In the lifespan of a woman nothing is more challenging or rewarding than the journey through motherhood. This challenge becomes a struggle if she has to navigate this journey with the added burden of depression. Even as awareness about mental illness is improving around us, it’s important to break some long held myths around mental wellbeing during and after pregnancy.
1. Pregnancy is a happy time: While this is true for most women, depression and anxiety during pregnancy is much more common than we think. Emerging studies show that for Indian women, the risk of developing depression in pregnancy is almost twice that of gestational diabetes. Yet, every pregnant woman gets routinely screened for diabetes, but there is no routine screening for depression in pregnancy in India.
2. As long as the mum is eating well and baby is growing, everything will be fine: If a pregnant woman has undiagnosed depression or anxiety, just physical wellness or growth is not sufficient for a healthy outcome. We now have irrefutable evidence that depression in pregnancy can lead to higher rates of pre-term labour and low birth weight. Babies are more fussy, harder to settle and have higher chances of developing long term emotional problems.
3. All she has to do is avoid stress and think happy thoughts: Easier said than done. If a pregnant woman is struggling with depression, it is more likely that she has negative, catastrophic thoughts, that are repetitive and not easy to “brush off”. It can be a very conflicting emotional state as everyone around her is happy for the new arrival and expects her to be so too. This often leads to guilt and low self esteem, which makes it harder to open up to seek help. While the external environment can be controlled to some extent, by increasing support and reducing stress, the internal turmoil usually needs professional intervention. This is especially necessary if the source of stress cannot be removed from the environment, such as financial problems, conflict in the family or domestic violence.
4. Everything will be fine when the baby is born: Right from the process of labour and delivery, up to choosing baby names, there are so many decisions to be made during a short span of time, that it can be a source of added stress for the depressed mother. Normal vs C-section. To breastfeed or not. Should you swaddle the baby tight or leave it in loose? Co-sleeping or separate? Who should come over to stay, mother or mother in law? When is the right time for mum & baby to step out? Not to mention more serious decisions in case of medical complications in the mother or the child. For many Indian women, there is no dearth of unsolicited advice coming from friends, family members and mere acquaintances. Often the fragile mental state of a mother during depression can be used as an excuse to take the decision making capacity out of her hands, shattering her self esteem even further and increasing her chances of staying depressed. If a woman is able to overcome depression during pregnancy with the right help then she will be in a better position to make decisions with a sound mind and reduce the risk for post natal depression.
5. She’s managing the baby well after delivery, she is fine: Immediately after delivery, the hormones crash and this may make the new mother tearful and irritable for a while (often known as baby blues) which settles within the first week, making you think the worst is over. The first month or two are spent in a blur of establishing feeding and sleeping routines; most mothers often get busy and are unaware of their own mental state, leading to the false belief that everything will be fine now. However, post natal depression usually develops about a month or two after delivery, often as late as 12-18 months and can last well until the child is 2. By this time, most women would have stopped seeing their obstetrician and all hospital visits would be in relation to the baby’s health, making it harder for anyone to pick up the symptoms. Altered sleeping patterns and exhaustion that comes normally with motherhood can also mask the symptoms of depression. If a mother has had depression or anxiety during pregnancy, chances are she’s remained depressed well into the post natal phase, with bubbling uncommon symptoms such as unexpected angry outbursts and fluctuating moods.
6. Everything will be alright if I stop worrying about myself and look after the baby: This is the typical mindset of many mothers who struggle with post natal depression, and it is often drummed into by society that the baby is more important now. This, along with the expectations that mums have of themselves, lead them to believe that they have to soldier on even if struggling fiercely from within, feeling isolated and unsupported, shedding silent tears when they think there’s no one but the baby watching. Unfortunately, babies are primal beings by nature and can pick up even the smallest signs of stress in their mothers. It is true, babies are more important in many ways, because they are dependent on their carers, but an unwell mother cannot provide this all consuming care effectively without consequences. Babies need an emotionally available mother to mirror their emotions and help regulate them. Studies have shown behavioural problems and a higher risk of mental illness in later life in children whose mums had untreated post natal depression. If left untreated, then these mums face a higher risk of more dangerous symptoms developing, such as suicidal thoughts or thoughts of harming the child. Her risk of developing recurrent depression in future also becomes high. In many women though, post natal depression will resolve itself but not without a life long negative impact on her and her family.
7. It’s her fault!: Despite rising awareness about depression in India, there is still crippling stigma attached to mental illness which prevents people from acknowledging it and seeking help. This becomes particularly more difficult when a baby is involved. There are many causes that can contribute to depression: Vitamin deficiencies, Anaemia, Thyroid problems, high blood pressure, diabetes, genetic vulnerability and external stressors to name a few. And yet the mother is the one to take on the blame for “being depressed”. While it may not be the poor mother’s fault for getting depressed, it often falls on her to seek help as only she is aware of the distress she’s going through.
8. If she sees a doctor, she will be given medications that will numb her forever or will harm the baby: Medications play only a small role in the treatment of depression and are only used in severe cases. The main stay of treatment remains counselling or psychological therapies, preferably from trained professionals. For some women, speaking to an understanding elder in the family or a spiritual leader may set her on the road to recovery, but only if she takes the first step of opening up and talking to someone. And if medications are indicated, studies are now revealing that the harm caused by staying depressed maybe far worse than the treatment of the same. Most international health organisations have also published guidelines on antidepressants that are safe during breastfeeding, allowing the mother to recover while still continuing to feed her baby. Post natal depression is a time limited condition that requires only a small course of medications and are not indicated to be taken for life.
Depression during and/or after pregnancy is more common than you think, has more far reaching consequences than you can imagine, and can be fully treated if you seek help at the right time.
Dr Ashlesha Bagadia
Perinatal Psychiatrist & Psychotherapist