All of us bring a range of expectations and experiences to parenthood. Many of these are based on both popular culture and from the culture of our own families or cultural groups. One common expectation in our popular culture is that parenting is easy, the skills are inborn - particularly in women - and that parenting occurs in the nuclear family. This is a recent phenomenon, and does a great disservice. Parenting is a shared responsibility, and works best when shared between the couple, with support from the extended family and the community. We know that women who do not have this support, or who perceive this support as unhelpful, have a much harder struggle with depression.

I used the word 'perceive' because it is perceptions that are important: I frequently hear complaints like "my husband does nothing at home, it's like having another child in the house". That is certainly how it appears to my patient and the experience of this is very undermining and often causes great anger and resentment. When I speak to the partner, I often hear "she won't let me do anything, and when I do it it is never good enough, so why bother". This perception of parenting is very disempowering and also leads to anger, resentment and withdrawal. Rather than following the natural response of blame that we all usually fall into, couples can bring about big changes by sharing their perceptions in a non-blaming way, identifying the problem, and then moving on to solutions.

Nobody can work indefinitely at a job for 24 hours a day, 7 days a week, without consequences of one kind or another. Sleep deprivation is a common consequence and this results in irritability, poor concentration and lowered mood. Many people with mild postnatal depression will respond to apparently simple measures like a few nights of good uninterrupted sleep.

Many of the expectations we bring to parenthood are based on our own experiences as a child growing up in our family. I think that almost universally, issues from our past that we may or may not have dealt with become reactivated with the birth of our children. It also results in a re-evaluation in our current relationship with our parents, as childhood perceptions are re-evaluated from our new perspective as a parent.

Many things can influence the expectations that we bring to parenthood: the imagined life of our child (our fantasy child) begins during pregnancy, and this fantasy child can become imbued with our hopes and fears. The gender of the child is an important influence on this - we may identify more readily with a child who is the same gender or birth order, or attribute fears and anxieties from our own childhood experiences onto this child. Some of us as children have experienced our own parents as harsh, critical, unsupportive, or even abusive. Our perceptions of these experiences will influence our approach to parenting and our expectations of our children. For example, this commonly occurs in parents who have themselves experienced childhood sexual abuse, and who naturally fear for the safety of their own child. Early parenthood often becomes a time when we become overwhelmed by feelings of anger or anxieties from these childhood experiences.

Another common psychological theme is that of loss. It amazes me how common a factor this is in people that I see with perinatal depression. This is sometimes immediate - the loss of a parent or a sibling around the time of birth presents the challenge of conflicting feelings of joy and loss. Sometimes memories and the pain of the loss are just as severe even though the loss may have occurred in childhood, or many years before. Painful memories associated with a previous termination or miscarriage may be revived with the birth of a new baby. Sometimes the loss is less obvious - the loss of independence, social status, income or loss of social circle. A particular loss felt by all parents is the loss of personal space the arrival of a new baby can create. Constant physical demands of caring for a baby can result in a type 'intimacy overload', where the period of separateness and quiet treasured by many mothers when their child sleeps can be upset by apparently normal expectations of intimacy from their partner. This can create a tension and resentment in the relationship.

A mother cannot be a mother without a baby. An important factor in the development of depression and its management is the nature of that complex relationship between a mother and her baby. This relationship of course begins well before birth and many aspects of it begin before conception, often beginning during a woman's own childhood. A baby is born into a relationship of hopes and expectations. This is in turn influenced by the baby's own temperament, present at birth and influenced by both biological factors - a physically maturing brain - and by its interaction with significant others, in particular with its main carer, usually its mother. There is a strong correlation between distressed babies and distressed and depressed mothers. Whether it is the chicken or the egg that comes first, recovering from postnatal depression must involve addressing both maternal and baby issues.

These issues may be difficult enough at any stage yet alone when a couple is dealing with sleep deprivation and the other upheavals of a new baby. Whilst these issues may or may not occur in the postpartum period, we know that all these issues are common themes in postpartum depression and that they are recognised risk factors.

With all of these potential issues, it sounds like even normal parenting can be hell. It isn't. There are the obvious joys in parenting that we all have experienced and would never give up. However parenting in the presence of depression is a real challenge - for parents, extended family and friends. It also becomes an opportunity for us to grow and develop as adults, parallel and complimentary growth to that of our children.

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Care to share your experiences?