When Rachel* gave birth to her second child, Zach, she expected to feel much like she had after the birth of her daughter. But, instead of the intense emotion she had experienced the first time around, this time she felt nothing at all. As the steady stream of visitors told her what a beautiful baby she had, Rachel smiled and agreed. “But inside, I was just numb,” she says.

When she went home from hospital she got herself into a routine with the baby and her older child. She appeared to be coping well but she couldn’t help feeling that something just wasn’t right. “I became convinced that there was something wrong with my baby,” Rachel says. “Even though he fed and slept well and was content most of the time, I just couldn’t shake the feeling that Zach was going to die.”

She became fearful of everything that could possibly happen to her baby “… illness, SIDS, choking, drowning, being in a car crash”. Yet Rachel still believed she was OK. She reasoned that all new mums worry about their babies. It wasn’t until her fears became scarily irrational that she realised something was very wrong.

Rachel went from being afraid something bad was going to happen to being terrified that she herself would harm her child. “I became obsessed with the fear that I might drown the baby in the bath or throw him out the window. I didn’t understand where these thoughts were coming from and I couldn’t tell anyone about them.”

She began to suffer constant anxiety and acute panic attacks, especially when driving. She often cried uncontrollably and was scared of being left alone with her children. She even fantasised about suicide. “I thought maybe Michael and the kids would be better off without me. I was in a dark, dark place.”

Finally, in desperation, Rachel told her doctor how she was feeling. “I was ashamed and terrified someone would take my kids away and lock me up,” she says. Instead, she was diagnosed with postnatal depression. With a name for what was happening to her, support from her husband and family and a combination of treatments, Rachel gradually began to regain control of her thoughts and her life.

Rachel’s story is not uncommon. It’s now believed that about one in seven new mothers in Australia will suffer postnatal depression (PND). Not all will feel as bad as Rachel, and some will feel worse, but all will be affected by the illness. It robs women of the joy of having a new baby. Left untreated, it can ruin relationships, shatter families and destroy lives. While there is a greater awareness of PND now, sadly, many women still suffer in silence, afraid of being judged or deemed a failure as a mother.

A matter of degree

Postnatal mood disorders exist on a scale. At one end is the “baby blues”, experienced by up to 80 per cent of new mums and occurring in the first week after birth. The baby blues is generally mild and transient, disappearing within a week or two. At the other extreme is postpartum psychosis (PP), a rare but serious acute mental illness that almost always requires hospitalisation.

Somewhere in the middle is postnatal depression, generally characterised as a depressed mood or feelings of anxiety lasting more than two weeks and occurring in the first year after having a baby. Common symptoms include tearfulness, anxiety, unexplained or irrational fears, lack of interest in the baby, listlessness, irritability, loss of confidence and inability to cope, memory problems, loss of appetite or marked increase in appetite, sleep disturbances and obsessive morbid thoughts.

Not all women with PND will experience all these symptoms or to the same degree. Symptoms can appear immediately after the birth, suddenly in the first few weeks or gradually over a period of weeks or months. Most women with PND will be aware that something is wrong but may be reluctant to admit it to others and may find it difficult to accept a diagnosis of depression.