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Finding hope and healing: How to navigate postnatal depression

We’re raised to see pregnancy and birth as a time of joy and celebration, so feeling utterly overwhelmed and depressed instead can give a new mom a sense of inadequacy and failure. Especially when, like Colleen Cornelissen, you are a trained midwife and have worked in a midwifery unit for 11 years.

She was 38 and already had a daughter, born of a teenage pregnancy when she was 19. ‘That had been tough – I’d had to stop my studies and find a job; I felt I’d let everyone down. But I’d bonded with Nicole immediately and we were close.’

This new baby was planned down to the T and eagerly anticipated. ‘I was overweight and diabetic and would need an induction, so I arranged to have it on a Saturday when the labour ward was quiet. My friends worked there, and I was looking forward to it.’

But life has a way of intervening. One Saturday a month before the baby was due, Colleen was helping Nicole register for university studies, ‘feeling stressed and pressured’, when she experienced what were suspiciously like contractions. She ignored them but felt them again at work that week, and on Wednesday night went into full labour.

‘I didn’t want to believe it! Baby was in breach and I had a spinal anaesthetic, so I could see her being lifted out. But after showing me her face, the hospital staff whipped her off to ICU. She was 2.7kg, but she was put on CPAP oxygen and drips for antibiotics, and when I saw her 12 hours later, I had a sense of unreality – this was not how it was supposed to be. I’d seen maternity patients struggle in this situation, but now I understood it on a visceral level.’

Discharged without her baby that Saturday, Colleen found herself weeping continuously. She was still crying when she saw her obstetrician for her six-week check-up, and found herself breaking down when she returned to work after her six months’ maternity leave, trying to conceal it.

‘I realised I couldn’t go on and saw a psychiatrist in private practice – I didn’t want to go anywhere people knew me, I was too ashamed not to be coping. He immediately diagnosed the problem: postnatal depression.’

Defining the problem

Colleen is far from alone. The ‘baby blues’ is estimated to affect as many as 50 to 70% of new mothers within two or three days of delivery, with weepiness, difficulty sleeping, and insecurity about being able to cope, which may last up to two weeks.

Postnatal depression, on the other hand, is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as ‘a major depressive episode with the onset of pregnancy or within four weeks of delivery’ that lasts longer than two weeks, though many experts report it can develop months later, says Dr. Eugene Allers, a psychiatrist at Life The Glynnwood hospital in Benoni.

Unless treated, PND can progress to chronic depression, with serious consequences. In South Africa, it’s estimated to affect between 16% and 47% of women in the year after delivery – and in this period about 10% of women are at high risk of suicide, reports Simone Honikman, director of the Perinatal Mental Health Project and an associate professor at the University of Cape Town.

Understanding the causes of PND

PND results from a combination of factors, the most common being hormone changes (especially the dramatic drop in oestrogen and progesterone after delivery), experiencing a traumatic birth, feeling unable to cope with the demands of the new baby, financial or other stress, lack of support from a partner or family, loneliness, and previous experience of depression, says Dr. Eugene.

Men can experience PND too – it’s estimated to affect one in 10 new fathers, reports the American Academy of Paediatrics. Research suggests they too have hormone changes during and after a partner’s pregnancy, especially a decline in testosterone. They can also feel disconnected from mom and baby, and struggle to adjust to parenthood and the changes it brings, including financial and relationship strains.

Seeing the signs

The DSM lists nine symptoms of PND: depressed mood most of the day and loss of interest or pleasure (anhedonia), along with insomnia or sleeping too much, a slowing of movement and thought or agitation, feelings of worthlessness or guilt, loss of energy or fatigue, impaired concentration or indecisiveness, change in appetite or weight, and suicidal ideation and recurrent thoughts of death.

‘If you have these, it’s essential to check in with your health provider for a diagnosis as soon as possible,’ says Dr. Eugene. They may ask you to complete a depression-screening questionnaire and do blood tests to determine whether hormone levels are part of the problem, and to rule out other conditions that may produce similar symptoms, such as infections, thyroid issues, or nutritional deficiencies.

Getting help

The focus of treatment for postnatal depression is medication, psychotherapy, and individual or group support. Antidepressants are often prescribed (many are safe to use during pregnancy or while breastfeeding), along with hormone therapy if necessary, and talk therapy with a psychologist, counsellor, or support group, says Dr. Eugene.

‘The psychiatrist had me hospitalised for 21 days, and treated medically and psychologically, but it was a long, hard journey,’ says Colleen. ‘I came to see that my first pregnancy contributed to my problems – I’d felt I couldn’t complain because I’d inconvenienced everyone. This time around too I tried so hard to stay in control, it’s how I’d always coped in life and at work. Caring for this new young life was overwhelming, and in my family, depression was not real – it was in your head.’

Under the care of a psychiatrist-psychologist team, she gradually improved. ‘I focused on bonding with my baby in one-on-one time. Nina is five now, and we couldn’t be closer! My relationship with Nicole has also strengthened, because through therapy I know to check in with her and ask how she’s feeling, and she does the same with me.’

Three years ago, Colleen joined Life West Coast Private Hospital, where she manages the maternity unit. ‘I’m now able to use my experience by giving my patients extra support and understanding. When I see signs of PND, I urge them to get treatment early – I know the difference it can make.’

Research has shown that positive affirmations, when used in conjunction with other therapies, are effective in restoring self-confidence by challenging negative thought patterns and intrusive thoughts. By repeating daily affirmations that emphasise their strengths and capabilities, parents can gradually shift their mindset towards a more positive view of themselves. To support you on your journey, refer to these daily affirmations that you can integrate into your day-to-day routine. Feel free to add any others that resonate with you.

For PND or other mental health support, contact your nearest Life Mental Health facility, SADAG on 0800 567 567 (crisis line) or 0800 456 789, or LifeLine on 0861 322 322.

The information is shared on condition that readers will make their own determination, including seeking advice from a healthcare professional. E&OE. Life Healthcare Group Ltd does not accept any responsibility for any loss or damage suffered by the reader as a result of the information provided.