Understanding Postnatal Depression and PNDA

General Medical

Dr. Sam Hay

Welcoming a little baby into the world is one of life’s wonders. But for some mums, it can prove to be one of the most trying times of their lives.

Postnatal depression is devastating.

It not only rips the heart out of one in seven Aussie mums, but the ripples spread through each young family, leaving more people to struggle with the daily grind of raising a bub.

High profile celebrities such as Drew Barrymore, Gwenyth Paltrow, and Elle McPherson sharing their experiences has certainly raised the profile of postnatal depression in the wider community. Along with their efforts, numerous awareness campaigns and the rise of social media, the stigma around the diagnosis is slowly reducing. 

Recent understanding of mood disorders in mums has broadened, leading to a more universal term of Perinatal Depression and Anxiety (PNDA) – rather than just ‘postnatal depression’. 

This is because mums suffer the same symptoms around the time of birth as well, not just in the year or so afterwards. In fact, up to 50% of mums are found to suffer symptoms before delivery. Basically, PNDA shares the same set of symptoms as commonly known conditions like major depression or generalised anxiety. But what distinguishes it is the association with pregnancy and having a baby. 

So just what are the symptoms we need to look out for?

PNDA is not just the ‘baby blues’. The period of the baby blues refers to around the third to seventh day immediately after birth, where feelings of anxiousness bubble over. It’s all related to hormone shifts as mum’s body adjusts to the next phase.

Having a baby can be hard. Very hard. It’s new, stressful, and most mums are completely clueless at the beginning. 

The reality is, dads can’t breastfeed - so they just don't really know what it’s like to fail at it. Dads also struggle to understand what it’s like to have the extreme body changes that mothers get - it’s the equivalent of menopause! A complete change in body image, an inability to shift excess pregnancy weight, and even loss of hair are unique problems for mums, not dads.

Whilst dads can be sympathetic and supportive, these stressors plus a multitude more are often just the beginning, triggering extreme maternal stress and anxiety. If left unchecked, PNDA may kick in and take hold.

But what symptoms set PNDA apart from understandable stress?

If you notice two or more of the following symptoms, for more than two weeks, then PND is likely for mum.

  • Low mood especially when you wake up
  • Lack of enjoyment in pleasurable activities
  • Lack of motivation to perform any task
  • Feeling tearful and wanting to cry all the time
  • Irritability without a justified reason
  • Feeling of guilt, low self-esteem and rejection and inadequacy as a mother
  • Lack of concentration level, forgetfulness and inability to formulate fixed decisions
  • Decreased energy level, fatigue and exhaustion
  • Fearful of and for the baby
  • Fearing loneliness or social interactions
  • Decreased appetite and disturbed sleep
  • Neglecting personal care and hygiene

Who is most at risk?

PNDA is a condition that effects all women, of all cultures and all ages. It can occur with the first baby, the fourth but not the first three, or with every single baby a mum has.

PNDA can pop up out of the blue for even the most stoic of mums who have always been well. The greatest risk however, lies with mums who have had past episodes of depression, anxiety, and especially PNDA.

Whilst many risk factors have been identified, there are several that seem to predominate. It’s important for mums and families to be aware if some or many of these are present:

  • Stressful life events during pregnancy or after birth (e.g. marital issues, moving house or emigrating).
  • Poor finances or social support networks.
  • Being a young parent, especially under 25.
  • Single parents.
  • Several previous kids.
  • Unwanted pregnancy.
  • Intense fears of pregnancy or childbirth.
  • History of sexual or childhood abuse, plus domestic violence.

So what do we have to do?

Prevention is the primary objective for all mums. Be on the look out – and everyone can do it.

In my practice we periodically screen expectant and new mums. We use the Edinburgh Postnatal Depression Scale questionnaire, an invaluable tool to take a snapshot of each mum’s level of distress and start a conversation about how they’re coping.

Mums aren’t the only ones at risk. Dads can suffer from PNDA too. We now understand that one in ten dads may also suffer from depression after baby is born.

The role of the dad is tricky. Often they are left juggling an early return to work to pay the bills, duties with the other kids, plus pitching in to help with new bub. PLUS, they have to be the rock for mum! Dad can’t fix most of the issues for mum we’ve touched on above– it’s not our breasts or our body. And that can be stressful, which only fuels issues with stress, anxiety, and low mood.  Plus, whilst the stigma for mums and postnatal depression is dissipating, the reality is that its still very high for dads.

The signs and symptoms for dads are virtually the same as for mums. Feeling incredibly fatigued or overwhelmed, loss of appetite or interest in sex, and withdrawal are common. In my practice, I actively encourage both parents to come to see me at baby checkups.

The foundation to treating any form of mood change associated with pregnancy and babies is structured psychological counselling.

If your special mum is at particular risk, then it’s important to provide support as early as possible. And this could be during pregnancy. Your GP or obstetrician can help with this, and those at greatest risk should see a psychiatrist and psychologist. In my practice I recommend all new mums, but even the experienced ones, regardless of risk, engage in some sort of counseling from their GP or a psychologist. It’s invaluable to build a toolkit of extra skills before baby arrives, so do it early!

So what else can be done?

Mums – if you’re struggling, you need help, regardless of whether you actually have PNDA. But help for PNDA doesn’t solely fall in the lap of doctors and psychologists. Whilst your GP is often the best first port of call, there’s a lot the family can do too. 

PNDA is often exacerbated by insecurities around how mum is caring for baby. Mums lose their confidence, or baby is just really tricky. And of course, this makes things all that much harder, because it can be very difficult for a struggling mum to admit they need help. And don’t get me started on blogs, Facebook, and online mothers' groups…

Can the early childhood centre, a mothercraft nurse, or services such as Tresillian offer invaluable mothercraft advice? Mum might need some new practical skills for her toolkit as well...

Could a lactation consultant come in and offer invaluable reassurance or guidance around breast feeding? 

Could a night nanny come in and give mum and dad a couple of nights sleep? Or, is it just time for grandma to come to the rescue?

Each family is different, and it’s important for all around mum to rally together to help.

Sometimes, symptoms become too intrusive and medications are required. This point is usually met with much resistance from mums, as ongoing stigma fuels the sense of failure. But what’s central is not only improving mum’s mood, but also their abilities, so they can look after baby the way they really want to.

If you or someone you know is struggling with Perinatal Depression and Anxiety (PNDA), visit the Centre of Perinatal Excellence (COPE) to access a range of high quality resources to help you through the emotional challenges of becoming (and being) a parent.


BMedSci, MBBS(Hons), FRACGP, GDipSpMed, DCH
Director Your Doctors®


Please note: Dr. Sam's blog is general advice only. For further information on this topic please consult your healthcare professional.

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