“I am afraid I am having baby blues,” that’s what Sandra (name changed) mentioned the very first time we spoke. “My family says it’s a phase and it will go away, but now it simply doesn’t seem to disappear”, and Sandra sobs.
Following childbirth, a lot of women go through the ‘baby blues’, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. But if these baby blues continue for a long time, they take the form of a depression medically known as postpartum depression.
In our society, where mental health conditions are extremely stigmatized and many people lack vital health information, maternal mental health often goes unnoticed and untreated. “I approached a lot of doctors including gynaecologists, none of them could help me understand my condition. My condition was not diagnosed until my friend’s sister who is a psychology student mentioned postpartum depression. I researched it and decided to consult a psychiatrist. I was relieved to know that what I was going through has a name and I am not the only woman going through it,” mentioned Sandra during the session.
According to WHO the global prevalence of postpartum depression has been estimated as 100‒150 per 1000 births. Around 22% of India’s new mothers suffer from postpartum depression post-childbirth. Postpartum depression can start soon after childbirth or as a continuation to antenatal depression. Sometimes, postpartum depression can lead to chronic or recurrent depression way after childbirth, which may affect the mother-infant relationship as well as child growth and development. “Initially I thought the baby blues would disappear in some time,” says Sandra and continues, “But when my daughter was 11 months and beginning to walk, I realised seeing her learning to walk didn’t make me happy or excited. I used to doubt myself that I was not being an adequate mother.”
Research states that children of mothers with postpartum depression have greater cognitive, behavioural and interpersonal problems compared with the children of non-depressed mothers.
What are some of the risk factors of postpartum depression?
After almost 3 sessions of therapy, Sandra disclosed “I went through a bout of depression during my college days when I had a breakup. I took a few sessions with my college counsellor back then and I was eventually okay. I always suffered from body image issues which were one of the factors why I didn’t want to become a mother. My mother always told me becoming a mother is the most difficult thing in life as she herself went through a lot of complications when she gave birth to me. My pregnancy was an unpleasant surprise and I had to go ahead as my husband was keen on having children.”
There could be certain factors (not always) in the past or in the history of a pregnant woman’s life which may trigger her depression during childbirth. It’s important to identify those risk factors. They may include the following:
- Having a mood disorder in the past like depression or bipolar disorder, anxiety disorder or history of postpartum depression during the first childbirth.
- A family history of depression or other mood disorders.
- Going through extremely stressful events, like loss of a job, financial constraints, relationship problems with your partner spouse or significant health problems over the past years.
- Having a child with special needs or health problems.
- Having twins or triplets.
- Lack of support from friends, family, and other members of the community.
- Having an extremely fearful mother who passed her personal traumatic experience of childbirth on to her daughter.
- An unplanned or unwanted pregnancy.
What are the symptoms to identify postpartum depression?
“We were unsure what was happening to her, it felt like she was getting distant from us and she was not the same person we knew,” said Sandra’s husband during the session. He further added, “She would have unpredictable mood swings, cry often, and withdraw herself from us. She stopped taking care of herself and would deny breastfeeding, expressing her fear of harming our child.” The symptoms of postpartum depression usually develop within the first few weeks after childbirth, but may begin earlier during pregnancy or later up to a year after birth. They may include most of the following if not all:
- Inability to sleep (insomnia) or sleeping too much
- Loss of appetite or eating much more than usual
- Severe mood swings and persistent sad mood
- Excessive crying
- Fatigue, loss of energy and lack of motivation
- Inability to find pleasure in activities you used to enjoy
- Intense irritability and anger
- Hopelessness & feelings of worthlessness, shame, guilt or inadequacy
- Diminished ability to think clearly, concentrate or make decisions
- Sometimes severe anxiety and panic attacks
- Withdrawing from family and friends
- Difficulty bonding with the baby & fear of not being a good mother
- Thoughts of harming self and baby
- Recurrent thoughts of death or suicide
Self-help techniques to manage postpartum depression
During the therapy sessions, Sandra was suggested the following self-help techniques to overcome postpartum depression. Slowly and steadily she regained her confidence and motherhood became easier for her.
1. Bond with your baby
Take special time out to simply bond with your baby by holding, by playing, talking, touching and feeling your baby in your arms. Successful bonding will allow your child to feel safe enough to develop fully and have secure and meaningful relationships throughout their life. Learning to bond with your baby benefits both you and your child. Close contact with your infant releases the hormone oxytocin. An increase in oxytocin makes you feel happier and sensitive to the feelings of your baby.
2. Eat healthy & exercise regularly
Try to include fish oils in your diet as they are rich in omega-3 fatty acids. Studies have shown that women who have low levels of omega-3 fatty acids in their body are more susceptible to postpartum depression. Studies have shown that physical activity during the postpartum period is an efficient way to achieve better psychological well-being as well as ease the symptoms of depression. Exercise helps to strengthen the abdominal muscles, relieves stress, promotes better sleep, and boosts energy. It’s a good idea to start with walking as it has the added bonus of being able to push your stroller at the same time. Target to be active for a minimum of 30 minutes a day.
3. Find some time out for yourself
Do things that you like doing. It will not only give a break from the monotony and routine of baby care but also help you get back to your baby refreshed and energetic.
4. Make time for adequate rest
Sleep when the baby sleeps, it’s the best way to make time for rest. Inadequate sleep is highly correlated with depression. Let your partner or a responsible adult take care of your baby while you make time for some rest.
5. Examine breastfeeding
Make sure your child is fed at regular intervals. This is not only healthy for your child but studies have shown breastfeeding to reduce the risk of developing postpartum depression. Sometimes some women show depressive symptoms while feeding, called Dysmorphic Milk Ejection Reflex (D-MER). Under such conditions, it’s ideal to listen to music or practice deep breathing techniques while feeding to distract yourself from the low mood. If that still doesn’t work then choose an alternate way of feeding your child.
6. Develop your support network
Find a peer and share your common stories. You may also talk to someone trusted in your family or close circle. Research has shown that talking about your feelings with others can help shift your mood and help cope with depression. If you find no one to talk within your circle then talking to a counsellor or a therapist is advisable.
7. Nurture the infant-father bonding
Studies have shown that infants whose fathers spend time with them, play and bond show better physical and emotional development, are successful in academics and have better peer relationships when they grow up. This will also give you time to relax and de-stress while your child is taken care of.
8. Take support from social media
There is a deepening bandwidth of famous Bollywood celebrities and Instagram celebrities these days coming out with their stories of postpartum depression or baby blues. In fact, many Bollywood actresses have talked about their journey through postpartum depression and how they overcame them. Postpartum fitness influencers on Instagram have helped a lot of women to have faith that they too can overcome their baby blues. Start clicking cute pictures of your baby and make scrapbooks for them to grow up and see or create their pages and post their pictures on social media and share with your friends and family. Comments and likes will encourage you to accept and nurture your motherhood and at the same time feel connected and not isolated.
Do men suffer from postpartum depression as well?
According to research, paternal postpartum depression actually does exist. A report in the Journal of the American Medical Association stated that 10 percent of men worldwide showed signs of depression from the first trimester of their wife’s pregnancy through six months after the child was born. New fathers do not go through the same changes in hormones that new mothers do, but men with low levels of hormones like testosterone are more susceptible to have postpartum depression.
Stress, changes in lifestyle, lack of proper sleep, lack of social support, and feeling left out due to mother-baby bonding can also be stressful for new fathers. Studies say that paternal postpartum depression may be more prevalent now, largely because this generation of fathers is more actively involved in parenting than the previous generation, feeling the same psychological, social, and economic stressors that some mothers have experienced since generations.
Making motherhood easy & meaningful
Motherhood should be a free choice and should not be forced. Culturally, motherhood is considered to be a symbol of self-worth, fertility and fulfilment among women, hence a lot of women naturally accept motherhood rather than introspecting on their willingness to reproduce and nurture or even have second thoughts about their choices.
There are a lot of myths which make it obligatory for women to experience motherhood. The generational myth of ‘happiness in being mothers’ is quite opposite in reality. In reality not all women experience ‘the bliss’ of becoming mothers as shown on soap operas on television. Society biases women to view motherhood through the rosy glasses of grand baby showers and naming ceremonies, distancing them from the reality i.e hyper-gendered roles of rigorous routine and duty post-motherhood, mostly women giving up on their jobs to take care of their babies. “I was scared of losing my job. I was scared I would no more be attractive with my stretch marks and disproportionate body. I silently bore the guilt of not wanting to become a mother and too afraid to express my feelings with the fear of being considered unfeminine,” said Sandra during the session.
In the wake of new maternal health reform where our country has seen a decline in the rate of maternal mortality, we need to work on capacity building to efficiently manage postpartum depression which is becoming more evident in modern women. Despite the launch of India’s national mental health programme in 1982, maternal mental health is still not a prominent component of the programme. According to WHO report, a meta-analysis on postpartum depression in India revealed a dearth of specialised maternal mental health services in health-care facilities, lack of mental health training among health care workers and scarcity of mental health specialists in peripheral health-care facilities. Furthermore, there is a lack of systematic data routinely collected on the proportion of perinatal women with postpartum depression. Sandra backed this up by adding, “When I told my gynaecologist that I may be going through postpartum depression, she outrightly denied no such diagnosis exists.”
While we wait for these measures to be taken at a policy level, it is important to understand that people with postpartum depression or sometimes professionals from other specialities may not recognize or acknowledge that they’re depressed. If you identify that a friend or loved one has postpartum depression, help them seek mental health consultation immediately. It is not advisable to wait and hope for improvement. Let’s make motherhood and parenthood easy and more meaningful.