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The other side of motherhood

KAMALA BALACHANDRAN

Postpartum depression sets in after the birth of a child. The causes can be both physiological and psychological.

PHOTO: S. THANTHONI

Get help: An artist's depiction of motherhood.

In art and literature, in folk tales and mythology, the mother, as the personification of love and compassion, has been glorified and put up on a pedestal.

So when Hollywood actress Brooke Shields disclosed that she had suffered severe, postpartum depression after the birth of her daughter, people were stunned. Many cynically observed that such an unnatural mental state, after childbirth, must be typical of Hollywood actresses.

Others, especially in India, declared that the incident was yet another sign of the decaying family values in the West.

But Dr. R. Raguram, a Bangalore-based psychiatric consultant on postpartum depression, confirmed the prevalence of the disorder among Indian women.

With over two decades of experience at the National Institute of Mental and Neurosciences, Dr. Raguram talked about how best one could handle it.

* * *

WHAT is postpartum depression?

Depression in general can be described as feeling sad or miserable. Most of us feel this way for short periods. But true clinical depression is a mood disorder, which can interfere with everyday life for an extended time. Depression that sets in after the birth of a child is postpartum depression.

This condition is different from what is commonly known as the baby blues. That can happen in the days right after childbirth and normally goes away within a week. A new mother can have sudden mood swings, crying spells, loss of appetite, sleeping problems and feel irritable and anxious. These symptoms are not severe and treatment is not required.

But in postpartum depression, the symptoms usually begin in the first six weeks after childbirth, and are far more severe.

One unique aspect is that the mother has homicidal tendencies to kill or hurt the child. In all other types of depression the patient has only suicidal tendencies.

A new mother is supposed to be joyous. How does depression set in?

There are physiological causes and psychological reasons. After pregnancy, hormonal changes may trigger symptoms of depression. During pregnancy, the amount of two female hormones, oestrogen and progesterone, increases. In the first 24 hours after childbirth, it rapidly drops back down to normal levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes can affect a woman's moods before she gets her menstrual periods. Occasionally, levels of thyroid hormones may also drop after giving birth. Often tiredness after delivery, broken sleep patterns and not getting enough rest keeps a new mother from regaining her full strength for weeks.

The psychological reasons are many. The new mother, especially if very young, may feel overwhelmed by the responsibility of caring for a baby. Feelings of stress could also arise from changes in work and home routines. Sometimes, women think they have to be "super mom" or perfect, which is not realistic and can add to stress. Complex feelings of loss can trigger depression — loss of identity; loss of career, control of situations; loss of pre-pregnancy figure, and feeling less attractive.

Another is having less free time or less control over time — having to stay home indoors for longer periods and having less time to spend with an older child, husband and friends.

Is the disorder a western ailment or is it prevalent among Indians too?

The incidence here is about the same as anywhere. But what we see at the clinic is only the tip of the iceberg. A large portion remains hidden, as most cases are never brought for treatment. The family invariably tries to hide the mother's "shocking" behaviour. Only when the situation gets out of hand and the family realises that the child is in danger, do people seek professional help.

What are the precipitating factors?

Many. First, the mother being unprepared for the role. People think that mothering is natural, but that is true only if the woman has unconsciously absorbed the skills. Earlier, a girl was included in the home making and child rearing activities. But now, especially in urban areas, girls grow up in exactly the same manner as boys. For such women, the sudden transition can be unsettling.

The second reason has to do with managing alone. This too is an offshoot of the changed social scene. Though most Indian women still have parental support in the prenatal and postnatal period, an increasing number are forced to manage on their own. The absence of the traditional support system, especially when the child is sick, can be very stressful. For many women the stress could begin after they have returned from their mother's place. In a nuclear family, she has to cope alone, as husbands are either unsupportive or too tied up with their work to help out.

Multiple births or unplanned pregnancies too can cause depression. The mother may worry about being financially or otherwise unprepared to face the responsibilities. An unplanned child disturbs the mother all the more if her career has been affected.

Are there any preventive steps?

Being mentally prepared for the new responsibility and developing the skills needed for mothering are the two most important moves one must adopt. At the pre-natal stage both parents should read up on the subject and have a fair idea of what to expect once the child arrives. Many hospitals have counselling sessions.

Many women start out with a glorious and unrealistic idea of what motherhood entails. When they find that the bundle of joy is, often, tiresome, they develop an overpowering sense of guilt.

What is your advice to a mother who suspects she is heading for postpartum depression?

Never hide or cover the symptoms because you are ashamed, or guilty about feeling depressed when you are supposed to be happy. Postpartum depression can happen to any woman. It does not mean you are bad or unfit to be a mom. What is important is that you and your baby should not suffer needlessly. There is help.

Discuss the matter with your husband/friend/doctor. While speaking to the doctor, if you mention only symptoms like tiredness, he/she might assume that the problem is physiological. Discuss your feelings openly.

Stop putting pressure on yourself. Do as much as you can and leave the rest

Do not spend a lot of time alone. Get dressed and leave the house. Run an errand or take a short walk. Spend time alone with your husband.

How is the depression treated? Can it be cured with intake of vitamins, more nutritious food?

There are two lines of treatment. Talk therapy, which involves talking to a therapist to learn to change how depression makes you think, feel, and act. Medicine, which is essentially an antidepressant, helps relieve the symptoms of depression. But talk to a doctor first about advantages and risks.

But depression can affect the baby's development, so getting treatment is important for both mother and baby. The risks of taking medicine have to be weighed against the risks of depression. Vitamins are helpful to improve general health but these alone do not constitute treatment. As with any ailment, postpartum depression responds fastest when treated in the early stages.

Contact Dr. Raguram at ramanathanraguram@yahoo.com

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