Pre & Postpartum Depression
Pregnancy, Parenting, and Identity
Pregnancy, childbirth and the early stages of infancy are life changing. For anyone embarking on this journey, together or alone, counselling can be a useful aid in navigating what is coming, or what is already happening.
1. Parenting and Identity
2. Fertility and Infertility Narratives
3. Pregnancy as a Life Transition
4. Multidisciplinary – Doctors, Midwifery and Counselling Therapy
5. Postpartum Syndromes – Depression, Anxiety, and Trauma
6. New Roles – Relationship, Responsibility, and Honesty
Pregnancy, Parenting, and Identity
Pregnancy and birth narratives are often written with cisheteronormatic assumptions: mothers and fathers, husband and wives, etc. The truth is that not all birthing persons identify as women and mothers, and not all child-bearing relationships
are made of one man and one woman. At Nightingale we are explicitly inclusive in our approach to pre- and postnatal counselling. For us, creating a safe space in which to discuss the dissonance between our own identities
and the roles and labels that culture attaches to parents can be an important part of counselling.
And it’s not just related to gender. Some people think they are “too old” or “too young”, too this or too-that, “to be a parent”. For others, their perceptions about what it means to take on motherhood or fatherhood or parenthood doesn’t
line up with their sense of self. These are legitimate and valid challenges that deserve compassionate inquiry.
Fertility and Infertility
More and more it is becoming commonplace for infertility to be discussed openly. Once a heavily stigmatized and shameful experience, we have finally come to realize that it impacts a great many of us. Within the first year of “trying”
to get pregnant, 85% of people will succeed — but this means that 3 in every 20 will not. And this can be hard.
Miscarriages are also a natural and normal part of the fertility journey for many. In fact, nearly 50% of pregnancies are lost before they become noticed. And at the 6 week mark, more than 10% of all pregnancies will end in miscarriage.
These are challenging experiences, often made more difficult by narratives of guilt, shame, or secrecy. Counselling can provide a safe and confidential space to acknowledge what’s happened and what it’s meant: perhaps it is grief
and loss, or perhaps relief, or some other feelings. Giving space for these experiences and emotions to be integrated is a part of prenatal counselling.
Multidisciplinary Teams – Midwives, Doctors, and Therapists
Pregnancy raises so many questions:
● What will happen to my body?
● Will the baby be healthy?
● How do I stay healthy during the pregnancy?
● How do I ensure a safe birthing experience?
For these questions, doctors and midwives make excellent companions. But these aren’t the only questions. What about:
● Am I ready?
● What will happen to my “old life”?
● What will happen to my relationship?
● How will I navigate financially?
While doctors and midwives can help us navigate many of the biological and practical questions of pregnancy, questions like these are perfect for
A common feature of the pregnancy and new baby literature is to make it all seem very scary. There are pitfalls everywhere, wrong turns which can apparently have terrible and permanent effects on the baby. These
fear-driven narratives are criticized today for catastrophizing, for medializing a natural process, for being used to control the bodies of birthing persons, and most commonly, for creating LOTS OF
The truth is that most babies are born happy and healthy, and most birthing persons finish labour happily and healthy. But, postpartum syndromes such as postpartum depression or postpartum anxiety do happen too, so while you needn’t
worry about them if you aren’t experiencing it, it can be helpful to know what’s going on.
Pregnancy itself is a major life change, one that will influence diet, lifestyle, roles, work, relationship and identity. Even for the most well prepared, pregnancy is a moment of life transition — perhaps joyous, perhaps doubtful,
but a transition nonetheless. Like all life transitions, navigating the complex ways that it will influence our lifestyle can be well served by guided conversation.
Deciding to continue with a pregnancy is a major decision, one which few people take lightly. The same is true for those who are considering, or who have decided to terminate pregnancy. In all cases, the news, the decision making,
and the outcomes of those decisions often lead us into uncertain waters.
After labour it is very common for people to experience unexpected moods over the following two weeks or so. Not only has it been, for most, an enormous and novel experience, there are also a cascade of hormones changing
in the body. Combine that with a brand new set of responsibilities and perhaps a good dose of sleeplessness, and you’ve got a recipe for changes in mood. Postpartum depression is different, and is a prolonged and severe
experience in which emotions, cognitions and behaviours are impacted.
The symptoms of postpartum depression include:
● hopelessness and helplessness
● feeling overwhelmed, perhaps feeling like crying or giving up on things is always just a second away
● lack of self care or baby care, e.g. refusing to breastfeed the newborn
● overwhelming fatigue not explained by mere lack of sleep
● lack of positive or connective experiences with baby, partner, or others
● suicidal ideas or feelings
For more information about depression and suicide, please see our page
For anyone feeling these symptoms, shame can make the situation even harder. Postpartum depression makes it difficult or impossible to meet the demands of the parenting role, and in our culture this can lead to feelings of
inadequacy or severe guilt. Therapy can be an essential part of healing from PPD and finding new ways to enter into parenthood.
Even after getting through the myriad challenges of pregnancy and labour, settling into new roles as parents isn’t always easy. For many people, the arrival of children in the household can signal:
● lost access to activities, hobbies, or sports as a result of new time requirements
● lost access to our partner, as new demands from baby take up their attention
● a sense of loss of the “old life”, even if we cherish our new life
● a new sense of duty which challenges our ability to relax, unwind, “turn off”
● a rebelliousness against the constraints of parenthood
● an erasure of the self, now completely understanding yourself as a “parent”
Navigating these new roles can be really hard. Our cultural narratives suggest that all new parents should be tired but happy. What do we do if we are not feeling that way? Who can we talk to?
For many people it is difficult to broach these topics with our partner / co-parent. Although we may have needs we’d like them to know about, we can feel guilty for being anything other than a perfect parent, happy to change
their life on a dime and give up what once fueled them. It doesn’t have to be this way.
Counselling therapy can help new parents communicate with themselves and with each other, learning to be transparent about just what’s going on for each of you.
If you’re like most new parents, you might be thinking that although counselling sounds great, how are you supposed to get away for that long! For brand new parents we happily recommend virtual therapy. You can sit in the comfort of your own home, next to baby, and as an individual or a
couple you are able to engage in compassion dialogue about just what is happening on this wild journey.