With one in 5 women experiencing perinatal anxiety, depression or both, this important mental health issue is finally emerging from the shadows.
Here we talk to an expert, a young mother, and a grandmother to understand how it can impact the life of the wider family, how to spot the signs, and what to do next.
There was little about Kristal MacDonald’s pregnancy that felt good. She was always teary; doctors said it was her hormones. She was anxious. Understandable, they insisted, because she had recently lost a baby from a previous pregnancy.
She also suffered from severe nausea and vomiting that was not so easily dismissed.
The young South Australian was wracked with guilt. What was wrong with her? She should feel joyful! She was carrying her first baby to term.
Even when her daughter arrived after a medically complicated birth, Kristal struggled to bond with her newborn. People assured her it would come, that she would know instinctively what her baby needed. She didn’t. The problems began to mount. She couldn’t breastfeed. The baby was lactose intolerant. She slept poorly. Kristal seemed to be crying constantly.
Over the following 12 weeks, she visited five GPs hoping desperately that one could make sense of her tears and her fears. Finally, she was given a name for her troubles – perinatal anxiety and depression. (Perinatal is the period of time of pregnancy and up to a year after giving birth.)
Kristal was relieved to learn she was not alone. At least one in every five women experience anxiety, depression, or both during pregnancy and often for a year – and sometimes more – after delivery. Some women will also experience what is known as postnatal psychosis, a rare but serious mental health condition that can develop in mothers soon after childbirth, causing major changes in mood and behaviour.
Some groups are more at risk of perinatal anxiety and depression than others. They include LGBTIQA+ parented families, Aboriginal and Torres Strait Islander families, as well as people from diverse cultural or ethnic backgrounds. For many, the fear of discrimination discourages them from ever seeking help.
“Being a parent, new or expecting, is not always great and it is normal to struggle,” explains Julie Borninkhof, CEO of Perinatal Anxiety & Depression Australia (PANDA), an organisation dedicated to supporting the mental health and wellbeing of expecting, new, and growing families.
“There are supports available and we need to normalise accessing them so that people can get help earlier.”
Ms Borninkhof believes there is a cultural view in Australia based on “a warm and fuzzy set of pictures around the joy of parenting”, and while that is so for many, it’s not universal."
It sets people up to feel like failures and carry a sense of shame when they don’t stack up against the cultural norm."Julie Borninkhof, CEO of Perinatal Anxiety & Depression Australia (PANDA)
It’s so important, she says, for expecting and new parents to trust to their gut instinct. “We tend to have a flag that goes off, mentally or physically, when something doesn’t feel right,” she explains.
When you have a baby, however, you are always putting yourself second and that compromises your ability to recognise the flags.".Julie Borninkhof, CEO of Perinatal Anxiety & Depression Australia (PANDA)
Frances Pegrem, a woman who raised seven children of her own, saw no signs of the difficulties to come when she visited her daughter shortly after she had given birth to her first child.
However, the grandmother received a call saying only, ‘please come back’. Frances was alarmed enough by the urgency in her daughter’s voice to fly to Melbourne immediately. “She had totally stopped speaking,” Frances explains. “She couldn’t feed the baby. It was such a shock to see a capable young woman in that state.”
Her pregnancy and birth had been normal. There was no history of mental issues. By the time of her first pregnancy, she had a successful career as a psychologist so the diagnosis of postnatal psychosis took the family by surprise.
Frances recalls that her daughter’s spiral into postnatal psychosis was as fast as it was sudden. Her withdrawal was frightening. “She thought everyone was plotting against her. She felt she didn’t dare speak.”
A mental health team supported her daughter on her journey back to better health.
It was heart-breaking because she’s such a lively, outgoing girl. She slept with me for a while. By the time I left six weeks later, she was recovering well. The medication helped and she was able to sleep again.“Frances
Unlike postnatal psychosis, perinatal anxiety and depression is far more common. The causes of perinatal anxiety and depression are believed to be a combination of genetic and environmental factors. Symptoms include sleep disturbance, not being able to eat, over-eating, or over-thinking things.
“Some of that can be normal,” explains Ms Borninkhof. “But what we do see is a compound experience of pulling away from things that make you feel normal – not engaging with friends, music, entertainment, and self-care.
“Withdrawal and disengagement are big markers.”
Telling the difference between anxiety and depression can sometimes be difficult. “For some, anxiety can be sitting with racing thoughts, feeling wound up like a rubber band, and not knowing how to escape this feeling of constant tummy churning.”
“The person with depression feels flat and perhaps hopeless and helpless – some liken it to feeling like a deflated balloon hanging on a wall after a party, as life goes on around them.”
She believes that family members have an important role to play in supporting these expecting or new mothers. “People often feel they don’t have the language or understanding to say, ‘this is what I see happening’.
“It doesn’t matter if you can’t name or fix it. Go on the journey of having a conversation to say, ‘looks like something is going on. What can I do to help?
“Don’t label it as ‘struggling’. Be mindful not to increase feelings of failure or stigma. We always encourage partners or grand[parents] who see that something is happening to engage with resources that are available.”
She believes the most important message for expecting or new parents to is let someone know if you are having difficulties. “That has to be the first step,” she says. “Reach out to a helpline like PANDA’s where you just have to pick up the phone and if you have concerns, you can even stay anonymous.
“Otherwise talk to your GP or your maternal health nurse or a psychologist.”
There are many days when Kristal wishes she had been more aware of perinatal anxiety and depression. But her journey has been one of learning.
“A woman’s power of intuition should never be under-estimated,” she says. “[Pregnancy is] a time when we are vulnerable but when someone sits opposite you and says things are not happening when you know they are, it impacts your confidence.
“Women need to be reminded to trust their gut instinct because it’s there to protect them.”
Pregnancy and motherhood are significant life changers, she says. “It’s an enormous shock to the system no matter how prepared you are for motherhood."
In this sort of situation, you must be guided by the woman having the experience. Ask her what she needs. With my daughter, we didn’t talk much. I just bought some wool, knitted, and just sat with her."Frances
Jean Hailes has partnered with two of Australia’s leading perinatal mental health organisations - PANDA and Gidget Foundation Australia - to support new mums.
All images are stock images.