In the absence of any reliable explanation of infant colic, it seems important to think more about how to survive it until it resolves rather than how to'cure' the colic itself.There are other sources of advice on infant colic but before trying out any 'natural' remedies it is always important to check this out with your GP or health visitor.

Managing infant colic . Try to adapt your evening routine so that one parent is free to manage the baby. If you are on your own, try to get a relative or friend to come around to hold the baby and give you a break.

. Find things that soothe the baby generally, perhaps a trip out in the car or pram, if that is at all possible at that time of the day. Maybe a bath or playing him some music will help.These things are very individual and some babies may become more distressed by further stimulation.

. Try to free yourself from the stress of the situation. Get as much support as you can. It may feel difficult to keep asking a relative or friend to come around and 'hold the baby' but remember this won't go on forever.

Remember too that other people will find the cries of your baby less distressing and therefore easier to deal with. For a mother the cries of her own baby stir up very primitive emotions, for others they are just the sounds of a baby crying. Also you have been dealing with the baby all day and all night too probably, so allow yourself to take some support if it is available.

. Alongside this, try not to allow yourself to become demoralised by the babies crying. Infant colic will resolve itself, no matter what you do.

Blaming yourself and thinking it is because you are a useless mother will only make you feel worse and less able to cope with a situation that is very emotionally demanding.

. There are self-help organisations that may be able to offer support and advice. Usually on a telephone help line you will be able to talk to another parent who has experienced similar problems (see list of addresses of organisations that can help on p. 181).

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Most babies do respond to being picked up and talked to or sung to.

However, many mothers have been told, perhaps by their own mothers, that picking up a baby too much will spoil him and make him cry even more. Is it such an awful thing to pick up a crying baby or are we just 'making a rod for our own back'? There is research to show that attending to babies'cries quickly actually decreases the amount of crying in the first three months. It is a decision really about what you want your baby to learn: 'don't bother crying because it makes no difference to how I behave'

or 'if you need something, then let me know'. Sometimes, if you are really struggling to cope, then you may have to put your baby down safely somewhere and let him cry while you take some moments away from the situation to calm down. However, routinely leaving a baby of this age to cry in his cot is not a good idea, babies can very easily become overheated and all that crying may mean he needs milk again more quickly.

Annabelle and Hugh's story Annabelle came to see me when her second child was six weeks old. She came as an urgent referral as the GP said she was 'absolutely beside herself with worry' about her son Harry. Annabelle told me that Harry was in terrible pain most of the time, crying and 'pulling his legs up to his tummy'. Harry had seen many doctors including the consultant paediatrician and all had concluded that her baby had 'colic'. Annabelle found this particularly difficult to accept as she had not had similar problems with her first baby and she deeply resented the suggestion that she was an anxious mother. In the course of our discussion it became clear that she was feeling very unsupported by Hugh who had a very busy job as a barrister and whom she said she hardly ever saw. She suspected that he might be having an affair and she resented the number of nights that he stayed late at work.

Harry's colic gradually disappeared over the next few weeks and Annabelle said she had been exhausted and distraught with the stress of dealing with the crying. With hindsight she didn't really think that Hugh was having an affair, she simply resented his time spent away from the home. Once Harry had improved, she felt she could cope generally and that she would just have to come to terms with Hugh's commitment to his job. Hugh was unable to come to the session that I had invited him to attend.

Sleeping 139.

Sleeping Within the first six weeks of your baby's life his pattern of sleeping may be very unpredictable. Gradually through the course of the first year of life his sleep will become more concentrated in the night-time and his periods of wakefulness during the day will increase.There is a great deal of variability between babies about how long they sleep at any one time. This is also clearly linked to feeding. As the size of the baby's stomach grows and as his feeding abilities increase, he will take in more milk and be able to sleep for longer periods. Some babies may sleep for three or four hours at a time during the day, others will be awake again after half-an-hour.

The fact that your baby wakes during the night is clearly a'problem' for parents as it disturbs their sleep and generally makes life harder during the day. However, health professionals will not be keen to diagnose your child as having a sleep problem before they are at least six months of age.This is mainly because night-time waking in the first six months is extremely likely but it is also because any intervention targeted at a child younger than six months is unlikely to be successful or, if it is, the results may be short-lived. Babies in the first couple of months will be waking because they are hungry and because they have completed a sleep cycle. Achieving your baby 'sleeping through the night' can become a great preoccupation but it isn't the whole story. Most parents, at different stages throughout the first few years of your child's life, will have to deal with settling problems or night-time waking. Teething, coughs and colds, changes in daytime routine, daytime sleeping: there are many things that can lead to night-time interruptions.

Coping with interrupted nights If you are finding it particularly difficult in the night, perhaps you could try some of the following: . If you can, express some milk and get your partner to take one of the night feeds.

. If you are bottle-feeding, you could share the feeding so that one of you does late nights and one does the early mornings.

. Try to sleepwhile your baby is sleeping. Ifyour babyonly sleeps in short bursts, then this may be unrealistic, as you can feel worse if you are woken again after 30 minutes. Alternatively, perhaps you can get someone to'watch' the baby while you get some sleep during the day.

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. If the baby is wakeful in the evening, ask your partner to'hold the baby'

while you get some sleep.Try to work out some sort of timetable so that you can both get sufficient sleep to manage the feeding.

. Most professionals who work with babies will recommend that you try to put your baby down to sleep while he is still awake, rather than rocking him or letting him fall asleep in your arms. This is so that your baby will be able to settle himself to sleep when he wakes from a sleep cycle at night rather than having to have you there.This is an issue to discuss with your health visitor and, like demand feeding, is a choice to be made by the parent. Many mothers may feel that this spoils their contact with their baby and they enjoy him falling asleep while feeding or being cuddled.

Is it OK for the baby to sleep in our bed?

Another issue linked to the sleeping patterns of babies is where your baby should sleep. Co-sleeping, or the baby sharing the parental bed, seems to be a growing trend in recent years and we perhaps imagine that this is a modern invention. However, for thousands of years infants have slept with their mothers and this is still very much the norm in many non-Western societies today. In fact, in some societies women think it almost neglectful for infants to sleep separately. However, we cannot necessarily compare these situations and a.s.sume that it is therefore safe. Our ancestors didn't sleep on mattresses, under duvets and in centrally heated houses.

The issue of co-sleeping has also become linked with the issue of 'cot death' or Sudden Infant Death Syndrome (SIDS). Since a directive in the last few years that babies should sleep on their backs, the rates of SIDS has dropped dramatically. The Foundation for the Study of Infant Death provides very good information about decreasing the risk of SIDS. Their address is given in the list of addresses on p.181and they have a very accessible website (www.sids.org.uk).

Clearly, certain sleep environments are more risky for babies.There has been research to suggest that co-sleeping might in fact be preventive in SIDS since co-sleeping causes a different level of arousal in babies.

Having your baby in the same room (in the early months) is also preventive perhaps for the same reasons. The relationship between SIDS and co-sleeping is complicated. A recent large population study identified certain risks to be avoided: co-sleeping on a sofa, co-sleeping after the recent consumption of alcohol, where you are extremely tired, the infant being under a duvet and parental smoking (Blair et al., 1999).

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Interacting, exploring and learning Feeding initially fills most of the baby's wakeful periods but gradually the baby becomes more alert and is beginning to explore his environment.

His tiny movements seem totally random but are in fact tiny steps in his development. As mentioned in the previous chapter, from a very early age your baby is able to recognise your face and your voice. Attachment is a two-way process and the baby is primed to develop a relationship with someone who will love and take care of him. One of the first things a baby learns to do is to make eye contact and then to imitate facial gestures.

If you hold your face close to your baby's and open your eyes and mouth widely as if surprised, an awake and alert baby will try to copy you (see Murray and Andrews, 2000, for amazing photographic evidence of newborn babies'capabilities). Also in the first six weeks, you will probably see the first social smile: babies will get their features into a 'smile' from birth but this is different from a smile that was intended. A smile will eventually be elicited by the approach of, or interaction with, the mother or father. Increasingly the baby will be soothed by a familiar voice and will begin to make sounds in response to the parents' talk. The baby will also be soothed by being picked up or held.

Communication between mother and baby does not begin when your baby starts to'babble' or says his first words; communication begins from birth in these interactions. It has also been argued that the turn taking that is necessary for communication in speech begins during feeding. Careful a.n.a.lysis of mothers and babies during feeding has shown that there is a 'burst^pause' cycle (Kaye, 1982). Basically, this means the baby feeds, then stops, before feeding again. Mothers will spontaneously 'jiggle' the baby during the pause and he will begin to feed again. A pattern develops so that the baby responds to the mother's encouragement to continue.

Mother and baby are'communicating' with each other about the feeding.

In the past, parents would not have been encouraged to communicate with babies as it was a.s.sumed that they just fed and slept in a rather mechanical way. However, psychological research evidence from the past 30 years shows that even from a very early age there is reciprocity between mother and baby.This responding to each other, which goes on without us even really noticing, seems to be central to how babies learn and develop in these early months.This is possibly too where early difficulties in feeding and with crying begin.Where mothers are very anxious or very depressed, they fail to respond to cues from the baby that he is hungry, tired or uncomfortable. Consequently, the baby may cry more as he is not eliciting the response that he needs.

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It seems important therefore to continue the dialogue that began back in pregnancy. It is important to try and relax and listen to and be guided by the baby. Both parents should feel free to hold, look at, talk to and listen to their baby. Previous generations may have believed that you 'spoil' a baby by picking him up too much but, in the long term, the more you know and understand your baby, the easier it will be to negotiate his infancy. This doesn't necessarily mean your life has to be totally dominated by the baby: if he learns that you'usually' respond quickly, then he will be able to tolerate a little frustration. If you only respond after he has cried for 20 minutes, then he will learn that this is what he needs to do to get your attention.

Your baby will grow and develop rapidly over the next few weeks and months. A baby's development will often be talked about in terms of achieving his 'milestones': such as lifting his head, sitting unaided, crawling or taking his first steps. Clearly, for all babies these have to happen in a certain sequence: you cannot walk before you can sit up. However, there is a wide age range at which these milestones will be achieved.

Right from birth, however, your baby will be weighed and measured and his progress on these measurements can be a source of anxiety or disappointment for a parent. Mothers will often leave the baby clinic proudly announcing their baby's weight (which really doesn't mean a lot to you unless you have a baby of a similar age) and this can be very difficult for a mother who has a baby that is not gaining lots of weight or later a child that seems to be developing at a different rate to his peers.These differences are usually insignificant in the long term, so it is important to try not to become too caught up in comparing your baby to others.

Changing relationships As discussed in Chapter 3, now there are new social roles to be learnt by all members of the family. By six weeks you are probably getting used to the idea of yourself as a mother or father, even if only in terms of getting used to people using the term in relation to you. This learning carries on throughout your child's life. A new baby can lead to unexpected reactions in others. You may find your own parents a great source of help and support or you may be disappointed by their lack of involvement or their over-bearing advice. Perhaps it's important to remember that they are learning too and that you may find it very useful in the future to have help and support from family members even if it involves some costs.

Often there may be disappointments or disagreements about the sharing out of tasks within the home. Sometimes post-natal emotional The recovery of the mother 143.

problems have their roots in dissatisfactions with the relationship between the couple. It is important to remember that you need to be explicit about the help that you need. Research has shown that where women asked for specific types of help, they got more support at home and their relationships improved. This may seem like stating the obvious, but in a situation that is new to everyone it is always important to keep talking about what you need.

Becoming a sibling If this is not your first baby, then you will have an older child or children who must learn a new role as brother or sister. It can be a very difficult transition for children to come to terms with a new baby and their reactions can be very varied. They may 'regress' in their behaviour, for example, start wetting again once potty-trained, they may want to drink from a bottle, want to be carried all the time or to sleep in the parental bed. You may worry that your child will 'resent' the baby only to discover that your child loves his new sister but is constantly angry with you. However your child reacts, he needs your support and understanding.Try to involve him with the new baby and to spend a little time, perhaps while the baby is sleeping, doing something just with him. Often your child may strengthen his relationship with his father or a grandparent at this time, so that he has a special person to be with when your attention is taken up with the new arrival.

The recovery of the mother Physical recovery: 'What happened to my pelvic floor?'

As the first six weeks progress women should start to feel much better physically. Usually any bleeding will have stopped or lessened considerably, st.i.tches should have healed and women post-Caesarean should be feeling that their wound has healed. Of course many women do have complications and prolonged healing and any concerns should be raised at the'six week check'.This is an appointment that you will have with your GP to discuss your health and well-being. It is important to get help with any concerns that you have rather than just hoping they will go away.

When you are discharged from hospital, you will probably be given some information on your health post-natally such as exercises for getting back into shape or how to improve the muscles in your pelvic floor. If this is 144 not the case, then try to speak to your midwife, health visitor or GP if you have any concerns. For example, some women go on to have problems with stress incontinence following physical trauma in labour. This can be prevented by exercise of the pelvic floor muscles.

The emotional journey continues Psychologically, most women feel that the first six weeks are an extreme and intense time emotionally. An enormous shift has occurred from the day that the baby was born to this point where the majority of parents are feeling a sense of life settling down to some sort of normality. That 'normality' might mean a baby that is totally unpredictable and a great deal of uncertainty but it is more the sense that you are coping with this new life, if still at the beginnings of it.

However, six weeks seems to be a peak time for women to start showing signs of depression. Around 10 per cent of new mothers could be diagnosed as depressed at this time. In some areas of high social deprivation, the figure is considerably higher (unpublished figures from my own work in an inner London area show levels as high as 25 per cent).This probably reflects the greater number of pressures that these women/families have to cope with. However, it shouldn't be thought that middle-cla.s.s families do not experience post-natal emotional problems: post-natal depression is common across all social groups and can affect anyone. That is not to say, however, that it is something that we have to be victim to, an 'illness'

that we just suffer and can do nothing about. Research has shown that there are ways of reducing the levels of emotional problems in new mothers both by preventing them from happening and by supporting mothers and families when they occur.

What is post-natal depression ?

As has been emphasised, all women have good and bad days when they are getting used to being a mother. The lack of sleep that many mothers experience would be enough to make most people feel fed-up or tearful.

Most new mothers will feel at times that they are not making a good job of parenting or feel sad about the things that they would like to do and can't. Depression, however, is something different to this, something deeper, more persistent and debilitating.

What is post-natal depression?

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What does it feel like?

In terms of symptoms, post-natal depression (PND) may be experienced in a number of different ways but characterised by the persistent low mood that is common to depression at any time.The most common symptom is to feel tearful and easily upset. For other women it may be irritability and mood changes that are troubling them. Often these emotions are linked to how the new mother is feeling about herself as a mother: she may lack confidence, feel useless and compare herself negatively to others. In Chapter 4, the 'biological' symptoms of depression were highlighted and these are common in PND: changes in appet.i.te, sleep problems and lack of energy, poor concentration and feeling unable to cope with the care of the baby and the usual daily tasks. Clearly, in the early days, after having a baby some of these problems can be mistaken for just the normal struggles of having a new baby. I have seen many women who have terrible sleep problems but attribute it all to'getting up to the baby'. Lying awake at five in the morning worrying about coping is not the same as waking to feed the baby. Depression after giving birth is often masked as tiredness or 'Well, everybody gets a bit tearful when they have just had a baby.'

Often post-natal sadness manifests itself as extreme anxiety, particularly about the baby or about some aspect of the birth or the mother's labour or recovery. Jenny, whose story was in the last chapter, became preoccupied with Hannah's milk intake to the detriment of everything else. Clearly, for many women these issues are very real but if you become preoccupied with your labour difficulties to a point where you can't get on with your life with the baby, then perhaps there are problems to be looked at in more depth.

Is it different from depression at any other time?

Statistically, depression is fairly common for women: being at home/not working and looking after children are two strong 'risk factors' for developing depression. So is there anything different about 'post-natal'

depression? Depression in the year following childbirth is fairly common but many young women of a similar age will also be depressed. However, women seem to be much more likely to get depressed at around six weeks after the birth of their baby, which does suggest that there are factors specific to those first few weeks that put you at risk for depression. As has been said, around 10 per cent of mothers will become depressed at this point but rates of depression do seem to peak again at points later in the 146 first year, so it is probably easier to regard the whole of the first year as a time of risk for post-natal depression.

For many women it may be that they have a history of depression and this is simply another stressful time that triggers depression but for a distinct group of women this will be the first time that they have been depressed. Another factor that seems to be common with post-natal depression is that it is often not recognised. For many women it is only when they recover that they realise that they were depressed and that their experience was different to other women's. Some women maybe never identify that they were depressed, they simply shut out the experience and get on with their responsibilities. It is perhaps difficult to admit to being depressed when the world around you is just seeing the positive. It's great to come round and 'coo' over the baby for half-an-hour but very different when you are with this baby 24 hours a day.

Clare and Ian's story Clare had worked as a nanny since leaving school, loved children and couldn't wait to start a family of her own. Her husband Ian was perhaps less enthusiastic but he wanted what Clare wanted. At 25 Clare gave birth to a baby boy, Edward, and initially all was well.

She received a great deal of help from her mother and in fact often stayed overnight there as Ian was a shift-worker and Clare didn't like being alone with the baby. When Clare came for help, she did so extremely reluctantly. She initially said that she had just been having a bad day when she had seen the GP who referred her, and really she was fine. She said she had been tearful at the time because she was having terrible problems with breast-feeding. When she began to speak about this, she was instantly in floods of tears and remained so throughout our meeting. She had stopped breast-feeding because of an infection in her breast, which she perceived to be a terrible failure, especially as she had always felt critical of mothers who bottle-fed. She said her mother had encouraged her to bottle-feed from the start and now at least she could get her mother to do some night-time feeds. She had spent all of the last week at her mother's house and said she was worried about things with Ian because he and her mother just didn't get on. Ian didn't feel confident that they could manage the baby and accepted that it would be better if Clare stayed with her mother, especially while he was working. Clare rarely went out and found the idea of going What is post-natal depression?

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shopping or out in the car without her mother almost impossible. She said she rarely got dressed at all most days and said she wouldn't eat a thing if her mother weren't cooking for her.

It took Clare many months to finally feel confident enough to look after her baby in her own home with Ian. Every time she got a bit better she would give herself a hard time about why she had been able to look after other people's children but was terrified of looking after her own baby.

What causes post-natal depression?

As with depression at any point in the life cycle, there are a range of ideas about what causes PND, including biological factors, social and life factors and things to do with your psychological make-up. There seems to be a range of factors that might cause a woman to become depressed after having a baby and these factors are different for each new mother. The enormous physical and hormonal changes a.s.sociated with pregnancy and childbirth may be a factor for some women. There are also genetic aspects to depression: if close relatives have suffered from depression, this makes your risks of experiencing it higher. Also if you have been depressed before, then the transition to parenthood may be another event that triggers depression.

The enormous social and life changes that occur when having a baby are probably the most significant factor: women have to a.s.sume the new role of a mother, saying goodbye to a child-free life and coming to terms with the responsibility of looking after someone else. This is obviously much more difficult where women are isolated and lack of support, have problems in their relationship and are struggling with other life issues such as unemployment, poverty and housing difficulties. There are also factors to do with your experience of the pregnancy and birth itself and a poor experience of labour, particularly in terms of it not meeting your expectations, can be a cause of depression. If you have had difficulties in your own childhood, particularly a poor relationship with your own mother, then this seems to increase your risk of becoming depressed.

No one factor or explanation seems to be enough to explain the occurrence of emotional problems following birth and perhaps the term 'postnatal depression' is just a label for similar symptoms caused by a wide range of different problems and experiences for different women. The stories below highlight some experiences of post-natal depression.

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Post-natal depression and birth-related problems Very many women find that at six weeks they have hardly recovered from the birth of the baby and aspects of their delivery may be holding back their recovery and it is not unusual for this to lead to depression. This may be particularly true where your baby is born pre-term, needs special care or is born with disabilities or health problems.The temperament of your baby may also prove challenging to you. If your baby has struggled with feeding and appears difficult to settle, then you are more vulnerable to feelings of inadequacy or confusion and this can slip into depression.

Fiona and David's story Fiona and David had their first baby, Louisa, when Fiona was 37.They both worked for a merchant bank and Fiona was hoping to return to work as soon as she felt well enough, but definitely intended to do so within three months. Fiona's labour had started within a couple of days of her maternity leave beginning and she said she had been terrified when she had felt the first contraction. She said she had a feeling of being 'caught out'and 'unprepared' since she had been so focused on her job just a few days before. Her labour was long and had eventually to be speeded up with a drip as her contractions had slowed down.This intervention had caused her terrible pain she said and there had been too much delay in her getting an epidural. She blamed this delay for the fact that she needed a forceps delivery after many failed attempts at trying to push the baby out. Fiona said that she had felt like she had been battered with a cricket bat afterwards. She found her st.i.tches terribly painful and she was plagued by cramping pains in her abdomen.Two weeks after Louisa was born, Fiona developed a bladder infection and was confined to bed with her mother having to come and help look after the baby. Eventually, she returned to hospital and it was discovered that there was retained placenta needing further intervention. After a course of antibiotics, she was feeling better but breast-feeding had broken down completely in this time.

By six weeks after the birth Fiona still felt she had not recovered and that her st.i.tches were still painful. A phone call from her boss to discuss her plans for returning to work seemed to be the trigger for her depression as it emphasised for her just how much her experience had been different from her expectations.

What is post-natal depression?

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Post-natal depression and echoes of the past?

Often we find ourselves drawn into repeating the patterns of our own childhood and where there were significant difficulties for our parents, particularly between them then this can cause difficulties for new parents both mothers and fathers. Having to care for a needy baby can stir up feelings of need in ourselves.

Karen and Colin's story Karen was 16 when she had her first baby, Sophia. Colin already had two children from a previous relationship although he did not see them regularly as the relationship with his former partner was difficult.

Karen struggled a great deal in those early weeks and felt totally overwhelmed at times by the baby waking at night and the constant feeding.

She said that at times she thought Sophia would be better off 'in care', something she knew all about having spent many periods of her own childhood in care. She told me that sometimes she had to leave Sophia crying in the bedroom and put her head under a cushion, as she couldn't stand it. She had little contact with her own mother who had been totally against the pregnancy as she had seven children of her own and said she didn't want to end up bringing up Sophia. Colin initially was very supportive and helped out with feeding at night but after the first couple of weeks he said he was exhausted and took to spending long periods in bed. Often there was no food in the house either because there was no money or because neither Colin nor Karen felt able to get to a shop. Colin absolutely idolised his own father and had hoped to be as good as him. However, Colin tended to be preoccupied with his inability to provide materially for the children and would go to his own father to get money to buy the baby elaborate toys and designer clothes.

In time Karen began to recognise that both she and Colin were totally unprepared for having children and that she desperately needed more support with looking after the baby. She moved in with an older sister and her husband and gradually with help from her sister became more able to cope with the care of Sophia. Karen intended to return to Colin 'at some point' if he could sort himself out.

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Post-natal depression and life events As previously mentioned, many women experience a number of life issues and events either due to the pregnancy itself or with it. For some women the sheer number of difficulties that they have to manage seems to be what triggers their depression.

Hayley and Enrique's story Hayley and Enrique were both pursuing careers in the entertainment industry. Hayley was a children's entertainer who hoped to break into children's television and Enrique was a drummer with a band. Enrique was often away on tour for long periods and with two uncertain incomes they had not planned their pregnancy. Despite all the obstacles and uncertainties they had begun to look forward to the birth of their baby. However late in the pregnancy Enrique had a chance to tour in the USA and they decided he should go as at least it offered some income. Just after Enrique's departure their landlord who was a 'friend' announced that he had sold their flat and wanted her out in the next month. Consequently, at 35 weeks pregnant, Hayley had to return to her mother's house 200 miles away. Hayley had to stay in the bedroom that she had had as a child and cope with her mother treating her like a 'naughty child' who had got herself into a terrible mess.

Hayley's baby, Joel, was born at 37 weeks and spent the first week in Special Care as he was of low birth weight and needed monitoring.

Hayley's original enthusiasm about the baby was completely crushed by the experience of the last days of her pregnancy. She deeply regretted having let Enrique go to the US, as after a short visit to see the baby he had to return. She felt that everything she had done had been the wrong decision. She was angry with Enrique, with her landlord and with her mother but at the same time felt she couldn't express it. Her mother was keeping a roof over her head and Enrique was trying to earn money. She felt trapped at her mother's house and although generally her mother was trying to help, she felt she couldn't stand to be with her and she spent a lot of time up in her bedroom feeling like she wanted to 'explode'. She also worried greatly about Joel who was gaining weight very slowly in the early months and she found the concerns of her GPand health visitor threatening as she was sure eventually Joel would be taken into care as she had proved herself 'such a useless mother'.

What is post-natal depression?

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After a couple of months Enrique left the band and returned home.

He found accommodation and Hayley joined him. Money was extremely tight but Hayley's parents did help out. Hayley said she had just become so miserable she couldn't get out of it. However, this was a turning point and gradually things improved. When Joel was a year or so old Hayley was beginning to enjoy her life again and she was rea.s.sured that Joel was 'fighting fit' now. She began to take some work doing children's parties as she had a friend who would look after Joel for an afternoon. It took time but gradually Hayley began to enjoy her new life.

Post-natal depression and support Very often depression occurs after childbirth because the new mother is socially isolated: she may have few family and friends around her and may find herself alone at home with the baby for long periods of time. Depression is more common where there are relationship difficulties or the partner is frequently absent. Sometimes people may be unaware that a new mother is struggling as she is 'keeping up a brave face' for the outside world.

Sue and Stella's story Sue had two children, Lauren and Josie, by donor insemination.

Following her first pregnancy she recovered well and Stella, her partner, was keen for them to try again for another pregnancy. They knew they could only have a small number of attempts at this treatment as they wished their daughter to have a biological sibling (and therefore they were limited by the donor supply). As Sue was in her early forties, they felt they should 'get on with it'and on the second attempt Sue became pregnant and had a second daughter. After this roller coaster of events Sue realised that the world would expect her to be blissfully happy: from an unlikely situation she had managed to have two beautiful children. However, the day-to-day reality of her life was, she said, a nightmare. Lauren, her eldest daughter, still woke regularly at night and came into their bed for the duration. Josie was feeding often at night and seemed to sleep very little during the day. Sue said she felt her age at times and although she loved the girls totally, she desperately hated the monotony of the days. Stella worked as a 152 journalist on a Sunday newspaper and spent less and less time at home as the week progressed. Sue had little real support with the children.

Both sets of parents lived at a distance and Stella's family still could not accept that she had not married a man and had a family.

Sue had very little support through these difficult times. She had avoided ante-natal cla.s.ses and mother and baby groups because she felt she might have to keep explaining her 'situation' to others. She found little in common with her friends as they either had older children or had not had a family. Everyone a.s.sumed that she was happy which made it more difficult for Sue to admit that she wasn't enjoying being a full-time mum. Things did improve for Sue when she employed a nanny two days per week. The nanny took Sue and the children to some local toddler groups and play facilities and Sue realised that she lacked confidence as a parent and felt that because of her circ.u.mstances she had to be 'beyond criticism'. She also realised that her fears of being criticised had adversely affected her confidence throughout her life and that she had avoided developing a life and career for herself and that she was very reliant on Stella. Sue began to take evening cla.s.ses and started to look at herself in a whole new way. For Sue the transition to parenthood had caused a fundamental re-evaluation of her ident.i.ty.

Post-natal depression and loss The transition to parenthood involves the loss of many things: for women their working life changes, their body changes and, more fundamentally, how they see themselves changes. There are changes for new fathers and the couple too, particularly in terms of their social life and their finances.

Many of these changes involve a sense of loss. Often this may coincide with or reawaken unresolved feelings of grief.

Janet's story Janet came to see me following the birth of her third child. She said that it was the most enormous struggle to drag herself out of bed in the morning and if it wasn't for the fact that her husband was able to drop her two older children at school, she doubted that they would get there at all. Janet said that she couldn't understand why she was being such a 'waste of s.p.a.ce' since usually she was a very capable person. Janet did What is post-natal depression?