Almost 6 months after giving birth to her baby, Lindy Soh, 26, felt blindsided when she was told that she might have postnatal depression (PND). In fact, the young mum, who thought it was a bad case of the baby blues, decided to get a second opinion just to prove her doctor wrong.
However, after an hour-long sit-down with a counsellor, Soh was told the same thing ― she had a mild case of PND. “I was in shock because I thought only women who had a negative experience with motherhood or a bad pregnancy got post-partum depression,” adds Soh. “I had a drama-free pregnancy and birth and was very happy to have a baby. How did I end up getting postnatal depression?”
PND can hit anyone, at any time and it usually happens within the first year of childbirth. It’s very often confused with the baby blues, which is a more common and milder form of depression that usually disappears after the first few weeks of baby’s birth.
PND can begin slowly, with symptoms varying from person to person. The most common signs to look out for are: Mood swings; anxiety; crying for no reason; lack of energy; and losing interest in everything, including baby.
Left untreated, PND won’t just interfere with a mum’s ability to care for and bond with her baby, but can also end with her taking her own life out of sheer hopelessness. Sadly, many mums who choose this path also take their babies with them in the process.
The good news is that we live in a time where mental health, especially maternal mental health, is getting more awareness. While no one know what exactly causes PND, there are certain factors that can increase a woman’s risk of falling victim to this disease. Here are five to keep in mind…
“A woman who has a loving mother helping her, looking after her needs…will feel very differently from a woman who has no family support or troublesome family members.”
#1 Bad pre-menstrual symptoms
Hormones definitely play a big factor in PND, notes counsellor Silvia Wetherell, who specialises in maternal mental health. You will experience a dramatic drop in oestrogen, progesterone and endorphins right after birth and this can trigger depression the same way premenstrual (PMS) changes produce mood swings. No single hormonal factor has been medically proven to distinguish those who develop PND and those who don’t. However, if you’re more sensitive to hormonal changes, you may be at higher risk. “So, if you are someone who has experienced a lot of hormonal fluctuations before becoming a mother, like really bad PMS, you’re more likely to suffer from PND that’s related to hormones later on,” points out Wetherell. By the way, hormonal sensitivity can also differ from woman to woman. Some will experience an almost immediate onset of depression which will crash down on them after childbirth, while others will feel their mood worsening as motherhood and childbirth recovery overwhelms them. Then, there are also womens who carry their untreated pregnancy depression into the post-partum phase.
#2 Experiencing stressful life events
Environmental factors can also contribute to a woman’s state of mind, and they can manifest in a variety of scenarios. “A difficult pregnancy, difficulty in conceiving, taking a long time to have a baby, difficulties in the relationship ― like if the couple is arguing a lot and the marriage is unstable ― can all play a part in causing PND,” Wetherell states. In her line of work, Wetherell also counsels women who lack practical and emotional support, plus, those who get the wrong kind of support. “A woman who has a loving mother helping her, looking after her needs and guiding her with the baby will feel very differently from a woman who has no family support or troublesome family members,” says Wetherell. Drowning in debt or worrying about making ends meet with a new mouth to feed can also trigger maternal depression. So can experiencing the recent death of someone close, even if it’s the passing of a beloved family dog.
“Breastfeeding is a huge one and can often be the first trigger,” warns Wetherell. The message that Breast is Best and that the World Health Organization supports it makes every woman feel pressured to breastfeed. So, when a mum is unable to do so exclusively for medical reasons or simply because she doesn’t want to, she is made to feel like a failure when she bottle-feeds her little one. “Also, you are told that everyone can do it [breastfeed]and it’s very easy and it will be fine. But it’s not, it’s really difficult,” says Wetherell. “You’re trying to build confidence as a mum, but then you encounter so many problems with breastfeeding and a crying baby that you can’t console ― it’s a very high trigger for PND.”
#4 Childhood trauma from the past
During her sessions, Wetherell not only touches on the factors that are affecting her patient’s present mental state, but also what from their past could have contributed to it. “Often, we will explore their childhood, and sometimes, there will be early childhood trauma,” notes Wetherell. One common trauma that Wetherell often has to tackle is dealing with new mums whose own mothers had postnatal depression and never really recovered from that. “Women who didn’t receive attuned empathetic caregiving as babies because their mothers were not emotionally available, will struggle a lot more as mothers themselves,” explains Wetherell. “Especially since now this mum is expected to know how to be a good mother when she didn’t have that role model.” It’s a hard pill to swallow, but the good news is that PND has more awareness these days and women are stepping up to get the help they need. This means they don’t end up passing on their baggage to the next generation and allowing history to repeat itself.
“Women who didn’t receive attuned empathetic caregiving as babies because their mothers were not emotionally available, will struggle a lot more as mothers themselves.”
#5 A history of mental disorders
In 2016, a study done by the University of Newcastle and Hunter Medical Research Institute, revealed that women with a history of mental health problems are overwhelmingly more likely to suffer PND than women who didn’t. The findings reinforce the need for early intervention for mental health problems in adolescence and young adults. “This would result in more positive maternal and infant outcomes while helping to tackle the cycle of poor mental health across the lifespan,” notes Dr Catherine Chojenta in the study that she spearheaded.
Between 15 and 20 percent of women who give birth will suffer from PND. While new mums make up the majority of these numbers, a woman’s chance of suffering recurring PND is also quite high. “First-time mothers tend to have the hardest time ever, but if a mother has had PND and goes on to have more children, she is more likely to get it again with every pregnancy,” Wetherell explains. However, there are always exceptions, she adds. She has treated women who two problem-free pregnancies, but struggle with depression with their third child. The reason behind this is still unclear as it could be a combination of factors, such as hormones or something more physiological. “There’s no guarantee and no one is immune. It can strike any woman, from any socio-economic status and country. But the good thing is that we are better at screening for it now,” Wetherell adds.