 |
| Watch out for symptoms of post-partum depression. - Photo ©iStockphoto.com/ michellegibson |
By BRIGITTE ROZARIO
The worst case that has been publicised of post-partum depression leading into psychosis is Andrea Yates in the United States. She was 37 when she killed all of her five children one morning. She filled the bathtub and drowned all of them.
It could happen to anyone, says Dr Adnan Omar, Head of the Counselling and Psychological Services Centre, Taylor's University College.
Pre and post-natal emotions are not to be taken lightly and pregnant couples should watch out for anxiety during pregnancy and depression after delivery.
According to Dr Adnan, it could happen to not just new mothers but also women who already have a few children. In the case of Andrea Yates, she had five children and she did not want the last child.
“ Firstly, she had her children one after another, their ages were not widely spaced out. Secondly, the problem became accumulated. Thirdly, she had a very cold husband. Fourthly, she did not want to have her last child. The last pregnancy was forced upon her by her husband because he was 'religious' and of the opinion that the pregnancy was a gift from God that should not be refused.
“ There was a combination of all these factors that exploded in a very bad way,” explains Dr Adnan.
Post-partum depression is certainly more serious than pre-natal anxiety and/or depression, he informs. Dr Adnan believes that it all depends on the pregnant lady's coping mechanism, how supportive her husband is and her support network.
Spotting symptoms
Because families are not trained to spot depression, Dr Adnan says the gynaecologist is the one who should spot potential problems when he or she engages the pregnant woman during checkups.
Basically, baby blues last no more than two weeks. About 80% of all women who have given birth will have some extent of the baby blues.
The baby blues' symptoms include a disturbed sleep pattern, loss of weight and fatigue. The woman, her hormones and body should adjust by two weeks and these blues would go away.
“ If these symptoms persist then we know that it has developed to become post-partum depression. Usually, the fourth day after giving birth is the peak of all the hormones going up and down and it should settle down as you get more sleep and begin to bond with the baby. Any of these symptoms that persist beyond two weeks, needs to be looked into and dealt with because, if not dealt with, it can develop into post-partum psychosis,” warns Dr Adnan.
Post-partum depression checklist (if you have five out of the nine symptoms below you are medically depressed):
- Depressed – tearfulness, hopefulness, anxiety, feeling of emptiness
- Loss of pleasure in all or almost all of your daily activities
- Appetite and weight change
- Sleeping difficulty (even when your baby is sleeping)
- Restlessness, sluggishness
- Extreme fatigue or loss of energy
- Feelings of worthlessness, guilt with no reasonable cause
- Difficulty in concentrating and making decisions
- Thoughts of death and suicide, or even of harming your child/children
Post-partum psychosis checklist:
- Feeling removed from your baby, family and surroundings
- Disturbed sleep, even when your baby is sleeping
- Confused, disorganised thinking, risk of harming yourself, your baby or anyone else
- Drastic changes in mood and bizarre behaviour
- Extreme agitation and restlessness
- Unusual hallucinations (involving sight, smell or touch)
- Delusional thinking not based on reality
It is important that the spouse, partner and extended family is also familiar with these symptoms so that they can look out for them.
Family history
When women go for their pre-natal checkup the gynaecologist would find out the family history to check if there is any history of depression. One of the predictors of having depression is if there is a family history of it.
Family history is one of the red flags that would pop up indicating there could potentially be a problem.
Among the red flags that signal potential problems are:
- Family history – If there is a family history of depression; if this is an unplanned pregnancy; if the lady herself was an unplanned child.
- Fertility treatment – If you have had to go through fertility treatment to get pregnant, you will have a lot of “what if” scenarios going through your head.
- If the partner/husband is absent through divorce or separation or if you choose to be a single mother.
- If the partner/husband is there physically but is emotionally absent. Sometimes that is worse because you expect your partner to help out but he is not supportive. Either he's not interested or he just doesn't know how to help.
- Your personal strength – In your life how have you dealt with difficulties. Part of being human is that we learn certain ways of doing things. In our family, when things get rough how do we deal with it.
These are the kinds of things that the gynaecologist should be looking at during the pre-natal checkups.
Besides looking out for potential problems, the couple should also watch out for panic attacks which stem from anxiety. Anxiety has four components – feeling overwhelmed (physically and emotionally); breathlessness, chest pains and sweaty palms; recurrent thoughts of your health or your baby's health; and a feeling that something horrible is going to happen.
If there is anxiety during the pregnancy or any potential depression after the delivery, the woman should get help from her support network and even find ways to relieve and handle stress, and even talk about her anxieties.
“ If you have five out of the nine symptoms in the post-partum depression checklist you are medically depressed and medical professional intervention is needed.
“ I think, in Malaysia, we are too quick to prescribe anti-depressant pills. These pills are safe in terms of breastfeeding but in terms of emotional healing you need psychotherapy which means you need to provide support and do talk therapy. And you need to teach the woman coping skills and how to handle stress.
“ Ideally she should go for talk therapy where she discusses what is worrying her and why she has these fears. Is she worried about the finances; that she won't be a good mother? Medication will not help settle these matters. It's better to talk about it.
“ Of course that will take time but it will teach her life skills and help her deal better with problems and stress in the future,” says Dr Adnan.
He emphasises that nothing gets better if you don't do anything about it. So, if you are showing symptoms of anxiety and depression, speak to a professional about it.
If a lady has post-partum depression and it is not dealt with, it might become severe after the next child. These fears, thoughts and emotions must be dealt with and she needs to learn how to better manage the stress in her life.
“ If you are constantly asking yourself 'What if', 'What if', 'What if', the depression level gets higher and higher as the months progress. If the depression is dealt with, then the woman will be better equipped to handle the next pregnancy. That's the point of going for counselling – you learn life skills and you won't have to go again for counselling in future because you have already learnt the coping skills and you can apply them to the next pregnancy.
“ But, if it is not taken care of, then the depression could become worse for the second pregnancy,” says Dr Adnan.
In order to not become overwhelmed and get depressed, Dr Adnan suggests planning everything from the point you find out that you are pregnant.
“ If hiring a maid is needed, then hire now. If you need to get your mother-in-law involved, then bring her to a meeting and discuss what you need help with. The more you plan ahead, the better off you will be because you need to take some time off for yourself.
“ Some ladies say they're going to devote every minute of their life to this new baby and soon they find they are neglecting themselves. You need to bathe or shower and get back to the point where you like how you look. You need to take care of yourself. While you are taking care of yourself, somebody else needs to help take care of the baby, so you need to get some help and support,” he says.
He advises husbands to prioritise so that they can be there to support their wife during and after the pregnancy.
What can the husband/partner do?
- Know the symptoms of depression.
- Talk to the spouse/partner – Ask them what's worrying them and try to comfort and reassure them. The husband or partner would be in the best position to do this.
- Get help as soon as possible because the longer you wait, the worse it gets.
During pregnancy, ladies need to work on expectations:
- You're not an angel and you will make mistakes as you try to be a good mother.
- There is no one definition for what is a good mother.
- What are your expectations of yourself, your husband/partner, your work, your child – you have to be very realistic.
- Managing expectations especially if you have to juggle family issues or you have work issues or even a bossy mother-in-law.
The support network (maid, nanny, babysitter, extended family, friends) must be formed in advance and you need to start planning so that you don't feel overwhelmed.
Dr Adnan's final advice for pregnant women:
- Get as much knowledge as you can about pregnancy, emotions and post-partum depression and anxiety.
- Learn the symptoms.
- Plan before and after – the more planning you do, the better off you will be.
- Do not be afraid to ask for help – the more you ask, the more help you will find. If people judge you, it's not your problem; it's their problem.
31st January....... The end of January finally.....
