It’s not just about the baby blues

Doctors and experts urge expectant mothers to watch out for signs during the course of pregnancy to prevent postpartum mental health complications.

Published: 01st May 2019 04:06 AM  |   Last Updated: 01st May 2019 04:06 AM   |  A+A-

Pregnancy

For representational purposes

Express News Service

CHENNAI: Simran Darira’s life changed after childbirth. She was expecting a vaginal delivery but had a Cesarean procedure after being in labour for 16 hours. “No one will prepare you for life after pregnancy. The routine suddenly begins to revolve around feeding the baby, cleaning up after them, tending to their needs and putting them back to sleep.

Odd sleeping hours, crankiness, pain while breastfeeding and apprehensions about parenting — every mother goes through a different experience. I was a fitness enthusiast before pregnancy. Cesarean loosens your stomach muscles, your body changes and you feel less attractive. An accommodating surrounding, understanding partner and few hours of normal life can help with postnatal blues,” says the interior designer, a first-time mom. 

What is postpartum? 
Postpartum psychiatric disorders can be divided into three types — postpartum blues, postpartum depression, and postpartum psychosis. Each type varies depending on the time of prevalence and intensity of symptoms. “Baby blues is the general mood swings that exists for a week or two after childbirth. It is seldom noticed and fades away without help. Postpartum depression is long-lasting. It continues for a few months and interferes with the ability of the mother to take care of the baby.

The mother will have intense irritability, fear of harming the child, feeling of inadequacy, anxiety, sleeplessness, low concentration and suicidal thoughts. This cannot be neglected and requires immediate help. Another extreme condition is postpartum psychosis that includes delusional thinking, hallucinations, and paranoia. Taking psychological questionnaires will prepare the couple for an educated childbirth experience,” suggests Sneha George, counselling psychologist. 

Support system
According to the National Institute of Mental Health, the levels of female hormones — estrogen and progesterone — drop after childbirth. This leads to chemical changes in the brain triggering mood swings. In addition, many mothers are unable to get the rest they need to recover from giving birth, resulting in tiredness. “We conduct antenatal classes for pregnant mothers after the second trimester to brief them on ailments, protective home experience, child labour and pain relief.

After 32 months, labour preparation classes, lactation and coping mechanisms are taught by neonatologist and anaesthesiologist,” says Thendral K, a gynaecologist from Rainbow Children’s Hospital. The maternity support system is said to be an evolving concept. Gynaecologists are ensuring topics around psychological and social factors are discussed during antenatal classes. 

The National Institute of Mental Health suggests that some women are more prone to depression. The causes include history of depression, loss of loved one during pregnancy, unplanned pregnancy, unexpected termination or medical complication, hereditary issues, lack of family support, and drug abuse. 

Seek therapy 
Early detection with a better support system may yield better results. “Medication and therapy work best. The method of treatment is based on the client’s health conditions, family structure, and personality. Safe anti-depressants are given gradually to not interfere with breastfeeding. The best way to prevent postpartum disorders would be to monitor and look out for signs of depression during the course of pregnancy. Women should be encouraged to open up.

Most of the cases go unreported due to the stigma attached to anything emotional or psychological. Sometimes even the fathers go through depression. Awareness has increased. If left untreated this can lead to chronic depression,” says Sujatha Velmurugan, a psychiatrist at Kauvery Hospital. 

Recent study
Ravi Prakash Upadhyay from Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi along with his colleagues conducted a study — Postpartum depression in India: A systematic view and meta analysis — to estimate the burden of PPD in Indian mothers and investigate the risk factors in 2017. The findings were based on systematic review and analysis of 38 studies involving 23,043 women. 

The incidence of postpartum blues was 300-750 per 1,000  globally, postpartum psychosis was .89 to 2.6 per 1,000 births and postpartum depression was 100-150 per 1,000 births. Some of the key findings suggest that the southern region of the country tops the PPD chart. Most commonly reported risk factors for postpartum depression included domestic violence, past history of illness, marital conflict, the birth of a female baby and stressful events. Children of mothers with postpartum depression have a greater risk of cognitive and behavioural problems. 

Mommy care 
Rakhi Kapoor, childbirth specialist and author of pregancy books, suggests: 
● Give your body a complete rest for 40 days for it to relax and get back to normalcy. ● Baby blues are common due to fatigue. Discuss with family, friends, and do not shy away.  ● Having a close-knit of understanding friends who are mothers help. You can take turns in babysitting, grooming and sharing experiences. ● A quick break, entertainment or distraction from routine helps. ● Embrace this phase without complaining. It’s momentary and you will overcome it. ● Involve your partner as much as possible and discuss your feelings with him. ● Educate, engage and empower women in opening up to discussing psychological problems.

Postpartum nutrition: Foods that aid healing and recovery

Ingredients
Tropical amaranth greens: 1 bunch, Split green gram dal: 1 tbsp, Shallots: 8, finely chopped, Garlic: 2 crushed, Mustard seeds: ¼ tsp, Cumin seeds: ¼ tsp, Asafoetida: A pinch,Turmeric powder: A pinch, Dry red chilli: 2 nos, Salt: As per taste, Oil: 2 tsp
Method
● Pluck the amaranth leaves and tender stems from the bunch, wash them well and strain the water. ● Wash the green gram dal and cook in 2 cups of water with a pinch of turmeric. ● While the dal is cooking, in a small pan heat oil, add mustard, and let it splutter, add dry red chillies, cumin and asafoetida. ● After a few seconds, add crushed garlic and finely chopped small onions and sauté till it turns translucent. ● Once the dal is cooked, add the greens and cook together for 5 minutes adding little water if required. Mash it up slightly with a hand blender. ● Add the mustard tempering and the sautéed onion, garlic to the greens and dal mixture. ● Add salt to taste and mix.

Benefits
High in iron and folic acid 
Helps maintain milk supply in breasts and helps avoid mastitis in breastfeeding moms
Rich in calcium, vitamin A and E 
Aids digestion

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