Do you know someone with PND/PPD? The answer is ‘yes’

Around 10-15% of women who give birth experience postnatal depression, so if you know more than eight women who are mothers, you probably know someone who has been through it – whether she knew that’s what it was or not.

Here are two facts you need to know about postnatal depression (known in North America as postpartum depression): it’s mostly hidden, and it can have an enormous impact on entire families.

Isn’t that a sad combination? Postnatal depression is often the worst, most traumatic thing that has ever happened to a person, and they’re likely to keep it a secret.

Any person who wants to be a good citizen, a good friend and neighbour, can make a real difference to society as well as to an individual and family, by getting equipped to support someone with PND/PPD. Think of the ideas in this post as a bit like doing a course in CPR: you’re upskilling so you can be useful in an emergency, in a way that saves lives.

Almost everything that follows is transferable to other support situations, too. If you know someone who is going through grief, relationship break-up, sudden or chronic illness, unemployment… anyone who needs a bit of extra care will benefit from your skilled kindness.

 

1. Educate yourself about PND/PPD

Postnatal depression – and all its cousins, like antenatal or prenatal depression, postnatal distress, and others – have traditionally been stigmatised and therefore hidden.

You may know very little real information about the signs of postnatal depression or how to help someone who is experiencing it. You may not know that there is good treatment available in most places.

One of the best places to go for information is this great New Zealand-based site, written by mental health practitioners: Mothers Matter. Go and have a browse around.

It also includes a list of other (NZ and international) websites and resources and a book list. You could look up the titles in your library’s online catalogue, or ring your local bookshop and see if they can order you something.

There is material especially for fathers here.

Here is a list of signs and symptoms of postnatal depression, from Mothers Matter:

• Feeling anxious, sense of panic
• No sense of enjoyment
• Feeling grumpy, irritable or angry
• Tearful or sad
• Feeling overwhelmed (everything is too much)
• Tiredness
• No motivation
• Can’t think clearly, poor memory and concentration
• Can’t make decisions
• Worry a lot
• Negative thinking
• Scary thoughts
• Suicidal thoughts
• Trouble sleeping
• Appetite changes
• Body aches and pains and headaches
• Feeling hot and cold or “flu” like
• Loss of sexual interest
• Not looking forward to things

[Read more at Mothers Matter.]

If you are concerned that a friend or family member may be suffering from postnatal depression or other maternal mental health troubles without realising it, here’s how you can help:

1. Research the local support networks. Is there a Maternal or Perinatal Mental Health Service in your area (‘perinatal’ means ‘around birth’, so includes both before and after a child is born)? If so, usually a midwife or GP can refer a patient, or your friend may be able to self-refer. Find the phone number if so. (New Zealand services are listed here; United Kingdom services, here. Otherwise search online for phrases like ‘maternal mental health service’ or ‘perinatal mental health service’ and your area).
2. Print out a factsheet or collect a brochure from your GP to show your friend, or your friend’s partner or other supportive person. Have a link to the Mothers Matter website handy.
3. Gently ask – either your friend or their partner or supporter – if everything is going all right. Here’s a possible script:‘Is everything okay? I’ve noticed that you don’t seem quite yourself. I know it’s pretty common for new parents to develop postnatal depression, and I wondered if it might be a good idea to talk with your midwife/GP/Plunket nurse/Health Visitor about it?’
4.  You could also suggest filling out this online questionnaire, the Edinburgh Postnatal Depression Scale, which is used by health professionals to screen for postnatal depression.
5. Offer to go along to an appointment with your friend, or to make the phone call, if that would be helpful.

2. Be ready for your friend to be different

Part of this education is realising that postnatal depression might make your friend a pretty different person from who you’re used to hanging out with.

Not only is there a new baby in the mix, with all the reprioritising that goes along with this new season of life, but like any mental health trouble, postnatal depression can cause small or large personality changes.

Some examples from my own experience of postnatal depression (you can click on the links to read more from me):

I went from being an extraverted people person to feeling overwhelmed by conversation or more than a couple of people in a room.

I went from being a confident problem-solver to an anxious, damp puddle on the sofa.

I stopped enjoying things. Have you heard of anhedonia?

I lost resilience. One or two small setbacks could have me in tears.

And I went from an unflinching debater of ideas and consumer of news media and crime fiction to feeling like I was wearing no skin, and any small emotional disturbance could rub me raw. I didn’t follow the news for a couple of years – too many sad stories. And I never clicked on a link about someone else’s sad story of someone dying of cancer or losing a child. It would have finished me off. I still don’t read murder mysteries anymore.

People’s experiences of perinatal mental illness differ widely, of course. Keep your eyes open for what’s going on for your friend, and try not to assume they’ll be quite how they were before.

Be gentle with them, and get to know them as they are now.

3. Ask (rather than assume) what would help most

Maybe you’d like to drop a meal off, but in fact, allergies in the family mean that that’s more stressful than helpful. Maybe you want to take the baby for a walk but anxiety about the weather or separation makes that not such a great offer.

So start off by asking what would be most use:

‘I really want to do something useful. What would be best? Meals, housework, babysitting, hugs?’

Whom should you ask? Each situation will be different, so use your judgement.

Consider starting either with your friend, if you’re close enough to get a genuine answer (not a polite refusal) and not to cause extra stress, or with their partner, or perhaps someone slightly more removed, like your friend’s parents, in-laws, siblings, or best mates, who might be able to give you an objective answer about what will be most useful.

4. Bring some food over

Offering help with meals gets special mention.

Cooking is very difficult to manage with a new baby, or ill health. Combine those two things and add in the increased nutritional needs of breastfeeding mothers and you will be remembered forever if you bring something over.

Try to make sure you are offering a meal that will suit the circumstances, in terms of timing and content:

‘I’d like to bring a meal around so you don’t have to cook.  Should it be for the freezer, or for tonight?’

‘What are three of your family’s favourite meals?’

‘Is there anything that you prefer not to eat or can’t eat at the moment?’

You could also set up a ‘meal train‘ (free online meal coordination) to make it easy for a bunch of people to pitch in.

For more detailed tips on cooking for new parents, check out these great posts:

Tips and recipes divided by dietary needs and preferences from Rachel Cooks.

Cooking for New Parents from Naptime

Advice and recipes from Kitchn

A BBC collection of freeze-ahead recipes for new parents

My post on lactation cookies: nutritious snacks for breastfeeding mums (and pretty much anyone)

(And you might also want to check out Bellyful, a charity that delivers free meals for new parents, and make a donation and/or request a meal for your friend)

A last word about how this might be different for families dealing with postnatal depression: I didn’t resume cooking for my family regularly until for at least a year after my baby was born. I just wasn’t well enough to manage it: meal planning, grocery shopping and food preparation just took too much brain space. I didn’t have the spoons.

So for your friends with postnatal depression (and in plenty of other circumstances), you may like to keep offering meals well beyond the newborn season.

 

I don’t take advertising or sponsorship for anything on Sacraparental. A new way you can give me time to write this kind of article is through Patreon. Come on over and have a look – you even get some behind-the-scenes stuff 🙂

5. Offer help in a way it can be easily accepted

Are you good at accepting offers of help? What about asking for help? No, probably not. Most people with postnatal depression find those things particularly difficult.

Health professionals have said to me that high-achieving women seem particularly susceptible to postnatal depression – and they’re definitely a group that aren’t used to asking for help, or admitting they need it.

So offer your help with these magic words.

Instead of an open-ended ‘Do you need anything?’ or ‘Can I do anything to help?’ which can easily be turned down out of politeness or a desire to appear more together than they are, go for something much more specific that shows you are genuine, and helps your friend save face.

‘I’m stopping in at the shops on the way over. What can I pick up for you?’ rather than, ‘Do you need anything at the shops?’

Do you see what we’re doing here? Your friend doesn’t need to figure out how to admit she is out of bread and apples and ask for help getting them. She doesn’t need to worry that she’s putting you out. She just needs to say the words ‘bread and apples, please’.

You could even make them feel like they are doing you a favour rather than the other way around.

Here’s one that my friend Karen said to me when I was at my worst: ‘I really enjoy doing dishes/playing with toddlers/mowing lawns.  Can I please do these/take her to the playground/come around on Wednesday to do yours?’

‘Can I take the baby out for a walk for an hour or two while you do whatever you want to do?’ A parent of a new baby often feels like they have no time for anything, and it’s hard to know what to prioritise. It’s also hard to choose putting up baby photos on Facebook – which might actually be a really healthy, socially connecting thing to spend time on – if you feel like you’re supposed to be doing housework or sleeping whenever you get a break.

For some more practical ideas on the kinds of things that might be helpful for families with a newish baby, you could also check out:

Code Name Mama

A great list from Mother Mag

6. Support good sleep

Sleep deprivation is a huge component of depression and is tough for any parent, however well they are feeling. For someone you know well, you might like to make this offer:

‘It’s so hard to get enough sleep, isn’t it. What I’d really like to do is put lovely new fresh sheets on your bed, tuck you up in it and take the baby for a long walk. Could I please do that?’

Other ways you can help your friend get enough/more sleep:

• Pass on this factsheet for tips on ‘sleep hygiene’
• If you’re really keen, and close to the family, offer to sleep over once or twice a week and help with the night feeding routine if that would make a difference.
• Offer to come over first thing in the morning. Often babies are up very early (between 5am and 7am) but then go back to sleep an hour or two later. This could be a great time for a mother to go back to bed and get another hour or two’s sleep if you’re around to listen out for the baby – or put bubs in a frontpack or pushchair for that period.
• Once the early newborn phase has passed and the family has a bit more breathing space, you could offer to work through these steps to make a get-more-sleep plan.
• Regularly offer to take the baby for an hour or two. If your friend knew she could rely on a once-a-week catch-up nap while you were on duty, that might be enough to make a difference.

 

7. If you are a good listener

If you know you are a good listener and are ready to hear whatever comes, here are some things you could usefully say:

‘If you’d ever like to talk about how things are going, I’m here to listen.’

‘Is motherhood/fatherhood turning out how you expected?’

If you have the capacity to make one of these offers:

‘A new baby can be hard work.  You can call me any time of the day or night.  You are not alone in this.’

‘You guys are used to being pretty on top of things. You don’t have to be, though, with us. You can always come to us on a bad day.’

Friends said those things to us when we were new parents and they were God-sent words of life and love.

(If you’d like to upskill, and become a really good listener, you might like to check out these six golden tips.)

8. Pace yourself

Compassion fatigue is a real danger when you are supporting anyone with a chronic illness or with mental health challenges. It may help to realise at the beginning that this is likely to be a season that lasts months or perhaps years.

There might be an initial period where the household needs a lot of extra support – as anyone with a new baby does anyway, right? But after that, have an eye on the future with the kind of support you are offering, and try to make it sustainable.

If you find it distressing or particularly draining to be around your depressed friend a lot, plan to intersperse your keeping-you-company visits with practical help. Drop around a meal or do some gardening to show your love rather than always having serious conversations.

Keep an eye on your own self-care.

9. Be in for the long haul

It is a great blessing you offer if you are able to be a friend who sticks around, and who carries on being the stronger one in the relationship, for a long period.

When everyone’s feeling well, it’s very bad form to be the friend who never calls but always has to be called. But when someone’s depressed (postnatally or otherwise), making that call is often such an Everest. If you can make it your job to take the initiative for the next year or two, you’ll be such a gift of a friend.

As I type this, I have in mind the dear friends – many of them, actually – who still take care of me in big and small ways, almost four years after I first developed perinatal depression. What a gift they have given me.

Thank you for being a friend

Thank you for caring enough about your friend to read this.

May you know the joy and satisfaction of caring for a friend through dark times, and may your friend’s family be forever better off for being surrounded by your care.

What else would you suggest? What has been helpful for you, or what have you observed? Please leave a comment below with your advice. 

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You might also be interested in these related posts:

A series on my experience of postnatal depression

Kathryn’s story of postnatal depression

Jenn’s story of PTSD and childbirth

A step-by-step guide to getting more rest

Tips for becoming a great listener

A post on living in the gap between our expectations and the reality of parenthood