Post-natal depression in mums of twins or more

"I didn't want to get out of bed, I felt I'd let everyone down and just kept crying all the time," says Miranda.

How familiar does that sound? I know I've been there. Thankfully I'm better now but please, if you are suffering, do something about it. It's not your fault, you haven't let anyone down.

Nor are you alone. Please go and read Emily's searingly honest account of her experience at Doing it All Again. Here you'll find a sometimes humourous, sometimes heartbreaking, but always compelling record of how having two young children can affect even the strongest and most articulate of women.

Miranda, mum to three-year-old twins Natasha and Bryony, adds: "The pregnancy had been terrible so after that, I thought I'd cope with anything. But the first seven months of my girls' lives were the worst I could imagine.

"Yet I kept quiet. I was a new mum with two lovely babies - who on earth would understand? The terrible stigma of being ill in this way meant I kept my fears and anxieties secret."

See also: Changing friendships after having children

"It was all a blur at first, an emotional rollercoaster of feeding, winding, changing. I had no sleep and my daughters seemed to cry all the time.

"My husband wasn't much help - he was out at work all day. I found myself getting moody and snappy. I was all churned up inside.

"I sat on my bed and sobbed with my head in my hands and couldn't see a future. I felt the fact that the washing up began to pile in the sink and my hair was a mess was all down to me being a useless mum who couldn't cope.

"But whenever I thought about how I felt, it made me even worse - what the hell did I have to worry about? I felt so guilty.

"Friends have been trying for a baby for years. Here I was with what they prayed for every day, but feeling terrible, how bad was that?"Yet I thought I was hiding my depression so well. People praised me on how well I was doing, saying they didn't know how I coped.

"It was only behind closed doors that I broke down and cried. Life was hell.""I should have had help from my health visitor, but mine didn't pick up on what was happening and I was too ashamed to say anything to her.

"My wake-up call came from my family doctor. I'm afraid as so many people do, I sobbed in her surgery. But she didn't judge me. Instead she asked me to fill in a questionnaire and from there, we discussed the best way forward.

"I was prescribed anti-depressants. I really wasn't bothered about all the horror stories of side effects and getting hooked, I just wanted to feel better.

"Today, a couple of years on, I'm happy to say I do. The pills took a couple of months to work but they have helped enormously.

"I've also spoken to my husband about being there more and confide in him more about how tough looking after two young kids can be."

Miranda's story is typical. Did you know post-natal depression was more common in mothers of multiple birth children? It's not exactly rocket science to understand that more than one baby means a greater chance of becoming ill, but still many mums struggle on, thinking they are to blame.

Mums of twins or more may be affected by:

* The increased stress of the reality of looking after more than one baby.

* Anxiety over their relationship or the financial pressure.

* Added worry over poorly or premature babies.

* Feelings of isolation.

* These feelings can be made worse by postnatal exhaustion.

Tamba reports that postnatal depression is more common among mothers of multiples, even up to five years after the birth.

The charity advises midwives to emphasise the importance of obtaining extra help to parents and to find time for their own relationship in the early weeks. Support from an extended family or friends and outside agencies is essential.

Initial problems that parents may meet include:

* Isolation, due to the practical difficulties of getting out and about.

* Less time to cuddle and enjoy each baby individually.

* Guilt at not being able to give each baby equal time if one is more demanding than the other.

* Exhaustion due to frequent feeding and baby care tasks and adjusting to new family relationships

* Babies’ sleep problems

* Jealousy and behaviour problems in older siblings

* Medical problems: Complications after birth and/or separation from babies while they are in Special Care, allowing babies home at different times.

* Some mothers have experienced a difficulty in bonding with the smaller baby where there is a significant difference in their birth weights.

Health visitors can also help prevent the debilitating disease of post-natal depression taking hold by encouraging families to make practical arrangements for coping.

Tamba urges them to:

* Encourage the family to accept all help offered and to seek assistance if it is not forthcoming.

* They may be able to benefit from local colleges running childcare or nursery nurses courses who have students needing family placements.

* Or they can contact Home Start whose volunteers are ideally placed to help new multiple birth parents, especially those who also have older siblings.

* Identify the problems and discuss possible solutions - the family may be too busy with the babies to do this.

* Clinic visits can seem impossible due to lack of transport, changes in routine, lack of practical help, restrictions on prams/buggies in health centres.

* Regular home visits for several months and/or extra pairs of hands at the clinic will be welcome. Babies may be less likely to miss developmental checks and vaccinations if visited regularly at home.

* Allow adequate time for discussion at health checks. Mothers may need to share fears and feelings of guilt and those in the early stages of depression can be more easily identified.

* Advise on how to deal with problems with older siblings - e.g. transport to school/nursery, jealousy and other behaviour problems that result from feeling overwhelmed or abandoned within the family.

* Parents should be encouraged to have some quality time alone with their other children to give them their full attention.

Jill Walton, Tamba’s honorary research consultant told me when I reported on another mum's depression: "PND has a gradual onset, somewhere between two weeks and several months. Two-thirds of sufferers recover within three months, although it can last for up to a year.

Symptoms vary, and can include anxiety, despondency, tearfulness, tension, inability to cope, irritability, panic attacks, tiredness and lethargy, loss of concentration, memory and appetite, loss of interest in sex, and loss of interest in the babies. Research shows that mothers of twins are more likely to suffer than single birth mothers.

"The onset of PND may be later and it may last longer. The sheer physical demands of having to cope with two or more babies at once make a mum more prone to PND. PND in mothers of twins is largely due to insufficient support at home, and the degree of disruption that twins cause to a family situation.

So please, please if you are reading this, do yourself a favour and read that last bit again - the degree of disruption that twins cause.

So you can forget any notion that it has anything whatsoever to do with you being a 'hopeless' mum.

Depression is a disease. Please speak up now, and get yourself looked after.

Be kind to yourself.

You know it makes sense! A cliche it may be, but you wouldn't ignore a broken ankle so don't ignore how you are feeling first thing in the morning - as that is when depression may have its strongest hold.

Sources of help and support:

Tamba Twinline and Meet a Mum.

Comments

[DIANE SHIPLEY]

great article, Linda, and the multiple-births angle is so interesting. I think for a lot of women it's a hormonal shift but I'm sure exhaustion is a huge factor too, especially with more than one baby! xx

[Linda]

Yes my doctor asked if it may be hormonal, I took the axe out of her head, smiled and said: "Dunno, what do you reckon?"

Thanks for commenting Diane, mucho appreciatedo.

[DIANE SHIPLEY]

LOL, and you're welcome Linda :)

Mucho goodo Spanish, too! x

[sue]

My daughter gave birth to twins 5 weeks ago and is suffering from pnd, but acts like she doesn't deserve to feel this way. This article is so enlightening...I hope it gives her the hope and help she needs...a concerned grandma

[Wendy]

Good actical on PND, i think i had PND (2 years on now, i am nearly back to my normal self) but i suspect the start was no sleep for 4 days in hospital, horrible food, blood loss (natural birth) and looking after two babies virtually on my own in hospital.

Anxiety and Panic Attacks were the worse, but in time with more and more sleep and Family and friends helping a bit more we got there.

[Linda]

Thank you everyone for your thoughtful comments, I do hope you can stick around. All the best to you. Wendy and June, thank you for sharing your stories.

[Panic disorders]

Consistency in using medications is a requirement that many patients may find demanding. Antidepressants and anti anxiety drugs are some of the most common interventions. However medication for panic disorders must only be taken under prescription.

[depression mood]

Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don't feel sad at all—instead, they feel lifeless, empty, and apathetic.

Whatever the symptoms, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

[tiredness]

If your bodyweight is too high or too low for your height you may feel tired because of this. An overweight person's body has to work harder to do everyday things, compared to a person whose bodyweight is normal. A person who is underweight might have less muscle strength and will tire more easily.

If your thyroid gland is not working properly - if it is underactive - you might feel exhausted all the time. Patients who suffer from heart disease or heart failure tend to feel tired most of the time, as do patients with anemia.

[depression signs and symptoms]

Chronic depression or dysthymia is a milder form of depression that affects millions. Find out if you or a loved one has chronic depression.

[Worried Husband]

My wife and I have twins, they are almost a year now - and its been really hard on my wife - she didnt bond initially with the twins but also had a "problem" with me as I was the one who wanted children. I am so worried about her, and its just been month after month of arguements between us and its to the point where divorce is now on the cards (which is the last thing i want). I think she has suffered from PND since their birth - but she wont even admit to herself that there might be an issue (clearly with all the arguments there is!).

I know the Dad always gets a bad rap with the 'no support' line but I honestly do everything I can to help and when I am at work all i do is try to think of ways to make her life a bit easier. I do EVERY night feed and have done since they were born, sometimes I end up going to work with just 2 hours sleep but am willing to do anything for my wife to feel a bit better.

I just dont know what to do she is just so angry all the time, and stressed and I am even considering quiting my job just to help her out -but as the 'problem' is myself, I'm not even sure that will even help!

Please help me - I can't even get her to consider talking to someone else be it a doctor, friend, family...

Any ideas or anything would be appreciated