Beyond baby blues: Understanding perinatal depression

"Pregnant or postpartum women who suffer from depression often carry it like a shameful secret," says clinical psychologist Dr Liezel Ferreria. "They don't reach out for help because they fear judgement for what they think will look like their inability to cope. But depression during and after pregnancy is very common."

"My message to every woman in this situation is that you are not defective or a bad mother. You are not to blame for, or at fault for developing perinatal depression. You deserve to receive help and support so that your mothering journey can be more fulfilling and easier to navigate. Don't try and get better alone and push through while you become more depleted. Rather use the mental health support resources available to you when you ask for help, and start feeling stronger and healthier. The sooner you can get the support you need, the better the outcomes for you, your baby and the rest of your family."

What is perinatal depression?

If you've developed depression during or after your pregnancy, you're not alone. Research shows that 21 to 50% of women in South Africa are affected by perinatal depression.

"Perinatal depression refers to a woman developing symptoms of a major depressive disorder during pregnancy or within four weeks of giving birth," explains Dr Ferreira. "Untreated perinatal depression can continue well beyond the first year postpartum."

"In the past there was a lot of focus on postpartum or postnatal depression, which is when a woman develops depression after giving birth. But many mothers develop depression while they are pregnant. In fact, half of postpartum depression cases develop during pregnancy and continue after birth and get progressively worse if left untreated. Untreated and unmanaged perinatal depression can have a significant impact on a mother, her child, and the family."

What's the difference between perinatal depression and the baby blues?

"'Baby blues' are common among new mothers due to dramatic hormonal changes after birth. Moms may experience fluctuating moods, fatigue, tearfulness, irritability and anxiety," says Dr Ferreira.

"However, the symptoms of baby blues are mild. Mothers can continue to take care of themselves and their baby and do not usually experience suicidal thoughts. The baby blues normally resolve without any intervention within 10 to 14 days after birth. Perinatal depression lasts for longer than two weeks and symptoms are more severe than those experienced with the baby blues."

Who is most at risk of developing perinatal depression?

There isn't one single cause of perinatal depression. The condition can affect any pregnant or postpartum woman. Fathers and people who become parents through other avenues (like surrogacy or adoption) can also develop perinatal depression. Biological, psychological and social factors or an interplay of these play a role in a person's likelihood to develop depression (or to be protected from it). These include:

• Biological factors such as your genetic make-up, living with one or more chronic illness, fertility challenges, previous miscarriages or stillbirth, a traumatic birth or unexpected changes to the birth plan, premature birth, and pain.
• Psychological factors like a pre-existing mental health condition, a family history of mental illness, the mother's age (teenage mothers and mothers who are in their late 30s and older), unplanned pregnancy, or the trauma of a newborn medical emergency.
• Social factors such as problem's in the couple's relationship, whether both parents wanted children or not, life circumstances like moving home during this time, job loss, financial stress, difficult living conditions, the number of other children or people the mom needs to care for, having two babies relatively close in age who are both very dependent on the mother, or having children with special needs.

Symptoms of perinatal depression

Perinatal depression has the same symptoms as major depressive disorder, including:

• Depressed mood
• Loss of energy
• Loss of interest in activities you once enjoyed
• Sleep difficulties
• Appetite or weight changes over and above what is healthy during and after pregnancy
• Poor concentration
• Feelings of worthlessness, guilt and hopelessness
• Anxiety
• Panic attacks
• Being constantly fearful, tearful and overly sensitive
• Agitation, irritability, feeling out of control
• Lack of confidence, poor self esteem
• Being terrified of being alone
• Feeling overwhelmed
• Suicidal thoughts

Untreated perinatal depression could impact both mom and baby

"Depression often leads to feelings of vulnerability, loneliness and helplessness, which could prevent the mother from seeking help or support. Perinatal depression that is left untreated can have significant negative impacts. For example, during pregnancy untreated depression could contribute to delayed foetal development, higher incidence of prematurity and low birth weight, and an increased rate of perinatal complications."

"The impact of perinatal depression isn't only experienced by the mother, but spills over into the family as a whole. Mothers who are depressed may lose interest in daily activities or interpersonal relations. They may become withdrawn and isolate themselves, experience problems with regards to emotional and physical intimacy, and find it difficult to give or receive support or to create a nurturing environment for their baby. The mother could struggle to bond with her baby and experience breastfeeding difficulties. She is also likely to neglect self-care, fuelling her depletion and inability to care for baby or carry out her daily activities. For baby, in the long-term, that lack of an upfront secure attachment can lead a child to have poor psychological, cognitive, behavioural and emotional development outcomes."

There is help for perinatal depression

"It is very important that moms experiencing perinatal depression seek treatment. A mom with mild symptoms can reach out to a psychologist. The psychologist can refer the mother for psychiatric treatment if necessary."

- Discovery Health Medical Scheme members are covered for up to two mental health consultations with a GP, gynaecologist or psychologist once they have activated their maternity benefit.

- Ask a GP, psychologist or psychiatrist about accessing our internet-based cognitive behavioural therapy (iCBT) benefit . Our partnership with SilverCloud provides members with an online course clinically proven to reduce symptoms of depression, worry and stress, with the added support of being able to access mental health care on your device, anytime and from anywhere.

- Contact the South Africa Depression and Anxiety Group 's helpline on 0800 567 567 for mental health support or to access the suicide crisis helpline.

"Combining psychotherapy and psychiatric medicine is most effective for treating severe depression."

- There is medicine that is safe for use during pregnancy and breastfeeding. Consult a GP or psychiatrist with a special interest in perinatal depression for guidance on which medicines you can use.

- Ask your Premier Plus GP or psychologist on our network to enrol you on our Mental Health Care Programme for further mental health care and access to additional benefits like GP consultations, psychotherapy, internet-based cognitive behavioural therapy (iCBT), and anti-depressant coverage.

Not sure where you stand? Complete the Patient Health Questionnaire-9 on the Discovery Health App to assess the severity of your depression symptoms and get further access to mental health benefits where appropriate.

Dr Ferreira also recommends that mothers take care of their overall health and have a strong support system in place during pregnancy and after birth.

"Good holistic selfcare is important to mental health throughout our lives, but especially when a woman is pregnant or postpartum and vulnerable to developing mental health problems. Pregnant or postpartum women need to prioritise healthy eating, exercise, sleep quality and quantity and making time for doing what they enjoy."

"There is also a strong association between poor support and depression, while good quality relationships and social support could be protective factors. Mothers should not feel shy to reach out for help and support from extended family members, friends and community groups. The health and strength of a couple's relationship is crucial in this life stage too. Couples can consider going for counselling during pregnancy to strengthen the relationship and prepare for the parenting journey - and not only in the case of baby number one, as each child adds degrees of pressure to the family context."

Life changes like pregnancy can be challenging, Discovery Health Medical Scheme is here to support you and your mental wellbeing through it all.

- Read about DHMS member, Toni Cowen's experience of perinatal depression.

- Find more mental health resources on our Discovery Mental Health Information Hub

Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act, and regulated by the Council for Medical Schemes. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.