Postpartum depression – light after crisis
1. Introduction: Storm in woman’s life
The Äidit irti synnytysmasennuksesta Äimä ry’s guidebook aims to provide information about depression during pregnancy, postpartum depression and postpartum psychosis. For the first time the guidebook discusses depression during pregnancy and postpartum psychosis, as these illnesses have recently emerged in Äimä’s assistance work.
In a woman’s life, pregnancy, childbirth and the postpartum period are challenging times with their hormonal, psychological and social changes. For many new or future mothers, it also means the onset of depression. Depression during pregnancy affects about 7-20% of expectant mothers, while postpartum depression affects 10-15% of mothers. Postpartum psychosis is rare, but it can be life-changing.
Depression can be described as a crisis that affects not only the mother but also her partner and the baby. The crisis requires the help of healthcare professionals.
Äidit irti synnytysmasennuksesta Äimä ry provides peer support to affected mothers through many different channels nationwide.
Leena Honkavaara, Editor, Äimä ry
Experts: Antti Ahokas, psychiatrist; Tove Hertzberg, psychiatrist; Kirsi Juutilainen, early interaction psychotherapist; Suvi Laru, psychologist, psychotherapist, EMDR therapist, teacher, Väestöliitto ry (The Family Federation of Finland); Ilmo Saneri, assistant for fathers, Miessakit ry; Mirja Sarkkinen, psychologist specialising in psychotherapy, early interaction trainer-psychotherapist; Hannele Törrönen, psychologist.
The guidebook is based mainly on interviews with the above-mentioned experts, which were originally published in the Äimä ry’s journal Äimän Käkenä. The experts have reviewed and updated the text for the guidebook. A grant has been received from the Päivikki and Sakari Sohlberg Foundation for this guidebook and its different language versions. Äimä ry’s basic funding is derived from the earnings of Veikkaus.
2. Depression during pregnancy
Approximately 7 to 20% of pregnant women suffer from depression during pregnancy. The percentage varies in different studies. Often there is underlying depression, but not always. Risk factors include, among other things, mother’s young age, single parenthood, unplanned pregnancy, problems with substance abuse and absence of a safety net. Traumas and relationship problems can increase the risk. Depression during pregnancy can lead to postpartum depression.
Changing maternal hormone levels can be linked to depression during pregnancy. The hormone levels of all pregnant women change – however, not everyone gets sick. In the background there may be contradictory thoughts about becoming a mother, difficulties in reconciling a career with motherhood and all the other difficulties of life that cannot be solved.
The body and mind experience an intense process of change during pregnancy. Confusion, fear and uncertainty may replace skills and the capacity to manage everyday life.
Depression during pregnancy is diagnosed as either mild, moderate or severe. Even the smallest signs of depression should be addressed, and you should seek help from professionals. Mild and moderate depression can be treated by consultation, for example, by therapy. A psychologist or psychotherapist helps with managing the worst stage.
In addition to consultations, peer support, physical activity, mindfulness, bright light therapy and similar treatments may also be helpful. The treatment is based on talking and listening: how is the soon-to-be mother really getting on? What kind of thoughts is she having about the baby? What kind of support networks and relationships does she have?
It has been quite common practice to rely on medical treatment during pregnancy, especially when the mother’s situation is difficult. If the mother has untreated severe depression during pregnancy, she may not be able to take care of herself. The baby in the womb suffers when the mother doesn’t eat, exercise or sleep enough. The mother’s depression may affect the developing baby. A depressed mother’s baby may weigh less and develop more slowly in terms of psychomotor skills.
The impact of depression medication on the baby’s development during pregnancy has been the subject of several research studies in recent years. There is still no convincing evidence that medication is detrimental, but in the absence of certainty, primary care should consist of psychological approaches. The use of medicines must be carefully weighed up and professional opinions should be trusted.
It is always best to talk to a psychiatrist about starting or stopping medication during pregnancy.
For depression during pregnancy, you may seek help, for example, from your own nurse at the maternity clinic, psychologists, psychiatric nurses, psychiatrists, the social services family care unit, maternity clinic or early interaction therapist.
Experts: Suvi Laru and Tove Hertzberg
“Why can’t I just enjoy life and be grateful?”
3. Baby blues is not a sickness
Up to 80% of new mothers experience strong mood changes. Everything makes you emotional, tearful, irritable. You may also experience anorexia and sleep disturbances. Mood swings are often caused by changes in hormonal balance, fatigue and release of long-term stress.
This condition – the lack of energy and mood swings associated with giving birth – is called baby blues. The condition is natural and has its purpose, which is to help the mother to adapt to a new life situation and to meet the baby’s needs. Normally the feelings of dejection pass in a few days or a week. If the symptoms continue, worsen or come back, it may be postpartum depression.
”I felt sorry for the baby for having such an unfit mum.”
4. A difficult delivery affects the mother
Giving birth is a unique experience and it may seem difficult, even if it was normal from the midwife’s point of view. A difficult delivery may sometimes lead to postpartum depression. If the experience bothers you to the extent that it interferes with everyday life and prevents you from enjoying the baby and baby time, you should seek help.
To some extent pain, anxiety and fear is always associated with giving birth. The first-time mother is facing a whole new experience, while in subsequent deliveries the mother has in mind previous birthing experiences.
Previous traumatic deliveries, bad hospital experiences, challenges associated with the pregnancy and the well-being of the baby can be underlying factors in a difficult delivery. Maternal depression, anxiety and various other problems affect the experience of giving birth. Difficult or traumatic experiences associated with one’s own childhood may also underlie a difficult birthing experience.
A woman who is giving birth may have difficulty in openly expressing her own wishes, needs and fears. Many fear the loss of control and feel shame.
The experience of giving birth is very individual and no one else can determine whether a delivery is difficult. From the midwife’s or physician’s point of view, delivery is difficult, for example, when pain relief fails or when unforeseen, unexpected and frightening events occur or the mother’s or baby’s well-being is compromised.
In Finnish maternity hospitals, the delivery and the mother’s experiences are discussed after the birth. It is good to talk openly during the discussion. The same discussion should be continued later in the maternity clinic with your nurse.
The nurse can provide contact details of a professional who is familiar with the feelings and reactions caused by a difficult delivery. You may also talk about a difficult delivery with the physician or gynaecologist who performs the postnatal examination.
A difficult delivery that is left untreated may overshadow the early months of the baby’s life. The mother may develop depression and it may be difficult to enjoy the baby. She may be worried and fear for the well-being of the baby, especially if the baby’s well-being was a concern during the delivery.
It is also important to discuss the fear of childbirth and actively seek help.
Expert: Kirsi Juutilainen
“I felt like I was a piece of meat and they were trying to squeeze the baby out of me.”
5. Mother’s changing hormones
Pregnancy, childbirth and the start of lactation cause rapid hormonal changes in a woman’s body. Hormone fluctuations are associated with depression during pregnancy, postpartum depression and postpartum psychosis.
During pregnancy, hormone production takes place in the placenta and the ovaries are resting. After expulsion of the placenta, the ovaries slowly resume their function, often with several months delay. After giving birth, the mother’s oestrogen levels (approx. 100 nmol/l) and can even reach menopausal levels (approx. 0.1 nmol/l). As a result, the brain’s serotonin levels decrease. This results in mood decline and weakness.
When sleep disturbances coincide with increased stress caused by life changes, the level of stress hormones increases in the brain. This further decreases serotonin levels.
When, in addition, breast-feeding hormones keep oestrogen levels low, the negative cycle is often complete. Mothers react differently and in varying proportions to hormonal changes, and their level of impact on mood can vary.
Mothers suffering from postpartum depression are usually treated with psychiatric drugs. Some doctors favour hormone therapy instead of or combined with traditional psychiatric medications. Whatever the method chosen, medication and hormone therapy is always prescribed individually.
Psychiatric drugs may have side effects, but these cannot be predicted. If medication is found to be inappropriate or ineffective, it can be changed. The medication doesn’t change the patient’s personality, so you shouldn’t fear it. It affects transmitters in the patient’s brain that are functioning inappropriately and incorrectly.
Expert: Antti Ahokas
“Why am I so useless?”
6. Postpartum depression can be the sum of many factors
In addition to hormones, many other factors can play a role in the development of postpartum depression. Sometimes there can be underlying depression or depression during pregnancy. For many, postpartum depression is the first experience of depression in their lives. Depression can also involve hereditary susceptibility.
Your own early maternal relationship and related problems may also exert an underlying influence. Becoming a mother can trigger a more widespread crisis in your life: problems related to your relationship with your own parents come alive in the form of distressing emotions.
Life changes when a baby arrives, feelings and life management are more uncertain than before. The baby is a responsibility and the amount of housework increases. You don’t have time for yourself and your relationship may suffer. Your presuppositions and beliefs about motherhood may differ significantly from everyday life with a baby.
Many depressed mothers are very lonely. Communities are not there to support and care for the mother and baby like in the past. The mother doesn’t necessarily have contact with anyone else who has a baby. Relatives live far away and friends are busy with their own lives. The more depressed you are, the harder it is to go out. Loneliness, isolation and feelings of difference go easily hand in hand. According to some studies, a mother may do better if a grandmother is available to support her in looking after her baby during the first months.
Help for postpartum depression is available from the following sources:
- Maternity clinic
- A public or private doctor or psychiatrist
- Psychologist or psychotherapist
- Psychiatric polyclinic or emergency cover
- Family counselling
- Äimä ry’s peer support
P.S. Be brave. Loneliness is alleviated if you are able to go to family cafés, baby gym or music classes, parish club etc. Approach people and seek interaction. Later you may also mention your illness, as many mothers are surprisingly positive and supportive about it.
7. Symptoms of postpartum depression
Fatigue: Mother is abnormally tired or even exhausted. Sufficient rest and sleep do not eliminate fatigue but it continues.
Sleeping problems: Mother can have different sleeping problems. It may be difficult for a her to fall asleep or she wakes up early in the morning. Alternatively, she may suffer from restless and intermittent sleep, waking up several times during the night. Mothers can also sleep more than usual or all the time.
Anxiety and worry: Mother is anxious and experiences negative feelings, which are often at their worst in the mornings. She finds it difficult to relax, she is uneasy and tense and thinks about the things yet to be done. Anxiety can also manifest itself as hyperactivity and striving for perfection.
Irritability: Mother reacts excessively to everyday difficulties. For example, she may be harsh with her partner and others close to her. Tension can rise rapidly.
Loss of zest for life: Mother’s mood falls, feelings of guilt and inferiority increase. She has more negative thoughts and feelings. She finds it hard to experience joy and remember good things and enjoy them.
Uncertainties about motherhood: Doubts about the ability to care for a child. The mother may wonder if she is doing things right, if she has the courage to do them, and she is afraid of doing the wrong things.
Excessive care of the child: Mother wants to do everything perfectly, she is concerned about the child’s health, eating and sleeping patterns and whether the child is alive or breathing. It is difficult for the mother to allow others to care for her child.
Depression, mood decline: A mother can be in low spirits, unhappy, and tired all the time or at a certain time of the day. Good and bad moments and days alternate.
Panic symptoms: Panic symptoms manifest themselves as strong and sudden physical symptoms, such as heart palpitations, sweating, anxiety, fast breathing and agitation. For example, they may manifest themselves as fear of a public place. Sometimes there may be momentary unrealistic states of mind or feelings of absence.
Obsessive thoughts: For example, a mother might be afraid of damaging her baby.
Fears: Mother has unrealistic, exaggerated fears about the situation, and these influence her actions. For example, she might fear the death of the baby or herself.
Changes in appetite: Mother can lose her appetite altogether or it can increase. There can be significant weight loss or gain.
Sexual problems: Mother’s sexual desire can reduce considerably or vanish altogether as feelings of pleasure disappear.
8. Anxiety is common for mothers
After delivery, mothers can also be severely distressed. It’s less commonly talked about. What is excessive anxiety and what is a normal and understandable level of distress? It is worth looking at. A baby is designed to make its parents feel tense and in a continuous state of alarm. In fact, a baby will not survive if the parents are not alert to its voice and ready to meet its needs. The mother is like any animal mother caring for her cubs.
At its worst, the mother’s anxiety is quite different: just overwhelming and unbearable. Some mothers with postpartum depression experience obsessive thoughts, panic and intense fear, and even feelings of persecution.
The mother’s anxiety may be vague or related to specific baby care situations. She may fear, for example, thoughts of willingly or unwillingly harming her baby, even if she would never really do that.
The baby’s unpredictability may be particularly hard to endure. Few can recognise what is wrong with a crying baby in every situation. The baby can be happy and satisfied one moment, and the next moment start crying without an obvious cause. Some babies are as easy to understand as an open book while with others it’s more difficult. The baby can be regular or irregular in its needs, difficult to care for, sick or premature.
It is important to understand when there is a need to seek help. Your own ability to perform in daily life is a good measure. Is the anxiety momentary or does it hold back your daily life? Are you able to enjoy the baby? Do you feel that the baby is someone you know or someone scary and unknown? Do you find yourself in a situation where you can’t do anything, you don’t sleep, you don’t enjoy anything, you are angry and tense?
If life seems unbearable or your baby feels scary and alien, you should immediately contact a healthcare professional: a counselling nurse at the maternity clinic, doctor, psychologist, psychotherapist. Safeguard your everyday life in every way.
Expert: Hannele Törrönen
“Depression is not something to be ashamed of. You will surely get help when you ask for it. Your loved ones and family help.”
9. The many faces of depression
Women affected by postpartum depression can be divided into two main groups:
1) mothers who have not previously had depression or who have had it only after giving birth
2) mothers who have had depression before pregnancy but whose treatment (e.g. medication) was interrupted due to pregnancy. In this case it is a recurrence of previous depression.
Postpartum depression has its own code in the classification of diseases (F53.1). Depression and therefore postpartum depression can be classified as mild, moderate and severe depression. Diagnosis always requires a medical examination.
There are a lot of mood tests available on the Internet, and the most trustworthy of them give a rather clear picture of your situation. At best they motivate you to speak about your feelings to a healthcare professional.
Some recognise their own depression easily. On the other hand, it may be difficult to identify depression. Sometimes depression may first appear as different physical symptoms. Its symptoms may include stomach upset, hair loss, mild fever, night sweats, feeling sick or dizziness. Headache, neck and back pain, pain in extremities, chest pain and gastrointestinal disorders can also be caused by depression.
The mother who is slightly depressed will cope with the chores and work of everyday life, although these require extra effort. The mildly depressed benefits from consultation, for example the support of a psychologist or a maternity clinic psychologist. Appropriate regular exercise has been found to help, especially with mild depression.
When you are moderately depressed, the ability to work and perform your daily tasks is considerably impaired, and the future seems hopeless. Moderate depression is often treated with psychotherapy and medication.
Severe depression causes interpersonal problems and suffering as the zest for life is lost. Death-related thoughts are common. When a person is severely depressed, such thoughts may even seem liberating. Severe depression may require hospitalisation.
In addition to severe depression symptoms, psychotic depression involves delusions and hallucinations, and a disturbed perception of reality. In this case the patient receives specialist psychiatric treatment (in hospital or with effective outpatient care). If necessary, treatment may also be involuntary.
Expert: Antti Ahokas
“In the morning I watched tearfully from the window as my husband left for work.”
“The fatigue escalated when my husband left for work. I felt that I was left alone with the baby.”
10. Postpartum psychosis is a rare illness
In Finland approximately 60-120 mothers suffer from postpartum psychosis annually. The prevalence is 1-2 cases per 1,000 births. Postpartum psychosis sets in within about six weeks of giving birth, typically within 3-10 days of labour. During that time, the sense of reality is blurred.
Confusion, unrealistic thoughts and fears, sometimes retreating into an inner world or manic behaviour are typical of this condition.
A person suffering from postpartum psychosis needs hospitalisation and in most cases this is involuntary. Even though this sounds frightening, postpartum psychosis has a good prognosis. In many cases, the illness lasts for a few weeks or months. However, postpartum psychosis is often followed by depression.
Initial symptoms include a reduced need for sleep, tearfulness, hyperactivity, restlessness, racing thoughts and speech, as well as retreating into a world of one’s own, out of reach of verbal contact. Then the mother becomes confused, suspicious, and possibly delusional. The perception of reality and the ability to perform daily tasks are reduced.
Early symptoms affect the mood, which may be elevated and irritable. In addition, symptoms appear in the mind as racing thoughts, concentration difficulties, delusional thoughts and grandiose delusions. The mother’s behaviour changes, that is, she can be restless, talkative, unrestrained, disinhibited. Physiological changes, on the other hand, are a reduced need for sleep and motor restlessness.
There is no consensus among scientists on the reasons behind postpartum psychosis. Previous symptoms of mental illness, especially bipolar disorder, may be underlying factors. Postpartum psychosis may be genetic. In addition to the genetic dimension, there needs to be a triggering factor, such as lack of sleep or a long labour, or particular sensitivity to a sudden loss of hormone levels.
Some studies, for example, associate the illness with first-time mothers, caesarean section, psychological factors or life events and living conditions.
Counsellors, the mother’s partner and other close family members and friends play a key role in identifying the symptoms. A mother with postpartum psychosis is commonly unaware of the illness: in other words, she does not recognise her condition as at all abnormal.
Medical treatment is initiated in hospital. When the acute symptoms subside, consultation is helpful. After being discharged from hospital, the mother also needs special support, for example from a psychiatrist, psychiatric nurse, child and family care services, home services and psychotherapist etc.
Äidit irti synnytysmasennuksesta Äimä ry provides peer support for mothers affected by postpartum psychosis via a nationwide internet group, a group meeting held in Vantaa as well as other events.
Expert: Antti Ahokas
11. How does my baby react to the depression?
Depression doesn’t always affect the relationship between the mum and baby. For depressed mothers the baby can be a source of joy and strength.
On the other hand, a depressed mother may be overtired and may withdraw into her own world. She does not always have the energy to smile at the baby, be playful, talkative and enhance contact with the baby due to her own discomfort.
The baby can also become quiet and withdrawn. When the baby has learned several times that the mother does not make contact or respond to its signals, it may start to withdraw and even resist contact and turn away. The baby protects itself from disappointments. The mother may feel that the baby is difficult, demanding, does not meet expectations and is somehow a stranger.
The early interaction psychotherapist can help the mother and baby to get to know each other. The aim is that the mother’s mind turns towards the baby: to check whether the baby is hungry, crying or tired, to learn to know who the baby is and how it expresses things.
The mother can feel extremely guilty and ashamed that things have gone like this with the baby. The amount of psychological pain cannot be measured. The mother can think: “I’ve ruined motherhood, someone else would be a better mother.”
Guilt or shame should not prevent the mother from seeing that the situation can be remedied. The therapy aims to observe the baby’s signals, movements, gestures and essence. And maternal skills can be improved.
Early interaction therapy also addresses the mother’s own childhood experiences: how the mother was cared for – or not cared for – whether she was treated fairly or not. The mother’s own guilt can ease when she reflects on the source of the depression and the factors associated with it.
In therapy, the aim is not to blame the mother but to try and understand her. The new grandmother can accompany her during the session. Women share their stories. Early interaction psychotherapists are found mostly in the metropolitan area but also elsewhere in Finland; you should check with the maternity clinic if there are any therapists in your town or a town close to you. On the public side, you may find this support in the therapeutic baby and family unit or the infant unit of paediatric psychiatry. In addition, there are private therapists throughout Finland.
Early interaction psychotherapy has for some time already been a rehabilitation psychotherapy reimbursed by Kela. Therefore, a parent with mental health problems can also apply with his/her baby for this therapy instead of traditional mainstream individual therapy.
Changes in the relationship between mother and baby can be made quickly. The baby, mother and family can make up for lost time and catch up with development.
Expert: Mirja Sarkkinen
“For depressed mothers the baby can be a source of joy and strength.”
”Without the depression I wouldn’t be able to understand the fragility of life in the same way.”
“My partner tried to calm me down as best he could and came to see me and our baby again in the morning.”
12. The partner’s role is important
A new mother is not always happy. She is irritated, exhausted, sleep-deprived and distressed. Her partner is confused about her behaviour. Everything that was supposed to be nice turns out to be troublesome.
The mother won’t give her baby to her partner but cares for the baby desperately. Or she hands the baby over to someone else: take the baby, I won’t make it, I’m not able to. From a partner’s point of view, it can also be incomprehensible that a mother doesn’t want to be left alone with her baby and the partner should be constantly available. The mother may be afraid of hurting the baby deliberately, even if she would never really do it.
Often the partner can indeed forget about pursuing hobbies and seeing friends. There are plenty of chores to be done when your partner spends most of her time breastfeeding and in bed. In addition, the woman may be continuously angry with her partner. A depressed mother often interacts with her partner more negatively than with other people.
The partner is confused, angry and afraid and feels unable to help, which is frustrating.
When the mother’s illness is finally diagnosed, the partner is relieved. The vague symptoms have a name and you can seek information on the illness. The partner finds out that help is available. The initial phase, when the uncertainty is greatest, is the worst. In fact, many partners would hope to have information on postpartum depression symptoms at an early stage.
After diagnosis, help is at hand. Nurse, psychologist, psychiatrist. Therapy. Family therapy. Medication. Support for the baby and other children. Cleaning support.
The partner may also have depression during the pregnancy or postpartum depression. It can be associated with life changes and their corresponding challenges.
Even though mental health problems are not serious communicable diseases, depression may in some ways be communicable. Living with a depressed mother for a long time may well compromise the partner’s mental health.
The partner sees a completely different woman from the one he fell in love with. The woman is not interested in sex and has very little time to take care of herself. A depressed person is miserable company in every way.
However, depression can also have many positive effects. If you go through difficult times together the relationship becomes stronger.
Expert: Ilmo Saneri
”The symptoms eased when my husband started his summer holidays.”
13. Äimä ry provides peer support in many ways
Äidit irti synnytysmasennuksesta Äimä ry’s main goal is to provide peer support for mothers suffering from depression during pregnancy, postpartum depression and postpartum psychosis and to support their close relatives. Moreover, the association provides information about these illnesses.
Äimä ry’s basic funding is derived from the earnings of Veikkaus. Äimä ry was founded in 1998 and it is religiously and politically independent. Äimä has dozens of volunteer peer mothers throughout Finland.
What is peer support?
- Peer support means that people in the same situation help each other. At Äimä ry, peer support and counselling assistance are provided by other mothers who have recovered from postpartum depression or postpartum psychosis.
- Peer support is a form of social support that is often perceived as a source of faith and hope. As such it has been shown to have a beneficial effect on recovery.
- The group’s support is based on the group’s own experiences, not from higher or external authorities. The group leader is not a therapist, but a peer mother. Trust and participation are essential.
- Peer support helps effectively to reduce the mother’s feelings of loneliness, difference and shame. Other mothers who have had similar experiences share their stories and their thoughts. Äimä’s peer mothers are also role models for those who are still fighting the illness. They have recovered well from the illness and are active members of the community and society.
Äimä’s services include:
- Peer support groups throughout the country. Updated information on group meetings is available on our website.
- Peer support at 040 746 7424 is also available during holiday periods. Please check the exact times on our website.
- Peer chats in groups and individual chats, please check the exact times on our website.
- Individual meeting with a supporting mother in different parts of Finland. Please check the locations on our website.
- Closed internet forums.
- Events such as peer support days, family weekends and relationship days. The programme is tailored to mothers and families.
- We participate in fairs, attend different events and organise information nights about postpartum depression.
For more information on our services please visit www.aima.fi
“I started to look for peer support on the internet.”
“Another mother has been an invaluable support for my recovery.”
Photographer: Emma Huttu
A mother’s story: depression during pregnancy
”I cried most of the day”
Depression hit me when I was pregnant. I became anxious when reading tabloids and started to have obsessive thoughts from morning till night. I was tearful and I got panic attacks because of the obsessive thoughts, because I was deeply distressed about them. I and my husband both noticed that the symptoms were getting worse. I cried most of the day.
I realised it was not going to go away by itself, so I sought help from a psychologist at the health centre and I booked an appointment with a doctor who prescribed depression medication. The estimated delivery date was at the end of June and I thought I needed to get well to be a loving and caring mother to my baby. The therapy and the depression medication helped. The obsessive thoughts disappeared in a week, which was a big relief.
Now, ten years Iater, in addition to my daughter I have a son who is just over one year old. During the second pregnancy, I talked about the earlier depression and medication at the maternity clinic. In fact, I was on medication for nine years. My son was born by emergency caesarean section because I had bad PID. The baby colic lasted four months. I was again tired, tearful and distressed. I went to the psychiatrist and I was diagnosed with depression and fatigue. I’m back on medication and it has helped.
Depression is not something to be ashamed of. You will surely get help when you ask for it. Your loved ones and family help.
Now everything is better again as my son has grown. We go to the family club twice a week and it’s very important for both of us. Life is really nice and wonderful. I wouldn’t change a day even though it has been tough at times.
A mother’s story: anxiety and panic attacks
”I wanted to jump from every balcony”
I was moderately depressed already during pregnancy. I was about to leave a job that I didn’t like and thought that my depressive symptoms would ease after the start of maternity leave. This was the case at first, but soon I found myself lonely and withdrawn in my own world.
The symptoms eased when my husband started his summer holidays, and I was looking forward to the delivery, expected in the middle of the summer. At the same time, I was in a state of unreality. I didn’t worry much about giving birth or anything related to the baby before the labour was induced after the due date.
Panic hit me at this point and I was really nervous during the whole labour. The midwives happened to be busy and unfriendly. I felt like I was a piece of meat and they were trying to squeeze the baby out of me. It all ended with a caesarean section and I gave birth to a healthy baby.
The first day I was in a euphoric state and I loved the little one more than anything. I practiced breastfeeding, but I don’t think I got enough support for it. The attitudes of the midwives seemed to be rather demanding: the bottle milk was held back and when the milk supply was low, the baby’s fluids dropped fast in the summer heat. Soon intravenous feeding was started and the baby was taken to the paediatric department for feeding.
I was separated from the baby for two days. I had some fever and pain myself after the operation. I was shocked that I had given birth to a baby, I had not been able to feed her and then she was taken away from me. I couldn’t go and see my baby.
In the end they brought her back and we continued with bottle milk. At home everything went relatively well while my husband was on paternity leave and helping with baby care. Although even during paternity leave I was at times aggressive and anxious.
I hardly breasfed because I was totally in panic when trying to breasfeed: the milk supply was insufficient for a big baby used to bottle milk. The baby cried and went crazy when given the breast, so most of her nutrition was from the bottle. For night feeding you had to go to the kitchen, warm and stir the bottle and in the end the feeding was done in a sitting position. At worst it took 40 minutes to feed one bottle. And the same process was repeated after two hours.
My husband and I took turns but I was still tired and grumpy. I still had pain from the surgical wound. I got scared of my own emotional state when lifting the crying baby up at night from the crib. I felt like I wanted to shake the baby, throw her away, do anything to make her be quiet and allow myself to sleep. I didn’t do that, but I was not very gentle either.
I was sad about my aggressiveness and inability to take care of the baby. Mentally I distanced myself from the baby. It was too hard to accept the failure in breastfeeding and my own feelings.
My husband returned to work and I spent days alone with the baby. I tried to go out with the pram, but I hardly had any social contacts. I was very lonely and anxious. I jumped every time the baby started crying. It was difficult to fall asleep at night after feeding the baby. Once I stayed up all night and fell asleep only in the morning just before the baby woke up. I lived life in a blur and day by day I grew more tired and anxious.
I sought help for the sleeping problems from the maternity clinic, the doctor at the health centre and a private doctor. They all gave me nothing but advice and a prescription for sleeping pills. The pills helped for a few nights, but in the end I was so distressed and in such a panic that even the pills wouldn’t calm me down enough to sleep.
I was still caring for the baby mechanically while being mentally distant. One Friday after a difficult week, I knew my husband would come home from work soon. I had spent the whole week thinking that I would just need to try to make it until the weekend. The baby started crying that afternoon. I lifted her up and I started to cry too. I was shaking so much that I had to put her down on the floor so that she wouldn’t fall. The baby got uneasy and just cried out loud while I was crying next to her without being able to look at her. We were both crying desperately. It lasted for a long time and I remember feeling like I was dying right there. I thought I couldn’t take care of the baby a moment longer.
My husband came back home that evening and promised to take care of the baby that night so that I could sleep. I was tossing and turning in my bed at night thinking that we lived on the 4th floor: I wouldn’t necessarily die if I jumped from the balcony but only get injured. It was the only thing I thought the whole night. I couldn’t do it anymore and I just wanted everything to end. I still didn’t sleep. In the morning I was sitting in front of my computer and I started crying. I was crying about everything: I had not been able to give birth, breastfeed, to be a balanced mum or to sleep. I just wanted to go away, to jump from the balcony.
Part of me was sad about the thought and I thought about the loved ones who I would leave behind. Yet I was so distressed that I was ready to try anything to end the misery. The distress also had physical effects: my heart rate was sky-high, I was breathless and sweating even without doing anything. All my limbs were numb, I was alternating between feeling cold and hot: just like when you are feverish and delirious.
I couldn’t stop crying. My husband called the health centre emergency service. They referred us to the hospital emergency service. We drove there with the baby. I watched every balcony from the car window and I wanted to go and jump. I was crying and I looked at the baby who would look back somewhat reassured. I hated myself for not being able to return the look, instead I turned my head away.
In the hospital I was finally being heard. The doctor discussed the situation with me and said I could come in or try being at home with medication. Only then she spoke about postpartum depression and told me it was quite a common condition for mums. I calmed down a bit and the psychiatric nurse assured me that I could always come to the emergency unit if I felt distressed. This was an important fact that stayed in my mind: that I could go home with a peaceful mind. I was so relieved to know that I could go to the emergency unit, because the distress was so scary and intense in the dark hours of the night.
The inner me, however, didn’t want to jump from the balcony. I wanted help for my distress. This was the start of a fast recovery. I was prescribed antidepressants and their use was monitored during the health centre visits. I went to psychologist consultations at the maternity clinic. Luckily the doctor and psychologist were both empathetic and understood me.
Moreover, I started to exercise and it gave me new energy. I got to know a neighbour who was also at home with a baby. These were important things for the recovery.
We went through everything later in the psychotherapy sessions when I was expecting my second child. I learned that I was susceptible to depression, perfectionism and got easily stressed. I live with it and try to keep my mind healthy. I’ve managed to do that thanks to better self-knowledge, and I feel that this experience has strengthened me. I don’t know what would have happened if I hadn’t got help. The feeling of being listened to was crucial in terms of recovering.
Currently I’m studying for a new profession and I hope that one day I can help others in need.
– Glass Sun –
Mother’s story: postpartum depression
”I was afraid that my roommate would change the babies”
My husband and I had been hoping to have a baby for a long time, and I finally became pregnant with some help from the Family Federation of Finland. The pregnancy was therefore a dream come true. I was happy about my growing belly and looking forward to maternity leave. However, slight fear and disbelief overshadowed the pregnancy period. I was also diagnosed with gestational diabetes which led to a new diet. I wanted to do everything right so that there wouldn’t be consequences for the baby. I was continuously wondering if everything would go well until the end, if this was true or not, if we were really going to have a baby.
Some relatives warned me about the big life changes to come, which sounded strange as I only felt positive about the future. I read a short leaflet about postpartum depression. I thought depression would only affect those who had had other psychological illnesses, or when the parents did not wish to have a baby. I knew very little.
The emergency caesarean section was a relief as I was tired, but a doom at the same time. When I finally managed to get pregnant my body couldn’t get the baby out. The caesarean section went well, and I had a glimpse of the lovely baby before he was taken into his father’s care.
I was soon taken to the maternity department with my baby and husband. The baby was lovely and the painkillers worked. In the evening my husband had to leave the department and I was left alone with the baby. I tried to breastfeed, but the baby couldn’t feed much and cried heart-brokenly. The baby slept during the day and was restless during the night. The baby’s weight dropped too much and the feeding weight checks were started; I had to do them myself and record the results with volumes and times, even at night.
I couldn’t sleep because the baby was crying and wanted to feed all night. He calmed down only by hearing the humming sound of the fridge in the break room, so I spent long weary times at night next to the fridge. Finally, the nurses took the baby to sleep next to the offices and gave him additional milk. In the meantime, I was however unable to sleep because I was worried about the baby crying and feared that I would be unable to recognise my baby among all the other babies.
The next day my baby was satisfied as usual and my roommate (probably to cheer me up) laughed while saying “You are lucky to have such a peaceful baby, shall we change?” This triggered a fear reaction in me; I was afraid that my roommate would really change our babies even though I knew it was absurd.
While being afraid and crying I was sending my husband texts at night saying that I was afraid my roommate would take our baby and I was afraid to close my eyes. My husband tried to calm me down as best he could and came to see me and our baby again in the morning. The baby’s weight increased and we were finally discharged. The time at the maternity department was distressing and I was more than happy to go home.
Everything went well at home during the paternity leave, breastfeeding was established and we could all sleep. When my husband went back to work I started to get distressed again. The baby was sleeping at night, but had a hard time to sleep during the day. The baby’s lack of rhythm and the unpredictability of daily life made me passive, while at the same time it kept me constantly on standby to meet the baby’s needs. The cry of the baby seemed like an echo in my head and wouldn’t leave me alone, even though the baby was happily asleep.
I couldn’t find a moment to cook for myself or sometimes even to get dressed. The baby didn’t want to stay alone for a moment and his weight began to fall even though breastfeeding was going well. We started the feeding weight checks again at the request of the maternity clinic and additional milk was recommended. The baby wouldn’t feed from a bottle and I wasn’t keen to start feeding him from the bottle. I had read about the benefits of breastfeeding and didn’t want to let it go.
I started to dread the next day and got distressed in the evenings. At night I was worried about the baby waking up wanting a feed and whether I would be able to feed him. In the early morning I was tense about the baby waking up and wondering how long the day would be. In the morning I watched tearfully from the window as my husband left for work.
The days went slowly, but we made it. The baby was lovely but demanding. I tried to force myself to form a strong attachment and to smile at the baby, even if it was forced, as I knew it was important. I was feeling terrible myself, even though everything was supposed to be fine.
I felt more guilty day by day. Why can’t I just enjoy life and be grateful? Why am I so useless? I felt sorry for the baby for having such an unfit mum. At the same time, I felt really lonely and that I was about to be crushed under the responsibility and baby’s needs.
During the day I was usually alone with the baby and my husband sometimes had long days at work. When relatives and old friends visited us, I pretended to be doing well. I had a hard time in the evenings, I cried and got panic attacks. My husband took care of the baby and he was therefore doing well.
A few times I tried to tell the nurse at the maternity clinic about my bad situation, but she said it must be temporary baby blues and talked about medication. It didn’t feel right. I wanted to be heard and seen and I wanted someone trustworthy to convince me that I would make it and that life goes on.
Our family training group got together once a month after the delivery. There one mum spoke openly about being depressed. I had the courage to talk about my bad feelings and I realised I was depressed. I felt better when I got home. Someone else, who seemed sensible, had similar bad feelings to mine.
I was no longer completely alone and I started to look up peer support on the internet. I found it at Äimä ry’s website. I didn’t call the peer support service; the stories of other depressed women gave me huge support already. Later I contacted the mum who had spoken at the family training group and we started visiting each other. This person has been invaluable support for my recovery and after five years we are still friends. I started to talk about my experience very openly to people I knew, even if not everyone wanted to hear about it. I had to talk about it for myself and until nothing bothered me anymore.
Breastfeeding was finally well established and the baby started to make more contact. I started to go out at times to pursue my own hobbies, which strengthened me as a mother. My condition started to ease during the summer about 6 months after the birth, and the days were no longer pure survival.
Nowadays I feel recovered and I’m happy to support other depressed mothers through Äimä. The story of every mother I encounter reminds me of how I longed for support myself and what good luck it was to find it.
On bad days, I fear that the depression will return and wonder what my depression has done to my child. Will he have problems later on in life? I cannot know that, I can only hope for the best.
I’ve stopped feeling guilty about the depression. Without depression I would not be able to understand the fragility of life and the complex human mind, or experience genuine sympathy for other psychologically vulnerable people, and I would not be so grateful for ordinary daily life.
– Sea Wind –
Mother’s story: postpartum psychosis
“I called the police and told them I wouldn’t take care of the baby anymore”
My son was born in happy circumstances, as a baby we wanted. Clinically, the delivery was considered a normal vacuum-assisted delivery. Personally, I was relieved about the vacuum extraction. During the postnatal examination the doctor asked if there was any trauma. “About what?” I replied. “The vacuum extraction? No, in fact it was labour pains… it was impossible to imagine them in advance.” The labour itself lasted about fourteen hours in total, out of which I pushed for nearly a couple of hours. The pushing was the worst experience of my life. My life changed in those two hours and in the shower after the delivery I realised I wouldn’t be the same person anymore. I had now experienced giving birth myself.
We stayed at the maternity department for five days and the time passed almost like a blur. Sometimes I felt as though I were watching the spectacle from somewhere else. I couldn’t believe I had a baby now. My body seemed numbed and nothing but dough in the abdominal area. During the next days I didn’t remember to take a shower, but luckily the nurse told me to freshen up. I had a baby and a labour experience from which I was recovering in a very confused state of mind.
The first days at the maternity hospital were spent learning to breastfeed the baby. I didn’t sleep well at night for a week. I was only wondering how the baby was doing and if everything was all right. Breastfeeding wasn’t simple at the beginning. My breasts started producing milk well only on the fourth day. The maternity hospital supported breastfeeding and the milk supply in every way. I received mother’s milk tea and acupuncture in order to increase the milk supply. Our baby was hungry and we had to give him extra milk.
Despite all this, everything went relatively well for the baby. He was healthy and his weight started to increase once breastfeeding had been established. Breastfeeding seemed then the most important thing for me and I felt that the baby also calmed down. I enjoyed the intimacy during breastfeeding. I breastfed every three hours day and night. Maybe I tried too hard to be a perfect mum.
The fatigue escalated when my husband left for work. I felt so lonely due to our reduced support network. I asked my mum to come and help me but she didn’t have enough energy. I felt that I was left alone with the baby.
I was so tired and exhausted. I told my mum that I couldn’t do it anymore and that I was going mad. She came one day and we managed to talk properly. I had a big need to tell her about the labour pains. However, I felt that I couldn’t share all that fatigue and exhaustion inside me. I didn’t notice in myself any symptoms of having been traumatised.
I felt the need to deal with an old grudge with my sister. I sent her probably hundreds of texts telling her how I felt. She answered in one text “Now you are not yourself, please prioritise baby care, change to disposable nappies, make friends with other mums.”
My mother-in-law told me how birth was supposed to go in her opinion. She also expressed other strong opinions. During the early days with the baby, however, my thoughts about my mother-in-law were excessive, they turned into an unrealistic fear. I started to think she was a genuine threat to our son.
It all culminated when my husband went to see his parents. I felt I was going to burst at home alone with the baby. For instance, I called the police, telling them I wouldn’t take care of the baby anymore and that I was totally exhausted. The ambulance took me to a closed psychiatric ward as the doctor visiting me at home gave me a compulsory treatment referral. Due to fatigue and stress I had acute psychosis and in addition chronic ulcerative colitis.
At night in the psychiatric emergency unit I thought that I would end up in the ward for the rest of my life when I saw an older man walking slowly in the corridor and I started panicking. Six male nurses came around the corner to restrain me by force. I attacked them aggressively. They put me in bed with restraints. There I shouted again and again “You won’t get my baby! You won’t get my baby!” until my voice was hoarse. I thought they were going to take my baby. I cried, I was hysterical and hopeless. In the morning they took me to the closed ward. The first days I refused to stop breastfeeding as it had been my job for the past four months.
I started to recover from the psychosis relatively quickly and the psychotic symptoms decreased quite quickly thanks to the medication and rest. I felt the energy running into me as I could sleep entire nights. I was in the ward for two weeks.
The medication was probably interrupted too soon because the psychosis returned the next year. At that time, I had paranoid thoughts about my husband. I also made vague phone calls to my close relatives and friends, including my sister, to whom I claimed to know that she was a victim of incest, although this is not the case.
At the psychiatric emergency unit, I had said that my husband was a terrorist with a bomb. I tried to get into the office though the reception window to see my papers. They put me in bed with restraints and I calmed down quickly. I got an intravenous sedative. I was in the closed ward for two weeks for a second time. I recovered quickly also this time. The psychotic symptoms decreased at a rapid pace.
Thanks to my son. He gives me a reason to be grateful in life and to live as a high-spirited and happy mother.
– Spring fairy –