- Depression, Anxiety and Childbirth
- Recommended books and articles on PND
Depression, Anxiety and
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
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
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.
E.P. Mills - Founder
Books on PND & Related Topics
- Atkinson, Dr Holly:
Women & Fatigue (Papermac, London, 1988).
Deals with Depression in relation to Fatigue.
- 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,
Syd: Dealing with Depression Naturally. (Keats Publishing,
Connecticut, USA. 1995) Offers
“natural ways” to treat depression – vitamins, homeopathy, exercise,
visualization, etc. May have
- 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.
- 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.
associated with Childbirth -
Guide to Management. (McGraw-Hill, Australia, 1996)
- 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)
- Comport, Maggie: Towards Happy
Motherhood. (Corgi Books, London. 1987)
A self-help book, offering sound and sympathetic advice on managing
- 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)
academic, and excellent.
- Cox, John L.: A Guide for
Health Professionals. Postnatal
Depression. (Churchill Livingstone, Longman, Edinburgh, 1986)
- 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.
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.
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
- Eagan, Andrea Boroff:
The Newborn Mother. (Own Books, Henry Holt & Co. New York, 1987)
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
- Figes, Kate: Life after Birth.
What even your friends won’t tell you about motherhood. (Viking, 1998)
and readable. Good.
- Flach, Frederic F., MD: The
Secret Strength of Depression. (Bantam, London 1986).
- Gillett, Dr Richard:
A practical self-help guide to prevention and treatment.
(The British Holistic Medical Association.
Dorling Kindersley, London. 1987).
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
Cait: Conquering the Beast Within. How I fought depression and won … and how you can, too.
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,
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
- 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
- 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.
Paperbacks, 1988) Discusses
symptoms and management of life crises that overwhelm people.
- Misri, Shaila, M.D.:
be Happy? Emotional problems of
pregnant and postpartum women.
& 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.
- Newton, Jennifer:
Preventing Mental Illness.
& 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
- Pacific Post Partum Support Society: Postpartum Depression and Anxiety.
A Self-Help Guide for Mothers. (1997). Simple, readable and
- Page, Andrew:
Don’t Panic! Overcoming
anxiety, phobias & tension. (Health Book Series, Australia).
- 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.
- 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
- Rowe, Dorothy. Breaking The
(Fontana, Harper Collins, London,1991)
- Rowe, Dorothy: Choosing Not
Losing. (Fontana, Harper Collins, London, 1988)
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)
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.
Verta: Rock-a-By Baby.
(Routledge, New York, 1996)
- Viorst, Judith: Necessary
(Simon & Schuster, London, 1986)
- Welburn, Vivienne: Postnatal
Depression. (Fontana, London, 1986)
(Compiled by Liz Mills: March 2000 )