Coping with Postnatal Depression
Depression affects about 10-15 % of women after childbirth. Postnatal depression is regarded seriously by medical health professionals and is upsetting not only to the women suffering from it but to their families as well.
Many mothers may experience mild "postnatal blues" and tearfulness a few days after delivery. In cases where this lasts beyond two weeks, professional advice should be sought. Approximately 3-5 % of women experience a moderate-to-severe depression that require medical attention.
Identifying the mothers that may be at higher risk of postnatal depression is an important first step.
A past psychiatric history is a significant risk factor. Some studies have shown a relationship between postnatal depression and obstetric complications, or complicated delivery such as assisted delivery with forceps or vacuum, or caesarean section. Although it is commonly believed that the mother's age and breastfeeding are linked to postnatal depression, many factors can play a role. Indeed, young mothers(below age 21 years) are at higher risk, and so are mature mothers, especially if the pregnancy is unplanned, or complicated by obstetric medical conditions. Breastfeeding can itself be a stressor for inexperienced mothers, but can also be therapeutic for mothers who are successful in nursing their infants.
Emphasis on educating pregnant mothers and preparing them for the childbirth experience, the postnatal period and how to manage their baby is important.Support and reassurance after the delivery of the child are also important.
Mothers who wish to breastfeed should be given the support and they should also be encouraged to have the baby room in with them.
Often there is an emotional swing away from the initial elation when the mother starts to experience the discomforts of peuperium, where the body undergoes multiple physiological changes following childbirth. Some of the discomforts include breast enlargements, pain in the episiotomy wound and the contraction of the uterus.
The mother may also experience fatigue from lack of sleep, anxiety over breastfeeding and caring for the infant. These may be heightened when she leaves the hospital, especially if there is little support and guidance back home.
Additionally, she may worry that she may be less attractive to her husband. Not uncommonly, new mothers may often experience a loss of sexual interest and libido because they are exhausted from caring for her baby. For mothers with postnatal depression, there is the added dread of getting pregnancy again, which can compound the lack of sexual response.
For mothers who have difficulty adjusting, arranging for good postnatal support and care, or a longer stay in the hospital after delivery may help in adjusting to the new baby.
In cases of mild depression, support and reassurance may be all that is needed from the patient's doctor and her family. For others with moderate or severe depression, medical attention is strongly recommended. After a full assessment, a management plan will usually include psychological support and therapy, and medications that are suitable for breastfeeding. These can include a a sedative or anxiolyticdrug or antidepressants depending on the presenting symptoms With most women being concerned of exposing their nursing infants to side-effects of medication, the choice of treatment regime can be carefully selected to fit the needs of mother and infant.
In helping mothers transit well into their new roles, we aim to help them understand the realities of motherhood, encouraging them to be patient with themselves as they learn to care for their babies. The guilt over their ambivalent feelings can sometimes be challenging to cope with, but with better support and care from those around, and better understanding of these emotional shifts, mothers with postnatal depression can overcome their difficulties. This also helps them build resilience to cope with the new challenges as the children grow up.
This article is contributed by Department of Psychological Medicine, KK Women's and Children's Hospital.