Understanding antenatal and postnatal depression

Mothers, as well as a few fathers, who experienced postnatal or antenatal depression (whether diagnosed or self-identified) or significant distress or anxiety over the perinatal period gave a range of explanations of what they understood perinatal depression to be, and discussed the reasons they thought they or others experienced it.

Several parents linked antenatal or postnatal depression to past experiences of mental health issues such as depression or anxiety, or to difficult experiences earlier in their lives including childhood sexual abuse, the loss of a parent, or difficult family relationships. They felt that this history made them more 'likely' to experience perinatal depression.

Melanie, a mother of one, said: ' ... a lot of really unresolved lifelong issues have all come to a head now in my life. I think I just had the wrong idea about what [depression] was and I probably had it for a long time. It just really intensified in the postnatal period for me'. Sila had experienced depression on and off for many years, often manifested as anger, including after the birth of his first child. He attributed these feelings to childhood sexual abuse, his father's murder, and a difficult relationship with his stepfather and said: 'I still carry those scars'.

Chelsea, a mother of one, said her psychologist's explanation of how her 'predisposition to anxiety' had made her vulnerable to experiencing postnatal depression 'made complete sense'.

Other parents felt that a family history of mental health issues was part of the explanation as to why they had experienced postnatal depression. Zara whose parents had been diagnosed with severe mental health issues and brother with Asperger's Syndrome said she 'didn't have much of a hope of coming out of that kind of a family environment without having mental health-related issues'. She experienced postnatal depression following the births of both of her children, and had recently been diagnosed with dysthymia.

Several parents referred to challenging life circumstances in pregnancy and / or early parenthood as contributing to the distress they experienced. These included moving house, experiencing financial strain, migration, health problems (their own or a family member's), relationship breakdown, family violence, and lack of support. Several families had moved far away from one or both sides of the family, including Chelsea who said: 'my family doesn't live close by so I didn't really have that support network. My husband's family [are] in [state name]. So we didn't really have someone to just come over and help tidy up the house or just help out - it was just overwhelming'.

Cecilia felt the depression she experienced after her daughter's birth was closely related to her relationship breakdown with her daughter's father.

Mishi, an immigrant mother from Pakistan, was able to safely leave her marriage after migrating to Australia. She had experienced depression in pregnancy and early parenthood due to family violence.

Some parents experienced a matrix of difficult circumstances. Melanie, a mother of one, had several miscarriages before conceiving her baby and three weeks' bed rest during pregnancy for a possible shortening cervix. During her pregnancy her mother was diagnosed with cancer and had lung surgery a week after Melanie's baby was born. Melanie and her husband started a new business and moved house when their baby was still young. Melanie started a new course and job, and when her baby was ten months old she had another miscarriage. As she said, there were ' ... just so many factors that - I felt the odds were really against me'.

A number of parents who experienced postnatal depression had babies with reflux (gastro-oesophageal reflux), 'colic', or asthma. Reflux usually meant very unsettled babies who had difficulty sleeping and feeding, or who vomited or cried frequently. This was very distressing for most parents and increasingly difficult to cope with as exhaustion 'set in'. Michelle experienced postnatal depression partly as a result of a very 'stressful' start to parenthood - her son had reflux and an allergy to cow's milk protein, Michelle had low milk supply and difficulties breastfeeding, and she had also had a difficult labour, emergency caesarean and post-operative complications.

Deb felt her postnatal depression was related to her second baby vomiting constantly, as well as her decision to start a university course.

Unlike her first baby, Erin's second baby had 'colic' and was 'fussy'. She thought she may have had postnatal depression at this time but didn't seek help.

Several parents commented that particular personality traits had seemed to make having a baby more challenging and possibly contribute to perinatal depression. These included being 'planned', 'organised', 'career-orientated', 'independent', liking 'control', 'high achieving' and finding it difficult to ask for help. As Sara L, a mother of two, reflected: 'they say the more organised you are the more likely you are to get postnatal depression because you can't organise things [with a baby], and I'm a very organised, I have a routine for everything, I'm a very organised person and I think [my son] just broke it. My routine went out the window'.

Elizabeth said her 'high achieving' personality and 'textbook' transition from school to university to career came 'crashing down' when she became a mother. It also made seeking help for postnatal depression very difficult.

Fred who experienced depression before and after his second child described himself as very 'goal-oriented' person. He reflected on how this had made adjusting to parenthood more difficult.

A couple of mothers referred to the idea of perinatal depression as a biomedical illness. As Elizabeth said: 'I guess I felt there was a stigma attached with having a mental health issue as opposed to a physical health issue. I was very happy to be vitamin D deficient, very happy to be iron deficient. I wasn't very happy for someone to say you have postnatal depression'.

While in a mother and baby unit, Anna remembered a nurse telling her to treat herself 'more kindly' and to think of postnatal depression as equivalent to a broken leg.

Many parents talked about aspects of contemporary life they felt contributed to their experiences of postnatal depression. These included growing individualism (making families more isolated), smaller family sizes and delayed childbearing (meaning that many new parents lacked experience with babies or children), and unrealistic or rigid ideals of motherhood.

A few commented that society had become very 'individualistic' and felt this made postnatal depression more difficult because parents felt isolated or reluctant to ask for help. As Kirsty, a stay-at-home mother, said: 'I think my generation have been raised to be independent and it's reinforced in the workforce because those sort of qualities that to further your career in the corporate world, in my experience don't work in parenthood. That was certainly my biggest downfall'.

Michelle linked the prevalence of postnatal depression to the lack of 'community spirit' living in a large city, and the 'shame' many new parents feel in asking for help.

Related to this, several mothers commented on how many people had little exposure to babies or children before becoming parents as a result of smaller family sizes. They felt this could lead to unrealistic expectations of early parenthood (see Expectations of parenthood). Some new mothers in this situation who found the experience more challenging than expected (particularly if they lacked social support) felt their struggle to 'cope' was a 'personal failing', which in turn could contribute to postnatal depression. Elizabeth, a mother of two children, described discussing her preconceptions of parenthood with 'reality' with her psychologist and commented: 'We don't have a lot of young children in the family so a lot of my perceptions came from what you see in movies and on TV, which you realise is not what real life is. So going to talk to someone was really, really helpful in that regard'.

Elly felt being 'unprepared' for the life changes a baby would bring was part of why she experienced self-identified postnatal depression, and reflected on some of the reasons she thought new mothers might struggle to adjust to parenthood.

Deb felt that a lot of informal knowledge about mothering or parenting had been lost due to becoming 'isolated' from extended family.

Finally, many mothers were critical of unrealistic or rigid ideals of motherhood (particularly associated with breastfeeding), often reinforced by health professionals or other mothers. They felt mothers who were unable to meet these ideals might feel inadequate and that, again, this might contribute to antenatal or postnatal depression. Michelle recalled appreciating hearing at the mother and baby unit she attended that the idea that 'breast is best and if you don't breastfeed then you're going to deprive your baby' was one of the 'myths of motherhood'. Melissa who had an elective caesarean and bottle-fed her baby talked about having to 'explain' this due to people's reactions and said: 'I did feel very much in my mothers' group that I was the bad mum'.

Zara reflected on the 'skewed values' around motherhood and the choices available to mothers. She felt becoming a mother involved having one's status 'downsized', which was particularly challenging to 'educated, older' mothers.

Tina felt that in her home country, Iran, women lost their 'feminine identity' once they had children. She disagreed with this, and appreciated gaining a 'very different' perspective' on Iranian cultural ideals of motherhood after moving to Australia.