Post – natal depression

The signs and how to avoid it

What are the signs of post-natal depression?

You should be wary of the following combination of signs:

• An overwhelming feeling of uselessness. You feel unwanted and of no help to anyone including your baby. When your baby does not stop crying despite your concerted efforts, you feel an overpowering sense of being rejected by your baby
• A crushing feeling of hopelessness. You feel that whatever you do, your circumstances are grim and nothing can be done about them. You feel that whatever efforts you or others put in anything, failure is imminent. This feeling may come in bouts.
• A compelling feeling and belief that life is worthless. This may be combined with suicidal tendencies or thoughts.
• Absolute exhaustion and tension.
• General irritability and irrational behavioural traits.
• Sudden disinterest in your hobbies.
• Personal neglect and untidiness.
• Lack of appetite and a general feeling of repugnance towards food of all types.
• Insomnia (chronic inability to fall asleep or to enjoy uninterrupted sleep).
• Restlessness.
• Bouts of aversion and indifference towards your baby, including an urge to harm the baby.
• Panic attacks and severe anxiety.
• Absolute loss of libido (sexual urge or desire) or disinterest in sexual intercourse.
• Hypochondria (chronic abnormal anxiety concerning the state of one’s health). There is constant worry about the health of your baby, other children or family members and friends.
• A sense of anxiety about your baby even though the baby is evidently alright.
• You feel guilty every other time even when it is obvious that you are not to blame at all. For example you may blame yourself for your husbands’ stress even when you have nothing to do with it.
• You wake up feeling well but the symptoms of depression take over as the day progresses.
• You are constantly feeling tired despite adequate rest. In this case you are unable to cope with the needs of the baby and other family members, and you feel that you are failing the family as a mother.
• Malaise (a mild sickness, not symptomatic of any disease or ailment). Such symptoms include chest pains, breathing problems, headaches, dizziness and stomach upsets.
• Obsessive thoughts or repetitive chanting thoughts or voices. Obsession is a state of strong attachment to objects or ownership. Repetitive chanting refers to thinking aloud but repeating the same things over and over.
• Thoughts that you will harm your child or another member of your family accidentally or deliberately.
• Fear or thoughts that you may sexually or physically abuse either your newborn baby or your other children.
• Having worries that everyday objects such as knives, stairs, toys or your car are dangerous and could harm your child, yourself or your family.
• Having many ‘what ifs’.
• Feelings that you are a ‘bad’ mother or a ‘bad’ person.
• A constant feeling of doom or dread that something bad is about to happen any minute.
• Having a constant need to discuss and revisit your delivery experiences because you felt it was so horrible and things were out of control or not being able to think or talk about the birth process altogether.
• A feeling of great sadness and that since the arrival of your baby, life is not worth living. Nothing gives you joy. Not even your new baby.
• Feeling that if you disappeared from your family members’ lives, everything would be okay for them; that you are the source of their unhappiness.
• Feeling numb and emotionless. This might extend to a point of lacking feelings for your baby.
• Hiding from people how you feel and deliberately putting on a ‘brave face’.
• Feeling like and/or actually harming yourself.
• Drinking too much alcohol and/or abusing recreational or prescription drugs.

Concealing all these feelings does not help. You need to talk to a doctor, a counsellor or a close friend. Early detection of postpartum depression ensures good prognosis and recovery.  Support from family members and is essential. Relatives and friends of mothers suffering from post-natal depression should support them physically, emotionally and spiritually. Your doctor may prescribe some anti-depressants if necessary.

What can one do to avoid post-natal depression?
Although there are no iron-cast guidelines on avoiding post-natal depression, here are some useful tips.

• It is important to be proactive about how you will eventually feel about your pregnancy and your newborn baby. Decide from the onset that you will enjoy your pregnancy, whatever difficulties may arise.
• One critical approach to childbirth is to recognise and accept realities surrounding your pregnancy, whether they are happy or unfortunate circumstances.
• It is also advisable to identify someone with whom to share your highs and lows. If such a person can live with you in the first few weeks after delivery, the better. If your partner is practical and can play this role, well and good. Have as much rest as possible and try to relax, in preparation for your baby’s arrival.
• Eat well during pregnancy and continue eating healthily even after delivery. It is not yet time to diet, watch your weight or worry about your waistline. If you find yourself unable to stop worrying about your shape, talk to your dietician or doctor. You will be advised on exercises and also on proper feeding.
• Closer to your delivery, that is in the third trimester cut down on your obligations, especially those unrelated to your pregnancy.
• Interact with other new mothers. While in the maternity ward, most mothers are willing to share their feelings. Take full advantage by walking around the ward and talking to others.
• Registering for and attending post-natal classes is one sure way of meeting mothers in the same situation as yourself. The positive effects of sharing experiences, however briefly, cannot be underestimated.
• Open up your heart and mind to those around you. Share your feelings with them depending on your level of ease. You will be surprised at how much support and advice they can give you.
• Do not shy away from seeking the assistance of a babysitter. This will allow you some free time with your partner.
• If you can avoid it, do not undertake drastic changes or decisions about your life just before or after delivery. For instance, it is not advisable to get into new romantic relationships, move houses, join college or change jobs close to your delivery date.
• Your house may be messy, but do not let this bother you. Decide how you want to sort this out without unduly stressing yourself. Accept help whenever it is offered. You may be tempted to say ‘I am okay’ or ‘I will manage’ but don’t. If you can afford it, get paid labour. You are supposed to be resting and you are entitled to the rest.
• Ask, ask and ask. Do not tire of asking for assistance. It is your time to be heard, and it will end as soon as you are up and running. So take advantage.

Can post-natal depression lead to death?
Post-natal depression on its own cannot lead to death. However, a woman can become violent because of it. A depressed mother can kill her own baby or harm others around her because she thinks that people want to harm her or kill her.

Help and treatment
Unfortunately, in Africa diagnosis for post-natal depression is not widespread and most women, especially those in the rural areas, have not and might not hear about its diagnosis in the foreseeable future. In developed countries however, awareness about post- natal depression has become increasingly widespread in post- natal care and diagnosis is ever improving. Health consultants and midwives are also well trained to recognise the symptoms and provide treatment.

Professional counseling should be started immediately post- natal depression has been diagnosed.

Emotional support is necessary and is critical in helping the patient recover. It is usually readily available from family and friends. Nevertheless, it is advisable that close associates of the ailing mother also meet with the healthcare professional taking care of her in order to get guidance on the type and intensity of emotional support the patient requires.

Medication may also supplement counseling and emotional support. The medication is non-addictive so you need not worry about its long-term effects. It does not interfere with breast milk or your baby’s health so you also need not get apprehensive about it. Your doctor will advise you on how the drugs work and for how long you will need to take them.

Hormones have also been used to effectively treat some women in this condition. It is not yet known with certainty how or why this works.

END: PG DEC 04 06 JAN 07/48-49