Postpartum Depression: Blissful Motherhood to Nightmare

Postpartum Depression: Blissful Motherhood to Nightmare

Becoming a mother is a dream of almost every woman, this good news brings happiness in their lives but motherhood is not blissful for every new born mother. As sometimes, it comes along with many unwanted difficulties. Postpartum depression (PPD) is a type of mood disorder which is associated with childbirth. About 10% - 15% of women suffer from postpartum depression (PPD) every year in India which can also lead to postpartum mood disorders (PPMDs) and postpartum psychosis. It’s common for most of the new mothers to experience “baby blues” after delivery.

In many rural areas and due to lack of awareness a lot of people still think that it is due to some Ghost (Bhut-pret) or paranormal activities, so, usually, they go to the local temples/Bhopaji for Jhad-phunk or Tantra-Mantra that can worsen the situation even more.

How different are “baby blues” from postpartum depression?

The term “baby blues” is used to describe feelings of worry, unhappiness, and severe fatigue that women experience after giving birth. There is a simple explanation- babies require a lot of care and therefore it’s easy for new mothers to be exhausted to provide that amount of care. Just like the baby, it’s the first time for the mother too. Baby blues affect approximately 70% - 80% of mothers and last merely a week or two and go away on their own.

Causes of postpartum depression:

Cause of PPD is not well understood but, hormonal changes, genetics, and major life events have been hypothesized as potential causes.
Evidence suggests that hormonal changes may play a vital role. Studied hormones which have been known to be the potential causes include estrogen, progesterone, thyroid hormone, testosterone, corticotropin releasing hormone, and cortisol.
Also. The fathers, who are not undergoing profound hormonal changes, can also have postpartum depression. The cause may be distinct in males.
Profound lifestyle changes that are brought about by caring for the infant are also frequently hypothesized to cause PPD.

Risk factors:

While the causes of PPD are not well understood, a number of factors have been suggested to increase the risk:

• A personal or family history of depression

• Moderate to severe premenstrual symptoms

• Stressful life events experienced during pregnancy

• Maternity blues

• Birth-related psychological trauma

• Birth-related physical trauma

• Previous stillbirth or miscarriage

• Formula-feeding rather than breastfeeding

• Cigarette smoking

• Low self-esteem

• Childcare or life stress; childcare inconsistencies may include feeding routines, sleep routines, and health maintenance

• Twins, triplets or other multiple births

• Low social support

• Poor marital relationship or single marital status

• Low socioeconomic status

• Infant temperament problems/colic

• Unplanned/unwanted pregnancy

• Elevated prolactin levels

• Oxytocin depletion

• Violence

About one-third of women throughout the world will experience physical or sexual violence at some point in their lives, violence against women was defined as "any act of gender-based violence that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women".

Psychological and cultural factors associated with increased incidences of postpartum depression include a family history of depression, stressful life events during early puberty or pregnancy, anxiety or depression during pregnancy, and low social support.

Violence against women is a chronic stressor, so depression may occur when someone is no longer able to respond to the violence.

Signs and symptoms:

Emotional Symptoms

A women showing symptoms of persistent sadness, anxiousness or "empty" mood, Severe mood swings, Frustration, irritability, restlessness, anger, Feelings of hopelessness or helplessness, Guilt, shame, worthlessness, Low self-esteem, Numbness, emptiness, Exhaustion, Inability to be comforted, Trouble bonding with the baby and Feeling inadequate in taking care of the baby, etc has the changes of postpartum depression.

Behavioural Symptoms

A lady who shows signs like lack of interest or pleasure in usual activities, Low or no energy, Low libido, changes in appetite, Fatigue, decreased energy and motivation, Poor self-care, Social withdrawal and Insomnia or excessive sleep may also suffer from postpartum depression.

Cognitive system

Diminished ability to make decisions and think clearly, Lack of concentration and poor memory, Fear that I cannot care for the baby or fear of the baby and Worry about harming self, baby, or partner are some of the other cognitive symptoms of postpartum depression.

Complications:

Left untreated, postpartum depression can interfere with mother-child bonding and cause family problems as described follows:

• For mothers: Untreated postpartum depression can last for months or longer, sometimes becoming a chronic depressive disorder. Even when treated, postpartum depression increases a woman's risk of future episodes of major depression.

• For fathers: Postpartum depression can have a ripple effect, causing emotional strain for everyone close to a new baby. When a new mother is depressed, the risk of depression in the baby's father may also increase. New dads are already at increased risk of depression, whether or not their partner is affected.

• For children: Children of mothers who have untreated postpartum depression are more likely to have emotional and behavioural problems, such as sleeping and eating difficulties, excessive crying, and delays in language development, etc.

Treatment:

Psychotherapy

• Cognitive behavioural therapy (CBT)

• Interpersonal therapy (IPT)

• Group therapy

• Family therapy

• Internet-based cognitive behavioural therapy (iCBT) has shown promising results with lower negative parenting behaviour scores and lower rates of anxiety, stress, and depression. iCBT may be beneficial for mothers who have limitations in accessing in person CBT.
Medication

• Antidepressants are required to deal with postpartum depression.

• Hormone therapy may be effective in women with PPD, supported by the idea that the drop in estrogen and progesterone levels post-delivery contribute to depressive symptoms.

• Allopregnanolone (brexanolone) are proved help while treating postpartum depression.

• Breastfeeding always plays an important role, it connects mother and child. It may decrease the symptoms of depression.

• Other

• Electroconvulsive therapy (ECT)

• Acupuncture, massage, bright lights, or taking omega-3 fatty acids are useful.

• Some educational programs should be run to create awareness in society regarding postpartum depression



Social and cultural factors in India:

There are so many social and cultural factors that can aggravate or lead to postpartum depression. A few of them are explained here.

Confinement period of 40 days

Usually, just after the delivery, the mother is expected to stay in a closed room and is not allowed to meet anyone other than her helpers, for 40 days. In India, this is just an exaggeration of the idea that the mother should be given rest from all domestic chores to recover. However, not letting her meet anyone for such a long period, especially when she probably needs emotional support the most, might act as a trigger to her postnatal depression.

Providing only one kind of food

For 6 weeks after delivery, the mother needs Calcium and Iron, which are found in easily-digested leafy vegetables. A well-balanced diet is recommended. Unfortunately, the new mother is given only one type of traditional food but not a balanced diet.

Adding a lot of ‘ghee’ (clarified butter) to the mother’s diet

It is believed that adding ‘ghee’ or clarified butter to her diet will give the mother strength, but it only increases the fat and delays the process of recovery. Also, post-delivery, the body has a tendency to gain weight; ghee will obviously add to this weight gain.

Not bathing

In some families, the mother is not allowed to brush her teeth or take a bath. This just exposes the baby and the mother to a number of germs and infections. How cannot bathing help heal a person? It is counter-productive and would make the situation worse, especially if the person is having postnatal depression.

Not having plain water (having water boiled with herbs)

Adequate fluid consumption is advised, especially, if the mother is breastfeeding. The kidneys produce more urine in the first few weeks after the baby is born, in order to remove the excess fluid which accumulates during the course of the pregnancy. If the water does not taste good, the mother would be unable to consume the amount of water required for her body to heal.

Tying a scarf around the ears and mouth

This ritual might help protect the mother from diseases since her immunity level would be low, but this is not recommended if she is already in confinement. If the mother is not comfortable, she might feel suffocated doing this, especially in the summer season.
All these rituals might end up adding to the frustration of the already-hassled mother and might increase the risk of depression. Having a baby is a period of huge change. It is common to feel varied emotions.

Take Home Message:

Family should give the full support and care to the new mother and try to make her happy and comfortable.

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Shikha Sharma

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