Janine Gard: Postnatal depression - a partner's perspective

Birth and parenting expert Janine Gard.

OPINION:
Janine Gard is a diploma-qualified birth educator (2005) and founder of Bellies to Babies antenatal and postnatal classes. She has helped more then 3700 parents prepare themselves mentally, emotionally and physically for their journey to parenthood and loves what she does. This week she talks about postnatal depression.

Welcoming your new baby is a time of joy, as well as a radical life adjustment for you both.

Your partner is recovering from pregnancy and birth, you are both learning to meet the needs of your newborn, and throw in the lack of sleep, times can be trying to say the least!

When postnatal depression is added into the mix, it can tip any sense of balance, and make the postnatal adjustment feel completely overwhelming.

It's important you know from the outset that you're a vital link to your partner's recovery. What you say and do now can make a huge and lasting difference, which means communication and connection are more important than ever.

Women who experience postnatal depression (PND) need a lot of support, that's a given. But I think we need to acknowledge what the partners go through as well. Dads and partners also live with the illness and can even experience PND themselves.

Your partner's struggle with postnatal depression will no doubt have an impact on you and your relationship together. Understanding that some of the stress in the home could be a symptom of the illness and not a reflection of your relationship, is important. As hard as it can be, try not to take things personally, especially when you feel pushed away.

If this is your first experience with depression, you might struggle with unexpected feelings. Leaving your partner alone could trigger concerns for safety and even feelings of guilt. You might feel uneasy about heading back to work. You might wonder if she will be able to care for the baby or any other children you have.

As the onset of PND is often gradual, many people don't realise they have it. Some might try to hide their feelings because they think they're a bad parent, a failure, or they'll be judged. Others fear social services might get involved or their baby may be taken away from them if they admit to being unwell. In fact, 30 per cent never get professional help.

Encouraging your partner to be open with their feelings. Making time to talk, be present and really listen, is important, let them talk uninterrupted. You might also need to be extra careful with your language and assumptions. PND is an illness, and it's not possible to "snap out of it" or cure it with positive thinking. It can be tricky to find the right words to talk about PND.
You could try phrases like: "I know you've been having a tough time lately." or " I've noticed you haven't quite been yourself."

If talking face-to-face is proving difficult, you could try to connect by sending a message. You could encourage your partner to write things down in a mood diary if they're struggling to talk. Journals and mood diaries can help people with PND to notice which people, places and activities can improve or worsen their mood. Sometimes all they need to know is that you're there and you understand —

● Postnatal depression: the symptoms

● A persistent feeling of sadness and low mood.

● Frequently crying for no obvious reason.

● Loss of interest in the world and no longer enjoying things that used to bring happiness.

● Speaking negatively all the time.

● Withdrawing from contact with other people.

● Lack of energy and feeling tired all the time.

● Trouble sleeping at night and feeling sleepy during the day.

● Feeling unable to look after the baby.

● Problems concentrating and making decisions.

● Loss of appetite or an increased appetite (comfort eating).

● Being agitated and irritable or an apathetic "can't be bothered" feeling.

● Feelings of guilt, hopelessness and self-blame.

● Difficulty bonding with the baby – a feeling of indifference, not wanting to play and no sense of enjoyment in their company.

● Frightening thoughts – perhaps about hurting the baby.

● Thinking about suicide and self-harm.

● Neglecting appearance, such as not washing or changing clothes.

● Losing all sense of time, for example, not being aware whether 10 minutes or two hours have passed.

● Worrying that something is wrong with the baby.

Being understanding
Being kind and gentle is essential as this is a difficult and sensitive subject. It might take time for your partner to feel ready to talk or to acknowledge that they might be experiencing PND. If your partner opens up about distressing thoughts they're having, try not to show you're too alarmed. The best thing you can do is not judge. It is normal to feel shocked, disappointed, scared, frustrated or helpless to discover your partner has PND. And it can be upsetting, stressful and exhausting to live with someone with PND.

What I want YOU to know
Giving her time out is important but so is spending time together. New mums can feel like they've lost sight of who they are, so you may want to find things you can still enjoy together like going for walks, watching a movie for a simple date night or seeing friends.

You should be present at doctor's appointments
We need to show the women we love that we support them. Also, it's crucial to establish relationships with your lead maternity carer (LMC) team before your baby is born. The relationships built with your LMC and other healthcare providers over the course of 40 weeks give you a point of contact to reach out to if something seems wrong with your partner during pregnancy and postnatally.

Become educated and feel confident in asking questions
Be an advocate for your partner. As partners, it's the least we can do considering we don't endure labour or birth. Nobody, not even a doctor, will ever know your partner the way you do, if something seems off, speak up and ask questions, it's okay to ask questions and if you don't understand or the health provider isn't listening to what you are saying, ask to speak to someone else.

Pay attention to her eating and sleep habits
Loss of appetite or gain should be a big red flag. If she's not sleeping enough, sleeping too much, or has trouble falling asleep or staying asleep, she may need help.

Make a postpartum plan
Don't be afraid to ask friends and family if they'll be willing to help out once your baby arrives.

Anyone who has had a baby and has the time will happily help. "It takes a village" is true, so find yours before the baby comes. Avoid calling her or implying that she is lazy. Feeling overwhelmed and exhausted is a symptom of PND. Housework can wait. Getting adequate rest is important for her, and for you.

Let her know she's needed
Always let her know how much she's appreciated and needed. Let her know how much she means to you and the baby. Make sure she knows there's never a situation where you're better off without her. Although she might require extra help during this time, reassure her she's not a burden.

A fed baby is a healthy baby
Please, please, please stress this to her. The pressures around breastfeeding are enormous triggers for some people, but not if it compromises her mental health. Formula is okay for babies, too.

Listen and validate her
Validating her fears and feelings. Even if these feelings seem unwarranted to you, they are real to her. Be a safe place for her to talk. Encourage her to discuss her feelings. Remember that she isn't always looking for you to solve a problem, she might simply need you to listen.

Recognise when simple decisions are debilitating
If your partner is having trouble making the simplest of decisions, there's probably something wrong. The simplest of tasks might become burdensome. For example, if she's saying, "I don't know how I can make it to my appointment this afternoon. I have to get out of bed, brush my teeth, wash my face, comb my hair, change the baby, dress the baby, burp the baby, put on socks, put on shoes, tie my shoes, put the baby into the car seat…" You get the point. Show support and encouragement for her accomplishments.

PND can make even simple tasks feel overwhelming. She might be feeling guilty about her inability to do things. Reassure her that you are pleased with whatever she can manage and that you are willing to pitch in as needed.

Listen to her when she talks about harming herself or the baby
If she says these things, take it seriously. Women are more likely to attempt suicide during the postpartum period than at any other time in their life. Seek urgent help from your GP, local mental health service or accident and emergency department.

Don't be discouraged
Do your best not to feel discouraged when she is withdrawn. In the midst of PND she might not be able to express her appreciation, but in time she will no doubt appreciate your patience and support.

Reassure her it doesn't last forever
She might feel that PND will last forever, a feeling that is a symptom of PND. Reassure her that PND can be treated and she can recover. Try saying things like, "I know you feel really bad right now, but your doctor believes you will get back to your old self." Avoid telling her not to worry or to get over her feelings. Avoid making major decisions while your partner is struggling with PND. As she recovers, you might find that many of the situations you thought existed were really symptoms of her illness.

Reassurance is important
Remind her that you are there for her and you will remain there for her. A common fear related to depression is that your loved ones will leave. Reassure her often that you are not leaving her.

Sex and intimacy
It can be challenging but reassure your partner that you are okay with her lack of interest in sex for the time being. She might be feeling very guilty while also feeling that intimacy is impossible. Remaining physically close, cuddling and other non-sexual touches can be important for both of you. If the lack of sexual desire remains as she recovers, it might be something to bring up with your medical provider.

Know that you are at risk, too
Being a new parent is a big task. Caring for a partner with PND also takes a lot. Do not forget to care for yourself. Keep these things in mind —

● Be sure you have someone to talk to during this difficult time such as a doctor, a trusted family member, or a friend.

● Do not blame yourself for PND. It is no one's fault that your partner is experiencing PND.

● You don't need to do everything yourself. Working, trying to keep up the home, and caring for your partner and your baby is a lot. Don't be afraid to ask for help.

● Get plenty of rest. You might be getting interrupted sleep due to a waking baby, but try to head to bed earlier than normal to get enough sleep.

● Remind yourself that this is temporary and with the right treatment your partner will recover from PND.

● With proper treatment and support, PND is a temporary illness. It can seem like it won't end, as it can take many weeks or even months, but it is a very treatable illness. Keep in mind that your partner's body went through nine months of changes, it can take a bit of time to get back to her old self.

● Know it can and does get easier.

● Hang in there – this is your family and they need your love and strength now.

■ Bellies to Babies Antenatal & Postnatal Classes, baby massage courses and baby and infant first aid courses, 2087 Pakowhai Rd, Hawke's Bay, 022 637 0624. https://www.hbantenatal-classes.co.nz/

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians

WHERE TO GET HELP
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

Or if you need to talk to someone else:

Lifeline: 0800 543 354 or 09 5222 999 within Auckland (available 24/7)
Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
Youthline: 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat.
Need to Talk? Free call or text 1737 (available 24/7)
Kidsline: 0800 543 754 (available 24/7)
Whatsup: 0800 942 8787 (1pm to 11pm)
Depression Helpline: 0800 111 757
Samaritans: 0800 726 666.