Postnatal depression (PND) is a type of depression that some women (and some men) experience after having a baby. It can affect around 10 to 15% of women [1] and it tends to occur within the first twelve months after birth. Like other types of depression, it is often misunderstood. If your partner doesn’t understand or underestimates the effects of PND, they might not be able to empathise with you and support you through it. This can cause a conflict in the relationship. Why is this happening? Your partner's misunderstanding or ignorance might be frustrating, but it may just be a lack of knowledge. As a nation, we’re not very good at differentiating between having a low mood, and being depressed. Your partner might assume that, if you have PND, you’ll be sad all the time and cry a lot. So, if your PND manifests itself in other ways, such as sleeping a lot, feeling numb, or withdrawing, it may not be recognised for what it is. Your partner may also assume that, if you didn’t get PND in the first few months, then you can’t be experiencing it now. However, PND can happen any time within the first year after giving birth. How can I help? Firstly, it might be helpful for your partner to know and recognise PND symptoms, some of which may include: Low mood. Loss of interest in usual activities. Feelings of worthlessness. Loss of energy. Crying spells. Insomnia. Fatigue. Anxiety. Poor concentration [1] [2]. PND is a real illness, and anyone suffering from it needs professional help. So it’s important your partner not only understands what PND is, but is willing to learn how it affects you. Try to open the conversation more broadly. Rather than trying to explain PND, try simply asking your partner for support. Different people have different ideas what kind of behaviour is supportive, so your partner may just have a different perspective to you on the subject of PND or depression in general. Relationships between couples following the birth of their child can be fraught, and depression is more likely to develop in both mothers and fathers in the first year of birth [3]. If you feel that your partner is not really paying attention or seems to lack interest, try to remember that people's perspectives are often formed through other people’s attitudes to depression – usually someone quite influential like their own parents. Stick with it, and ask for your partner's undivided attention to explore the issue. Encouraging your partner to speak to a medical professional or a health visitor could be helpful, as they are equipped to explain PND from a psychological and biological standpoint. They may also be able to provide further support resources for you both. References [1] Yiong Wee, K., Skouteris, H., Pier, C., Richardson, B. and Milgrom, J. (2011) Correlates of Ante- and Postnatal Depression in Fathers: A Systematic Review. Journal of Affective Disorders 130(3), 358–77.[2] Andrews-Fike, C. (1999). A review of postpartum depression. Primary care companion to the Journal of clinical psychiatry, 1(1), 9.[3] (Davé, Petersen, Sherr, & Nazareth, 2010).” (p.29)

One in five people will experience a form of depression at some point in their lives [1]. If your partner is depressed, you can play an important role in helping them get better. Depression is more than just a low mood. It’s a prolonged illness, whose symptoms include a lack of energy, a loss of interest in things you might normally enjoy, feelings of low self-worth, and changes in sleep and appetite [2]. A sudden onset of depression in your partner can have an impact on your relationship. You may have to take on a temporary caring role, which can put unexpected strain on you [3]. Some of your partner’s symptoms can affect you too: Low mood. When your partner is feeling down most of the time, it can feel like you don’t have access to the person who is most important to you. Loss of interest and energy. Your partner may lose interest in the things you like doing together, like going out, cooking, and even sex. Concentration. Depression can affect concentration, even to the extent that your partner struggles to stay involved in a conversation. Sleep and appetite. You may notice changes in your partner’s eating and sleeping patterns, which can affect their mood even further. It can also disrupt your own eating and sleeping as established routines get lost. Low self-worth. You may notice your partner being more critical of themselves and possibly lashing out at you too [2]. You may also wonder if you are responsible for your partner’s mental health problems. While there are sometimes external causes, including relationship problems, depression can often come along out of nowhere [4]. You can play a positive role in your partner’s recovery [3]. One of the first things you can do is notice the signs of depression and encourage your partner to seek help. Often, the quickest route to support is through your GP, who can make a diagnosis and refer your partner to appropriate support. There are many forms of mental health support, but it’s likely that your partner will undertake some form of talking therapy. They may be given exercises to take home. You can offer support by encouraging your partner to complete the exercises or, if appropriate, by getting involved directly. Your partner’s doctor may recommend couples therapy, which has been shown to be effective for people with depression [5]. If this is recommended to your partner, it doesn’t mean that your relationship is in trouble; it just means that you are being asked to get involved in your partner’s recovery. Attending sessions together means you can be better informed and more involved. Whether you are directly involved in your partner’s treatment or not, there are many ways you can be supportive: Encourage them to seek support. Getting your partner into professional support is one of the best ways you can help. Learn about depression. Read up on depression and its symptoms. A good place to start is the OnePlusOne and NHS guide, ‘Depression and low mood: A guide for the partner’. Set aside blame. Accept that the illness is happening, and don’t blame your partner or yourself. It’s here, and it’s treatable, so just focus on recovery. Notice the signs. Be aware of your partner’s symptoms and the things that can set off an episode of depression. Get support if things seem to be getting worse. Solve practical problems. When someone is depressed, problems can be magnified and may seem insurmountable. You can help your partner by solving practical problems, which could be as simple as doing more than your share of housework for a little while. Listen more. Clear communication and active listening can help your partner to feel better supported and more in control. Do some exercise. Help your partner to get some gentle exercise, even if it’s just a walk around the block. This can have the added benefit of helping with sleep problems. Get your partner out of the house. While it might seem easier to avoid social situations, it’s often best to try and turn up to things that they would usually enjoy. Even if you plan just to go out for half an hour, you can help your partner break out of the loop of depression and inactivity. Notice what helps. What usually makes your partner feel better – a morning walk? Cooking a healthy meal? Make a note of what works, and encourage your partner to do more of it. Keeping a mood journal can also help you to show your partner that they have been making improvements, as they may find it hard to focus on the positives [6]. Seeing a partner go through depression can be upsetting but, with the right support, even the most severe cases can be treated. As with any illness, you should seek professional help if you are worried. Recovery is likely to be gradual, but it is possible, and you can play an important part. This article gives just a quick overview of how you can support a partner with depression. For a more in-depth look, we recommend reading, ‘Depression and low mood: A guide for the partner’, co-produced by OnePlusOne and Northumberland, Tyne and Wear NHS Foundation Trust. References [1] Bolton, J., Bisson, J., Guthrie, E., Wood., S. (2011) Depression: key facts. Retrieved from http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/depressionkeyfacts.aspx [2] NHS (2015). Low mood and depression - NHS Choices. Available at http://www.nhs.uk/conditions/stress-anxiety-depression/pages/low-mood-and-depression.aspx  [3] Crowe, M. (2004). Couples and mental illness. Sexual and Relationship Therapy, 19:3, 309-318. [4] Hickey, D., Carr, A., Dooley, B., Guerin, S., Butler, E., & Fitzpatrick, L. (2005). Family and marital profiles of couples in which one partner has depression or anxiety. Journal of marital and family therapy, 31(2), 171-182. [5] Bodenmann, G., Plancherel, B., Beach, S. R., Widmer, K., Gabriel, B., Meuwly, N., ... & Schramm, E. (2008). Effects of coping-oriented couples therapy on depression: A randomized clinical trial. Journal of consulting and clinical psychology, 76(6), 944. [6] NICE (2009) Depression: The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90. Available at www.nice.org.uk/CG90.

If you’re pregnant and going through a separation, you might be worrying about how the breakup will affect your child. Stress One of the things you might be thinking about is how the stress of separation or divorce might affect your baby’s development in the womb. Research has found that relationship strain during pregnancy appears to be linked to negative cognitive and behavioural development in children [1]. If separation is the right thing for you as parents, it’s possible to minimise the stress and remain supportive to each other. This might be very difficult, especially if there are unresolved issues between you but, by being reasonable, rational and respectful, it is possible. Take your time to talk through a plan of action. If you decide to stay together, talk to your partner about how you can help reduce stress during the pregnancy. Maybe take up some light exercise together, or practice some yoga designed for pregnancy. If you do have arguments, take the calm and collected approach. If things get heated, take a break and return to the issue when you feel calmer. A two-parent family You may want your child to be brought up by two parents, especially if you were raised by both parents and want your child to have a similar upbringing. Some studies have found that children in two-parent homes are less likely to grow up in poverty [2], and are also less likely to develop emotional problems [3]. But, single-parent families are becoming more common and there is lots of support available for single parents. The number of lone-parent households in the UK grew steadily from 1.8 million in 2003 to nearly 1.9 million in 2013 [5]. While some research suggests that children in single-parent families have poorer outcomes, other research shows that, when it comes to their overall happiness, family composition doesn’t really matter [6]. It’s the quality of the relationship you have with your child that counts. If you stay with your partner, talk about how you want to raise your child. You both may have different ideas of what family life will be like. Take the time, hear each other out and make compromises where you can. Adjustment You may have been brought up in a single-parent household and found it hard to adjust to life. You may have witnessed conflict between your separated parents and, at times, may have felt caught between the two. A poll of 500 young people found that one in three felt that one of their parents had tried to turn them against the other during the breakup [4]. If your own upbringing in a single-parent household was difficult, it’s understandable that you wouldn’t want your child to go through a similar experience.  It’s important to nurture a good co-parenting relationship with your ex-partner. A good place to start is to seek mediation or create a parenting plan so you can agree on how you will raise your child. References [1] Bergman K., Sarkar P., O'Connor T.G., Modi N., Glover V. (2007). Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. Journal of the American Academy of Child and Adolescent Psychiatry. 2007 Nov; 46(11):1454-63. DOI: 10.1097/chi.0b013e31814a62f6 [2] Gingerbread (2018). Single parent statistics. Retrived on 16 April 2018 from: http://www.gingerbread.org.uk/content/365/Statistics [3] Parry-Langdon, N. (2008). Three years on: Survey of the development and emotional well-being of children and young people. Office for National Statistics [4] Office for National Statistics (2013). Families and Households: 2013. Retrieved from http://www.ons.gov.uk/ons/rel/family-demography/families-and-households/2013/stb-families.html [5] The Parent Connection. Children in single parent families no less happy than those in two parent households. Retrieved from: http://theparentconnection.org.uk/blog/children-in-single-parent-families-no-less-happy-than-those-in-two-parent-households [6] The Parent Connection. 1 in 3 young people say one parent tried to turn them against the other during divorce. Retrieved from: http://theparentconnection.org.uk/blog/1-in-3-young-people-say-one-parent-tried-to-turn-them-against-the-other-during-divorce

During your pregnancy, sex can become a complicated issue. Your desire can decrease, your discomfort can increase, and you might just lose interest altogether. Or, you might still be in the mood but find that your partner is backing off! All of this is perfectly normal and very common. Sexual enjoyment tends to decline as pregnancy goes on. Around 22-50% of pregnant women find intercourse painful and many women find it difficult to orgasm. It’s normal for your libido to decline too, largely to the change in hormones, and feeling sick, tired and physically uncomfortable [1]. And, as your body changes, you might just feel less sexy. This is particularly likely during the later stages of pregnancy, when you’re all achy and bloated. About a quarter to a half of pregnant women feel less attractive than before, and only 12% feel more attractive [1]. Giving it a go If you do feel up to having sex, there’s no reason you shouldn’t give it a go. For the majority of healthy pregnant women and their partners, sex is perfectly safe, even in the last few weeks before you give birth [1]. If you’re not sure whether it’s OK, seek advice from your doctor or midwife but, if you do want to have a go, give yourself time to be in the mood, and accept that it might take longer than usual. It’s possible that your partner will be reluctant, which can be frustrating. However, don’t assume that it’s from a lack of desire, or a loss of sexual attraction. One possible reason for hesitancy is a fear of harming the baby, which inhibits at least a quarter of male partners, and a quarter to half of expectant mothers [1]. Talk to your partner. Have an open and honest conversation about how you both feel right now. If your partner admits that they’re feeling funny about sex, try not to get annoyed or take it personally – you won’t be pregnant forever! If you’re feeling a bit insecure, make it clear that you are learning to adjust to your changing body and that, even if sex is off the table, a little TLC would be appreciated. Finding other ways to feel close If you really don’t want to have sex, don’t force yourself. Be honest with your partner, offer reassurance that it’s not a personal rejection, and ask for the support you need. It might be helpful to discuss this article, and reassure yourselves that these are common adjustments that couples face during pregnancy. If you’re feeling icky and your partner tries to reassure you that you look beautiful, accept the compliment and choose to believe them. Lots of people find their partners especially attractive when they’re carrying their child. Finding other ways of being intimate that aren’t sexual – like hugging, kissing, and massage – can help you bond when sex isn’t available. Just spending quality time together can help you maintain a sense of closeness. And remember that you won’t feel like this forever. Though there will be new challenges for your sex life when your baby comes along, the physical changes you’re experiencing during pregnancy should return to normal about three months after the birth. Some women even experience more intense orgasms than they did before [1]. References [1] Von Sydow, K. (2000). Sexuality during pregnancy and after childbirth: A meta-analysis of 59 studies. Reproductive Health Matters, 8 (15), 183. doi:10.1016/s0968-8080(00)90068-5

Since finding out she was pregnant, your partner might have been reacting to you differently during sex, or avoiding intimacy altogether. It might seem like she’s aroused less often or less attracted to you. Aside from simply missing something that you enjoy, sex an important way to feel closer to your partner. Without it, you may worry that you will struggle to stay close. While it might feel like it, a lack of sex during pregnancy is not a personal rejection. A quarter of new dads say they’re worried that their partner may no longer be interested in having sex [1] but it’s important to recognise that a decrease in sex during pregnancy is normal, and not your fault. Less sex during pregnancy is normal Your partner may be experiencing a decline in libido. This is very common during a time of changing hormones and physical discomfort like backache and water retention. Bear in mind that 22-50% of pregnant women experience painful intercourse, and reaching orgasm becomes progressively more difficult as pregnancy goes on [b]. Sex may have become a stressful experience for your partner. On top of this, about a quarter to a half of pregnant women feel less attractive during pregnancy, and only 12% feel more attractive [2], so your partner may just not be feeling as physically confident as she’d like to. Be open and honest with your partner. Talk about your concerns and tell her that you want to be supportive. If she is worried about her changing body, you can reassure her that you still find her desirable, but the most important thing is to respect her needs and desires. If she is experiencing a loss of libido, remember that this has nothing to do with you as a sexual partner. It might be helpful to discuss this article with her – talk about how these are common changes that couples face all the time during pregnancy. Can sex during pregnancy harm your baby? Up to half of women and at least a quarter of men worry that having sex during pregnancy will harm the baby in some way [2]. From a medical point of view, there is no reason to ‘forbid’ sex for the majority of healthy pregnant women and their partners, even in the last weeks before the birth [2]. If you’re not sure whether you fit into this category, seek advice from your doctor or midwife. Remember also that anxiety around sex isn’t always rational, and your partner may find it difficult to shake the fear. If that’s the case, try other ways of being intimate. You may find that other kinds of sexual activity that don’t involve vaginal penetration are a bit easier but, if not, things like hugging, kissing or massage can all help you feel closer to each other. Looking to the future Don’t expect things to pick back up again too soon after the birth. Your partner will need time to recover, and you might soon sense another obstacle to your sex life – fatigue. Irregular sleeping patterns, feeding schedules, nappy changes, and constant attention to the baby will probably continue to get in the way of your sex life. You might want to consider asking a family member or close friend to take care of the child for a while so you and your partner can spend some time together as a couple. If you’re used to having spontaneous sex, this might seem a little too regulated, but it might be a start. Finally, try to remind yourself that it’s not forever. As your child settles into more regular patterns of sleep, you’ll begin to find that there are more chances to be intimate without being interrupted by a crying baby. References [1] Houlston, C., Coleman, L. Milford, L., Platts, N., Mansfield, P. (2013). Sleep, sex and sacrifice: The transition to parenthood, a testing time for relationships? OnePlusOne. Retrieved from: http://www.oneplusone.org.uk/wp-content/uploads/2013/05/Sleep-Sex-and-Sacrifice-OPO-report-FINAL-embargoed-until-29-May-2013.pdf [2] Von Sydow, K. (2000). Sexuality during pregnancy and after childbirth: A meta-analysis of 59 studies. Reproductive Health Matters, 8(15), 183. doi:10.1016/s0968-8080(00)90068-5