How to Help a Woman Survive Postnatal Depression
Assess sleeping problems:
- What are the sleeping arrangements for the family?
- Who gets up at night with the baby?
- Does the baby sleep in the same room as the parents?
- How many hours sleep does the mother get? (If she is exhausted, other strategies are less likely to be effective.)
Suggestions:
- Take turns getting up with the baby at night (express milk if breast-feeding)
- Consider having the baby sleep in the same room as the parents.
- Ear Plugs!
- One partner to sleep in a separate room occasionally.
- Stress that sleep deprivation is temporary.
- Don’t look at the clock – turn it to the wall.
- If the woman can’t sleep after 15-20 minutes, she should get up, go into another room and do something relaxing or boring.
- Try to keep as regular a schedule as possible.
- Avoid tea and coffee and heavy meals before bedtime.
- Have thyroid and haemoglobin checked.
Assess eating patterns:
- Does she skip meals?
- Does she try to prepare meals from scratch? (Convenience foods, frozen meals, etc save time and energy.)
- Does she drink adequate fluids?
- Suggest keeping healthy snacks on hand.
- Suggest taking any prenatal vitamins left over, or a good multivitamin tablet.
- Explain that low blood sugar aggravates depression and fatigue.
Focus on the basics:
- Help the woman keep her expectations realistic. (Women with PND tend to be perfectionists.)
- Explode the “superwoman” myth – she does not have to do it all.
- Help her to structure her day – make a simple plan.
- Advise her to keep her “to do” list short – 2-3 items.
- Get the woman to ask herself, “Is it important to my whole perspective on life?” e.g. “How important is it to have a fancy christening party?”
Help the mother to develop a support system:
- Teach the woman to ask her friends or family for help. (Women with PND have difficulty asking for help.)
- Tell the woman that she is “borrowing favours” – eventually she will be able to repay them.
- Imagine a scenario that she has to be admitted to hospital – What would the family do then?
- Consider asking for help from husband or other family members> (Women with PND often have partners who work long hours at jobs or studies.)
- Avoid spending time with people who make her anxious, or make her feel unhappy.
- Explore babysitting options.
- Identify local programmes for mothers and babies.
- Realise that parenting is 3-generational. The mother may be trying to live up to or rebel against the way she was parented.
Help her to identify and express her feelings:
- It is OK to have negative feelings.
- Explore motherhood as a loss, e.g. loss of self and old way of being
- Loss of independence
- Loss of spontaneity
- Loss of career
- Loss of intimacy
- Loss of joy, energy, sleep
- Help her to educate herself about PND by reading books.
- Tell her that it is usual for women suffering from PND to lose interest in sexual intimacy.
Recognize the good job that she is doing:
- This is the most dramatic adjustment in a woman’s life, and it takes time.
- Give as much encouragement as possible. Point out what she is doing right. (Most women with PND feel guilty if they are not enjoying their babies – most do a more than adequate job of taking care of their babies.)
Ask the woman to tell you what she needs:
- Often you will be the first person who asks.
- The time she invests in herself (e.g., rest relaxation, breaks) will be the best gift she can give to the baby.
- Self-care is not selfish.
- Help her to challenge the motherhood myths : that bonding is immediate, that breast-feeding is natural and easy, that mothers are perfect, all-knowing, always loving, always patient and serene.
- Help her to remember and slowly rediscover the person she was before the baby came.
- Don’t allow her to compare herself with anyone.
Encourage her to rediscover her sense of humour:
- Rent a funny video; but avoid TV talk shows and news. (Women with PND are very vulnerable to problems, and tend to worry excessively.)
- Read funny books.
- Take time off to have fun with her partner, or at least rediscover each other.
Suggest postponing major life changes:
- Don’t move house.
- Don’t file for divorce.
- Don’t change jobs.
Reassure her:
- That recovery from PND takes time and patience, often several months or longer.
- That she will get better.
- That it is not her fault.
(Adapted from: Grazyna Mancewicz & Sherry Thompson (St. Joseph’s Women’s Health Centre, Ontario)