‘It can hit everyone’: Postnatal depression is surging, and it’s still misunderstood

Postnatal depression – which affects a minority of both mothers and fathers to newborns – is still under-recognised and under-researched, while Britain’s crumbling healthcare system means more people aren’t getting the help they need. Eloise Hendy speaks to many on the frontline fighting for change

‘Having a baby is so life-changing for both men and women, and we need to talk more about the lows of parenting’ (iStock)

Carolina Mountford suspected something was wrong for months before going to her GP, but fear kept her “trapped in silence”. She was afraid of being judged if she spoke honestly about how overwhelmed and anxious she was feeling. More significantly, she was afraid her baby would be taken away from her. “I had no idea that there was amazing support available in the form of mother and baby units,” she tells me. So she tried to ignore it. But rather than dissipating, her feelings of despair intensified as the months went on. Mountford’s baby turned one, and by the time she did go to her GP, she was in “a desperate and very dark place – I was having suicidal thoughts”. The GP diagnosed her with delayed onset postnatal depression, though Mountford now thinks it was less a case of delayed onset than delayed diagnosis, “due to my inability to seek help, and no one noticing or asking how I was.”

Most new mothers experience what is known as the “baby blues”, as the sudden hormonal and life changes that come with childbirth prompt mood swings, crying spells and difficulty sleeping. Postnatal depression (PND) – also known as postpartum depression – may be mistaken for this at first, but, crucially, the baby blues tend to pass within a fortnight. PND is both more severe and longer lasting. Without support or treatment, it can develop into a debilitating mental disorder that interferes with a parent’s ability to bond with and care for their baby, or handle daily tasks and activities. It can cause panic attacks and suicidal ideation, and even lead a new parent to attempt to harm themselves or their child.

Yet, despite now being recognised by medical and mental health specialists alike as a debilitating condition affecting a significant minority of new parents, PND is also still shrouded in stigma, as well as being under-recognised, under-researched and often misunderstood. As Mountford says, there are specialised support units available for those suffering, but – as with other forms of mental health care, such as eating disorder clinics – these are reserved for people in crisis, and it can be difficult to access early, “non-urgent” treatment.

Meanwhile, other avenues of support are often not signposted sufficiently before and after childbirth, meaning those who might need help are either not aware of their options, or not checked in on by professionals trained to spot early symptoms of PND. If this wasn’t concerning enough, recent research also indicates that cases of PND may be on the rise in the UK.

The research, which was commissioned by women’s nutritional health company Wild Nutrition, and undertaken by Perspectus Global in March, found that 42 per cent of the women surveyed had put themselves under pressure to be “back to normal” 12 weeks after birth. A similar proportion said they in fact felt worried “all the time”, and over a third reported they had suffered from depression. The study found that nearly half of women (42 per cent) feel totally unprepared and unsupported in their first three months as a new parent. Searches for postnatal depression support have also risen by 50 per cent in the last year. All this suggests that for many new mothers the “baby phase” is a time of great difficulty rather than a time of great joy. Worrying as they are, though, these statistics may only be the tip of the iceberg when it comes to the true scale of PND in the UK.

Until fairly recently, postnatal depression was imagined to only affect new mothers, yet in the last few years more attention has been paid to the fact that new fathers can suffer, too. Emma Roberts is a mother and baby coach specialising in PND, and says she is “very aware that PND is on the rise, especially for men”. Over the past year, Roberts has worked with two families where the father experienced severe mental health difficulties after the birth of a child. In one case, the new father’s mental health deteriorated to such an extent that he jumped off a hospital building. Thankfully he survived, Roberts says, but she also notes that, having met the man before he became a father, she “would never have expected that this would happen”.

As this suggests, people who suffer with PND often have no history of mental illness, and no way of predicting how severely becoming a parent might affect them. “Having a baby is so life-changing for both men and women, and we need to talk more about the lows of parenting,” Roberts stresses. She adds that the rise in PND cases is also directly related to staff shortages and lack of funding in the NHS, as well as the after-effects of the pandemic, and the cost of living crisis. “We are not able to get doctors appointments as easily as before,” she says, meaning “women and men are at home suffering on their own with no support”.

All I’d ever heard was how wonderful and magical it is to have a baby, and when I didn’t share that experience, I felt something must be wrong with me

Silke Thistlewood

Natallia Miranchuk is CEO and co-founder of Soula, which provides personalised support and education on pregnancy, childbirth and postpartum for pregnant people, their partners and doulas. “Even though I’m a certified doula and coach, it didn’t help me to escape postpartum depression myself after giving birth to my second child,” she says. “It can hit everyone despite their age, income, or marital status.” Like Roberts, she also emphasises that “some external circumstances, which are uncontrollable, can enhance anxiety and trigger depression during the sensitive postpartum state”. By the end of 2022, for example, Miranchuk notes “plenty of families were hit by the cost of living crisis, mass layoffs, and global political and economic problems”.

Child and adolescent psychotherapist Alison Bruce also pins the surge in postnatal depression on the ways the healthcare system is currently being stretched to breaking point. “The learning curve of new parenthood is extremely steep and anxiety-provoking,” she says. “The adaptation to breastfeeding can be painful and sleep is at a premium.” Yet, with the NHS overloaded and underfunded, the care and support new parents require seems to be lacking. “The move to hybrid working has exacerbated the frequency of postnatal depression cases,” Bruce suggests. This is not simply because it increases the social isolation new parents can feel, but also because it has set up an expectation that everything can now be done remotely. Bruce says many new parents are reporting that, post-Covid, some medical appointments continue to be conducted over the phone or online. “Mothers and newborn babies must be seen in person,” Bruce states plainly. “It is simply not possible to gather all the non-verbal cues that might be indicative of depression via technology”.

Silke Thistlewood suffered from PND and anxiety after the birth of her first child. She admits she “hated the baby phase” and “felt woefully underprepared for the reality of life after birth”. Despite having done everything she could while pregnant to educate herself about caring for a newborn, she spent the majority of her first year as a mother “feeling scared and overwhelmed”. This was compounded by feelings of shame, as she believed she should be feeling happy. “All I’d ever heard was how wonderful and magical it is to have a baby,” she notes, “and when I didn’t share that experience, I felt something must be wrong with me.” As the months went on, she found herself with a “very short temper, feeling tearful all the time and generally losing enjoyment of things”.

“I was able to claw back some control and create a new normal in which I could function by basically moulding my entire life around the needs of the baby”. While she admits this was “exactly as exhausting as it sounds”, Thistlewood says this intense focus was the only thing that kept her anxiety and depression in check. “As time went on the intensity of it all reduced,” she says, “and I was able to carve some time out for myself, and my own thoughts”.

‘We delude ourselves into thinking it’s more efficient to see more postnatal families online’ (iStock)

But then, four years later, she had a second child. Unlike with her first, she was “unable to cater to her every need. That’s what eventually drove me to seek medical help – I didn’t want to be in tears in front of my four-year-old every day”. Antidepressants took the emotional edge off, but “it wasn’t until some time had passed that I felt things eased up and became manageable.” Getting outside every day was vital, and ideally chatting to another grown-up in some capacity. “I remember trekking through heavy snowfall one day with the baby in the sling,” Thistlewood recalls, “just so I could exchange some words with the cashier at the local shop, buying something I didn’t actually need.”

“In hindsight,” Thistlewood adds, “having someone stop in for a few hours a couple of times a week would have been exactly what I needed.” Ultimately, though, she believes “the thing that would have helped most would have been for someone to tell me that it was OK to find motherhood hard.” Years later, she is “still cross” about her experiences. “It shouldn’t take new parents months of ‘muddling through’ to reach a point where they feel their heads are finally above water again.”

Fiona Minett, who experienced severe PND and anxiety after the premature birth of her daughter, says similar. She had experienced mental health difficulties previously, so was “comfortable seeking help”, but emphasises “this was a much more intense experience – a total disconnect and emotional shutdown”. At her GP appointment, she remembers “being asked a lot of questions and filling in a questionnaire to assess if I was a risk to myself or to my child”. Like Thistlewood, she was also prescribed antidepressants. While they helped, she now says she “can’t help but feel that the offer or provision of some personal therapy or counselling to provide space to work through the feelings I was struggling with would have been helpful.” She received no guidance from her GP on alternative resources. “It’s hard enough to put one foot in front of the other every day… the thought of jumping through hoops for support is overwhelming.”

Miranchuk is hopeful things will change, however. “Today people are speaking more openly about postpartum depression,” she says, noting “there are communities and organisations that educate people about how to support friends and family members in a vulnerable emotional state”. Bruce also stresses the importance of community support. “We need to be encouraging new parents to get out into the community with their babies by providing forums for them to do so – platforms that link together the different services [available].”

‘We need to be encouraging new parents to get out into the community with their babies by providing forums for them to do so’ (iStock)

She mentions the Monday morning baby group at Randolph Beresford as one such service that draws from local maternity hospitals, maternity support staff, GP practices and nursery schools. Similar groups can provide a safe space for new parents to meet, discuss, get professional advice and, where needed, seek referrals for follow-up care. “We delude ourselves into thinking it’s more efficient to see more postnatal families online,” Bruce says. “We increase service-user statistics at the expense of providing quality care.”

Ultimately, while it may be nowhere near enough, there is help at hand if new parents feel able to take the first step and speak to someone about how they’re feeling, rather than suffering in silence.

When Mountford eventually went to her GP, she was prescribed antidepressants. While this “didn’t suddenly make everything better,” she says it did make life manageable. “I was able to at least function, which was more than I’d been able to do the previous 12 months.” From there, she was able to begin to re-engage with everyday life – “to start getting out for fresh air, and finally start to see purpose and enjoyment in life once again.” She has now safely come off medication and says life is “amazing”. “I am so glad I am still here and didn’t act on those destructive thoughts when I felt there was no way out. Things really do change, even if you can’t see it or feel it. Never, ever give up.”