Saturday, December 3, 2016

Does postnatal depression affect your future fertility?

A new study has shown that postnatal depression may affect a woman’s future fertility, highlighting the need for more awareness and support for new mothers.

The birth of a child ought to be a time of great happiness for a new mother, especially if the path to motherhood has been a particularly long and difficult one.

For many women the experience is just that, with fatigue or frustration in the early days – sometimes referred to as ‘the baby blues’ – almost wholly offset by the irreplaceable bond that develops between mother and child.

But for one in 10 new mothers, childbirth is followed abruptly by postnatal, or postpartum depression (PND). This debilitating and frustrating mental illness can cause new mums serious difficulties, but beyond that, can also have a negative impact on future fertility.

“I’d read about the baby blues, but about six weeks after he was born I knew something wasn’t right,” says 34-yearold Vicki, a personal trainer and mother to William, who is now four. “I was crying about 15 times a day and even the smallest tasks were overwhelming; I couldn’t be bothered to brush my teeth or shower, which is really unlike me. I just didn’t feel like me.”

After a very tearful visit to the doctor, Vicki was diagnosed with PND and prescribed the antidepressant medication The birth of a child ought to be a time of great happiness for a new mother, especially if the path to motherhood has been a particularly long and difficult one. For many women the experience is just that, with fatigue or frustration in the early days – sometimes referred to as ‘the baby blues’ – almost wholly offset by the irreplaceable bond that develops between mother and child.

But for one in 10 new mothers, childbirth is followed abruptly by postnatal, or postpartum depression (PND). This debilitating and frustrating mental illness can cause new mums serious difficulties, but beyond that, can also have a negative impact on future fertility.

“I’d read about the baby blues, but about six weeks after he was born I knew something wasn’t right,” says 34-yearold Vicki, a personal trainer and mother to William, who is now four. “I was crying about 15 times a day and even the smallest tasks were overwhelming; I couldn’t be bothered to brush my teeth or shower, which is really unlike me. I just didn’t feel like me.”

After a very tearful visit to the doctor, Vicki was diagnosed with PND and prescribed the antidepressant medication ageing, where the median age of a country becomes older over time. This demographic change is mostly caused by women having fewer children, and can have significant social and economic consequences. Given that PND has a prevalence rate of around 13% in industrialised countries, with emotional distress occurring in up to 63% of mothers with infants, this research suggests that investing in screening and preventive measures to ensure good maternal mental health now may reduce costs and problems associated with an ageing population at a later stage.

For Vicki, her experience with PND has meant that though she longed for a second child, she found herself physically unable to begin the process, saying: “I was terrified it might happen again, hence why I’ve waited almost five years to get to the point where I could summon the belief that this was something I could do again.”

Whilst it has long been known that infertility can affect mental health, leading to feelings of anger, isolation and even full psychotic episodes, the idea that postnatal depression can affect fertility is less explored – let alone postnatal depression in men. It is not known exactly why PND would affect secondary or tertiary fertility but stress is commonly believed to make getting pregnant harder, in some cases even halting a woman’s ovulation entirely. The implication then that PND may be as traumatic as major birth complications would suggest that it is connected to anxiety.

It is thought that up to 15% of new mothers may experience some degree of PND, but health experts fear that it may actually be double that figure, given that many women suffer in silence.

The National Institute for Health and Clinical Excellence (NICE) states that new mothers should receive checks from a GP or a health visitor in the immediate weeks after the birth in an effort to assess the new mother’s emotional state and perspective on the challenges that lie ahead.

However, the stigma attached to PND prevents some women from speaking up about how they are feeling, with health experts renewing calls for more in-depth and detailed guidelines relating to maternal mental health so that practitioners may recognise the early symptoms.

This was the case for Danielle. At the age of 33, and having struggled to conceive, suffering multiple miscarriages along the way, she was swept under by a wave of postnatal depression shortly after the birth of daughter Flick. “I’d lost my mother to cancer in the weeks before Flick’s birth, and I think that made me particularly vulnerable,” she says.

“After being told by a midwife that my symptoms of depression would ease up after a few weeks, I was too afraid to mention the increasing sense of hopelessness that was enveloping me. I actually feared my daughter would be taken away. This may sound irrational, but as I have gone on to discover, it is actually a common misconception for mothers in the midst of depression.”

Lynne Murray, Professor of Psychology at the University of Reading, has this to say about the challenges new mothers face:

“Part of feeling depressed is that you feel guilty and you feel you’re a bad mother.

When you’ve had a baby, you probably have people coming up to you and saying, ‘Oh, it’s wonderful’, and expecting you to be on top of the world and functioning well.

“If you’re not feeling great, because depression is associated with feeling guilty anyway and low self-esteem, then that, coupled with people’s expectations that you should be functioning well, can make you feel even worse.”

The good news is there are plenty of treatments available now for both pre and postnatal depression, from the more traditional combination of medication and talking therapy to alternative options like meditation and reflexology, which can complement prescribed treatments.

Acupuncture has shown to be effective in easing the symptoms of depression during pregnancy and could help prevent the development into full PND. However, the absolute most important thing is that any woman gripped by PND gets the support and reassurance she needs.

For Danielle, who now has two daughters aged 13 and 11, it was Cognitive Behavioural

Therapy that she found most helpful in curing her depression: “I remember being quite cynical about CBT, but after a few sessions I started to feel confident again and that allowed me to open up to my friends and family, who I’d previously felt alienated from.”

It’s generally accepted that the roots of these problems take hold because most women don’t realise there is something wrong and subsequently mistake what is a serious illness for their own weakness.

Feeling disconnected from loved ones is a common symptom of most types of depression, and combined with such a life changing event it’s no wonder reaching out for help feels so hard.

“I have always been such a healthy and active person and that’s why I was so surprised when I felt so dreadful,” explains Vicki. “I felt like such a failure as a mother but also too proud to admit that I needed help. It was a friend of mine, also a mother, who noticed that I was behaving strangely and suggested I talk to a doctor.”

Vicki describes feeling a great sense of relief post-diagnosis, something not uncommon with depression sufferers, and it wasn’t long before she began getting back to her old routine. Simple things, from going for a long walk or meeting a friend for coffee, count as small actions that add up to a full recovery.

The big question is, how does this affect a woman’s approach to conceiving her second child?

“Whilst I was keen to start trying for my second child, I had the double anxiety that I would struggle to conceive and miscarry again, and then if successful, I would suffer from PND,” admits Danielle.

“In the end I was on holiday with my family in Australia and fell pregnant completely out of the blue. Thankfully everything was much easier second time around.”

Vicki is in the process of trying for her second child and says that for her, the biggest lesson has been learning to relinquish control. “I’m just trying to relax more from the get-go. I’ve started practising yoga and meditation… of course there’s no way of knowing exactly what triggers postpartum depression but having been through it before I’d like to think that this time I’d be able to recognise the symptoms quicker and get help.”

Postnatal depression is not a burden that new mothers ought to carry alone, and the more open we are about the subject, the easier it will be to support those who are suffering. From more training for health visitors to simply breaking down the taboo and protecting your future fertility, talking really is the best therapy.

Kate Brian
A former Channel Four News journalist, Kate is the author of The Complete Guide to IVF and Precious Babies. She’s the London representative for Infertility Network UK and Editor of the Journal of Fertility Counselling. Kate’s children were both IVF babies, and she specialises in writing about fertility.

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