasgow, UK. 1990)  Readable, general overview of depression at different stages in the life cycle.
  • Dix, Carol: The New Mother Syndrome. (Unwin Paperbacks, London. 1987)  Easily read, compassionate and recommended.
  • Dunnewold Ann L: Evaluation and Treament of Postpartum Emotional Disorders. (Professional Resource Press, Sarasota, Florida. 1997)  Academic. Excellent for practitioners.
  • Dunnewold, Ann & Sanford, Diane G.:Postpartum Survival Guide. “ It wasn’t supposed to be like this …” (New Harbinger, California, 1994).  Excellent, accessible and practical.  Highly recommended.
  • Eagan, Andrea Boroff: The Newborn Mother. (Own Books, Henry Holt & Co. New York, 1987)  A sensitive description of the process of adjustment to motherhood.
  • Eisenberg, Arlene, et al: What to Expect the first year. (Simon & Schuster, London, 1996)
  • Feinmann, Jane. Surviving the baby blues. (Ward Lock, 1997)  Excellent, understandable and helpful book about postnatal depression.
  • Field, Peggy Anne & Marck, Patricia Beryl, Eds: Uncertain Motherhood. (Sage Publications, London, 1994)  Sensitive and thought-provoking book about maternal behaviour in non-optimal outcomes of pregnancy.  Recommended for health professionals.
  • Figes, Kate: Life after Birth. What even your friends won’t tell you about motherhood. (Viking, 1998)   Comprehensive, and readable.  Good.
  • Flach, Frederic F., MD:  The Secret Strength of Depression. (Bantam, London 1986). 
  • Gillett, Dr Richard: Overcoming Depression.  A practical self-help guide to prevention and treatment.  (The British Holistic Medical Association.  Dorling Kindersley, London.  1987).  This book does what it promises to do!
  • Hamilton, James Alexander, & Harberger, Patricia Neel (Eds.): Postpartum Psychiatric Illness. A Picture Puzzle.  (University of Pennsylvania Press, Philadelphia, USA, 1992).  A scholarly, informative classic.
  • Huysman, Arlene M: A Mother’s Tears.  Understanding the Mood Swings that Follow Childbirth. (Seven Stories Press, New York. 1998)  An excellent, research-based, accessible book, useful for clinicians and lay public.
  • Irwin, Cait: Conquering the Beast Within.  How I fought depression and won … and how you can, too.  (Times Books, Random House, New York, 1998)  A teenager’s powerful description of her journey into the darkness.
  • James, Jennifer: Women & the Blues.  Passions that hurt Passions that  heal. (Harper & Row, San Francisco, 1988.)  Deals with depression at different times in a woman’s life, offering practical advice.
  • James, Kath.  The Depressed Mother.  A Practical Guide to Treatment and Support.  (Cassell, London.  1998).  A nurse writes, explaining PND, its effects and management.
  • Kendall-Tackett, Kathleen A. & Kantor, Glenda Kaufman. Postpartum Depression. A Comprehensive Approach for Nurses.  (Sage Publications, London, 1993)  What you would expect.  Very good.
  • Kleinman, Karen R. & Raskin, Valerie D.: This Isn’t What I Expected.  Overcoming Postpartum Depression. (Bantam Books, New York, 1994)  An excellent book for sufferers and those around them, with lots of practical guidelines.
  • Kumar, R. & Brockington, I.F: Motherhood and Mental Illness.  Causes and consequences. (Wright, Butterworth & Co., London, 1988) Academic, important reference work.
  • Lake Tony: Defeating Depression.  (Penguin, 1987).  General depression.
  • Lewis, Cynthia Copeland: Mother’s First Year. (Betterway Publications, Virginia, USA, 1989)
  • Lipkin, Mike: Lost and Found.  My Journey to Hell and Back.  (Human & Rousseau, Cape Town, 1995).  Rivetting, personal experience of depression.
  • Littlewood, Jane & McHugh, Nessa. Maternal Distress and Postnatal Depression. The Myth of the Madonna. (Macmillan, 1997)  Takes a multifactorial view of PND; research-based.  Very useful for care-givers.
  • Marmorstein, Jerome, and Marmarstein, Nanette: Awakening from Depression.  A Mind/Body Approach to Emotional Recovery.  (Woodbridge Press, Santa Barbara, USA, 1992).  A Self-Help Guide to managing general depression.
  • Maushart, Susan: The Mask of Motherhood. (Vintage Australia.  Random House, 1997)  An excellent book that looks at the reality of becoming a mother.  Recommended.
  • McConville, Brigid: Beating the Blues. (Headline Book Publishing, London, 1996)  Very readable, self-help book about depression, including PND.
  • McConville, Brigid: Mad to Be a Mother. (Century Hutchinson, London, 1987).  Readable anaysis of the pressures and anomalies that face mothers in today’s society.
  • McCormick, Elizabeth Wilde. Nervous Breakdown.  A Positive Guide to Coping Healing and Rebuilding.   (Unwin Paperbacks, 1988)  Discusses symptoms and management of life crises that overwhelm people.
  • Misri, Shaila, M.D.: Shouldn’t I be Happy?  Emotional problems of pregnant and postpartum women.   (Simon & Schuster, New York, 1995)  Comprehensive, compassionate and realistic.  Recommended.
  • Murray, Joanna: Prevention of Anxiety and Depression in Vulnerable Groups.  A Review of the Theoretical, Epidemiological and Applied Research Literature.  (Gaskell, Royal College of Psychiatrists, London, 1995)  Academic and professional.
  • Murray, Lynne & Cooper, Peter J. (Eds): Postpartum Depression and Child Development.  (Guildford Press, New York, 1997).  Scholarly and excellent.  Recommended.
  • Musikanth, Susan: Depression Matters. (Jonathan Ball Publishers, Jeppestown, 1997)  Readable, useful and practical.  General Depression.
  • Newton, Jennifer: Preventing Mental Illness.  (Routledge & Kegan Paul Ltd., London, 1990).  Academic, reviews research, makes recommendations for treatment.
  • Oakley, Ann: From Here to Maternity. (Penguin, Middlesex, England, 1986)  An overview of various stages of early motherhood, from pregnancy onwards.  Realistic and readable.
  • Pacific Post Partum Support Society: Postpartum Depression and Anxiety.  A Self-Help Guide for Mothers. (1997). Simple, readable and down-to-earth.
  • Page, Andrew: Don’t Panic!  Overcoming anxiety, phobias & tension.  (Health Book Series, Australia).  Self-help booklet.
  • Phillips, Jenny. Mothers Matter Too!  A positive approach to life for mothers at home. (Penguin, Middlesex, England, 1985).  Feminist, realistic and helpful.
  • Placksin, Sally: Mothering the New Mother.  Your Postpartum Resource Companion.   (Newmarket Press, New York, 1994)  An excellent resource book for new mothers.
  • Price, Jane: Motherhood. What it Does to your Mind. (Pandora Press, Unwin Hyman, London, 1988)  A realistic, helpful and readable book about early motherhood, including postnatal depression.
  • Priest, Robert:  Anxiety & Depression.  A practical guide to recovery.  (Martin Dunitz, 1983).  Very simple.  General.
  • Raskin, Valerie Davis, M.D.: When Words are Not Enough. (Broadway Books, New York, 1997)
  • Rix, Juliet: Is There Sex After Childbirth? (Thorsons, Harper Collins, London, 1995)
  • Roan, Sharon L. Postpartum Depression.  (Adams Media Corporation, 1997)
  • Rowe, Dorothy. Breaking The Bonds. (Fontana, Harper Collins, London,1991)
  • Rowe, Dorothy: Choosing Not Losing. (Fontana, Harper Collins, London, 1988)
  • Sanders, Deidre:  Women and Depression. (Sheldon Press, London, 1987)
  • Sapsted, Anne Marie: Banish Post-Baby Blues. (Thorsons, England, 1990)
  • Scarf, Maggie: Unfinished Business. (Ballentine Books, New York, 1988)
  • Sebastian, Linda. Overcoming Postpartum Depression & Anxiety. (Addicus, 1998)
  • Dalton, Katharina: Depression after Childbirth. (Oxford University Press, 1985) 
  • Shaw, Fiona: Composing Myself.  A Journey Through Postpartum Depression. (Steerforth Press, Vermont, USA, 1998) .  Dramatic, disturbing personal account of Postnatal Depression.
  • Shaw, Fiona: Out of Me: The Story of a Postnatal Depression. (Viking, 1997)  See above – British Edition.
  • Smith, Gerryilyn & Nairne, Kathy: Dealing with Depression. (The Women’s Press, London, 1995)
  • Swigart, Jane:  The Myth of the Bad Mother.  The Emotional Realities of Mothering. (Doubleday, New York, 1991).  Excellent look at the psychological processes of care-giving from birth to adolescence.
  • Taylor, Verta: Rock-a-By Baby. (Routledge, New York, 1996)
  • Viorst, Judith: Necessary Losses. (Simon & Schuster, London, 1986)
  • Welburn, Vivienne: Postnatal Depression. (Fontana, London, 1986)

(Compiled by Liz Mills: March 2000 )