My daughter or daughter-in-law has postnatal depression

Becoming a grandparent is a wonderful experience – you too will have had nine months of expectancy. Nine months to prepare and build your hopes and aspirations for your new role; for the family you will become and a new life that will be so precious to you. There is the awareness that life will never be the same again but you do not expect your daughter/daughter-in-law to be mentally ill as a result of childbearing.

It can be difficult to adjust to your new role as a grandparent if you also see your daughter/daughter-in-law suffering. If everything is okay it is still a period of adjustment and learning when to step in, when to stand back and when to take over. You want them to feel successful as new parents in the same way you have guided them through everything else in their lives.

If the sufferer is your daughter and either you or any other close relatives have or had mental health problems please her know about it and encourage her to let her midwife and health professionals know. Much of the latest research shows that if there is a history of mental illness in the family then it does increase the risk of your daughter developing it. If people are aware of this then everyone can be on alert for any signs developing.

I am aware that in years gone by postnatal illness was not spoken of and there are many, many women who battled alone and have never spoken about it. One lady in her 70’s told me that when she read about my story in the local papers she could not believe it. She told me for 50 years she has carried the guilt of her puerperal psychosis with her and believed she was the only one who had ever threatened to harm their baby. She told me hearing my story had helped her come to terms with her illness.

How many more ladies must there be out there? So please, let relevant people be aware of past illnesses. If there was family history of heart problems or cancer you would share that information. So why be silent and fear stigma over a mental health issue?

One new mother, let’s call her Adele, told me how let down she felt by her mother, whom we shall call Hilary. Adele really struggled with postnatal depression whilst trying to prove to her own mother that everything was okay as she did not want to disappoint her, so never admitted her true feelings. One day when they both were chatting Adele confessed how bad she had felt during the early months of her a baby’s’ life. Hilary replied that he had also had a tough time when Adele was a baby but had never liked to tell anyone.

The moral of that story is honesty – If Hilary had warned Adele when she was pregnant, she would have been given the choice to tell her health professionals or not. If she had and they followed NICE guidelines (2007) then Adele could have been under closer scrutiny of care. If mother and daughter had been open and honest with each other when the new baby arrived it could have made life easier for both of them. Adele would have felt comfortable sharing her troubles with her mother and consequently Hilary would have felt far more useful and supportive. They all lost out through ‘not saying’. 

What is normal?

I don’t think anything is! All babies, pregnancies, relationships are unique and when you combine them all there is an infinite number of varying factors. However, if you have any reason to doubt that your daughter/daughter-in-law is behaving in ways which do not seem ‘normal’ PLEASE seek help.

Signs to look out for

Exhausted – Sleeping far too much or hardly at all. A new born will naturally mean sleep patterns are very different but just be alert to extremes.

• Lethargic – A ‘can’t be bothered’ attitude for anything from not wanting to change the baby’s nappy to getting herself dressed.

• Loneliness – when your son/son-in-law or baby’s father goes back to work does she complain of this? Is she making any effort to get out and about?

• Aggressive – is she making threats to you, verbally or physically? Is her manner nasty with you and others?

• Anxious – all new mothers are naturally concerned about all aspects of their new role and want to do it well. However, if your daughter/daughter-in-law seems to be anxious over apparently ‘silly’ things, e.g. getting the curtains dry cleaned, this could be a sign that things are not ‘normal’.

• Irrational, Irritable – like PMT but threefold. Are you loved one moment then hated the next? Can you do nothing right? What’s new you may say, but if this is getting much worse be alert for other sigs too.

• Nervous Energy – Does she never stop? Always on the go? Tell you she is fine and that she ‘can manage’? Is she running on overdrive?

• Emotional – is she on a rollercoaster of emotion? Laughing one minute, crying the next?

What can you do to help her

• Firstly accept that THIS IS NOT YOUR FAULT!

• You are not the only family to go through this and sadly will not be the last.

• DO NOT take it personally – she is not carrying out a vendetta against you. SHE IS ILL.

It can be so hard to accept these crucial points.

If she has had a caesarean section it may be easier to treat her like ‘an invalid’ initially as she cannot lift, etc. However once the physical healing has taken place it is hard to realise that the mental scars can take much longer to deal with. Yet the process is the same. Fundamentally she needs TLC – tender love and care. This can be so very, very hard bearing in mind how difficult both she and the situation might be.

What to avoid saying

You say	She thinks or says	The truth
Pull yourself together	I am not a pair of curtains!	Impossible to do
I had six children and was fine	So what? I am not you!	What goes on in other homes is not your responsibility
What have you actually done today?	What? Other than get through it and tend to a new born? Isn’t that enough?	A newborn baby can be extremely demanding. If there are extra siblings the job is HUGE.
You look a mess	But the baby has been sick on me three times in the last hour alone	She simply hasn’t time or energy to look after herself
We haven’t been invited round for a while	Are you surprised?	A planned visit from anyone is basically too much
This room looks dusty	Well – clean it!	Time, effort and energy get in the way but also a sense of reality – does it really matter? Or could you offer to help?
You’ve worn that dressing gown for three weeks now	It’s the only thing that fits	It may be the only thing she feels comfortable in

What can you do?

Tell people!

Talk to your daughter/daughter-in-law. Tell how that you found things difficult too, if that is relevant. Keep all channels of communication open for her. Listen to her. Be there. Sometimes just having someone there is enough – they do not need to speak.

Perhaps you will need to take time off work to support her – my Mum had to for me. The more open and honest you can be with people the better.

YOU need support too so do not be worried to confide in your best friends and close family. The more you can work together the better. You may have to talk to them without your daughter/daughter-in-law being there – this is not sneaky but done out of concern and love. You need them to support you too and also to make them aware of the do’s and don’ts.

Acceptance

Accept that she is ill and at the same time keep the hope alive that this will be a passing phase.

Education

Find out about the diagnosis. The hundreds of people who have told me their stories have shown me that postnatal depression is a unique illness – the symptoms, personality, circumstances, can all affect the actual condition.

Support from NHS

This varies widely across the country.

You may have to be the one who tells the health professionals how she really is. I did a great job initially of telling them that I was fine. No-one likes to admit things are difficult. I could put on the smile and make-up and a good show. Bear in mind that it may take a very experienced professional to see through this facade. Also they may have limited time and not pick up on the signs so you may have to point them out, either with daughter/daughter-in-law there or make a separate appointment. As things progress you may also need to see your GP for support too. Do not suffer in silence and also put on an ‘I’m fine’ front because ultimately you will crack!

Earlier this year a couple gave birth to much wanted twins. After being discharged from hospital the babies were doing well but Mum seemed more and more out of sorts and began to display strange behaviours. Her husband noticed and made an appointment for them to see the doctor the next day. During that night the new Mum went walkabout in her pyjamas. Her body was found on the nearby motorway in the early hours. I recall this story to remind you that although this is rare it can and does happen. PLEASE shout out when you see the signs.

I also went walkabout in the early hours of a December morning when I was at my worst. I just wanted a walk in the drizzling rain. At the time it seemed a peaceful and pleasant thing to do. I was not thinking rationally. I was found curled up on a church doorstep wearing only my nightie. But for this other lady she found a motorway. We shall never know what she was thinking that night but I would guess there was no form of logical thought. But her husband is now left with his twin daughters without their mother.

Self-harming

I began to self-harm in the worst stages of puerperal psychosis. I had no previous history of this and only did it for a short time. In retrospect I did it because my rambling brain could not focus on anything – inflicting pain made it stop for a few seconds.

This website is useful on this area. http://www.sthnosecrets.org.uk

Medication

If she has been prescribed as needing medication support her decision to take it. If she feels that you are disapproving it can make it difficult for her. Again find out about it so you understand why she needs it.

Get support from others – physically

Carer and Tots groups

These are not just for the parents. See if you can go with your daughter/daughter-in-law if she wants you to or suggest you take the baby and give her some ‘me time’.

Specific support groups

Find out if there is one in your area. Please let me know about it and we can add it here.

Perhaps there may be sessions for both of you to attend?

e.g. Stockport Beat the Blues group.

Find a friend and support – internet groups

Families who are isolated can find some great support on the internet with forums, e.g. www.pni.org.uk

Phone a friend!

http://apni.org/Our-Function.html

Offer help

The best things you may well be able to offer is practical help, e.g. shopping, ironing, cooking. My dad used to just call in and state that he needed bonding time with his grandson! He would banish me to bed, bathroom or to go out. By saying it was his need, not mine, I was able to accept it!

Go with the flow

Postnatal illness is a roller coaster ride for you all. Learn to enjoy the ‘ups’ together and grit your teeth through the bad. Eventually the more even keel times will return.

Feel good!

When I taught children with severe learning difficulties we used sensory stimulation a great deal. We often overlook the importance of the senses and I know they can have a fantastic affect on mental health. As a parent I think you can make a huge difference to this area. The chances are that she has forgotten how to make herself feel good or that she doesn’t deserve it. You can help by showing her otherwise.

• Look – what makes her smile? Why not get her favourite DVD in and tuck her up on the settee to watch it whilst you take Junior out?

• Touch – what makes her go ‘ooo’? Did she have a favourite teddy as a child? Can you get a furry blanket for the sofa which reminds her of it?

• Taste – what does she like to eat? Surprise her with a pot of her favourite ice cream on a wet, Tuesday teatime and tell her it is compulsory she indulges in it. Perhaps run her a hot bath, candles, etc. for her to eat it in the bathroom? Again, insist that it is your time with the baby. Don’t blow it by knocking on the door every few minutes asking where things are, like a nappy!

• Smell – which aroma reminds her of a happy time and place? Buy her the same flowers that were in her wedding bouquet.

• Sound – which music makes her emotional, happy or sad? Treat her to a new CD. Drive out to the local beauty spot and let her listen to the birds or the waves crashing on a beach.

Can you think of at least one ‘feel good’ thing to do every day? Remember that it is the little things that count.

Day out

On a ‘good’ day be assertive and suggest a walk together or look for something novel, e.g.www.localkids.co.uk

Compliments

When was the last time you said something nice to her? Tried it and you got your head bitten off or told you were lying? Sounds about right! Women often find it hard to take compliments even when they are well. For example, you say they look good in a certain dress and they reply with ‘This old thing? It makes my thighs look big’. Know the scene?

Well sorry but you just have to keep trying! Even if she has been sitting for hours but she did actually get dressed at some point, tell her that you like her in that shade of pink.

I used to HATE people telling me that I looked well when inside I was screaming and crumbling. It made me feel a fake.

So pick on physical things instead or an action she has done.

Cuddles?

Normally I am a very affectionate, touchy feely girl. I love hugs, kisses and physical gestures but when I was poorly I pushed everyone away.

I felt worthless so why would anyone else want to be close to me? I seemed to have lost contact with my new body.

So my advice is to be patient. Do NOT take any rejection as an insult. I know I physically pushed my Mum away and I actually bit my Dad as he tried to comfort me!

So if you are getting rejected what can you do? It goes back to TLC. Give her feet a rub whilst you are on the settee. Just hold her, especially if she cries. Just be there. Book her a massage.

Give her time but in a feeling of closeness and security , not pressure.

In time this will help in the healing process and may well bring you even closer.

Nutrition

When I was suffering with postnatal illness no-one stressed the importance of a good diet. When people feel low they often go for the ‘comfort’ foods of cakes, biscuits, etc. Yet it is vital that your daughter/daughter-in-law has fresh fruits, vegetables and all the usual healthy eating suggestions. Make sure they have little and often meals. Remember that their body has had a terrific change due to pregnancy and it needs care even if they do not have postnatal depression!

Weight loss? Forget it if they are really poorly – they have enough to deal with. As their mood lifts then by all means encourage them try to do this if it is important to them but otherwise take it off their worry list for the time being.

Be patient too! If you make comments about her size and shape this is likely to really upset her and make her eat more!

Treats? I am all for them! If they fancy a bit of chocolate then go for let them enjoy it.

Substance abuse

Some ladies may turn to alcohol or other forms of substance abuse in order to mask their postnatal depression. If this is your daughter/daughter-in-law PLEASE seek professional help as there are other, less harmful, ways to deal with it.

Exercise

When I was a patient in the psychiatric hospital, the occupational therapist prescribed me some gym sessions. At first I hated it but gradually the natural raising of serotonin, ‘the feel good’ chemical, began to lift my mood. I would pedal away on the gym bike but close my eyes and think of bike rides in happier times. In Australia they have pram walking groups for ladies suffering with postnatal depression.

Put the baby in the pram and get out of the house. Fresh air and a walk will do you all good. There are plenty of baby-friendly aids out there for walks, bikes, etc.

Baby Massage

I feel this is very under-rated as a wonderful technique for both mum and baby. Did you know that some areas have sessions for other carers too?

Sleep

I remember all the advice of ‘when baby rests you should’ but I did not take it! If Dominic did sleep in the day I used that time to catch up on housework; sort out the post, do the ironing. It always seemed that just as I decided to sit down then he would wake up again and the feed, change, entertain routine would start all over again! So my question to you and your daughter/daughter-in-law – does it REALLY matter if the cushions aren’t plumped up? That the lounge hasn’t been dusted for weeks? Does anyone ever say on their death bed ‘I wish I’d done more house work’. I do not think so!

New mothers are so good at trying to be everything to everyone and feeling they have to achieve such high standards in everything they do, that they can lose themselves in it all. The important thing is their health and it is vital that they DO rest when baby does. This is a phase – it won’t be like this forever, so encouraged them that their health, not housework matters. As the grandparent you can suggest you do some chores ‘as you are bored’.

Night time sleeping. What was that? We got very little. Time and time again we told our health visitor that we were not sleeping but the months rolled by and circumstances deteriorated. I reached a point of not sleeping as I couldn’t see the point. My baby would wake me as soon as I did. I feel this was the biggest factor in my complete breakdown. So please take sleep seriously for your partner!

In retrospect I feel that my mood was rubbing off on baby Dominic – he did not sleep well due to being anxious about me and so the vicious circle began. When I was in hospital he did sleep far better for Nick. Maybe because Nick did not breast feed like I could or just because he was much calmer than I was? Who knows but it did make me feel even more hopeless at the time. Beware your daughter/daughter-in-law if you do something apparently ‘better’ than her! Reassure her that they are the most important thing for their baby. See what I mean about always being in the wrong even if you do something right?!

Take all suggestions of getting a baby to sleep through but fundamentally do what suits you and your family. Professionals and well meaning friends can sometimes make you feel worse about your techniques but if they work for you then go for it!

It’s not like it was in my day!

My Mum often says she feels sorry for the new mothers today as pressures seem so much higher. Back in the early 60’s when I was born more mothers stayed at home. Netmums have done an interesting survey on this.

http://www.netmums.com/h/n/CAMPAIGNS/HOME/ALL/1021//