How to Write Postnatal Depression

The image one has of a woman becoming a mother is always maternal, sweet…like once she gives birth, everything falls into place.

Sadly, it’s also an image predominant in the rare romance novels where the author goes beyond the happily ever after and shows the characters living life to their fullest.

Reality is different, and raw, and sometimes painful. Not every woman gives birth and becomes the perfect mother. That is a myth, and it does more harm than good in the long run.

There is nothing wrong with holding a baby in your arms for the first time, and feeling a void. Of not immediately liking the little bundle of joy everyone says is the new reason for your being alive. Of thinking you’re a bad parent, and you need to stay away…

This is called postnatal or postpartum depression.

It is a mental illness that affects the mood, and statistics show it affects more women than one would think—an estimated 15% according to the American Journal of Obstetrics and Gynaecology.

Symptoms

The trouble with postnatal depression is that it doesn’t necessarily start the day after the birth.

Sometimes it could start a few weeks later, or a few months later, but always within the first year.

Furthermore, symptoms are not easily shaken off and can last anywhere from two weeks to a full year.

Mild mood swings after giving birth (feeling happy one moment, sad the next) are what doctors call ‘baby blues’, and don’t last long after the birth.

Most medical practitioners consider these normal in the mother after birth.

Yet when it doesn’t go away, and instead becomes deeper and more set, it is called postnatal/postpartum depression.

Some of the other symptoms:

Trouble bonding with the baby
Frequent thoughts for either parent that they’re not a good parent
Thoughts of harming themselves and/or the baby
Feeling sad, worthless, hopeless, guilty, anxious—all the time
Prone to irritability or anger
Losing interest in things they previously enjoyed
Withdrawal from others
Loss of memory and concentration
Lack of appetite
Insomnia

In most books and even movies, a new mother magically balances the lifestyle changes brought about by pregnancies, but the reality is not all black and white.

Symptoms like those mentioned above can be integrated in the storyline if you wish to show a more realistic side of life after having a baby.

Causes

While it can affect anyone, postnatal depression is more likely to affect the mother.

Some factors that can contribute to its onset are family history, biology, personality, life experiences and environment.

Sleep deprivation after giving birth has been linked to postnatal depression as well.

According to the American Journal of Psychiatry, 50% of postnatal depressive episodes begin prior to delivery, driven by low self-esteem and fear of upcoming lifestyle changes. Hormonal changes (specifically those caused by oestrogen, thyroid, testosterone, and cortisol) have been linked to postnatal depression.

A second or third pregnancy does not automatically mean the chances of postnatal depression are lessened. On the contrary, a mother who previously delivered and had no symptoms can still be at risk after later births. Women who miscarry can also get postnatal depression.

It’s important, given the points mentioned above, that if you’re writing a character with postnatal depression you have a solid cause for it, and keep in mind that it does not necessarily start right off the bat once the parents bring the baby home—it can take time.

Risk factors

When developing the background story for a character with postnatal depression, keep in mind the below risk factors, as well as the causes mentioned above.

Women with a history of depression can be more at risk of developing postnatal depression. A poor support group (bad relationship with the father, no family help) can also contribute by creating a stressful, isolated environment where the mother has to cope alone with the new lifestyle changes brought about by a baby.

Cigarette smoking and formula-feeding have been shown to contribute to onset of the depression, but an even higher risk factor is stress brought about by lack of resources, such as financial. Women with low incomes that may not have wanted/intended the baby have an increased risk of developing postnatal depression.

Women who suffered physical trauma or birth-related trauma are also more likely to develop the depression. Furthermore, 80% of women who deliver experience ‘baby blues’, which increases the risk of experiencing a deeper depression later on—leading straight to postnatal depression.

In some cases (1 in 1000), postnatal depression can lead to postnatal psychosis and being admitted to a mental institute for more serious treatment. It is also in the case of the psychosis that many mothers committed infanticide (the American Journal of Psychiatry puts the figure at 8 per 100 000 births in the USA).

Treatment

Once diagnosed, doctors usually prescribe a mix of antidepressants as well as counselling. Cognitive-behavioural therapy is especially common as a treatment for postpartum depression, as it teaches problem-solving and stress management skills. Though used more in mild to moderate stages, it works well in addition to antidepressants.

Self-care is essential to recovery. If the mother cannot take care of herself—eating, sleeping, relaxing—the symptoms may only worsen. Exercise has also been shown to help improve mood swings associated with this type of depression.

One last thought for the writers out there. It has been shown that emotional closeness and support by the partner helps to avoid the onset of postnatal depression, especially if there is good communication between parents.

When writing about this type of mental illness, keep in mind that while it isolates the mother, it also has ramifications to the rest of the family that may be trying to help out.