Strategies that work

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.

Recognise 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)