Having a baby is a major event in any woman's life and this is particularly so in the case of a first baby. Motherhood is an exciting and wonderful experience.

The majority of women (85%) get through pregnancy, childbirth and the year that follows, without any major psychological difficulties. The emotional upset following delivery ranges from the very common, mild and short lived `baby blues', through postnatal depression, to the more serious but rare condition, puerperal psychosis.

The main thing to remember is that if you have postnatal depression don’t despair: it is treatable and you will make a full recovery.

The first days after childbirth

The ‘Pinks’ - For the first three days or so after giving birth most women, although tired, experience a ‘high’. They feel happy and excited about the baby and they may experience difficulties sleeping. This period is sometimes referred to as the ‘Pinks’. A minority of women experience a feeling of anti-climax after the birth and some even dislike their new baby initially, which can be very distressing. Generally all these feelings pass in a matter of days.

The ‘Baby Blues’ - Around the third day, the happy period ends abruptly and for some 60% of women the `Baby Blues' are experienced. The ‘Blues’ are characterised by emotional mood swings, which oscillate from feeling sad to happy and back again. Most women at this time find they cry easily at the least thing and can feel very irritable. The ‘Baby Blues’ are generally attributable to marked hormonal changes that are occurring around this time. Hormones such as progesterone and oestrogen, which were at very high levels during pregnancy, suddenly drop and at the same time, a steroid hormone called prolactin is on the increase.

At around this time the milk ‘comes in’. The breasts tend to be full and painful and there may be anxieties about establishing feeding.

The ‘Blues’ do not last. Most women experience them for just 1-2 days. Even when more severe, the ‘Blues’ resolve within 10 days of delivery. As such they can be regarded as a normal reaction and do not require any treatment. However, it is important for family and friends alike to recognise the symptoms when they occur and offer reassurance and support to the mother.

The first weeks after childbirth
During the 6-8 weeks after childbirth new mothers return to normal, both physically and emotionally. Full emotional recovery may not occur until the baby and mother are sleeping through the night, thus allowing for some kind of routine. As such, mothers who breastfeed may take longer to recover emotionally than mothers who do not.

It is a general characteristic of this period that mothers tend to be very easily upset and are over sensitive. New mothers in particular can be over anxious with regard to the baby's health and their own wellbeing. Some women experience very transient feelings of sadness or guilt during this time, others experience a sense of unreality and strangeness, sometimes even wondering if the new baby is really theirs.

Above all, in the early weeks, it is very common to feel overwhelming exhaustion and many of the symptoms described probably arise out of fatigue. Dealing with all the emotions and also the practical issues arising from having a new baby, can take its toll.

Postnatal depression
There are two types of ‘postnatal depression’. The first type is called postnatal depression and it refers to a less severe form of depression. The second type is more often referred to as puerperal psychosis and it is a major form of depression that is biological in nature. Both of these types of depression are quite different in their cause and, therefore treatment is different.

The symptoms of postnatal depression generally start some weeks after the baby is born. Approximately 15% of women are affected. Feelings of tiredness, irritability and anxiety are common. Definite feelings of sadness and unhappiness are less common. As a result, many women suffer from the condition without recognising it and do not seek help. They assume that what they are experiencing is due to being tired from coping with the new baby and perhaps other children, or having interrupted sleep due to the baby crying.

Symptoms include:
- Feeling tired and finding everything an effort.
- Worrying excessively over the baby, for example, constantly checking on baby.
- Finding it hard to cope with even minor day-to-day mishaps. Finding it hard to concentrate and, as a result, being more forgetful.
- Feeling tense and nervous much of the time.
- Being panicky for no good reason.
- Feelings of sadness and a tendency to cry easily.
- Feelings of inadequacy, feeling `no good'.
- Not wanting to be alone.
- No interest in sex.

The condition generally starts within six weeks of giving birth and it lasts in or around three months. This is its natural history without any treatment or intervention. Postnatal depression almost invariably has disappeared of its own accord by the time the baby is a year old or usually, much earlier.

Postnatal depression can happen to anyone. Women who are most at risk of developing it are women who have a poor relationship with their husbands. Examples of this would be lack of support, be it practical or emotional, or overt disharmony. Also at risk are women who have had psychological problems in the past of one kind or another. As such, women who have vulnerable personalities are at risk of postnatal depression because they are likely to have difficulty adjusting to the demands of a new baby.

Treatment of postnatal depression
Postnatal depression can be successfully treated by individual counselling or group psychotherapy. Regular group support sessions appear to be successful both in treating and in preventing postnatal depression by providing information, practical advice and emotional support. Medication does not have a major role to play in postnatal depression although some medication in the short-term may be helpful to alleviate certain symptoms such as inability to go to sleep.

It is important that women and their families are aware of the symptoms and seek help early rather than allow it drag on for months.

Coping with postnatal depression
To cope well with a new baby, it is very important to try and ensure sufficient rest. Ideally, a partner should look after the baby on alternate nights to allow a good night's sleep at least every second night. If a baby sleeps by day, the mother should rest during these periods rather than take the opportunity of trying to catch up with household chores, thus tiring herself out still further.

It is important to accept practical help from others, rather than trying to be `Superwoman'. Having regular breaks from the baby helps. Allowing someone else babysit to allow for a trip to the hairdressers or perhaps an evening out also helps. If a mother is worried or anxious about the baby or herself, it is very important that she confides in her partner or family about these worries and if necessary, seeks expert advice from a health care professional rather than allowing worries get `bottled up'.

DO
Get adequate rest
Eat a balanced diet
Talk over any worries or anxieties with someone close to you.
Accept practical help from others.
Involve your partner in looking after baby.
Get some fresh air and exercise every day if you can.
Take a break at least once a week such as a trip to hairdresser or visit to friends.
Avoid any extra pressures.
Avoid people or situations that upset you.

DON'T
Bottle things up.
Get over-tired.
Try to do everything.
Refuse help.
Isolate yourself from others.
Feel you have to be the perfect mother.
Avoid getting help if you are feeling low.

Remember, postnatal depression does not last forever. It lasts weeks rather than months, and complete recovery is the rule.

Does antenatal depression exist?
Yes, it does. We tend to associate pregnancy with both physical and emotional wellbeing, but the evidence is that in the first three months of pregnancy, at least up to 10% of women become depressed. This is particularly so if they are currently having marital difficulties or having doubts about having a baby. Women who have had abortions in the past sometimes go through a depressive patch when they become pregnant again. Most of these depressive symptoms clear as the pregnancy progresses. There is no direct association between antenatal and postnatal depression, although marital disharmony is common to both.

Advice for families:
Try to be patient.
Try to understand.
Find out all you can about postnatal depression.
Remember, postnatal depression will pass.
Be as helpful as you can in both practical ways and in giving emotional support.
Remember, it is helpful for a mother to talk about her worries and fears.
Allow her time to talk. Postnatal depression is a treatable condition - encourage her to seek help and follow advice.
Give reassurance. Depression is a frightening experience for anyone. It helps to be reminded that all will be soon well again.

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