Sunday May 15, 2011
More than baby blues
By LIM WEY WEN
Postpartum depression: when it is not just baby blues.
IT was supposed to be a joyous occasion, but actress and TV host Wardina Safiyyah Faddhullah Wilmot was at one of the lowest emotional points in her life as a mother after the birth of her second child.
“I went through a period of depression, and I still have goose bumps thinking about it. When I think about the things that I said and did, I still feel a pang of guilt. It was so horrible, I would never want any person to go through what I went through again,” she says.
It is this wish that spurred her on to share her story unreservedly with the world, to remind women that if they experience depression after what is said to be the best experience a woman can have, they are not alone.
Two weeks ago, in a small room full of journalists, psychiatrists, and mental health workers, she recounted her ordeal once again before she went on to facilitate a discussion on the subject.
“I was cranky, I was crying a lot, I got irritated easily, and I was screaming at my daughter all the time,” she describes. “At one point, I even thought about harming myself.”
Not one of the many books she read about childbirth and babies had prepared her for it. “Believe me, I’ve read every baby book I can find cover-to-cover. But that’s the thing. Everything I read is about the baby. There is very little information about the mother,” she says.
Although she had never had it diagnosed, what Wardina experienced – she found out later from the Internet – are the typical symptoms of postpartum depression.
It is not a “new” condition, and it is certainly on its way to shedding its reputation as a subject people do not discuss in public.
It is, however, something that most people, including mothers, do not think that they would experience. And despite being able to discuss the subject with their friends, not many women who experience it are willing to admit it.
“The sad thing about postpartum depression is that the mother who is experiencing it is often denied the right of being depressed, as she is not supposed to feel sad during the joyous event,” says consultant psychiatrist and Malaysian Psychiatric Association president Dr Abdul Kadir Abu Bakar, one of the panelists at the discussion. “Everyone expects the pregnant woman to look forward to the day when she can cuddle her baby, and start her journey of motherhood.”
The truth is, and many mothers can attest to this, motherhood is not an easy ride. But the good news is this: once the rough patches are navigated, many may find the journey well worth the trouble.
When is it not just the blues?
Due to the hormonal changes in a woman’s body, it is actually normal for mothers to experience mood changes after delivery. Baby blues are common, and even expected.
“During pregnancy, most of the female hormones in the body that encourage good health and well-being are being kept at high levels by the placenta,” says Dr Abdul Kadir. “But when the placenta ‘leaves’ the body after birth, the hormone levels in the mother’s body drops suddenly. That’s why she can experience mood swings and restlessness up to a few days or even one week after delivery,” he explains.
But if the symptoms last more than 12 days, and are accompanied by feelings of worthlessness, loss of interest in doing anything at all, and a persistent low mood that does not let up, there is a chance that it may be postpartum depression.
With postpartum depression, the hormonal changes have resulted in certain chemical changes in the mother’s brain that causes the symptoms to persist. In rare instances, these changes can cause puerpural psychosis, a condition that causes mothers to exhibit psychotic symptoms.
To simplify the difference between just having the baby blues and postpartum depression, Dr Abdul Kadir turns to an unlikely sport: football.
“Imagine that you’ve been preparing for this football game for nine whole months. You are so excited; you can’t wait for it to happen. But just after the game is over, you have this unexplainable feeling of loss, which you will get over after a few days. That’s the baby blues.
“Next, imagine that you are in the same football game. You’ve prepared for nine months. You’re thrilled that it’s finally going to happen. But after the game is over, all you can think of is what you have done wrong before, and during the game. That’s postpartum depression,” he says.
For Wardina, it started one week after she gave birth, and lasted for six months. “I wasn’t prepared, partly because I did not experience anything like this with my first baby. After I came home from the hospital, I couldn’t sleep, or rest, because there was just so much to do in the house.
“After it went on for weeks, I told myself this could not be it. This is not me,” she recalls. She went to her gynaecologist to find out what was wrong, but as she was feeling fine in her doctor’s office, her doctor did not suspect anything amiss. “The moment I went home and stepped into the house, I started crying again,” she says.
Wardina suspects that some of the reasons that may have made her more vulnerable to postpartum depression when she had her second child – not her first or third – were due to the circumstances she found herself in during that time, five years ago.
“My husband did not understand what was happening at first, because he thought I was just being cranky and illogical; my mother was not in the country; and I had a new maid. Due to all these factors, I had to manage the house almost all on my own,” she explains.
“All I wanted was for someone to listen to me, accept my situation, and not put any extra pressure on me. I wanted someone to understand what I was going through. It might sound selfish, but I think this is the least people can do for a woman who has just gone through labour. That emotional and physical support is so important,” she emphasises.
As she did not know that it is possible for women to seek help from their doctors or counsellors, she looked to the Internet and found an online support group instead.
“Surprisingly, the support I got was from across the ocean because the group was from the US,” she recalls fondly. “Sometimes, we just need someone to tell us that it’s okay to feel this way, and that everything is going to be alright eventually.”
Indeed, support is one of the most important factors that can protect a mother from developing postpartum depression. In fact, the support Malaysian mothers still receive from their family members is one of the reasons why the rate of postpartum depression (an average of 7%) among mothers in this country is still lower than other countries (including the US) where the rates can go up to 20% to 25%, says Professor Nor Zuraida Zainal, another consultant psychiatrist on the discussion panel.
“Women in Malaysia still have their sisters, mothers, mother-in-laws, or confinement ladies to help them with their responsibilities. It doesn’t really matter who the person is, having somebody to help you around the house helps,” says Prof Zuraida. “Besides that, breastfeeding can also protect the mother from developing postpartum depression,” she notes.
Wardina agrees. When she had her third baby, her family was there for her every step of the way. “Because they knew what I went through, nobody left me alone this time. I did have the blues, but it didn’t last that long. The depression did not come.”
On top of that, she also believes that her faith and religion played a big role in her recovery. “I think having faith and a positive attitude is important because it gives you a sense of security. It certainly put me in a better state of mind.”
It’s going to be all right
How, then, can we support mothers who have just given birth? It does not take a lot of effort to provide mothers with the support they need, says Wardina.
“Just help the mother take care of the baby for a while, or help her change her baby’s diapers, so that she can rest. When a simple act like going to the bathroom to bathe is already challenging for you, every bit of help counts.”
That is exactly what she does now. Whenever a friend or relative welcomes a new baby, she takes time to visit the mother just to see how they are holding up.
“Sometimes, when I ask them how they are, or tell them that it is okay to feel sad sometimes, some of them burst into tears,” she recalls.
If there is one thing Dr Abdul Kadir wanted all of us in that room to remember, it is this: postpartum depression is due to chemical changes in the brain, it is preventable, and it is treatable. In other words, postpartum depression is not due to a personal failure, or a result of a mother “not trying hard enough”.
“If your symptoms are mild, getting support and some form of counselling will help you. If they are moderate, medications and a special kind of counselling, called cognitive behavioural therapy, can help,” says Dr Abdul Kadir.
“But if the symptoms you are experiencing are severe, like when you have thoughts of suicide or harming your baby, you may need medications. In some cases, we may need to resort to electroconvulsive therapy,” he explains.
The success rate of treatment is as high as 80%. “However, like any disease, the earlier you seek help, the better your prognosis will be,” he explains.
Even though Wardina did not eventually seek medical help to overcome her bout of postpartum depression, she encourages mothers who are experiencing it to seek help.
“Because I believe that if I sought help when I was going through it, I might not have had such a hard time recovering. Or I might have recovered faster,” she says.