The mother of misery

Baby blues are a normal part of life for a new mother. But what happens when they take a turn for the worse?

During your pregnancy, everyone will assure you that everything you are feeling will get better after the first three months. The nausea will subside, as will the fear of miscarrying. When you enter your sixth month, they will tell you to ‘just be happy and eat’ without worrying about the weight gain as it will disappear after the delivery. When the last trimester comes, you will repeatedly be reminded how very close to the finish line you are and the only obstacle left in your way is labour. People always claim that giving birth is one of the most fulfilling things a woman can do and so you should prepare to brave the final storm before basking in new-mommy bliss. You convince yourself that once your little bundle of joy is in your arms, you will whisper in his/her ear that it was all worthwhile. But when the time arrives, you might be shocked to know that the warm, fuzzy feeling is often quite short-lived.

No matter how much you have looked forward to this moment, chances are the emotions you experience after childbirth are ones you will never want to recall again. You are physically and emotionally exhausted, your baby needs to be nursed every two hours and breastfeeding can be agonising. Your husband is introducing the baby to everyone as ‘ours’ when he was never on the receiving end of kicks during pregnancy, nor did he experience even an ounce of pain before becoming a father. And, to make it worse, that bump you have been sporting for the past nine months hasn’t entirely disappeared yet. Such thoughts occur to the best of in the days following delivery. This period of emotional turmoil is termed ‘baby blues’ and — contrary to what society might propogate — completely normal.

Be it your first child or your fifth, one can never get used to the tumultuous baby blues. The mood swings, litany of complaints, frequent teariness, feelings of dependence and stress can be extremely taxing. What is important is to remember that you are not alone in this battle and have no reason to feel guilty or ashamed. Most women who tell you they weren’t anxious, frustrated or weepy during the first few weeks after childbirth are simply hiding their feelings. The expectation to be rejoicing in motherhood is so high that it leaves many struggling to come to terms with these emotions.

But that can potentially destroy you. If you are feeling sad, let yourself be heard. Nobody is a supermom — it is perfectly alright to reach out to friends and family for help and take your time to recuperate. My doctor recommended making myself as comfortable as possible in my new role, to the extent that if I wanted a good night’s sleep I could replace breastfeeding with formula milk at night. Remember that if you’re happy and relaxed, you will automatically be a better nurturer.

Being a new mom is hard and there will always be days when you feel you weren’t cut out for this role. Instead of resorting to self deprecation, remind yourself that someone out there has possibly had it worse. Take solace in the fact that baby blues are temporary and soon you’ll start feeling yourself again. And if you don’t, please don’t take it lightly. 



Dilaira Dubash heads the Magazine desk at The Express Tribune.
She tweets @DilairaM

The prevalence of Postpartum Disorders

If baby blues persist, one should immediately seek medical assistance. The doctor might find that what the patient is going through is a classic case of Postpartum Psychiatric Disorders. The disorder manifests itself in three main stages: the basic baby blues, postpartum depression (PPD) and lastly, postpartum psychosis.

According to research conducted by the Centre for Women’s Mental Health at Massachusetts General Hospital, about 85% of women undergo some degree of mood disturbance during the post-natal period. “There is no single cause for this but a combination of physical, emotional and social changes certainly contribute,” explains Dr Nazila Bano Khalid, a psychiatrist at Aga Khan Health Services in Karachi. “The sudden drop of pregnancy hormones after delivery is a potential reason too,” she adds.

Women who miscarry are also at risk of the disorder as the loss of the child could leave her severely depressed. “It is a very traumatic experience for the patient,” says psychiatrist Dr Uzma Ambareen. Dr Nazila adds that depression due to unplanned or unwanted pregnancies also falls under this category.

However, despite its rampancy, postpartum disorders are largely misunderstood and often go undiagnosed. While most women bounce back to normalcy soon after the first month or two have passed, others run the risk of developing major psychiatric problems. Every woman has her own unique experience and so, understanding her post-baby behaviour is of utmost importance.

In general, baby blues can be alleviated through support from family members and adequate rest. In institutions such as Civil Hospital Karachi, patients are sent to post-delivery wards where they have to fill in a questionnaire. “The form has a number of questions to helps us comprehend whether the woman is likely to suffer from postpartum depression or not,” informs Dr Nusrat Shah, a gynaecologist at the hospital. “If we suspect a tendency, we ask them to see a psychiatrist.”

More than just baby blues

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), baby blues are a temporary condition and the mildest form of post-natal psychological trauma. About 30% to 75% of women begin to show signs within two or three days of delivery. The most common symptoms include anxiety, peevishness, loss of concentration, poor sleep and a general ‘low’ feeling within. Typically, the symptoms dissipate within two or three weeks following delivery but at times, they persist and grow into full-fledged postpartum depression.

DSM-5 states that the chances of postpartum depression are high throughout the first year of motherhood, particularly in the first four months. About 10% to 28% of women suffer from it on and off although the severity begins to recede after two weeks. “Also, those who experience postpartum depression in their first pregnancies are likely to go through it the next time they are pregnant too,” shares Dr Nazila. She highlights a list of the seven most common symptoms of the depression which include:

A low feeling throughout the day, almost every day.

Loss of interest and pleasure in usual activities.

Significant changes (increase or decrease) in one’s weight and appetite.

Insomnia or hypersomnia.

Fatigue or loss of energy.

Decreased concentration or indecisiveness.

Recurrent thoughts of death or suicidal ideation (both for herself and the infant).

When things get out of hand — Postpartum Psychosis

Although it is rare, close to 2% of new mothers fall into the third and most severe form of PPD, i.e. Postpartum Psychosis Disorder. As per the DSM-5 Criteria, the onset of one or more of its symptoms — within four weeks of delivery — might prolong the period of depression from (a minimum of) one day to (a maximum of) one month. “The patient may lose touch with reality and harm herself or the child,” explains Dr Uzma. “In such cases, immediate medical attention is a must.” The symptoms are as follows:

Delusional thoughts or hallucinations.

Disorganised speech and/or catatonic behaviour.

Sleep disturbance and agitation.

Risk of suicide or infanticide.

Dr Uzma adds that women who have previously undergone or are suffering from other psychiatric issues such as bipolar disorder or schizophrenia are more likely to develop postpartum psychosis disorder.

A call for help

After years of working with the mentally-challenged, Dr Uzma has arrived at one conclusion: Many women hide their illness lest they are perceived as un-motherly or crazy. They also feel that no one actually listens or understands since the basis of PPD goes against the prevalent cultural norms, she adds. “They choose to internalise their suffering and remain quiet,” says Dr Uzma.

But since any disorder — physical or mental — is curable only if acknowledged, it is important to encourage women to come clean. Perhaps this was why 26-year-old Hollywood starlet Hayden Panettiere spoke about her personal experiences so openly. “I suffered from postpartum depression. You are not alone or crazy, ladies!” said Hayden in an interview with US Weekly.

Ishrat Ansari works on the Karachi desk at The Express Tribune

Published in The Express Tribune, Ms T, November 29^th, 2015.