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Postpartum Depression: Why Self-Care IS Child Care

Experiencing postpartum depression may be even more overwhelming in today’s post-Covid world. Here’s how and why you don’t need to go through it alone.

Having a baby and then caring for a newborn can be an amazing, life-affirming experience.

It can also – simultaneously – be a physically, mentally and emotionally gruelling one. Your body is healing and your hormones are surging. It may take a while to figure out things like feedings. And you may find yourself feeling desperate for more sleep or more than the occasional shower. Which is why postpartum depression is a topic that has to be talked about.

Now, during this pandemic – with so much uncertainty and turmoil – many new mothers are dealing with even more heightened emotions and greater anxiety. They may be concerned about the virus itself, or stressed out due to restrictions placed on hospital visits and doctor appointments.

Heap on top of that a sense of isolation, a result of various lockdowns and social-distancing measures in Singapore and around the world. “Diminished social interaction and support may be the greatest hindrance to a woman’s adjustment to motherhood,” says Silvia Wetherell of Alliance Counselling, a Singapore-based team of counsellors. Meanwhile, the concept of “me time” is more elusive than ever, with most parents balancing working from home and child care all under one roof. It’s an unprecedented time, with far-reaching consequences.

Summary:

  1. Rise in the cases of postpartum depression
  2. Recognising the symptoms
  3. Dispelling myths of postpartum depression
  4. Start the healing process
  5. Shifting the focus
  6. Where to seek help

Rise in the cases of postpartum depression

One of those unfortunate consequences is a rise in cases of postpartum depression and anxiety worldwide. Pregnant and postpartum women surveyed during the Covid-19 pandemic reported increased mental-health distress, according to the results of a Harvard study published in April 2021. And Dr. Sandy Umboh, a consultant in psychiatry at KK Women’s and Children’s Hospital, concurs. She says, “Anecdotally, our clinical team observed that the Covid-19 Circuit Breaker period in 2020 was particularly challenging for new mothers.”

While research and awareness about postpartum depression have grown over the last decade, many women still struggle in silence – not realising that the experience is shared by many others. In Singapore, for instance, the prevalence of postpartum depression was most recently reported to be 6 to 8 percent. In other countries such as the US, the estimate is 10 percent. But, experts caution, these numbers can be a lot higher, as postpartum depression is often undiagnosed, due to a lack of physician screening or women not seeking professional help.

If you, or someone you know, identify with these increased feelings of depression and stress after giving birth, read on. There is hope and help out there.

Recognising the symptoms

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First, let’s define what postpartum depression is and what it isn’t. “Many women show some depressive symptoms after childbirth, with experts estimating up to 80 percent of mothers experience the ‘baby blues’,” shares Silvia. Tears, exhaustion and emotional instability are usually just part of the journey of caring for a newborn.

The difference, continues Silvia, is in whether “the depressive symptoms intensify, and last longer than a couple of weeks”. Professionally known as Perinatal Mood and Anxiety Disorders (PMADs), Silvia elaborates that it is estimated that 10 to 20 percent of women and 8 to 11 percent of men worldwide experience PMADs. Yes, men can suffer from them, too.

The symptoms can start during pregnancy or at any time in the first 12 months after giving birth, and are similar to signs of clinical depression, for the most part. “Some mothers may experience severe sadness or emptiness, while others might feel numb,” says Silvia. “There could also be a belief that one is a failure as a mother. Some women might worry excessively about their baby, while others show a lack of interest.”

Zoe, a full-time mum of two, experienced some of those symptoms after having her second baby in 2020. “I felt little motivation to do anything,” says the 30-year-old, who has a son, Robin, 4, and a daughter, Leah, 1. “My appetite was badly affected, too. Swallowing food became a chore, even if I was hungry.”

In addition, she recalls, “Around six weeks after I gave birth, I started feeling this dizziness – it felt like I was rocking all the time.” Zoe’s anxiety eventually translated into physical fears of dying. “I kept telling myself that there’s something in my brain,” she says.

But, after many breakdowns and several doctor visits, Zoe was still considered to be completely healthy. These assurances by doctors did not console her.

Dispelling myths of postpartum depression

Why are there so many misconceptions about postpartum depression?

“Postpartum depression, like so many of the challenges new mothers face, is unfortunately shrouded in misunderstanding and judgment,” explains Tanja Faessler, founder of Counsellingconnectz, a holistic family-focused counselling company (learn more about it here).

Here are some common misconceptions about postpartum depression (PPD) that need to be dispelled:

“I don’t look sad, so it can’t be PPD.”

A depressed mum doesn’t necessarily look visibly sad all the time. Dr. Sandy Umboh from KK Women’s And Children’s Hospital notes, “Although some women with postnatal depression do cry frequently, others may be emotionally numb, anxious or irritable. Some depressed mothers may even appear calm and efficient, while struggling with symptoms that cannot be seen physically.” If in doubt, speak to a mental health professional.

“Women with good support don’t suffer from PPD.”

Sometimes, women can “tick all the boxes” for a solid foundation and still struggle emotionally. Good support may be a protective factor against PPD, but it does not prevent it.

“Only first-time mothers get PPD.”

Mothers can be diagnosed with PPD with the first, second, third and even sixth baby.

“Mothers with PPD are often violent to their children.”

This is perhaps the most damaging of myths. Violent mothers make it to the headlines, but those struggling in silence – day in, day out – do not. If left untreated, and especially in vulnerable situations, postnatal depression can lead to neglect and extreme emotional outbursts. More often than not, however, it does not lead to violence.

Start the healing process

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Sadly, Zoe’s experience is not uncommon. And, most experts will tell you, the first step toward mental healing – from any sort of depression or anxiety – is recognising and validating a person’s internal struggle. From fears of dying or of being a bad mother to lack of motivation for daily tasks, these emotions should not be diminished.

Vernessa Chuah aims to give such mothers the time and space to heal. As the founder of Mindful Space, a child-parent platform for holistic well-being and learning, she runs a Mother’s Circle support group. “The goal of the Mother’s Circle is to provide a safe space,” she shares. “Sometimes, mums come in and they have a lot of baggage and can’t tell anybody else.”

It’s this baggage that can damage a mother’s mental health, as well as her ability to be “present”. “We cannot support our children and family, if we are running thin and on 10-percent battery all the time,” says Vernessa, a mother of a 3-year-old daughter.

Dr. Umboh agrees, saying, “There is a societal expectation that having a baby means being happy and fulfilled. In reality, parenting is hard work. A healthier and more humane approach to helping mothers with their emotional struggles would be to accept and support them.”

Vernessa concurs. “Without some validation, mothers can feel like they are in a ‘pressure cooker’,” she says, adding that “a judgement-free zone is important”. In her Mother’s Circle group, women practise journalling and verbalising their thoughts to help find their voice.

Zoe says she finally recognised her anxieties were a mental trap, and her constant fear of dying was actually common for a new mum. “When you have a baby, you want to be there for your child and see every milestone,” she says. “It makes you even more afraid of dying.”

Shifting the focus

[The Aim is] to fill a mother’s cup of self-care, so she has more capacity and compassion for her kids and family.

Vernessa Chuah, founder of Mindful Space

Raising awareness is important for dispelling misconceptions about postpartum depression, while normalising the fears around giving birth can help lift the burden off new mums’ shoulders. Mental preparation for how life will change – whether that be less time for hobbies, work or relationships – will help “temper feelings like guilt, dismay and self-blame,” says Dr. Umboh.

More importantly, says Silvia, “We need to start systematically screening women in pregnancy and postpartum, so they can be referred toward getting the appropriate psychological support.” For example, the free EPDS (Edinburgh Postnatal Depression Scale) questionnaire, which has been widely validated, takes only two minutes to complete. Proper screening not only normalises the prioritisation of a mother’s mental health, it can also identify more women who are struggling and urge them to seek support.

And there is more medical hope on the horizon. In June 2021, researchers from a US based biotechnology firm published promising Phase 3 results for zuranolone, a new drug being evaluated for treating postpartum depression, in the Journal of the American Medical Association (JAMA). “Zuranolone provided significant reductions in depressive symptoms and was generally well tolerated,” they wrote. The drug has received the US Food and Drug Administration’s (FDA’s) Breakthrough Therapy designation and, if it is FDA-approved, will be the second drug specifically intended for the treatment of postpartum depression. (Currently, antidepressants are most commonly prescribed, with anti-psychotics given for “more severe” cases, according to PostpartumDepression.org.)

Ultimately, Singaporean mum Zoe sought out traditional Chinese medicine (TCM) treatments like acupuncture and massage to release her physical stress, and that, she says, helped to alleviate much of her postnatal depression and anxiety. “When all the physical ‘things’ were gone, I started to feel better mentally,” she shares.

Her journey shows that, in essence, self-care is an extension of child care. “Give time to care for yourself,” Zoe encourages. “You need time to slow down and clear your mind. Just focus on the now.” It’s why advocates for new mums like Vernessa will continue doing their good work: “[The aim is] to fill a mother’s cup of self-care, so she has more capacity and compassion for her kids and family.”

Where to seek help

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Do these struggles of motherhood resonate with you? There are several ways to reach out and gain support in Singapore.

1. Speak to your family doctor or obstetrician

Alternatively, you can visit the KK Women’s and Children’s Hospital and reach out to the KKH Postnatal Depression Intervention Programme. (Call 6294 4050 to book an appointment.)

2. Find a support group

The Mother’s Circle at Mindful Space or Meetup groups like Mindful Mums create a safe space for all women, and welcome any emotion – big or small. “Our groups bring together women from all over the world and walks of life,” says Silvia Wetherell, the organiser of Mindful Mums. “It’s very moving to see these women find such common struggles, and support each other with kindness.” Go to mindfulspace.com.sg or meetup.com/moremindfulmums for details.

3. Find support from family and friends

Easing a mother’s burden can give her the space to replenish her energy, whilst letting her know her baby is loved and cared for. And Vernessa of Mindful Space says close family and friends can help out by “offering to do household chores, make healthy meals or help in childcare”. Tip for loved ones: Beware of overstepping boundaries. Positive reinforcement is typically welcomed, but avoid projecting what you think is best.

By Isabel Wibowo for The Finder Kids Vol. 31, September 2021.

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