Something was off when she brought her first newborn son home 3 weeks ago. Instead of enjoying the intimate time to care for and bond with her baby, she struggled with terrible feelings of helplessness and the inability to cope with the new arrival. R, 30, had a cesarean section for prolonged labour. The initial symptoms of the “baby blues” had become worse. Whatever things her husband did to please her did not work. She felt sad and would not talk to her husband most of the time. She had difficulties with breastfeeding as both her breasts were engorged and painful and the abdominal scar was hurting whenever she moved. She began to alienate herself from her family members. She also suffered from insomnia. R had suffered from postnatal depression (PD).
Prevalence of PD Postnatal depression is a form of depression that occurs within the first year after childbirth. It is a serious mental health condition that affects mothers shortly after childbirth. This condition can have significant and lasting impacts on the mother, her child and her family. In Singapore, PD affects about one in 10 to 15 mums.
Causes of PD The cause of postnatal depression is not completely understood. The following are some of the contributory factors:
Genetics: Studies have shown that patients with a family history of postpartum depression have an increased risk of experiencing the same condition.
Hormonal Changes: The dramatic hormonal fluctuations during pregnancy and after childbirth can trigger PD.
Emotional Stress: The transition to motherhood is often accompanied by overwhelming emotions, stress, and sleep deprivation, which can exacerbate depression.
History of mental health issues: Women with a history of depression or anxiety before and during pregnancy are more susceptible to PD.
Social and Relationship Factors: Lack of support, relationship problems with the partner and in-laws, domestic violence and financial stress can increase the risk of PD.
Symptoms of PD
Many new mums experience "baby blues" after childbirth, which commonly includes mood swings, feeling a bit down, anxiety and difficulty sleeping. Baby blues usually begin within the first 2 to 3 days after delivery and may last for up to two weeks. However, if the symptoms persist or become more severe or start much later, one may have to suspect PD.
Common symptoms include
· Persistent sadness or low mood
· Loss of interest or pleasure in looking after the baby
· Feelings of guilt, worthlessness, or hopelessness
· Withdrawal from family and friends
· Sleep disturbances: Insomnia at night and feeling sleepy during the day
· Changes in appetite
· Lack of energy and fatigue all the time
· Difficulty in looking after herself and her baby
· Difficulty concentrating
· Thoughts of self-harm or harming the baby
Diagnosis Postnatal depression can be diagnosed by observing the behavior of the mother, talking to her about her emotional feelings and doing a depression screening test using a questionnaire.
Treatments Postnatal depression is a treatable condition, and seeking help is crucial for the well-being of the mother and the family. Treatment includes:
Psychotherapy or talk therapy with a psychiatrist, psychologist or other mental health professionals. Through therapy, patients may find better ways to cope with their feelings, solve problems, set realistic goals and respond to situations in a positive way. Sometimes family or relationship therapy also helps.
Antidepressants: Most antidepressants can be used during breastfeeding with little risk of side effects for the baby.
Coping strategies:
Seek Support: Reach out to a trusted friend or family member, a therapist, or a support group.
Self-Care: Getting adequate sleep, eating well, and engaging in gentle exercise when possible.
Share Responsibilities: Involve the partner and other family members in the care of the baby to lessen the burden.
Set Realistic Expectations: Accept that perfection is not attainable, and it is okay to ask for help when needed.
Fortunately, R’s husband alerted me to her condition. She was immediately referred to the psychiatrist. Together with therapy and medications, her condition improved and is now under continuous monitoring.
Important note for Mothers Postnatal depression is a serious condition that affects a significant portion of new mothers. By understanding its causes, recognizing the symptoms, and seeking help, we can provide the necessary support and treatment to help mothers recover and provide a healthy and nurturing environment for their children. Family and community support, combined with professional help, can make a significant difference in the lives of those affected. It is essential to raise awareness about this condition and encourage open discussions to remove the stigma surrounding it, ultimately fostering a healthier and happier postpartum period for all mothers and their children.