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When is PND NOT PND? Part One

According to NHS direct:
"Postnatal depression (PND) is a type of depression some women experience after they have had a baby. It usually develops in the first four to six weeks after childbirth, although in some cases it may not develop for several months. There is often no reason for the depression.
There are many symptoms of PND, such as low mood, feeling unable to cope and difficulty sleeping, but many women are not aware that they have the condition. It is important for partners, family, friends and healthcare professionals to recognise the signs of PND as early as possible so that appropriate treatment can be given.
It is very important to understand that having PND does not mean you do not love or care for your baby."
And this is absolutely true - for women with PND it's important they get effective support as soon as possible; for those supporting mums to be aware of signs and help mum obtain the help they need.

But, I also wonder how often PND is MISdiagnosed.

Via Milk Matters I see lots of mums who have been struggling for various amounts of time with different problems, but what I've noticed is a large percentage are either diagnosed with PND, or it has been suggested to them they may be suffering from it.

It confuses me.

If someone is living in a really difficult situation - perhaps their baby cries excessively, or pulls off the breast mid feed to writhe and cry; mixed in with painful feeding plus perhaps discomfort between feeds. Throw in a baby who will never be put down and so parents are sleeping in shifts whilst the other holds baby on their chest, which after weeks creates extreme tiredness.  Add to the mix that the mum has often seen numerous health professionals and had either a) conflicting information b) numerous attempts at help none of which have worked c) mum feels like she is banging her head against a brick wall.

Do we expect her to be doing an Irish jig of happiness?

A mum last week springs to mind.  After weeks of feeding problems, pain and a constantly unsettled (ie screaming for long spells) baby, she had gone back to the doctor again about the ongoing agonising pains in her breasts.  She had already taken multiple courses of antibiotics, and so the pain was now assumed to be thrush and had been medicated accordingly.  As it still hadn't improved she had gone back to the doctor, by now pretty desperate, describing the pain as "unbearable"and the doctor recommended more antibiotics.

"How will that help?" She had asked confused, "baby becomes more unsettled each time I take a course - and it hasn't stop the pain before."

The Doctor advised the mum that if she did not like how he was treating her she was welcome to complain to the practice manager.

The mum, promptly burst into tears.

Do you think you may be depressed?  the Doctor had asked....

I don't feel depressed the mum told me - in pain, frustrated at the conflicting advice which never resolved the pain and utterly BEEPED off, yes!

Her story is not an isolated case.  Many mums who have spent weeks or months struggling, experiencing ongoing pain which can impact on how mum feels about baby (who may always want to feed as soon as he goes to mum, which for her equals pain) seriously broken sleep - not just with a frequently waking baby, but a frequently waking baby who cries for hours when he does wake are in a fragile emotional/mental state, but is that depression?

In many cases when the pain stops and the baby settles - mum describes it as "life changing".  When the situation that is so tough improves, so does mum.  Of course some women suffer true PND, but I also wonder if it isn't at other times a rather large sticking plaster for incompetent care.


  1. I too have always defended my mental state; having a permanent history of depression is not something I am embarrassed to have, but in my career it is a career ender; & I have noticed that the questions always say have you been treated for depression, not did you actually have it & improve on their drugs??? my thoughts have always been sure I am sad, but atm my LIFE REALLY DOES SUCK! & when I have relented and taken their drugs, they have never worked at all despite the duration/doage/type. I also think vascospasm is misdiagnosed as thrush (or poor attachment) all too often and thrush treatments such as ice packs actually make it much worse. Thank goodness we only ever have one "first born" and if you get it sorted for the first it makes subsequent ones easier (not easy but easier). No one explained to us that our preterm (almost 36wks so came home with us) baby was likely to have digestive issues; so for the first 4 wks he cried for hours on end from about 9pm to 4am & I just kept sticking a boobie in him until someone pointed out that he was actually being made sick from my over supply/excessive foremilk! I started expressing and mixing the milk together to get more balanced milk and the problem self resolved.

  2. I was stuck in a very unsupportive and in fact emotionally abusive relationship when my child was a newborn. I posted on an internet forum for advice and over half of the suggestions were that I sounded stressed, upset and anxious and perhaps I was suffering from PND? Um, no I wasn't! I was having a perfectly normal response to an extremely stressful and upsetting situation!

  3. I know what you're saying. There are incompetent Dr's out there. I think it's more complicated than that. But to start with, the Dr. isn't a very good diagnostician. S/he should have put Mom on an elimination diet to see if an intolerance / allergy to something in her diet was causing the baby's screaming. That is sometimes the case w/ fussy babies (certainly not always). The Dr. is personally unacquainted with the toll on mom caused by caring for a chronically screaming/fussy baby (again based on the limited info in the post).

    Here's where it gets more complicated than simple poor diagnostic ability. Having a fussy baby correlates positively with a diagnosis of PND, but the cause cannot be assessed simply from a positive correlation. Ongoing abx for presumed mastitis is probably not helpful. No info is given regarding baby's growth and development or any other issues going on with mom. That may / may not be all the assessment the Dr. gave to a suspected Dx of PND. More needs to be known about the entire assessment than is known from this piece of information.

    I'm sure there are people out there misdiagnosed with PND. A better assessment needs to be made and/or reported to be able to discuss the topic. To do any less minimizes a serious health and safety issue for moms, babies and whole families: a health issue that is very often undermined and poorly understood by our communities at large.

    It would be nice to have all that info and a truly informed discussion before a thought like 'is PND misdiagnosed' (the general public will read 'overdiagnosed') is put out there for public consumption. I think to do less leans toward irresponsible since PND can be fatal.

    BTW, I have had that screaming/fussy baby who doesn't sleep properly / sometimes at all and PND with little support. This isn't just a reply based on myself.

  4. My son has FPIES, this scenerio happened to me...and I know my pediatrician was in a caring place when she asked me. I agree that it needs to remain in the differential for doctors to cover when coming across this situation- not that the babies crying is from the mom's PND, or the mom's inability to cope but that if there is something to be diagnosed for the baby, that the mom is also taken care of- a constantly screaming baby will fray the nerves of the strongest mother.

  5. Is PND the name for a woman who experiences any type of depression AFTER she has just given birth? Or is PND a type of depression that is specifically related to the hormones during pregnancy, labour and birth? Because I think it's the latter and therefore a medical condition where the mother becomes unwell purely because of pregnancy, labour and birth. I do not believe PND is a mother who has had a baby and who is feeling low or depressed or tired or stressed. You can be all those things and literally at the end of your tether, but without suffering from a hormonal imbalance or other medical problem.

    It actually annoys me how many dads I see who say they finally went to buy their wives formula after they were crying that breastfeeding was so hard, "because she was so close to getting PND". Stopping breastfeeding carries a MASSIVE risk of actual hormonal imbalance, and therefore medical PND.

  6. Very interesting and thought-provoking post. It is often ironically the case that professionals turn out to be the cause rather than the cure of PND.


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