When the joys of motherhood begin with despair

CHENNAI: The recent incident of a 23-year-old woman from Kerala suffocating her newborn and hurling the body onto the road had shocked everyone. Last year in August, a 20-year-old jumped from the terrace of her house in Ramapuram after giving birth to a baby two weeks earlier.

One was a case of murder, and the other was an attempted suicide. Different scenarios in different states but they have one thing in common — both women had postpartum depression (PPD).

Postpartum depression is a complex health condition that affects a lot of new mothers after delivering a baby. Also known as ‘baby blues’, but more intense and lasts longer, it’s characterised by uncontrollable weeping, anxiety, insomnia and exhaustion, leading to the inability to take care of the baby, and complete everyday tasks. These symptoms begin a few days after delivery, and can last for months, and in some cases, even a year.

It affects approximately 1 out of 7 women, making it a widespread mental health problem that requires immediate attention.

Societal judgement

Notwithstanding the joys of motherhood, no girl is informed about the challenges of motherhood, and certainly, not the toll it takes – physically, emotionally and mentally.

“People began asking me about family planning as soon as I got married. Though I was happy to know I was pregnant, I was also overwhelmed with the sense of responsibility and financial burden,” recalls Priyanka (27). “After delivery, these feelings were exacerbated, as my baby was born under-weight. Since she was on a ventilator, I saw her only 36 hours after her birth.”

When anything goes wrong with the baby or during the delivery, the mother is inevitably blamed. When family members don’t support the mother, it compounds the problem of anxiety and stress. Recognising symptoms and seeking help for PPD can be challenging due to societal stigma surrounding mental health issues.

Priyanka concurs, and adds: “I was blamed for my daughter’s low weight. This led to self-blaming. Plus, my body did not produce adequate breast milk. When people asked me why I was choosing alternatives to breast-feeding, I felt ashamed. With each day, it became difficult. I would break down almost every day for more than two months.”

Identifying signs

Dr Rajsri J Shankar, senior obstetrician and gynaecologist, Apollo Cradle and Children’s Hospital said that PPD symptoms can be characterised by shame, guilt, or inadequacy, often leading to a feeling of failure as a parent, followed by severe mood swings, with mothers rapidly oscillating between happiness and profound despair.

“New mothers also lose interest towards life in general, and are constantly hit with fatigue. Abnormal dietary habits, such as overeating or under-eating, and significant weight fluctuations unrelated to diet, lack of focus, and the inability to take decisions, characterised by a lack of emotion or extreme fear regarding bonding with the infant, pile on the challenges. Since PPD manifests in myriad ways, it requires a multifaceted approach to treat it,” explained Dr Rajsri.

Selvanandhini G, consultant gynaecologist, obstetrician and foetal maternal medicine at Women’s Centre by Motherhood, Coimbatore, noted that distinguishing between PPD and depression may be difficult, which often leads to delays in seeking appropriate care.

“Fear of judgement and perceptions of ‘unfit mother’ further prevents young mothers from seeking help,” she added. “Several risk factors are associated with PPD – a history of depression or anxiety, hormonal fluctuations after childbirth, stressful life events, lack of social support, relationship issues, difficulties associated with breastfeeding, etc. Healthcare providers commonly use screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS) to identify symptoms in new mothers.”

Since women are socially conditioned to dismiss their health concerns, self-care takes a backseat. However, prioritising self-care, particularly sleep, is essential for managing PPD.

Disturbed sleep patterns are common among new mothers whose circadian cycles keep changing with the baby’s. “Establishing a consistent sleep pattern can regulate the body’s internal clock and improve sleep quality. Go to bed and wake up at the same time every day, even if it means adapting your baby’s sleeping habits to yours. Before bedtime, use relaxation techniques such as deep breathing, gentle stretching, or meditation. Good hygiene habits impact your capacity to sleep well,” elaborated Dr Rajsri.

Postpartum psychosis

Unlike PPD, postpartum psychosis is more pronounced. Meaning that mothers suffer from severe depression to the extent that they want to hurt themselves and even the baby too. This requires serious medical intervention.

General physician Dr Akila Ravikumar with Neuberg Diagnostics observed: “This is severe depression and needs to be identified early. The mother would require professional help, and in many cases, a psychiatrist. She may need medication to tide through it. Since there’s enough research to show that babies do, indeed, sense and react to their mothers’ emotional cues, it’s also important to observe the baby.”

No woman can manage postpartum psychosis on her own, which is why doctors often stress on the importance of family and loved ones to be supportive – both physically and emotionally. Senior psychiatrist Dr Poorna Chandrika at Institute of Mental Health recalled a case of a young mother who killed her baby. “This 27-year-old had been experiencing intense pain while breastfeeding. When she mentioned it to her husband and his family, they dismissed her concerns, accused her of being negligent and urged her to continue feeding the baby,” she stated. “After a fight with her husband, she threw her baby into a lake.”

In the Indian family set-up, women are primary caregivers of their children. It begins as soon as the child is born. With nuclear families, they’re more burdened, as they juggle house work, child rearing, career and their own health.

“Not many are aware of the adverse impact of PPD, and how much it affects new mothers internally and externally. It’s important to tell young mothers to focus on their own health, and also educate the husband and family on PPD,” she opined.

Symptoms of PPD

• Severe mood swings

• Crying inconsolably

• Difficulty bonding with the baby

• Withdrawing from family and friends

• Loss of appetite or eating more than usual

• Inability to sleep, or sleeping too much

• Fatigue

• Less interest in activities you used to enjoy

• Intense irritability and anger

• Fear of inadequacy as a mother

• Feelings of worthlessness, shame, guilt or inadequacy

• Inability to think clearly, concentrate or take decisions

• Restlessness

• Severe anxiety and panic attacks

• Thoughts of harming the baby

• Thoughts of self-harm, suicide