Post-natal Depression-The way in and the way out

Dr. Edmond Wamwana examines this important but much-neglected subject of pregnancy.

One woman narrates: ‘EVEN though I attended all my antenatal clinics at a reputable hospital, no one told me about post-natal depression. I had also heard of baby blues but I thought it meant an irritable baby. A few days after the birth of my daughter, I found myself crying day and night without having quarreled with anyone. I cried for two good weeks. I could not understand what was happening to me until a delayed visit to a doctor revealed I had post-natal depression. ‘

The assumption of maternal bliss
It is generally expected that a new mother is a happy mother. The birth of a child is assumed to be the ultimate manifestation’ of a woman’s femininity, and the authoritative confirmation of her fertility and procreational ability. She is expected to be overwhelmed by maternal bliss. However, the birth of a baby in some cases puts the mother in an emotional and psychological confusion. She may be torn between her new-found physical freedom (through separation with the baby) and the entry into a new phase of captivity and 24-hour responsibility for maternal care. She may be torn between the joy of seeing her own offspring and the circumstances which led to the pregnancy. She may both love the baby and hate the reasons for its existence. She may be torn between the happy prospect of bringing forth. a family and the demise or interruption of her career or professional dreams. She may love being a mother and hate what it has done to her physical looks. She may be torn between breastfeeding her baby and surrendering her role to a nanny. She may be torn, torn, torn, about many, many, issues. Earlier experiences of a difficult pregnancy, which sometimes may be inter-twined with the risk of losing one’s life, may also weigh on a mother after delivery.

What is post-natal depression?
Referred to as PND, this is a temporary condition characterised by altered behaviour and does not normally last for more than six weeks after delivery. If it persists beyond six weeks it is classified as a psychiatric condition that needs medical help.

What causes PND?
The cause is not known though it can be pre-disposed by familiar history of psychosis (severe mental disorder resulting in loss of contact with reality). Though it is usually associated with overload demand, that is, adjusting to the new life the birth of a baby, the demands of motherhood, little support from people around you, and the sense of loss of freedom, hormonal fluctuations only make it worse. This situation can get out of hand if not attended to. If you notice any of the symptoms, you need to seek help as soon as possible.

What triggers depression after delivery?
After delivery there are several changes that take place in the body as it tries to get back to its normal state. These include hormonal changes whose levels suddenly fall after delivery. Within the first 7:2 hours, the hormones will have dropped back to their normal levels unlike the. period after conception when the rise in hormone levels is gradual. When these hormone levels drop, the body finds it difficult to cope with the sudden changes within it. There are also other adjustments to make now that there is a baby in your life. You may find that your relationships with various people are being strained as a result. These are factors that make adapting  to the new situation very difficult. If you fail to adapt, you may slip into a depression. This type of depression is called post-partum or post-natal depression (PND).

Do all women go through post-natal depression?
Not every woman goes through post-natal depression after delivery and even to those who do get post-natal depression, it may not occur after every pregnancy. Its severity also varies from one woman to another and from one pregnancy to the other. PND, however, is a serious condition that may derail you from your normal activities. It may prevent you from looking after your baby. In the majority of cases, this attack stays hidden. You may feel ashamed’ of it, refuse to accept it has happened or not recognise it altogether. PND is not reserved for anyone type of mother; it has occurred even in circumstances where the pregnancy was a happy one, the spouse had been supportive, the baby was appreciated and awaited, labour and eventual delivery were superb and there is no history of PND in the family. PND can happen when least expected. Watch out for symptoms of PND as it does not always appear immediately after delivery; it may attack weeks or months afterwards.

Who it at risk of getting PND?
At least ten per cent of women are hit by some form of depression after delivery. In the majority of cases, this attack stays hidden by the patient who may feel ashamed of it or refuse to accept it. In other cases mothers do not recognise PND altogether. As it is not clear how PND starts, it therefore not possible to identify a risk group; although certain circumstances are suspected to precipitate PND. Such cases include an unwanted or accidental pregnancy, a rape-related birth, a premature birth, delayed labour, prolonged labour, an emergency or unexpected caesarian section, delivery complications, baby defects noted upon birth, or a still-born baby. Women whose family has a history of depression, a difficult pregnancy, or pre-delivery stress build-up, those with unstable or no relationships, and those with no close confidants are all thought to be in the risk circle. There have also been suggestions that women battling with declining relations with their mothers and those who have lost parents at a young age, especially those whose mothers died at child birth, are at risk.

Is post-natal depression the same as baby blues?
Post-natal depression must be differentiated from ‘baby blues’. Baby blues is a more common mood condition that occurs following childbirth. It is normal for mothers to experience baby blues for a few days following birth characterised by feelings of irritability and gloom and episodes of crying. This is more common in first time mothers and in those who had problems with the pre-menstrual syndrome, a condition affecting some women before menstruation where they experience temporary physical and mental variations like irritability, moodiness and headaches. Baby blues have no specific treatment other than reassurance and usually resolve on their own.

What should I do when I feel depressed?

Since PND cannot be prevented, it is necessary to follow these tips:

• If you feel depressed, talk to a counselor or a close friend.
• Rest as much as possible. Fatigue only makes PND worse. Take a nap during the day. At night get help with feeding the baby. Grab every opportunity to take a rest whenever it arises.
• Ensure that you take a balanced diet; eat plenty of fruits and vegetables. Avoid snacks and junk food. Do not diet at this time. Eat little but often to ensure a constant supply of energy.
• Engage in gentle exercises such as walking. Or take a ride in fresh air. Let somebody responsible take care of the baby while you are away.
• Avoid major stressing situations such as moving into a new home or redecorating the house. The stress involved will only leave you feeling worse.
• Do not worry unnecessarily over your child especially when the baby has no problems.
• Do not bother yourself or worry about the things you do not want to do. Forcing yourself to do certain things will only end up upsetting you.
• Feel free to ask for help whenever you need it, and when offered help, take it.
• Try to spend some time with your partner if you can.
• Talk to other mums with new babies, for instance when you are at the clinic. You may find that they have the same difficulty.
• Accept that you need help and that it is not your fault that you developed PND.

END:PG 03 /49