Tuesday, July 25, 2017

When postpartum depression sets in

 

Having a baby is an experience that can cause a mixture of powerful emotions from excitement and joy to fear and nervousness. However apart from such amazing experience, some women are faced with a possibility of living through something unexpected after giving birth and that is depression.

While many new mothers are said to experience postpartum baby blues after childbirth including anxiety within the first two to three days after delivery, some new mothers on the other hand are believed to experience a more severe form of depression known as postpartum depression.

 Martha Joseph*, 28, is one among  women who went through such an experience after giving birth to her first child two years ago. According to her, the arrival of her baby girl was expected since she and her husband were eagerly trying to get pregnant for several months.

‘I remember how the first few days of my postpartum went well with few days of baby blues, however one month after I gave birth, things turned for the worse. I suffered from severe anxiety not being able to relax even when my baby was sleeping. I had lack of sleep and was always bad tempered,” explains Martha.

One thing that she never would have recognised was her possibility of suffering from postpartum mood disorder, “It did not occur to me that I would suffer from something that I have always heard and seen on TV and books. I always thought that it was a common condition for women living in European countries,” says Martha who after three months of suffering wanted to feel like herself again and therefore sought for help.

“A visit to my doctor and after several checkups I was finally told that I was suffering from postpartum depression. My doctor told me that anxiety was usually a big factor in postpartum depression and gave me the medications and monitored me carefully and within weeks I showed improvement,” she says, adding, “I have been doing much better since and I wish other women would be more open to seeking help such as medical advice when things get out of hand. I thought that what I was going through was normal that’s why I looked for medical help very late something which was not right. There is help for this curable, temporary illness.”

 

A common problem

Martha’s case represents a wider number of cases of women who have and continue to suffer from postpartum depression. The World Health Organization (WHO) identifies postpartum depression as a serious public health problem that can lead to enduring mental illness for women and serious psychological and emotional consequences for their families.

 Often characterised by feelings of loss and sadness, insomnia, lack of energy, forgetfulness, irritability and poor functioning, worldwide about 10 per cent of pregnant women and 13 per cent of women who have just given birth are said to experience a mental disorder, primarily depression. In developing countries this is even higher, that is 15.6 percent during pregnancy and 19.8 percent after child birth according to World Health Organisation.

A gynecologist at Muhimbili National Hospital who requested  anonymity said postpartum depression can be viewed as simply a complication of giving birth and that signs and symptoms can range from mild to severe, “first we need to know that a woman experiencing motherhood can have a mixture of feelings after giving birth which can lead to what we call postpartum baby blues. Usually this comes with a number of symptoms which may include mood swings, anxiety and sadness and in most cases these symptoms usually last only a few days to two weeks after giving birth,” says the gynecologist

He went further saying  that postpartum depression  signs and symptoms are more intense and last longer compared to baby blues and without  noticing can interfere with a mother’s ability to care for her child. “If a mother has severe mood swings and she finds it hard bonding with her baby or that she withdraws from family and friends and has less interest in doing the activities she used to enjoy doing before or that she fears that she is not fit to be a good mother then this can be signs that a mother is suffering from depression.”

He says there are factors that contribute to postpartum depression, including having emotional concerns.

“A mother may feel less attractive or she might feel like she has lost control over her life. There is also the change that comes after a woman giving birth, for instance change in hormones; estrogen and progesterone may contribute to postpartum depression.”

He says if ignored, postpartum depression can cause a lot of problems especially when it comes to mother and child bonding. “If a mother is left untreated  for months or longer, it can become a  chronic depressive disorder and children of mothers who have untreated postpartum depression are likely to have emotional and behavioral problems; such as sleeping problems, they may also have excessive crying habits,” he says.

 

It’s treatable

With appropriate treatment, he says postpartum depression can be treated within six months, however in some cases it may last much longer. “With psychotherapy and antidepressants, a woman suffering can find better ways to cope with her problem. That’s why it is important to continue treatment after they begin to feel better,” he advised.

Studies from Sub-Saharan Africa identified a range of risk factors for post partum depression naming few factors such as unwanted and unplanned pregnancies to be associated with postpartum depression. Lack of emotional or practical support from husbands or partners was also a significant risk factor. Furthermore, family stress and being consistently unhappy during pregnancy are associated with it.

A research titled “Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: A mixed method systematic review’’ showed a number of significant factors that could lead to depression – one among them include age, with younger mothers said to be more at risk for depression, similar to findings in Western cultures.

“Undesired gender of baby was found to be a significant risk factor, as there is an overall preference for male children within patrilineal society where an heir is considered of great importance. Having an unplanned pregnancy was found to be a significant risk factor in women who lived in a peri-urban environment but this association was not evident in women who lived in a rural environment. Although child bearing is often seen as desirable in African culture, the meaning ascribed to pregnancy and its context may be different to urban and rural women,” the study reads in part.

Gertrude Simon is one among many women who was caught between the cultural perceptions where being a single parent and having a baby out of wedlock was socially unacceptable, “I went through a lot including being stigmatised by some of my friends, family members and community after I had a baby out of wedlock. Born and raised in a Christian family, that was not expected of me,” she says.

Having a weak support system from family members and from a man, who impregnated her, let alone having financial problems and unplanned pregnancy was enough to cause a lot of emotional issues that led her into depression.

“I was 22 then, still in college depending on my parents to pay my college fees. My father was really angry and so was my mother. I could understand why they were angry because apart from our family having financial problems, I was the first born and my father had too much expectations from me, he expected me to set a good example to my other siblings. But I failed them, that caused a lot of pressure during and after giving birth since I had all these feelings of worthlessness, shame and guilt, however thanks to my aunties and grandmother who counseled both me and my parents. That’s when they came into terms with my situation,” says Gertrude.

Postpartum depression is the most common complication of pregnancy and childbirth, affecting up to 15 per cent of all women within the first three months following delivery. Research has shown that mothers of infants born prematurely have almost double the rates of postpartum depression, particularly during their time in the neonatal intensive care unit (NICU).

Research led by Betty R. Vohr, MD, director of Women & Infants’ Neonatal Follow-Up Program and professor of pediatrics at The Warren Alpert Medical School of Brown University in the US,  found that there are certain social and emotional factors that further increase the risk of postpartum depression in mothers of preterm infants. The research, entitled “Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants,” has been published in The Journal of Pediatrics by Katheleen Hawes of the Center for Children and Families at Women & Infants Hospital of Rhode Island,  US elaborate more on post partum depression.

“We found mothers with a previous mental health disorder and experiencing negative perceptions of herself and her infant at NICU discharge were at increased risk for depression one month post discharge, regardless of the infant’s gestational age at birth,” explained Hawes.


By Esther Kibakaya

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