How do I Know Whether to Seek Help? Ask yourself the following questions:

  • is this a change from my usual self?
  • do these things significantly impair my ability to engage with life and the important people in it?
  • does it seem to be getting better or worse?
  • when I have a bad day does it feel like the end of the world?
  • do I have the resources I need available to me to overcome this?
  • am I able to enjoy my baby? (and other children)
  • am I still interested in the things that usually give me satisfaction?
  • do I still have things to look forward to? (and if so, do I?)
  • can I see a time when things will improve?
  • do I feel well enough supported?

What Can I do Now?
This is very much a matter of personal circumstance. Some women find that once the baby begins to sleep for longer periods, becomes less dependent and more interactive, they feel better. Finding a person you trust to talk to about the way you are feeling can also begin to change things for the better. For others, the ‘solution’ is more complicated, and will involve trying a range of things, including seeking more specialized/expert help or support. In the same way that different factors have ’caused’ the distress in the first place, different factors will help resolve it.

With ‘the family’ and peoples’ lives in general taking so many different forms these days, it is difficult to make suggestions which won’t somehow exclude somebody – not everyone has a partner (and they may be of either gender), or other family members or friends. In addition, everyone has different resources at their disposal. Read the following suggestions with this in mind, and try to interpret each according to your individual situation.

+Self Help

Take stock of your current situation – develop a plan of action. Approach this as you would any other project – work out what needs to be done, what resources you have available/need to access, and what needs to be given up or let go in the meantime – including any unhelpful ideas about who should be doing what for whom, who deserves what, who caused what … if you’re feeling too demoralized or distressed to do this yourself, ask someone you trust to help you think it through.

Get real, and be prepared to change something which isn’t working for you right now. The picture of motherhood often portrayed in the media is unfortunately not a good match with reality for many of us … the clean, contented, and regular baby, the slender, glowing, energetic and attentive mother, the happy, supportive, and helpful family and network of friends … you may need to adjust your expectations – of self, the baby, others – depending on the reality of your own experience. For some of you this will mean lowering expectations of self and others, but it may also mean expecting more in terms of support and shared responsibility.

Small babies are sometimes unsettled for prolonged periods of time – resisting this won’t change it, and may just make it worse. Accept that your life is going to be disrupted for a time (not forever – although it can feel that way sometimes), and organise yourself around this accordingly. Sleep deprivation will make you feel as if you are going crazy if it goes on for long enough – ease up on the demands you place on yourself until you begin to get enough uninterrupted sleep, and have the energy to pick up your usual patterns of activity again.

For those of you with partners, this may mean sharing night-feeds, or moving out of the main bedroom into a spare room where you can feed the baby with minimum disruption in the night, in return for your partner taking responsibility for some other tasks you would normally do.

If you don’t have a partner or live-in support, this may mean avoiding all but the most essential tasks during the day, to conserve your energy for night-time. Rest when the baby does during the daytime if possible. ‘Resting’ may mean just sitting on the couch, on the doorstep, or watching TV for brief periods during the day. If the baby is also alert during the day, make sure you get out of the house for a bit each day.

Acknowledge that you deserve (rather than need) support. Many women these days aren’t used to being ‘helped’, and may view requesting support at this time as a sign of weakness. Remember, mothers who receive good ‘mothering’ themselves (via someone to listen, notice, understand, respond empathically and practically, share tasks) at this time are in a much better position to be ‘good’ mothers themselves. This is also often a component of good therapy.

Request support and practical assistance. Although asking for help and support may be difficult, the important thing to remember is that people often really want to help, but don’t know how – or feel as if you look so capable, you don’t want any help, or that you’d be offended if they offered. Having said this, there will be some people you really don’t want ‘help’ from, because the price is too high – you need to weigh the value of not receiving vs receiving help from these people.

Try this: leave a list on the fridge of tasks you’d like done – for partners, visitors, other family members – to choose from next time someone says “what can I do to help?” Ask visitors to run errands for you on the way over. Let them know beforehand that if they visit, they’ll need to make their own cup of tea etc.

Make time out. Get over the fact that you may need to ask for this, or organize it yourself. In an ideal world those who love us would see what we needed and assist us to get it – in the real world there are many reasons why this might not happen, not all of which are about how they feel about you at that point in time, or how valued you are in general. Give yourself permission to take some time out – eg. introduce a bottle-feed occasionally if you are finding the demands of breastfeeding overwhelming; ask a friend for some relief childcare (and reciprocate when you feel able), get some home-help/disposable nappies if you can afford it, go out with friends without the children occasionally.

Keep it simple, and keep your workload to a minimum. Only do what is really necessary – unless you are determined to be superwoman, this is likely to be different from your usual list …

Try using the ‘top drawer, middle drawer, bottom drawer’ system to prioritise tasks. Top drawer = anything which absolutely has to be done today (feed the baby, feed yourself, pay the power bill), middle drawer = things it would be good to do today – not essential, but desirable (do the washing, make the beds), and bottom drawer = things which can be put off till tomorrow (fold the washing, tidy the lounge).

One bite at a time. Even everyday things may seem overwhelming, especially if you think in terms of everything which needs to be done at once – chunk it down into steps, and focus on taking one bite at a time, rather than trying to swallow the whole meal.

Clear one space. Have one place in the house free of clutter where you can sit (or if you’re knocking yourself out trying to keep the whole house tidy, allow yourself to leave part of it undone !).

Find someone to talk to about how you are feeling. And keep talking about how you feel, to people who are able to listen and be supportive. If you have friends or family who are critical or unsympathetic – don’t invite them around or spend too much time with them.

Establish some realistic expectations about babies and children. Learn about what babies and children generally do by talking to and mixing with mothers or other ‘experts’ willing to share a range of experiences, reading, questioning, and then decide what is best for you – your baby and situation may not be like other peoples’.

Express your feelings/meet some of your needs in other ways. If you enjoy writing, keep a diary or journal (or weblog !) of your thoughts and feelings, paint/draw, knit, do a jig-saw puzzle, create something satisfying, no matter how small.

Release yourself from ‘shoulds’. Especially the ones which don’t seem to be working for you – change them to ‘coulds’ – this gives you a choice.

Try to spend time just ‘being’ and interacting with the baby over everyday things. We tend to get too hung up on ‘doing’ these days, and the need for ‘special’ equipment and activities to ‘develop’ our babies – try just watching your baby, following their lead, lying on the floor with them, turning everyday activities into the focus of play and conversation – and remember to give them space from you from time to time.

Nurture/treat yourself. This may mean resting, rather than flogging yourself because you aren’t exercising, tidying, worrying, creating … select simple treats … a bubble bath, listen to a favourite piece of music or the radio, watch something funny on TV or video, meet a friend for coffee, savour a piece of chocolate.
Get some light. Get outside, sit by a window, open the curtains, spend time in the lightest room in the house – especially in the winter Time.

Try a relaxation technique. eg. a tape, visualization, or deep breathing. The easiest way is to place a hand on your tummy, push your hand upwards as you breathe in slowly, upwards to your shoulders, hold, and slowly breathe out from the shoulders down to your tummy, with your hand going down slowly as you breathe out, saying ‘relax’ to yourself. Repeat 3-4 times at intervals during the day – or whenever you catch yourself feeling uptight.

Try to eat well. Have foods in the cupboard or fridge that are quick to prepare or snack on – fruit, nuts, cheese, tinned or frozen food – and aim for small frequent meals, especially if you are breast-feeding. Use a time when you have most energy to make a sandwich that can be eaten when you have less. Slow-release carbohydrates in foods like wholegrain bread, hummus, baked beans, vegetables, and fruit, and proteins like cheese, eggs, tuna, meat, tofu, are best. Veges in the fridge like celery and carrots make good quick snacks for other children too. Remember you need to feed yourself in order to be able to feed others.

Exercise may be the last thing on your mind right now … think small – a walk to the letterbox, round the block with the baby in the buggy – getting out of the house, even for 5 minutes, can shift your perspective.

Sort your thinking. Depression and distress can trick you into thinking in ways that keep it going – be alert for negative, global, catastrophising thoughts, especially those which fault you, and which have become habitual/automatic. You may need to talk to someone outside your immediate circle to help nip these in the bud, or seek some professional help. There are a number of good self-help books available which can help you stop, examine, and redirect your negative thoughts. You may also find the website moodgym.anu.edu.au useful if you have internet access.

Notice and deal with your feelings. For some of you, this will mean allowing yourself to feel some fairly painful and uncomfortable things, for others, finding a way not to feel them so intensely they overwhelm you. It’s important to make a conscious connection between various events and circumstances in your life and your responses to them – joining up thoughts, feelings, and behaviours in a way that makes sense.

Don’t neglect your spiritual needs. Whatever form these may take … go to church, walk along the beach, light a candle, soothe your senses …

Try to make special time for your other children. Sometimes even a little special attention goes a long way. Toddlers seem to have a way of becoming more demanding if they sense their usual sources of attention and comfort may be in short supply – but the ways they tell you this (eg. becoming naughtier/clingier/noisier than usual) can often make it less likely you’ll want to spend positive time with them. They’re after reassurance that you haven’t gone forever, and needing a little extra attention while they adjust to sharing you. If you can, arrange to spend some time with them without the baby – even 5 minutes out in the garden can make a difference.

+Ways Your Partner, Family, and Friends Can Help

PND affects the whole family (and some would say, arises because of the whole family’s circumstances, both past and present). It is in the whole family’s interests to do what they can to support and assist – criticism, too much unsolicited advice, or believing the woman has somehow ’caused’ it to happen, are not helpful.

Here are some ways in which partners can provide support:

  • include yourself in visits to or with the doctor, healthcare worker (ask her first)
  • take a positive lead with housework and childcare – try to do things without being asked
  • get up to the baby during the night. A breastfed baby can be brought to the mother to minimize her sleep disruption. Sharing the feeding by introducing some bottlefeeds may be helpful
  • be a buffer for the mother – screen phonecalls and visits, and keep all unnecessary tasks and demands to a minimum
  • don’t invite people for dinner unless they’re going to bring it and help fold the washing!!
  • develop a support system for yourself too – partners are also post-natally distressed sometimes, and you may feel isolated and unsure what to do – find someone to talk to
  • accept that anger, frustration, and despair may all be expressed (by both of you) when things are difficult – sometimes seemingly irrationally. Try to make some time to talk about how things are for both of you when emotions aren’t running high
  • it may seem counter-intuitive, but try just listening to how she feels, without trying to fix it, offer suggestions, solutions, or telling her what she ‘should’ be doing or feeling (she knows this already … it makes her feel worse)
  • childbirth, night-feeds, and all the attendant demands of a new baby are likely to impact on passion and sexual interest – for many women at this time, sex will feel like just another demand on the ‘to do’ list – be patient, and remember to offer non-sexual affection and touching
  • relationships often suffer at this time – try to keep talking to each other about what is happening. You may also want to consider relationship counselling, especially if you have longstanding issues which seem to be getting worse
  • organize some regular and ‘special’ time alone together – go out to a movie, for a walk, cook dinner and watch a video – these things tend to disappear without you noticing
  • it may not seem likely at times, but remember – you will get her back

For visitors (whether friends or family) in addition to some of the things above:

  • keep visits short (unless she wants the company)
  • ask when might suit
  • make yourself useful – ask if there’s anything she’d like from the shop, check the list on the fridge, ask if she’d rather you hold the baby or attend to household tasks (or both, while she has a lie-down or goes out for while)
  • offer to collect/drop other children at school, kindy, or daycare
  • make your own cup of tea, and one for her too
  • make her a sandwich for lunch/prepare the dinner so it just needs reheating
  • bring some labour-saving gifts and treats (disposable nappies, frozen dinners, healthy snacks, a magazine, something personal for her, rather than the baby)
+Professional Help

It is really important to seek a professional opinion if concerned in any way, but not always easy to know where to start. Talk to someone you already have contact with and trust about what you are experiencing eg. your GP, midwife, or Plunket Nurse. They may be able to help, or refer you to someone else who can.

Physical health
It is always important to have your physical health checked out first. Ask your GP to check your thyroid function, iron levels, and general health. Attend to any breast infections immediately – they can rapidly develop into something more serious (sometimes infection-related delirium has been mistaken for post-natal psychosis). Remember also that if you’ve had a caesarian delivery or other complications, your body needs time to recover.

Medication
There is a lot of misinformation about the advisability of taking medication while pregnant or when breastfeeding, much of it unnecessarily negative. It is very important to get good information from a recognized source, and to weigh the benefits of taking/not taking it for you, the baby, and your family, before making a decision. Your GP may prescribe medication for you eg. for depressive symptoms, anxiety, or sleep difficulties, and midwives can also prescribe some very short-term (less than 2 weeks) medication to assist with sleep in the early post-natal phase. He/she should discuss this with you in detail first – what the medication is for, when you should take it, what the alternatives are, and any possible risks to yourself/the baby vs the risks of continuing as is.

With any medication, it is important to take it as prescribed, and discuss with the prescriber any side-effects or intention to stop/change. Stopping some medications suddenly, even if you are feeling better, can lead to a relapse in symptoms. This is a complex area which needs to be considered with a person who has expertise. If you are dissatisfied with the advice given, seek a second opinion.

Alternative therapies
Some people have found a range of alternative therapies helpful eg. cranial osteopathy seems to work wonders for some distressed babies.

Counselling and therapy
Many women find it valuable to be able to talk issues through with a person trained to listen and offer guidance and support, but it can be difficult to know where to access these services, and who is the right person eg. counsellor, psychologist, psychiatrist, phone supporter. Getting the right ‘fit’ between yourself and the person you choose is really important, and it depends on the nature of the issues you want to explore/address, what kind of person you are, and your budget. It’s OK to shop around, and to take someone else with you if this will help. You may want to include your partner or other family members also.

Prices will vary from around $75 – $130 per hour for private counsellors, psychotherapists, and psychologists, but many will reduce fees for beneficiaries or people on low incomes. Some problems such as panic attacks, obsessive-compulsive symptoms, post-traumatic responses, and any longstanding or severe depression, may respond best to specialized therapy, and may be needed before any of the other strategies suggested in this booklet can have much effect on how you feel.

Mental Health Services
People can self-refer to local adult Community Mental Health or Child Adolescent and Family teams, based in Wellington city, Porirua, Kapiti, and Hutt. Your GP can also refer you. These services have specific criteria for acceptance, and there may be a wait-list in some areas. They should, however, be able to recommend where else you can access help and support in your local area. Their contact numbers are listed in the front of the white pages under Capital and Coast and Hutt Valley

District Health Boards
The Specialist Maternal Mental Health Team covers all Wellington areas, but require a referral from your GP, midwife, or other specialist service. Any GP or midwife can phone the Team for help and advice.

For mental health emergencies after hours, Hutt and Wellington have separate services (Crisis Assessment and Treatment Teams, known as CATT), accessed through their main switchboard numbers:

  • Hutt Phone 566-6999
  • Wellington and Kapiti Phone 494-9169

If you feel your doctor, counsellor, or other health professional is not the right person for you, you have the right to change or ask for a second opinion.