Episode 5: August 2
PND is an illness with symptoms that range from moderately distressing to severely debilitating, which can surface at any time during the first year after childbirth.
Symptoms include: difficulty in seeing the funny side of things, weepiness and sadness, loss of enjoyment, blaming herself unnecessarily, feelings of inadequacy and/or guilt: believing she's a bad mother, anxiety and/or irritability, feeling things are getting on top of her, changes to sleep patterns (difficulty in going to sleep, inability to get back to sleep or waking early), changes in eating habits - under or over eating, spending money inappropriately in a bid to feel better, difficulty bonding with the new baby, hostility towards partner, thoughts of harming herself or her children. (While some PND sufferers report a lack of attachment to their infants, the vast majority never harms them.)
- Important to note that most new mothers suffer from passing anxieties or low moods, but when those emotional states become frequent or persistent it's likely she's depressed. No two cases of PND are identical.
- Can't say for sure how common PND is because it often goes undiagnosed, but it's estimated that somewhere between 10-15% of mothers suffer from it in the first year after childbirth. Former director of the Mental Health Foundation, Dr Max Abbott, has gone on record saying depression among mothers of babies and preschoolers is of epidemic proportions.
- Women have a one in three chance of developing a mental illness at some stage during their lives but are more vulnerable during the first 12 months after childbirth and when their children are preschoolers.
- Shouldn't come as a surprise: having a baby, especially for first-time mothers is the most significant upheaval, physically, emotionally and spiritually that the average women experiences (Lorrie Bennett, head of Waitemata Maternal Mental Health Unit). Women and men often fail to appreciate the losses they may experience when a baby arrives - loss of freedom, social contact and pre-parenthood partner relationships to name a few (Bennett).
- Most new mums work through the adjustment to parenthood and emerge all the more confident and assertive for it, but for others the transition proves tougher.
- Not a modern-day malaise: medics wrote about it nearly 200 years ago.
- No society in the world immune from the severe from of PND - the type of depression, which probably has a hormonal component. As to whether or not we're seeing an increase in PND, it's hard to say. We are more aware of it these days, so there are more reported incidences.
As yet, doctors are unclear about how big a part biological imbalances play in the wider incidence of PND& those with a history of PMS are vulnerable to abnormal hormonal behaviour& Oestrogen (the happy hormone) is present in increased amounts during pregnancy. What happens around the third or fourth day after childbirth is the oestrogen levels rapidly drop bringing on the relatively common 'baby blues'. Typically oestrogen levels even out, but some mothers experience ongoing low moods (PND) because the oestrogen levels remain low.
Biological factors aside, there are some recurring social and psychological susceptibility factors running through sufferers' lives:
- The three main predictive factors for PND are: a past history of PMS, a strong ambivalence about giving up work and having had a conflicting or difficult relationship with their own mothers: they were either terrible mothers or so perfect they feel they could never emulate them.
- Others who are most at risk are mothers at either end of the age spectrum ie young mums and older mums, new migrants, women with poor social support, women with a past history of depression, those who had trouble getting pregnant/had assisted reproductive technology/ had high expectations of motherhood. "Depression is the void between the fantasy and the fact".
- Anecdotally, mental health professionals report an over-representation of certain occupational groups presenting with distress/depression after childbirth: school teachers, flight attendants and health workers (even the occasional Plunket Nurse) as well as career women whose work provides clearly defined structure and predictability.
- Isolation plays a big role in PND too. Motherhood can be very lonely at times, more so today when partners work longer hours, grandmothers aren't around and community ties are weaker. The health system undervalues mothers, routinely shoving them out of hospital after 2 days. In a study of Sydney mothers, it is linked to a one in four incidence of PND among mothers discharged within 48 hours of giving birth.
- Women are tending to have children later in life when they're more set in their ways - they have higher expectations. Many have established careers where they get lots of positive feedback and rewards. "The only reward for a new mother is the absence of crying". Pressures to perform pile on us from all directions - many of them, self-imposed. "As a mum these days, you're supposed to be able to do it all and look good while you're doing it. Women often approach having a baby as another work project. They set hugely high standards for themselves. It's not good enough to be good enough. They have to be perfect."
- How well does society value motherhood? Women are getting mixed messages: if they work they're neglectful mothers, if they don't and 'just' look after their children they're lazy and unmotivated and probably unfulfilled. It's as if 'women asked to have it all, now they have to carry it."
- We are all under much greater time pressure these days, and babies as any mother will know, aren't good at sticking to time schedules, routines etc. Likely to do a big poo just as you're heading out the door. "We're trying to get babies to fit into our busy, structured, ordered lives& hard to live with the gentle ebb and flow routine which babies like." Another contributing factor of today's society is the lack of family support. Women are having children later so their own mothers are older. Younger mothers are still working. Migrant mothers a risk group (see below)
- Many sufferers don't realise they have PND. They have good days and bad days and just think 'this is what it's like being a mother' (especially first-time mothers). Some women are reluctant to discuss it for fear of being tagged a 'nutter', because they're copers/ independent people and too proud to seek help, they're terrified that if they own up to PND their children will be taken away.
- While many women recover from PND spontaneously within a year or two, left untreated or inadequately treated, the condition can linger for years. But with the right treatment the recovery rate is excellent. Health professionals and survivors encourage mothers to seek help sooner rather than later. Not simply because her own recovery is likely to be quicker but also to minimise the impact on herself, her partner and her children.
- Evidence suggests babies of mothers with untreated PND - who enjoy fewer positive interactions with their mothers - experience some delays in cognitive, emotional and behavioural development. When PND is left untreated and becomes very chronic is the mother develops new patterns of behaviour, which becomes her mothering style& withdrawn, doesn't interact, sullen etc. This does affect the child's behaviour and development. More potent in boys for some reason. The good news is that if there's another involved non-depressed adult or even an older sibling, the damage is mitigated.
- Falling victim to PND might feel like the end of the world, yet it can signal the start of a new and better world. It's often a beginning of a new me, a time to get things in perspective, re-evaluate your life.
There is no single recovery package that works for everyone. Beating depression typically means learning to be kind to yourself, accepting support, taking anti-depressant medication for a period and undergoing professional counselling. There are anti-depressants where only a tiny, almost undetectable trace crosses the placenta or enters breast milk.
- New dads also can suffer from depression, far more frequently than most people realise. It's especially common amongst partners of PND sufferers who report feelings of frustration, hopelessness, rejection, anger and guilt. (1 in 4 male partners of PND sufferers have major depressive symptoms). Sometimes though dads' depression arises solely from their own difficulties adjusting to parenthood, in particular coming to terms with the changes a baby brings to the couple's relationship. They go through a kind of grieving process. Anecdotal evidence suggests men tend to seek refuge in alcohol, excessive work or time spent away from the family. Isolation, money worries and unemployment increase a dad's likelihood of becoming depressed. Seems to be more common amongst fathers of daughters rather than sons says Harold Breiding-Buss of the Father & Child trust: "He may be asking himself, does this girl really need me?'
- PND definitely affects a couple's relationship. It's hard to live with someone with PND. Often couples need help with their relationship/ counselling etc
- PND is one of a number of types of depression associated with having children. Others include prenatal depression (depression during pregnancy, affecting around 10% of mothers, babies more likely to arrive pre-term); The baby blues (tearfulness, low spirits and anxiety that hits between 50-70% of women on day 3 or 4 after delivery. Typically lasts for only a few days but the mother needs support, otherwise she's at greater risk of PND); Postnatal (puerperal) psychosis (an acute psychiatric disorder affecting one in 500 women, which develops within days or weeks of giving birth. Probably largely triggered by biochemical upheavals. Hallucinations, delusions, paranoia, severely depressed moods or high manic states); Post-traumatic stress disorder (PTSD): triggered by traumatic events surrounding pregnancy, birth or the early postnatal period. Affects around 7% of mothers. If unresolved it leads to depression. Shares some symptoms with depression, but has 3 distinguishing features: flashbacks and nightmares, reliving the traumatic event, a feeling of being numbed and avoidance of places or situations that trigger flashbacks, being on-guard, in fight or flight mode. To lower the risk of PTSD it is advised that all mothers review their birth experience either with their lead maternity caregiver or another person of choice.
WHO TO TURN TO FOR HELP:
- Talk to your GP or Plunket Nurse or contact your local Citizens Advice Bureau who can direct you to organizations like Pregnancy Help, Parents Centre, peer support groups and your local community mental health centre.
- The Post Natal Distress Support Network Trust supplies info on maternal mental health and runs an Auckland PND support group. Phone (09) 836 6967; PO Box 21-338, Henderson, Auckland 7.
- The Mental Health Foundation supplies a booklet on PHN Phone (09) 300 7010 or visit www.mentalhealth.org.nz
- Telephone counselling lines include Barnardos parent Help line 0800 4 PARENT (0800 4 727368
- To contact the Father and Child Trust phone 903) 372 9140 or visit www.fatherandchild.net.nz
- Many PND survivors recommend the book Beyond the Baby Blues - Overcoming Postnatal Distress in New Zealand by Arlene Goss
CHOCOLATE AND BANANA BREAD AND BUTTER PUDDING
4 tbsp Mainland butter
8-10 slices white bread
1/2 cup chocolate chips
2 bananas sliced and peeled
5 cups Meadow Fresh Calci Kids milk
A little additional butter
Butter the bread, cut into triangles and arrange in a buttered dish with the chocolate chips and the banana slices until all are used. In a bowl whisk together the eggs and milk, pour gently over the bread and scatter a little butter on top. If you have time let the pudding sit in the fridge for 30 mins before baking for the bread to absorb the milk. Bake for 40-50 mins in an 180degC oven.
Nutritution Fact: Meadow Fresh Calci Kids has 50% more calcium than Meadow Fresh Family Homogenised milk - and it has Vitamin D to help the body absorb the calcium. Just what kiwi kids need to help them grow up healthy and strong!
Go to www.meadowfresh.co.nz for more info
AsTTle, " Assessment Tools for Teaching Learning", is a new system on CD ROM, which enables teachers to track the progress and achievements of students and groups of students against national standards better than ever before.
AsTTle is a test designed by the School of Education at the University of Auckland by a team lead by Prof. John Hattie. It's been bought and implemented by the Ministry of Education. Students currently use it in years 5-7 and it assesses Literacy and Numeracy, in both English and Maori, in Reading, Writing and Mathematics. Development is already underway on developing AsTTle for students in Years 8 - 10 in literacy and numeracy.
Education Minister Trevor Mallard launched the new Literacy and Numeracy Assessment Tools for Teaching and Learning (AsTTle) - Version 2 in February 2003. More than 48,000 primary school children have been involved in the development of the AsTTle tool.
AsTTle is one of a range of tools available to New Zealand teachers and should be considered in the wider context of school-wide assessment practices. Other traditional tests (PAT, STAR, TORCH, NSW English tests) look at a general knowledge of what children know. AsTTle tests how well they know the curriculum.
AsTTle provides information that can be interpreted and used to improve student learning. Teachers are able to reflect on the impact of their teaching programmes, develop clear and challenging goals with students, and provide feedback that focuses student energy on what it is important to learn. AsTTle data can also be used to monitor trends and patterns of achievement across the school and across student groups to inform strategic planning.
The tools include tests that are able to be used any time during the school year and can be designed to suit the whole class, a group of children, or individuals. They show teachers how students are doing in relation to the rest of their class and in relation to students throughout the country.
Assessment Tools for Teaching and Learning are available FREE on C.D. Rom to all New Zealand schools. The use of the AsTTle tool is voluntary. The tests have been closely aligned to other curriculum materials including the National Exemplars and Assessment Resource Bank materials. Professional development seminars are available to support teachers learning to use the tools effectively.
How to Train your Dragon, by Cressida Cowell (age 8 -
If you're looking for a book to encourage your 8 year old son to get immersed in a story, then try "How to Train your Dragon" by Cressida Cowell.
A Viking boy - Horrendous Hiccup III, supposedly writes it. To be allowed to reach maturity in this Viking group, each boy has to capture and train his own dragon. Horrendous, unfortunately, can only find the runt of the litter, and encounters more than a few problems in trying to raise him, not least the embarrassment of having the smallest dragon of all.
In the end though, our little dragon turns out to be a huge and hilarious hero. The book is very funny, with occasional bursts of schoolboy writing and the odd line drawing to keep the reader involved and amused. It's long enough to challenge them, and clear, simple and funny enough to make them love it.
Book reviews by The Children's Book Shop.
www.bookhive.org/books (2-12 yrs)
An American site which is a guide to literature for babies and toddlers through to primary and intermediate school-aged children.
For every age group there are pages and pages of books recommended and reviewed. You can listen to a story told by acclaimed storytellers like Donna Washington; or discover fun activities - the best of which are the Harry Potter Quiz, and the lovely bookplates, which you can print off and put inside the front cover of your favourite books. Kids and parents alike will enjoy this site.
Websites reviewed by the Children and Teens department of Auckland City Library
Be one of five winners for a toy and clothing package.
From Planet Fun select toys from a pre-selected range to the value of $300 from the educational Leapfrog range - information-rich gadgets for all ages like a talking globe ... or clock up some fun family time with a board game.
And from Pumpkin Patch you can kit out the kids for summer 2005 to the value of $250. From gorgeous outfits for babies, through to cool gear for growing boys and girls.
To enter, look for the coupon in the Homegrown pages of the current copy of Little Treasures Magazine.