According to a WHO report, close to 1 billion people live with mental disorders. This has worsened amid the ongoing pandemic, with millions more grappling with mental health issues across the world. Although the importance of mental health has been recognised during COVID-19 times, there is one condition that is rarely spoken about -- postpartum depression (PPD). Better known as ‘Baby blues’, this is a very common psychiatric complication associated with childbirth.
“I vividly remember the case of a 21-year-old educated mother who had a normal delivery, which was surprisingly smooth without much hassle. She had anxiety issues during her pregnancy period and immediately after the delivery of her child, she started screaming and crying. There was some pre-formed notion in her mind that she had to cry,” explains bioethicist and consultant gynaecologist Dr Roopa Varughese.
Common symptoms include mood swings, tearfulness, anxiety, insomnia and irritability. PPD can cause disruptions in the mother-child relationship which is essential for child development. Mothers become reluctant to breastfeed their children which is crucial for the growth of the baby. Children having mothers with PPD show greater behavioural and interpersonal problems. Women with a family history of mental disorders and poor coping skills to deal with anxiety fall under the high-risk category.
“Women feel the pressure to be able to fit into the ‘perfect mother’ image set by society. Often the initial signs of PPD are ignored as people feel new mothers need time to adjust to the role they have been preparing for. Families do not understand the needs of new mothers,” says clinical psychologist Vidya Meenakshi. The reluctance to seek help owing to the stigma of mental illness also aggravates the PPD situation.
“It may not be very easy to recognise the symptoms and a window of two weeks is given for the mother to adjust to the new role. Beyond this, if the symptoms exist, it is referred to as a PPD case. As a lot of physical and hormonal changes occur in a woman during this period, the symptoms vary from patient to patient. PPD is an overwhelming state and it is common for women after childbirth to go through this phase,” said Dr Roopa Varughese.
Support from the spouse and family can make a huge difference for women who may be reeling under the pressure to adjust to their new role.
Some cases of maternal suicide and infanticide following postpartum depression have also been reported. “In one particular case, the mother was diagnosed with high risk PPD and refused to accept her child. She tried to harm the child and commit suicide. Although the mother was saved, the baby met with an unfortunate death,” says psychiatrist Dr Varun Rajan.
Depending on the nature of the case, treatment for the condition could range from counselling to hospitalization. The patient can usually be treated with a dose of antidepressants and proper counselling. For extreme cases, hospitalization will be required as the patient may have suicidal thoughts which could be detrimental to the life of the child.
“Ideally we can help patients who tend to go through PPD by recognizing the condition right from the time they start visiting the gynaecologist during the pregnancy period. By working closely with the gynaecology department, we can make headway in such cases at the earliest,” says Vidya Meenakshi.
The key is to create an environment where mothers can express their mental health insecurities without any hesitation as there is still huge resistance in society to take help. While the situation in urban regions is a bit better when it comes to approaching experts, people in rural areas still do not seek help owing to the patriarchal system, socio-cultural factors, lack of awareness and many other reasons.
"The more we talk about postpartum depression, the less of a taboo it becomes. In an effort to reduce the stigma, mothers should share their own experiences especially in rural areas as word of mouth is a powerful and impactful way of motivation," says Dr Roopa.
“In a crisis situation similar to the present pandemic, it is necessary that health facilities monitor women who are pregnant or have recently delivered for possible symptoms of depression. Detecting and treating depression right at the beginning could prevent detrimental long-term effects on maternal and infant health and local healthcare providers should be trained to identify this,” she adds.