Postnatal Depression

Category: Birth & Beyond

You should be celebrating the latest addition in your family but it isn’t always the case. Postnatal depression hits without warning and could happen to anyone who’s just had a baby…even you.

WORDS CINDY LIM


Many across the world were stunned when Felicia Boots 35, killed her two children - Lily Boots, aged 14 months, and her 10-week-old brother Mason – in Wandsworth, south-west London. Boots suffered postnatal depression following the births of both children and ended up smothering her babies in their own home soon after.
In her own words, Felicia said "...I am a good mum and I never meant this to happen...” But the worst did happen and can happen even to the best of mums, and this tragic case further stresses the importance of getting treatment for postnatal depression.

What is Postnatal Depression?
Postnatal depression is a type of clinical depression which can affect women typically after childbirth.

A new baby means change in your life, and sometimes this change can turn your life upside down. Suddenly faced with sleepless nights, endless feeding and nappy changes, your life is no longer your own and you may feel a choking sense of helplessness and responsibility or burden.
Many women experience erratic mood swings and emotional highs and lows following the birth of a baby. This is normal, but when symptoms persist and get in the way with a woman’s ability to handle things, she may be suffering from postnatal depression.
“Depression affects about 10-15% of women after childbirth. Postnatal depression is regarded seriously by medical health professionals and is upsetting not only to the women suffering from it but to their families as well,” explains Dr Sandy Umboh, psychiatrist, Department of Psychological Medicine, KK Women’s and Children’s Hospital.
Postnatal depression can even start while the woman is pregnant in fact, or be part of a longstanding depression.

Symptoms of postnatal depression include:

  • Low mood
  • Irritability
  • Poor sleep
  • Lack of interest in the baby
  • Lack of interest in previously enjoyed activities
  • Feelings of hopelessness
  • Constant suicidal thoughts
  • Poor appetite
  • Poor concentration or forgetfulness
  • Loss of energy/fatigue
  • Excessive self-blame or guilt
Who is at Risk?

There are multiple risk factors that may contribute to the onset of postnatal depression.  

“A biological predisposition (such as having a personal or family history of depression), adverse social circumstances (unwanted pregnancy, poverty, poor marital and family support) and personality factors (excessive need for control and perfectionism) are risk factors,” explains Dr Cornelia Chee, director and senior consultant, Women's Emotional Health Service, Department of Psychological Medicine, National University Hospital.
Shares Dr Umboh, “A past psychiatric history is a significant risk factor. Women with psychiatric problems have a higher risk of suffering from postnatal depression. Some studies have also shown a possible relationship between postnatal depression and obstetric complications, or complicated delivery such as assisted delivery with forceps or vacuum, or caesarean section. Young mothers (below age 21 years) are at higher risk, and so are mature mothers, especially if the pregnancy is unplanned, or complicated by obstetric medical conditions. Breastfeeding itself can also be a stressor for inexperienced mothers.”

What are the Triggers of Postnatal Depression?

“Very often, we see women who have a combination of several factors; common to all may be a relatively poor quality of sleep due to the inevitable disruptions caused by awakenings. For first-time mums it is often adjustments to role transitions, both intrapersonal as well as interpersonal with her partner and/or family; for some others it may be a lack of emotional and practical support; and for existing mums it could be handling the older children at the same time. Juggling work and family is also an issue,” says Dr Chee.
Hence, there has been increased emphasis in recent years on educating pregnant mothers and preparing them for the childbirth experience, the postnatal period and how to manage their baby. Support and reassurance after the delivery of the child are also important. Mothers who wish to breastfeed should be given the support and they should also be encouraged to have the baby room in with them.

Treatment of Postnatal Depression

To prevent statistics like Felicia Boots, it is important that women seek help early as postnatal depression is very treatable.
“In cases of mild depression, support and reassurance may be all that is needed from the patient's doctor and her family. For others with moderate or severe depression, medical attention is strongly recommended. After a full assessment, a management plan will usually include psychological support and therapy, and medications that are suitable for breastfeeding. These can include a sedative or anxiolytic drug or antidepressants depending on the presenting symptoms. With most women being concerned of exposing their nursing infants to side-effects of medication, the choice of treatment regime can be carefully selected to fit the needs of mother and infant,” advises Dr Umboh.

How Can Family and Friends Show Support?
  1. Give reassurance that the new mother is not alone and that she will get better.
  2. Provide a listening ear without making any judgments and do not offer solutions or advice unless requested.
  3. Ask how you can help.
  4. Understand that she can have her "mood swings" and instead of reacting instinctively by retaliation and scolding, stay calm and communicate to her that you would like to help.
  5. Offer help with household chores and childcare needs before she asks for it and continue to offer assistance as she might find it difficult to ask for help.
  6. Provide assistance and encouragement to help build her confidence in looking after baby.
  7. Encourage her to make time to go out for some sunshine, spend time with spouse/ partner, meet with friends, engage in physical activity or any other activity that is relaxing for her.
  8. Encourage and help her to seek professional help when needed.

Source: Department of Psychological Medicine, KK Women’s and Children’s Hospital

How Can I Help Myself?
If you have symptoms of postnatal depression, simple steps to take would be to talk to a supportive friend or relative, to seek practical help if necessary, and to practice self-care.

 

Rest whenever you can
Organise baby care schedule to enable others to help such as expressing breast milk so that someone else can help with a night feed and you can catch up on your sleep. Accept offers of help from relatives and friends, and ask for extra help and support when needed. You do not need to be a “Superwoman”.

Eat well
Eat regularly so that you will have the energy to carry on. Take supplements if necessary since you might have difficulty finding time to prepare and have a meal, and may have no appetite to eat.

Exercise
Make time for yourself to do things that you enjoy or help you to relax, such as simple breathing or relaxation exercises. Engage in physical activity such as brisk walking.

Be realistic
Set realistic expectations. Prioritise yourself and your baby. Unnecessary chores can wait or be delegated to someone else. Be kind to yourself and not be too hard or critical.

Meet other parents
Meet other new mums for emotional and practical support. You can speak to friends and family who are also new parents, people you met during antenatal classes, or join parent-and-baby forum groups.

Seek professional help
Talk to your doctor, obstetrician or a counselor. You may be referred to a psychiatrist. Do follow treatment advice and involve your spouse, partner, family member in your treatment.
“In extreme cases of postnatal depression, you read about it in the papers – suicide and/or killing of the baby and other children. But a far greater silent majority suffer in terms of affecting the bonding between them and their baby, in increased marital tension, frayed family relationships, and excessively harsh or inconsistent parenting. Children of depressed mothers are at higher risk of developing a whole host of emotional and behavioral problems in childhood, and more likely to develop depression later in life. Hence, seeking help early from a professional who is well-versed in postnatal depression would be ideal,” explains Dr Chee.

Thanks for sharing!