Family/Whanau support

The arrival of a baby into a family can affect many people, not only the parents. The new baby may have special significance for grandparents, aunts, uncles, siblings and the extended family/ whanau.

What is important?

The significance of the baby in a family is influenced by many factors such as:

  • The culture the baby is born into.
  • The gender of the baby.
  • Whether there has been a major loss for parents or family members in the past.
  • The expectations of various family members.
  • How the baby fits into the dynamics (emotional connections) within the family.

It is important for family members to think about what a new baby might mean to them and reflect on how this might affect the way they relate to the baby or her/his parents. For example, a grandparent that has had a family of all girls may react in a special way when they have a grandson.

Adjusting to the baby

Whatever the expectations of family members it is important to support and encourage the mother and father to have their own relationship with the baby (as long as the mother and father want this and can provide it safely).

Mothers and mothers-in-law can be very important at this time to a new mother. If they have time, they can provide support, help, and backup – especially if their daughter/daughter-in-law is unwell. Increasingly, grandparents are unable to give this support – they may be employed or busy with their own retirement interests, they may not live close by or they may be too elderly or frail. Those that do provide support can find it very rewarding.

Grandparents, especially grandfathers, sometimes find it easier to relate to their grandchild compared to how they related to their own children when they were babies. It can be a very exciting time for them to be around babies again. It gives them the opportunities to develop close bonds to their grandchildren. They may have been too busy to develop close bonds with their own children when they were at this stage.

The diagnosis of PND or a related condition

Often family/whanau can miss the signs of postnatal depression. A mother can be afraid that if she expresses how she feels she will be judged to be “not maternal” or a “bad mother” for not coping.

A mother of a daughter who experienced PND says …

“I was relieved when my daughter got a diagnosis of PND as she was clearly unwell and was not coping. She was self diagnosing and everyday thought she had something else wrong with her.

I did not experience PND when I had my three children and, as a consequence, did not pick up on any of the signs or symptoms. I did not know anything about PND. It was difficult for us as a family because we had no information. We often felt isolated not knowing what was going on. I feel that new mothers today do not get as much support as we did in our day.

The father of this daughter says…

“I thought my daughter was acting like a hypochondriac and I told her to pull her socks up and get her act together. Obviously now I know that this was not the right way to approach the situation. As a consequence the relationship with my daughter was rather strained for a time.”

How to support a mother

Listen quietly but with interest.

Try to understand – it’s hard for someone who is depressed or anxious to explain how they feel.

Avoid judging or getting angry – it’s no ones fault.

Be there (this means to be emotionally available as well as physically present). Be patient.

Help reduce stresses. Offer practical help. If a person isn’t sure what help they want, offer alternatives or suggestions e.g. “I would like to help, can I cook a meal or take the older children out?” “Your house looks fine, but I know some people find they don’t have the energy to do any housework – can I vacuum or hang out the washing, or something?” (Don’t have your own agenda about what you think needs doing – do what they want done!)

Support her to do the baby cares herself rather than take over and do them (unless she asks you to). Just being with her and her baby when she is anxious will help. If she is very unwell she may not be able to do this.

Give positive words of support, affection and encouragement. Be positive about any accomplishments no matter how small they might seem.

Don’t take what they say personally. Remember that when a person is unwell or stressed they can say things they don’t mean, and their mood can change quickly.

Remain positive. Provide encouragement and lots of positive reinforcement – even if what you are saying seems obvious. When someone is depressed they are not thinking in their usual way and they have great difficulty seeing the positives.

When reassuring, try not to dismiss a persons concerns. Instead of saying something isn’t a problem say, for example, “ I can see that is really worrying you – I will be with you to help with that”

Due to the indecisiveness of depression a person may need guidance and support with decision making– but don’t jump in too early with your solutions.

Offer distracting thoughts or activities, especially if you can see that they are going round and round in circles in their thinking or are overwhelmed by their feelings.

Help them to get out and have fresh air and exercise. They may not feel motivated to do so but will often feel better if they do.

Help get regular meals/snacks especially if breastfeeding.

Help her to have time away from her baby doing something pleasurable, such as getting her hair done, having a massage – but not doing the groceries.

If she is suffering a lot and not getting better, help her to get help. (See Support)

Take seriously any negative thoughts she may have about harming herself, or her baby, and get help urgently.

Remember

  • Sometimes offering help is not easy.
  • It may not seem to be appreciated.

“We were all really surprised when Katie told us that she had postnatal depression. She had always seemed so capable and would take everything in her stride. It just goes to show that PND can happen to anyone. Our whole family became very supportive of Katie. We all talked about what was happening and now that she is well, we still talk about it. We felt it was important to be open and honest and involve everyone in the family. We tried to be supportive of her without taking control. She still had a new baby that she needed to bond with. We would do practical stuff for her, such as cleaning, washing and preparing meals. We were lucky that we could be on hand whenever she needed us” – Elaine, a grandmother

“Family support was the most important thing to help me get through. I didn’t need medication. As soon as I told everyone how I felt and what was happening everything started to get heaps better.” – Katie

How to support a father

  • Men are less likely to want to talk but encourage them gently if they seem ready for this. For example, offer some openings for them to talk like asking “it can be tough with a new baby – how’s it going”
  • Partners need to know that they are not failing their baby or partner if they feel stressed
  • Offer practical support
  • Be available to them
  • If necessary, help them to get help. Men are even more reluctant to do this than women.
  • Family members often forget that the partner of a woman with PND will also be suffering.Remember to offer him your support and help.

How to support other children in the family

Other children in the family

The needs of any other children in the family also require attention. Mothers with depression may only be able to care for and cope with the baby. They may not be able to cope with any other demands. Toddlers in particular can be difficult and a depressed or anxious mother may find it even harder to keep up.

One of the ways other family members can assist is tohelp care for the siblings of the baby.

Older children may feel rejected and confused if they no longer have time with their mother,because she is busy with the baby and depressed. Some one-on-one time with their mother is important. In this situation, help with the baby can be useful.

“I found it too hard to deal with a busy toddler. I just wanted her to go to other people so that they would look after her. She became too difficult for me to cope with. Now that I’m well, I can manage to keep her busy during the day. I now try to do special things with her when my husband comes home from work and he takes the baby” – Katie

What should I say to the children?

This will depend on the age of the child, their developmental stage, their ability to understand, and their own emotional state.

Some general guidelines

  • Give a simple and brief explanation of behaviour. Don’t go into detail about underlying feelings or thoughts. For a preschool child, you might say,” mummy is resting because she is very tired”. You might want to give it a name such as “mummy has the go slows” or “mummy has the cries”, or mummy has the “grumps’ if irritable (agree on a family terminology).
  • If “mummy” is having trouble responding with positive facial expressions then explain this by saying something like “mummy’s face is stiff – it is hard for her to move it but it will get better”.
  • It is important to explain that “mummy will get better” but that you are not sure when. “The go slows can hang around for awhile but mummy will get better”.
  • Children may secretly blame themselves. It is important to tell them that it is not their fault. “It is no ones fault and that this can happen sometimes in a family but it will go away”.
  • Do not blame anyone.
  • Explain to children that their mother is being looked after and getting help.
  • Do not look to the children for emotional support.
  • Children should not need to look after their mother – help them feel this is not their responsibility. (This is not the same as encouraging and praising them for helping with tasks)
  • Don’t expect too much of your children – they are also having to adjust.
  • Maintain their routines whenever possible
  • Remember that children have an amazing capacity to ‘get through’ as long as they have someone they can feel close to

How Grandparents can help

Jane, a grandmother, tells her story:

(many grandmothers have said similar things)

My daughter rang me with a plea to come up (we live in different cities) or, she said, “something awful might happen”. When I arrived the next day I found a very sick daughter who wasn’t able to cope with the day-to-day duties. I found the next 12 weeks very stressful trying to fit in with an active family with lots of work to do. I took over the duties each day but there were many times when I was questioned about what I was doing. I was just trying to keep the family together.My daughter didn’t talk to me much and she also got cross because she didn’t like the way I did things.

I was not told anything by the Mental health team. One day my daughter took off in the car. I rang the Mental health team and they thought she might want to take her life. They rang the police and we all went out trying to find her. We thought she might have gone to the beach and thats where we found her. That was the worst day.

My daughter realised she needed me but she wanted me to be invisible.. She didn’t want me around except to cook meals and look after Holly. I spent most evenings in my bedroom after I had put Holly to bed. I would not wish this illness on anyone. I didn’t know how to look after someone with a mental illness but I had to. We all wanted my son-in-law to be able to keep going to work. Even though it was hard at the time I am now thankful I did go and help. My daughter is now grateful for what I did.

Take care of yourself too

Mood and anxiety problems often run in families so it would not be surprising if you too struggled with some of these issues as well.

  • You need to look after yourself while not burdening the new mother with your worries.This does not mean hiding important things from her.
  • It may bring back issues that you have hidden about your own parenting. Some women recognise their own past PND when seeing it in their daughters.
  • You may find that you need your own counselling to deal with some issues. It is never too late to seek help and you may find that you can be a better parent and grandparent because of it

Queer families and post-natal depression

It can happen to queer parents too…

By queer, we mean any lesbian, gay, bisexual or transgendered parent. This is an all encompassing term that the authors have carefully considered and believe to be an appropriate term.

Sometimes being a lesbian, gay, bisexual or transgendered parent can feel like a pretty invisible position. It’s easy for people to make the assumption that because you have a baby, you are in a heterosexual relationship. The transition to becoming a parent is also rife with different kinds of issues, which may present more challenges along the way.

Conversely, becoming a queer parent may be a great opportunity to become more comfortable with your own identity, to connect more with your family of origin and to get lots of positive feedback from other people about what a great parent you’ll be.

There is not a lot of research out there, but what research has been done suggests that lesbian mothers may experience slightly higher rates of symptoms of post-natal depression. Importantly, this research also suggests that there might be different kinds of reasons involved.

Risk Factors

What might be risk factors for post-natal depression in queer parents?

  • Stressful experiences with conception, such as using IVF, dealing with donor issues, negotiating parenting with lots more people involved.
  • Legal and societal discrimination making it harder to secure parenting rights.
  • Previous depression is a risk factor for post-natal depression. Research fairly consistently shows queer people are around 2.4 times more likely to experience mental illness than heterosexuals. So more of us are at risk for post-natal depression to start with.
  • Social support structures often change from being focussed on friends to focussed on families of origin when you become a parent. Some queer people have experienced difficult relationships with their families, potentially making this transition more complex.
  • Worry about social stigma and your child potentially being discriminated against.
  • If you are not the biological or birth parent, you may feel hidden and neglected in the process of having a baby. Just like Dads can get post-natal depression, there’s every reason to believe that queer non-biological parents can too.

Advantages

What are some advantages to being a queer parent, which might be protective when it comes to mental illness?

  • The child is often much-wanted and carefully thought about.
  • You’re more likely to have talked about how you want to parent, and what your expectations are.
  • Many people will be more excited for you because you’re doing ground-breaking new things.
  • Research suggests that although you might be worried about your children being discriminated against, very few queer parents actually report instances of this. In fact, most report being surprised by how positive others are toward them.

What helps?

What do Queer parents say has been helpful for them?

  • Being out to your midwife and doctors. Try it! They’ll be more open than you think. If they aren’t, then it’s quite okay to change and find someone who is more comfortable with you.
  • Find support where ever you can. There are often groups of queer parents in the larger cities. Even if you can’t make it to meetings, you might be able to get in touch with other queer parents to talk things through.
  • Use your information and contacts to find health professionals who suit you. For example, do you know anyone connected with the health field or other queer parents who could recommend a midwife?
  • Belonging to a social network for queer families eg. rainbowfamiliesnz.org
  • Talking explicitly about how to manage role-confusion when you have two Mums or Dads.
  • Deciding in advance what you’re willing to tell people about how you created your family.

Ask for help

Most importantly, remember it’s okay to ask for help! Good places to do this include: your GP, your midwife, your local mental health services, a counsellor… And you have a right to receive treatment that is respectful of your sexual and gender orientation.

References

Bos, H.M.W; van Balen, F; van den Boom, D.C. (2004) Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families. Journal of Child Psychology and Psychiatry. Vol 45(4)

Gartrell, N; Rodas, C; Deck, A; Peyser, H; Banks, A.(2006) The USA National Lesbian Family Study: Interviews with Mothers of 10-Year-Olds. Feminism & Psychology. Vol 16(2)

Ross, Lori E (2005) Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors.Women & Health. Vol 41(3)

Ross LE. Steele L. Goldfinger C. Strike C (2007). Perinatal depressive symptomatology among lesbian and bisexual women. Archives of Women’s Mental Health. 10(2)

Short, Liz (2007) Lesbian Mothers Living Well in the Context of Heterosexism and Discrimination: Resources, Strategies and Legislative Change,

Feminism & Psychology. Vol 17(1)

Rural isolation

Rural isolation is a unique problem in a number of areas in New Zealand.

Many rural people live large distances away from their nearest town and families can often be quite isolated from one another. There are additional problems when there is a lack of support services nearby. GPs are often quite a distance away and can be busy and overworked. Psychologists and psychiatrists may not be available locally, so support services for women with mental health problems may be quite limited. Extra childcare may not be available.

This geographic and social isolation can lead to anxiety and stress even in women who are well. Rural women with PND and anxiety disorders often find that the isolation and lack of local supports cause addition problems.

It can be hard to ask for help in a small community where everybody knows everybody else.

The internet is becoming a valuable tool for assisting these women. There are programmes trialling online counselling treatment programmes. Isolated women may find these advances a help. (One current site for online CBT is www.moodgym.anu.edu.au)

Jackie’s story

Jackie lives on a farm in an isolated rural area on the West Coast with her husband.

She had PND and anxiety and suddenly became unwell two weeks after her daughter was born. “It suddenly hit me like a ton of bricks. I felt as though I couldn’t bond with my daughter. I asked for help. Initially I was told that I had “first mother syndrome” and that I was fine. I wasn’t. I tried breastfeeding but my daughter was not gaining weight. I felt a failure as a mother and hopeless at breastfeeding. I changed to bottle-feeding. Then I worried that I wasn’t cleaning the bottles well enough and that she would get sick.

I suddenly stopped sleeping and was sent to a psychiatrist 50 km away. I told him that I felt as though I hadn’t had my daughter. What I meant by this was that I couldn’t bond with her. He put me on a strong antipsychotic medication, which made me feel like a zombie. I couldn’t do anything, not even shower myself. I stopped taking this but stayed on an antidepressant medication, which worked well for me and slowly I improved.|
During this time I felt very isolated where we lived. There were no younger women around me who had recently had babies. I felt awful and lonely. The closest town was 30km away and there were no supports here for me.

I had my second child a year ago. I developed problems with anxiety and depression again but this time I was much more aware and got onto medications quickly. I still worried about my baby’s feeding and his weight gains. I stopped breastfeeding at ten days and this time I felt great about stopping. I didn’t need the pressure of trying to breastfeed on top of my depression and anxiety. There was pressure from Plunket to continue breastfeeding but this time I knew what was best for me and my son.

My family was great, but again, there wasn’t much outside support for me. Plunket could only come and visit me at home twice other than that I had to go to the clinic which was 30km away.

My midwife came and visited me once a week for six weeks after my son was born. There were no other support services available. There are now younger women living in my area which helps. Rural women can be very isolated and need more support for mental health problems. It is very hard to admit to having PND and women should not be embarrassed about it.”

Disclaimer

The information and advice found on this website aims to reflect current medical knowledge and practice. However, this is not a substitute for clinical judgement and individual medical advice. The website authors accept no responsibility for any consequences arising from relying upon the information contained on this website.

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