The baby is born the discomforts of pregnancy are gone; you know that looking after a baby will be hard work and tiring. There will be the feeding day and night, nappies to change, crying to cope with. Yes, crying to cope with, you expect this from the baby but there seems to be a lot of crying from you, what is going on. You should feel happy, everyone says: isn't your baby lovely, aren't you lucky, aren't you happy?.

You don't feel lucky, you don't feel happy. Instead there are feelings of stress, anxiety, confusion, fear and exhaustion. You love your baby, you wanted this baby so much, and you remember how you dreamed of holding them in your arms and preparing for their arrival. In the dream you did not cry, you did not feel alone, nervous and useless.

Post natal depression, no, you can't have that, you wanted this baby, you don't get depression, no that wouldn't happen to you. Then you start to cry again. No one plans to get PND; no one wants to get it. It is not your fault, it does not make you a bad parent, and it does not mean you don't love your baby.

It can happen to anyone. Brooke Shields, a Hollywood actress, wrote her story on postnatal depression called "Down came the rain". The title is based on the poem "Itsy bitsy spider": "down came the rain and washed the spider out".

Quote from her book: "At first I thought what I was feeling was just exhaustion, but with it came an overriding sense of panic that I had never felt before. Rowan kept crying, and I began to dread the moment when Chris would bring her back to me. I started to experience a sick sensation in my stomach; it was as it a vice were tightening around my chest. Instead of the nervous anxiety that often accompanies panic, a feeling of devastation overcame me. I harldy moved. Sitting on my bed, I let out a deep slow guttural wail."

Brooke also talks about her recovery ending the book with the rest of the poem "out came the sun and dried up all the rain, and itsy bitsy spider went up the spout again".

Most parents have some tearful days, it is hard work looking after a new baby. Sometimes you will feel exhausted and overwhelmed. You may feel you don't get much time to yourself and sometimes feel lonely if you are unable to get out of the house. It is normal to have "bad days" but it is different if "every day is a bad day" then it is important to talk to someone.

If you think you may have PND look at the following list and circle the words that you feel like most of the time.

• Anxious
• Annoyed
• Happy
• Frustrated
• Peaceful
• Lonely
• Resentful
• Weepy
• Guilt
• Joyful
• Shame
• Stressed
• Tired
• Love for your baby
• Despair
• Pleased
• No confidence
• Exhausted
• Angry
• Pride
• Confident
• Fearful
• Numbness

Have you picked all the unhappy and upset words? You may wish to use the Edinburgh Postnatal Depression Scale

With this check the answer that comes closest to how you have felt in the past 7 days, not just how you feel today. Fill it in yourself and then show this to someone close to you or to a health professional such as your Midwife or GP, or complete it with their assistance.

Postnatal depression is an illness that can affect mothers and some fathers. It is not the same as the baby blues or psychosis.

The baby blues is common in approx 75% of women on the 3-4 th day after giving birth. It includes crying, feeling low and anxious. It often doesn't last long.

Postnatal psychosis is an uncommon condition which effects around 1 in 1000 women after giving birth there are often delusions and hostility. This will need psychiatric treatment.

Birth trauma can also cause depression and/or post traumatic stress disorder (PTSD). For more information about this contact Trauma and Birth Stress (TABS): www.tabs.org.nz, email: ptsdtabs@ihug.co.nz.

Postnatal distress (often people prefer to call it distress than depression) which includes sleep deprivation, anxiety, depression, low mood, effects of birth trauma and stressful coinciding life events, happens in approx 20% of women. Severity can vary and for some it lasts a short time and others longer. The sooner it is accepted and talked about the sooner you will feel better.

There are lots of different theories about the cause of postnatal distress/depression. Most of them talk about hormonal imbalance, lack of sleep, lack of support and stress.

The Post and Ante Natal Distress Support Group (Wellington) Inc. http://www.pnd.org.nz/ is a voluntary support group, lists the following as some of the most commonly proposed contributing (predisposing, precipitating, and perpetuating) factors:

• Hormonal and biochemical changes (including thyroid dysfunction).
• Sleep deprivation and physical exhaustion.
• Pregnancy or post-natal recovery complicated by health issues such as hyper-emesis, gestational diabetes, pre-eclampsia, post-partum haemorrhage

• Difficulty conceiving
• History of miscarriage, adoption, death, or other 'loss' of a child (eg. health issues)
• Birth trauma - physical and emotional (sometimes this triggers memories of earlier experiences of abuse/abandonment, even though the trigger itself can seem relatively minor to others)

• Unresolved issues (eg. related to identity, independence, self-worth, control, competence and achievement) from earlier experiences
• Unresolved grief for loss of valued relationships, places, roles, status, health, hopes, lifestyle
• History of trauma and abuse - physical, sexual, emotional - which is unresolved - whether recent, or many years ago

• Previous or existing mental health issues - including eating disorders, alcohol or drug abuse, depression
• Not feeling ready/wanting to be a mother
• A big negative difference between expectations (of pregnancy, labour and delivery, the baby and parenting) and reality - resulting in a sense of incompetence, dissatisfaction, unwelcome dependence, and loss of control

• Family history of mental health issues
• Unsatisfactory relationship with own mother/father/caregivers - as a child, and/or now
• Current relationship difficulties (with partner, children, family and friends)
• Difficult 'fit' with the baby eg. hard to feed, predict, or comfort; health problems; not liking the baby, or feeling as if the baby doesn't like you?
• No-one to confide in or share with

• Lack of practical and emotional support (from people you feel OK accepting this from)
• Lack of experience with babies/feeling helpless and hopeless as a consequence - especially if there are no parenting models around who you trust and respect
• Feeling as if you don't have the resources available to meet the demands on you (eg. time and energy, support, money, skills and knowledge) - whether actual or perceived
• Stressful life events/circumstances with negative consequences

• A society that devalues and disempowers mothers in many ways, but also seems to expect them to be able to manage everything - often in the absence of sufficient support.
• Pressure to 'achieve' as a parent
• Conflicts between mothering and other roles (eg. work)
• Stigma about expressing difficulty or dissatisfaction with mothering
Cultural differences which result in isolation and disadvantage eg. minority group, refugee, and immigrant experiences.

Taken with permission from The Post & Ante Natal Distress Support Guide, which can be obtained from http://www.pnd.org.nz/

• When in doubt, just take the next small step
• However bad a situation is, it will change.
• Get outside every day.
• Put some laughter and singing into your day.
• Put love and joy into your day, cuddle baby, hug your partner/friends, pamper yourself with a longer shower or bath, and put lovely photos of baby on your cell phone and round the house.
• Find out about relaxation and breathing and do it regularly.
• Notice the thoughts which keep you feeling anxious, sad, down, irritable and guilty and try to substitute them with ones that are more helpful.
• At the end of every dark tunnel there is light but you will need help to get there.
• Talk to someone.

Mental Health Foundation of New Zealand
Email: info@mentalhealth.org.nz
Web: www.mentalhealth.org.nz
More info: PND Brochure

The Post & Ante Natal Distress Support Group (Wellington) Inc. PND Telephone support line: 04 472 3135
Ava