I’m taking a huge guess here – but I’m going out on a limb to say that most new mothers have asked themselves this question at some point in the first few years of becoming a mother.
Welcoming a new baby into the world is an experience like no other. Being a new parent brings a whole gamut of emotions, responsibilities and questions. Many of which we’re completely unprepared for.
But what happens when those emotions, responsibilities and questions become too much? When “unprepared” becomes “unable to cope”?
When does new parent overwhelm become postnatal depression?
Is it just the baby blues? Or is it postnatal depression?
Current statistics tell us that postnatal depression (PND) now affects one in 7 new mothers and one in 20 new fathers. But despite the increased incidence of PND in our society, there still seems to be misunderstanding about what PND actually is and how it is treated.
Beyond the “Baby Blues”
In recent years there’s been an increased awareness of the “Baby Blues”, that short period of time after childbirth in which new Mums can feel exceptionally sad or teary for no apparent reason. This episode generally coincides with the new Mum’s breast milk “coming in” and is primarily hormonal in its cause.
However, postnatal depression shouldn’t be confused with the baby blues, because it is something else entirely.
When feelings of sadness, hopelessness, fear and worry extend beyond a period of a few weeks it can signal that the mum is in fact experiencing postnatal depression.
How do I know if it’s PND?
The difficult thing about diagnosing PND is that the early signs and symptoms are so similar to the general experience of many new mums who may be overwhelmed with their new role as a parent.
Feelings of worry, exhaustion, bouts of tearfulness or irritability, feeling inadequate as a mother, feeling unable to cope, blaming yourself when things go wrong, being overly critical of yourself, decreased sex drive, difficulty concentrating, difficulty sleeping, loss of appetite. The majority of mothers can relate to having felt these emotions as a new mother – but they are also classic symptoms of PND. So how do we know if a Mum is just “going through a rough patch”, as opposed to something more serious?
From a health professional’s perspective, we will do an in-depth interview to help each woman determine whether it’s a case of the “blues” or if it’s actually depression.
What we look out for is these types of issues:
- Difficulty being able to laugh and see the funny side of things
- Decreased ability to look forward to enjoyable activities
- Blaming yourself unnecessarily when things have gone wrong
- Feeling anxious or worried without good reason
- Feeling like things are frequently “getting on top of you”
- Difficulty sleeping or sleeping excessively
- Frequently feeling sad or miserable quite often
- Frequent bouts of crying
- Having thoughts of harming myself of others
In particular, we want to know how long these feelings have been experienced, generally if it’s more than a two week period, the likelihood that it’s actually depression is increased. (although with the last point about thoughts of harm, it’s important to address these, no matter how long they’ve been occurring.
With the early stages of depression there is no definitive test you can take which will answer “yes” or “no” to the question of “do I have postnatal depression?”. Which is why I always encourage anyone who might be worried they have PND to seek support from an experienced and understanding health care worker. They can help women work through these issues above.
I think I could have PND – what do I do now?
In my professional opinion, when it comes to seeking help for PND (even if you’re not sure its PND) , it’s a case of “better safe than sorry”. Seeking support and advice early is always recommended, as the types of interventions generally suggested for a woman with mild PND are the sort of things that would also support any mum who is simply overwhelmed. These might include:
- One to one, or couples counselling
- Relaxation and stress management strategies
- Mindfulness and meditation strategies
- Changes to diet and lifestyle – including sleep and exercise
- Increased practical support around the home
As with many other things in life, PND generally occurs along a continuum. It is rarely black and white. The experience of PND can range from a mild case with the mother experiencing just a few of the common symptoms for a period of a few months, through to extreme PND where a mother may feel exceptionally hopeless and have thoughts of self-harm or suicide. Both examples would be considered depression, they’re just at different levels of intensity.
Many women put off seeking help for PND due to a number of reasons, frequently downplaying or talking themself out of speaking up. “It’s really not that bad”, “I’ll feel better once I get some decent sleep”, “It’ll get better once my baby is older”. These kind of assumptions can delay women from seeking timely support.
We know that early detection and treatment is the best possible course of action for parents who experience PND. If we can recognise the signs early, parents can access the type of support services listed above, and make lifestyle changes straight away. In many cases this can help to prevent the depression from becoming worse. But when PND is left unaddressed for long periods of time, it can escalate rapidly, meaning more intensive treatment options could be required, including the addition of psychiatric care or antidepressant medication.
For anyone concerned that they, or someone they know, might be experiencing PND, the best course of action is to seek support from a health professional. Speaking to your maternal health nurse, midwife, obstetrician, or GP is generally the first step. But you can also feel confident seeking out a counsellor, mental health OT, or psychologist, which in many cases doesn’t require a referral.
For further resources about PND, please visit the following websites:
If you require immediate support, please contact Lifeline on 131 114
Last week I posted a facebook update about C-section scars and asked how many of you had been advised to undertake scar massage following your surgery and healing. I was utterly surprised that not one of you had been given this information. Just as none of the amazing ladies I had spoken with at a presentation recently had either.
So I’ve decided to write a post on the subject. Because I get the feeling this is an issue which is affecting many, many women unknowingly. If you’ve ever had a C-section (or any other type of abdominal/pelvic surgery), if you had a severe perineal tear during birth or if you’ve had gynaecological surgical procedures, such as for endometriosis – then read on!
First post on the subject: What’s an “adhesion”?
This series is all about scar tissue and adhesions, and the impact they can have on your insides! But I’m going to start by talking about hands. Bear with me, it’ll all make sense soon….
I first came across the issue of scar tissue and “adhesions” when I was working in hand therapy. At this time a fair percentage of my clients were angry young men who had punched walls or windows instead of people in acts of displace rage, and had sustained significant traumatic injuries to their hands – a far cry from my current role as a Women’s Health OT! My job back then, as an OT/Hand Therapist was to custom build a thermoplastic hand splint for my client and to develop a rehabilitation program to promote healing, repair, motion, flexibility and strengthening of their hand structures. Part of this was to advise them how to prevent adhesions. In hand therapy adhesions are a big bad. We want to avoid them at all costs, because they can seriously interfere with the functioning of your wrist, hand and fingers. As anyone with opposable thumbs will tell you – that’s pretty important.
Whenever we cut or tear a body tissue, as in a surgical cut or an accidental gash or puncture wound, the body will immediately start to repair itself through the inflammation process and the formation of scar tissue. Now, trust me when I say that scar tissue is a pretty awesome invention – I’m not bad-mouthing it at all. It’s a totally necessary function of our amazing bodies which allows us to repair and put back together parts of our body which have been cut open. Quite important really.
So the primary goal of scar tissue is to close over wounds in the fastest way possible – but left unchecked it will just shoot this scar tissue out everywhere forming messy webs, instead of the nice neat bonds which adhere only to the structures we want them to adhere to.
Do you remember the scene in Spiderman when Tobey MacGuire first realised he could shoot spiderwebs out of his wrists? (Which, btw, is totally gross!) Anyway, he goes a bit cray-cray, shooting webs here, there and everywhere in the privacy of his bedroom – which ends up with spiderwebs soaring all across the room haphazardly, sticking everything together in one big interconnected webby mess.
Yeah. Good one Spidey.
Now, I couldn’t find a screenshot of the scene I’m talking about, so here’s a gratuitous pic of Tobey Maguire without his shirt on instead. You’re welcome.
This is kind of like what scar tissue does inside your body when it’s left to its own devices.
Basically, it goes all Spiderman-in-training on you and shoots little scar tissue tendrils out everywhere. So the scar tissue that is forming within your skin layer might start shooting tendrils down to your underlying muscles – which bonds the skin to the muscles, or it might go further and send tendrils down which attach the muscles to your internal organs – such as your bowel or bladder. This is what we call an “adhesion” when two structures which aren’t supposed to be joined, end up stuck together. This is bad news, because it means that one or more of those structures might not work the way it’s supposed to work from that point on.
Here’s a little activity for you to try. Make a fist a few times with your right hand. See how far tightly you can close that right fist. Now, with your left hand, pinch the skin on the back of the right hand and try to close the right hand into a fist. Notice how you can’t close it as far. Now let go of the skin and see how you can close that fist even further.
This is kind of like what an adhesion does. It attaches the skin to the muscle, which means that we can’t move that muscle through its full range of motion anymore. See why we’re pretty hot on it in hand therapy?
Yeah, yeah Sarah – but what has this got to do with C-section scars??
Clearly, the impact of adhesions is quite obviously demonstrated on our hands, which are designed to move through a wide range of intricate movements. But it’s not so easily demonstrated on our bellies. Which don’t require the same dexterity as our hands. Which is why this so often goes untreated for so many women.
But the fact is, that this very same scar tissue process is happening in our bodies after we have a C-section. And the thing with a C-section is that there are several layers of skin, muscle, organs and fascia involved. All of which are cut and which need to be sewn up separately following the delivery – which is why the stitching up phase is much longer than the incision phase.
So knowing that we have several layers of body tissue all healing and all producing scar tissue at the same time, there’s a very real possibility of abdominal adhesions here. So there you go. Hand therapy to C-sections in quick flick of a surgeon’s scalpel.
Stay tuned for the next instalment, where we’ll talk about the impact scar tissue and adhesions can have on our internal abdominal and pelvic structures, how we can go about prevention adhesion formation and what we can do to reverse any which may have already formed.
Until next time,
Did you know that up to 65 percent of post-natal women will experience lower back pain in the 18 months after giving birth?
Or that 45 percent of all post-natal women will experience incontinence within seven years of pregnancy?
What about the fact that 10 percent of women who experience pelvic girdle pain during pregnancy will continue to have persistent pain for two years or more following delivery?
What do these stats tell us? That post-natal injury is normal, right?
No – it just tells us that it’s common. But common does not necessarily mean normal.
What I’m talking about here is not just an issue of semantics. It’s more an issue of acceptance, attitudes and belief.
The post-natal period is an extremely vulnerable one for many women – both emotionally and physically. During this time our bodies are recovering from the enormous strain which has been placed on them over the past 40 weeks or so. I’m not just referring to the struggle to get our flat tummy back (mine was never flat to start with!). What I’m talking about is restoring our posture and alignment after several months of having a changed centre of gravity. Allowing our joints, muscles, tendons and ligaments to return to their pre-natal state after being stretched, pulled and pressurised in so many different ways to accommodate our growing baby and our changing body structure. Allowing our hormonal balance to be restored.
This all takes time (did you know it can take up to 500 days for some tissues to fully heal?), and often the body can’t do it on its own. This is when we have the potential to develop what appears to be a chronic injury.
Because it happens so often, society just accepts it as “normal”.
“Oh you’ve got back pain – yeah, that’s just normal after having a baby.”
I say don’t use the word “normal”.
My mission through my private practice and this blog is to encourage women to challenge this notion that postnatal injuries are “normal”. By giving them this label, we are subconsciously telling women that they should just expect these injuries to occur – “It happens to everyone, just get used to it and get on with life.”
Back pain is common – but that doesn’t mean you have to accept it as normal!
Last year during my post-graduate studies I completed a literature review on the incidence of soft tissue injuries among post-natal women. One of the more concerning themes that emerged in my research was the often dismissive nature regarding these injuries – both from the women themselves and also from their treating health professionals. Issues such as back pain, pelvic pain and diastasis recti (abdominal separation) were often considered to be “normal” post-pregnancy states which would eventually improve spontaneously given time – therefore they sometimes weren’t given proper consideration or treatment early in the pre-natal period. This belief is a concern to me. It tells me that health professionals need to be proactive in the physical rehabilitation of post-natal women. Not only to provide early-intervention treatment or referral to other practitioners, but also to educate women on the difference between “common” and “normal” post-natal injury and recovery.
For the vast majority of situations, these injuries can be addressed, overcome and even prevented – with the right support, treatment and advice.
So please, if you are struggling with one of these conditions and have been told – “don’t worry, it’s just normal, it’ll go away eventually”. Don’t accept that. Demand a treatment option. Seek a different practitioner. Find a qualified Women’s Health Occupational Therapist, Women’s Health Physiotherapist, or Women’s Health trained Pilates Instructor.
If you want to work with me here in Adelaide, you can undertake my one to one OT Core Restore program,
Or if you’re from anywhere else around the globe, you can join my five week online Core Floor Restore postnatal wellbeing program.
Addressing injuries early and appropriately will speed up your healing and recovery time. And that will mean you can get back to “normal” much sooner.
Until next time,
ps. Just in case you want the references:
Gustafsson, J. & Nilsson-Wikmar, L. (2007). Influence of specific muscle training on pain, activity limitation and kinesiophobia in women with back pain post-partum – A ‘Single subject research design’. Physiotherapy Research International, 13(1), 18-30. doi: 10.1002/pri.379
Lee, D.G., Lee, L.J. & McLaughlin, L. (2008). Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork & Movement Therapies, 12(4), 333-348.
Vermani, E., Mittal, R. & Weeks, A. (2009). Pelvic Girdle Pain and Low Back Pain in Pregnancy: A Review. Pain Practice, 10(1), 60-71.