Is postnatal depression an appropriate response to childbirth?

I bet they keep you healthy
I bet they keep you healthy?
Postnatal Depression and Multiples

20. "I bet they keep you fit and healthy?"

Is postnatal depression an appropriate response to childbirth?

Well, yes and no. Physically I am probably stronger than I have ever been, I have developed muscles in places I didn’t even know we were meant to have muscles. But mentally, well there I haven’t faired so well.

After my first daughter was born, a friend kindly popped over to cook me a sausage sandwich and hold my tiny baby while I ate said sandwich. A mother herself, we were discussing adapting to this new life, when she said, “I think postnatal depression is an appropriate response to childbirth”. And I hate to say it, but I do agree with her.

I had a traumatic birth with my daughter, which left me very ill for a few weeks. I’m not talking just a bit sore down under ill, but blood poisoning, blood transfusions and the like. So you can imagine my recovery was somewhat slower than most. And therefore my bonding with my daughter was some what hindered. Now, don’t get me wrong here, we love each other to bits, but the early days weren’t fun. Far from. For a while I ignored the depression. I’ve had a history of it, so I’m used to those feelings.

But after a few months passed, things got easier, but my mood didn’t.  I admitted I probably had postnatal depression. I was avoiding answering the telephone or making calls. I wasn’t eating properly – food was a source of comfort not nutrition. I lost all self-esteem. I didn’t want to nor have the energy to socialise. Slowly I had stopped engaging in children’s activities. And this for me (and this really is my own personal opinion, I am not an expert) but this is where depression being an appropriate response turns into an inappropriate response.

It is normal to get down after a baby. Nothing is quite how you imagined, you’re not sleeping, you’ve hardly time to brush your teeth never mind your hair or chose an outfit or a matching pair of shoes. So of course in those early days being depressed is normal. I think you’d need to be concerned if you didn’t feel a sense of depression some of the time.

The nice guidelines say that;

"At a woman’s first contact with primary care, at her booking visit and postnatally
(usually at 4 to 6 weeks and 3 to 4 months), healthcare professionals (including midwives, obstetricians, health visitors and GPs) should ask two questions to identify possible depression.
– During the past month, have you often been bothered by feeling down, depressed or hopeless?
– During the past month, have you often been bothered by having little interest or pleasure in doing things?"

I mean, in honesty what woman, who has just given birth and not slept for more than two hours straight for the last month, would answer no to that first question?

When you do need to be careful is when that depression becomes disproportionate to your situation, and when that depression starts becoming a barrier to bonding with your child, or stops you from taking your child out into the big wide world as they grow. Then, in that situation, depression is not an appropriate response at all, and you need to seek support.

This all led me to wondering whether there is an increased risk of post natal depression when you’ve been blessed with twins.

I came across an article in The Guardian, which supports this theory;

Mothers of twins or triplets have almost twice the average risk of postnatal depression, a survey by the Twins and Multiple Births Association showed today.

It found that 17% of mothers who had a multiple birth experienced PND, compared with an average of 10% among all mothers. Another 18% of mothers of multiples were not sure if the feelings they had amounted to postnatal depression.”

The 18% who were unsure were probably way too tired and far too overstretched to know if they were coming or going never mind depressed. I am lucky in that my GP always asks how I am and my mood is whenever I take any of my snotty fevered kids in for a check up. I know what he’s asking, and I appreciate his observations. It is really important that health professionals, GPs and midwives look out for signs of post natal depression, as the likelihood is that the mother is too busy to notice herself.
And then lets not forget the daddy in all of this.

The actual report from TAMBA that The Guardian article was referring to (and of which I am a member of and highly recommend to any parent of multiples).

"Fathers of multiples may also suffer from postnatal depression, as a few respondents described:
“My husband suffered much more than me. He got very depressed”. Another father had to take four months off work to deal with his depression. Related to this, a particular issue arose around family breakdown with fathers unable to cope with the shock of multiples and subsequent PND for single parents of multiples."

So lets not forget that it isn’t just us mothers who can suffer. One of the big differences between my daughter’s arrival and the boys’ arrival is the involvement of ‘daddy’. When my daughter was tiny I would do the night feeds while daddy slept. However when the boys came along we would each feed one boy, and regularly have to nudge each other awake as one dropped off mid feed. We were both pushed beyond our limits, emotionally and physically.

Given that just the news that I was having my twins was enough to send my mental health into a spiral, I was pretty sure that I would need support with looking after my mental welfare once they arrived. And I was right. In some ways those early days were much more enjoyable than my first child, in part because I wasn’t nearly as ill this time, secondly because I didn’t wait to arrange treatment. Under the guidance of my doctors, my consultant, and my perinatal mental health workers I took treatment during my pregnancy and I continue to treat my postnatal depression now.

Therefore I didn’t wait to reach a low, as I have learnt the hard way that ironically it is harder to seek out help when you are at your lowest, as you lack the motivation. I anticipated the depression and treated it. And I am glad I did. Being a mother of any number of children is hard enough, being a mother of multiples is bloody hard, and leaves you with very little time or space to rationalise your thoughts, never mind notice that you might be depressed.

I’m not for one second saying that any mother of multiples will suffer from postnatal depression. However what I am saying is that it is understandable that it could be easy to fall foul of it, but that you are probably so busy dealing with the day-to-day trials and tribulations, the daily marathon you have to run just to reach the end of the day, that you might not notice it is happening. You might not notice that you’ve tipped from an appropriate amount of struggle, to an inappropriate and debilitating amount of struggle.

Therefore it is key that health workers, GPs, midwives, family and friends should educate themselves on the signs of postnatal depression, and look out for them even more when speaking with a mother, who quite frankly, has her hands full.


  1. Such a brave and lucid post. I had no idea about the research connecting multiples and PND. Is it wrong to say it doesn't surprise me though? It feels a little wrong, because your boys are clearly such a blessing and it's almost as if I'm connecting their characters with the inducement of depression! But it's not that, is it? It's just that caring for two tiny people at once, however amazing they are, tests a person to their limits (and them some). But, look, they haven't killed you (yet!), they've made you (and your family) a hell of a lot stronger.

    1. If doesn't surprise me either Hattie. As you say, not because anyone with my kids would push them into depression - but rather the sleep deprivation, the stress, and the constant demands on your attention might leave you weaker and more vulnerable to depression, and less likely to notice it happening.

  2. What a brilliantly constructive post. I too had a lady tell me that she thought PND was a perfectly rational response. There IS a correlation with multiples: you're more likely to have had an EMCS, with all that entails, you've had double the hormones, if you're BF then double the amount is draining out of you, and depression 'proper', rather than just being a bit sad, is medical. And then chuck in all the emotional factors - you're knackered, everything is so much more difficult, a future of double trouble stretches in front of you...I stupidly didn't do anything about it, thinking pills would make me woozy and would go on my records as being a case to watch. Until I went pop and capitulated. Surprise surprise, the pills DO help because they're merely counteracting an imbalance in your brain. Life doesn't suddenly look bright and shiny over night, but MUCH more even sailing.

    Well done for speaking out. I hope it helps some fellow twin Mums.

    1. Helen, well said! Too many people believe that depression is an emotion - it isn't and people often deny themselves treatment because of society's ignorance and the associated stigma. Laura's blog is one of the ways we can break this - No-one should have to suffer in silence when there are effective treatments. Mums of twins and multiples deserve respect and should be educated about the increased susceptibility to post natal depression.

    2. Hi Helen. Thanks for your comment. For me that's the crucial part - being able to notice and recognise when it's tipped from being an appropriate response into clinical depression which requires treatment. Sometimes what we think is just the normal experience appropriate to our situation is actually far harder than it ever needs to be. I'm not saying that treating post natal depression would even make parenting twins easy, but it can remove that black cloud. X