How do I know my risk of postnatal depression?

This is an important question because understanding your risk gives you something useful: the opportunity to prepare.

Knowing your risk is not predicting whether you will develop postnatal depression. It is understanding the factors that may influence your mental health, recognising what may increase your vulnerability, and identifying what may protect you.

Understanding your risk, allows you to understand what you need to protect your mental health.

Everyone can develop postnatal depression

When we consider the biological, psychological and social changes that happen during pregnancy and the transition to motherhood, it is not difficult to understand why any woman potentially can develop postnatal depression.

Every organ system in your body undergoes change. Sleep changes. Hormones change. Your physical experience of pregnancy changes.

At the same time, your identity, beliefs, priorities and relationships may change.

And that is when everything goes according to plan.

Pregnancy is dynamic and life continues to happen. Pregnancy complications, concerns about your baby's health, fertility difficulties, pregnancy loss, financial pressure, work stress, relationship difficulties and other significant life events can all add to the emotional load.

These circumstances do not mean that depression is inevitable.

They simply form part of the picture.

Know your vulnerability

Although any woman can develop postnatal depression, some women are more vulnerable than others.

Recognising your vulnerabilities makes it possible to recognise where you may need to pay more attention and prepare more carefully.

Ask yourself:

Have I...

• ever experienced depression or another significant mental health problem?
• experienced significant anxiety or mood changes after the birth of a baby?
• stopped psychiatric treatment because I became pregnant?
• been significantly affected by my mental health in the past, for example requiring hospitalisation or time off work?
• experienced significant symptoms recently, such as persistent anxiety, low mood or insomnia?
• experienced complications during this pregnancy?
• experienced a pregnancy, birth or other event as traumatic?
• been affected by significant life events such as bereavement, relationship conflict or financial stress?

These questions do not give you a score that predicts whether you will develop postnatal depression.

They give you information. And information can help you prepare.

If any of these questions concern you, it is worth discussing them with your healthcare professional before or during pregnancy, rather than waiting until after the birth.

So what do I do with this information?

Knowing that you have risk factors should not leave you frightened.

It should help you decide what you need.

A useful starting point is to ask:

Which group do I belong to right now?

There are three broad groups to consider.

1. Women who are generally well

If you are entering pregnancy without a significant mental health history and you are not currently experiencing significant symptoms, this is an opportunity to build and protect your foundations.

Think about the things that support mental health: sleep, movement, nutrition, connection, relationships, practical support and healthy coping strategies.

I think about resilience in much the same way as physical fitness. We cannot all become elite athletes, but we can all become fitter.

The same is true psychologically.

Building resilience does not mean that difficult things will not happen. It means increasing our capacity to deal with challenges and recover from difficult experiences.

What can I strengthen now, before I need it?

2. Women who have a mental health condition

If you have a known mental health condition, pregnancy is a good time to review how it is being managed, ideally before pregnancy if possible, but it is never too late.

Reviewing treatment does not mean stopping treatment. Remember whether you choose to stop, start or continue treatment during pregnancy are all choices with advantages and disadvantages. These decisions require careful consideration of your individual circumstances.

The important question is:

“What is the safest and most appropriate way to manage my illness during pregnancy?”

There should be no knee-jerk decisions.

Medication needs to be considered alongside the potential consequences of untreated or undertreated illness.

3. Women experiencing active symptoms

If you are experiencing significant anxiety, depression, insomnia or other mental health symptoms during pregnancy, this deserves focused attention.

Please don't simply tell yourself:

“I'll see how I feel after the baby is born.”

Your mental health during pregnancy matters in its own right. Significant symptoms during pregnancy can also tell us something about your vulnerability after birth.

Getting help early is not a sign that you are failing.

It is a strategic part of taking care of yourself.

From awareness to action

Once you have identified your vulnerability and the group you currently find yourself in, the next step is to move from awareness to risk analysis, from risk analysis to choice, and from choice to action.

1. Become aware

Look at the factors that may influence your mental health: biologically, psychologically and socially.

What is happening in your life right now?

2. Identify your vulnerabilities and your strengths

What increases your vulnerability?

But just as importantly:

What protects you?

We can become so focused on identifying risk that we forget to identify the things that are already working in our favour.

Your relationships, coping skills, support systems, knowledge and previous experience may all be protective.

3. Ask: What do I need right now?

Once you understand your vulnerabilities and strengths, the choices available to you become clearer.

You may need more support.

You may need to review your treatment.

You may need to address your sleep.

You may need to speak to someone about what you are experiencing.

Or you may simply need to put a plan in place for what you will do if things change.

Remember that every choice has potential benefits and risks.

The goal is to consider those in the context of your situation.

4. Take action

Your next step does not need to be big, and it does not need to be the final decision.

It simply needs to move you one step closer to protecting, maintaining or restoring your mental health.

Knowing your risk is about preparation, not prediction

You do not get a single number that tells you whether you will develop postnatal depression.

Your risk is influenced by many factors: your previous mental health, current symptoms, treatment history, physical health, pregnancy, relationships, support system and what is happening in your life.

And even if you have several risk factors, postnatal depression is not inevitable.

Your risk is information.

And information can help you prepare.

The goal isn't to remove every risk from pregnancy and motherhood.

It is to understand your risk early enough to strengthen your position, put the right support in place, and protect your mental health as much as possible.

Confident decisions in pregnancy are knowing how to make decisions in the presence of uncertainty that will allow mothers, babies and families to thrive!