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| The Whole 9 Months
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Pregnant And Blue
What you should know about perinatal depression
By Kaylene Tan
It’s not just the hormones that cause depression. The causes of perinatal depression are usually an interplay of various factors, and it is different for each woman.
Family support is very important for women with before-baby blues. Loved ones should look out for the early signs of depression and seek help before the condition worsens.
The mainstay of treatment is psychotherapy, and we really only use medication when the woman suffers from depression that is at least of moderate severity. |
Angela, 32, was depressed throughout her first trimester. Hers was a much-desired pregnancy - she had tried hard to conceive, experienced a miscarriage earlier, and finally succeeded. She suffered such bad morning sickness, she had to be hospitalised for dehydration because of excessive vomiting. Despite counselling, Angela was so physically and mentally drained that opted for an abortion. Her husband was reluctant but agreed for the sake of his wife’s health.
Expecting a baby is one of the most joyful experiences in a woman’s life. But for 10 to 15 per cent of women in Singapore, being pregnant spells a period of depression and great anxiety.
Explains Dr Adrian Wang of Adrian Wang Psychiatric and Counselling Care, “Perinatal depression refers to mood changes that can occur anytime before, during or after childbirth. Typically, the commonest periods that this can occur is during the first trimester of pregnancy, when hormonal and physical changes can cause physical discomfort and emotional changes, and just before delivery, when fear and apprehension can overwhelm the mother.”
Perinatal depression symptoms are similar to those other anxiety or depressive disorders including gloominess, tiredness and weepiness. In severe cases, the sufferer harbours suicidal thoughts.
Dr Wang adds, “Symptoms specific to perinatal depression include feelings of guilt because of an inability to enjoy her pregnancy, marital strain and feelings of despair caused by an inability to bond with the unborn or newborn child.”
It is normal for pregnant woman have anxieties and worries, although such signs are short-lived, lasting days, at most. Nor do the symptoms impact the mum-to-be’s ability to function and enjoy her pregnancy. In clinically significant perinatal depression, the symptoms are intense, may last for weeks, and can cause disruption to the person's ability to function, Dr Wang explains. When this happens, seek help from your doctor who may refer you to a psychiatrist.
OUT OF WHACK
Dr Helen Chen, head and senior consultant psychiatrist, KK Women’s and Children’s Hospital (KKH), notes that there is growing awareness of this condition amongst the obstetricians, who refer more patients to KKH. She adds, “There’s also better awareness in the community and less stigma - we are heartened to know that women are coming forward early on their own for help.”
When a pregnant woman is tearful or emotional, the common reaction is “It’s her hormones!”. Dr Chen explains, “It’s not just the hormones that cause depression, which is the common myth - otherwise, 100 per cent of all women will get perinatal depression, since everyone experiences hormonal changes. The causes of perinatal depression are usually an interplay of various factors, and it is different for each woman.”
Besides hormonal and physical upheavals, pregnancy is a time where a woman has to deal with many psychological changes. Some adjustments are more challenging, which can take a toll on a mother-to-be. For example:
• If the pregnancy was unwanted or unplanned.
• If you have a challenging relationship with your own mother. Your pregnancy may awaken unresolved emotional conflicts.
• If you have a history of depression.
• If you are a teenage or young mother.
• Work stress - the prospect of giving up work or juggling work and motherhood.
• Marital problems - fearing sex with husband, feeling unattractive to him.
• Financial problems - worrying about how to support the family.
• A complicated pregnancy, had difficulty conceiving or a previous miscarriage.
• Foetal abnormalities.
Dr Chen notes that if perinatal depression is left untreated, and if the causative factors such as marital and financial problems are not resolved, it is highly likely that the woman will remain depressed after giving birth. She points out, “Studies have shown that up to two thirds of depression presenting in the postnatal period actually starts in the antenatal period.”
ALL'S WELL
How to stay in the pink if you are pregnant.
• Take it easy - Taking care of yourself is part of taking care of your baby. so find some “me time”. Read a book, get a massage, sleep in or meet up with friends.
• Get some exercise - Swimming, walking and antenatal yoga classes are pregnancy-safe.
• Talk it out- Make your husband a part of your pregnancy. Talk about your thoughts, dreams and what the baby has been up to in your tummy today. |
FROM HERE TO MATERNITY
Perinatal depression doesn’t just affect the woman’s well-being adversely, but also her marriage and family life, career, and even her the baby, as it may hamper mother-infant bonding.
Dr Chen explains, “A depressed mother is usually locked into her own depressive world, and unable to respond in an empathic and nurturing manner to her baby. It has been shown that infants of depressed mothers show impaired emotional and cognitive development, have problems with self-regulation or temperament and are also at greater risk of depression in adult life.”
Depression can also lead women to turn to alcohol, smoking, sedatives or drugs. The condition affects the mother’s physical health, as she either comfort eats, which brings risks like excessive weight gain and gestational diabetes, or eat poorly, which affects foetal growth.
Says Dr Wang, “In severe perinatal depression, the condition can be so bad that it causes a retardation or slowing down in foetal growth, and even low birthweight of the child. Fortunately, this isn’t common.”
FAMILY MATTERS
Depression can also affect the mum-to-be’s relationships with loved ones, especially her husband and older children as she may be more withdrawn, pessimistic or irritable. Family support is very important for women with before-baby blues. Loved ones should look out for the early signs of depression and seek help before the condition worsens.
Says Dr Christopher Chong of Chris Chong Clinic, who has referred patients to a psychiatrist, “I tell them seeing a therapist or psychiatrist is not a sign of weakness. It's a sign that you are a good mother who is keeping her baby and herself healthy.”
However, an unsupportive spouse can prevent the woman from seeking the help she needs. Dr Chen notes that patients often tell her that their husbands don’t understand or believe them, and tell them to snap out of it, which can make lower her self-esteem further and make her feel worse. Also, because of the stigma of mental illness, the mother may keep her suffering to herself, since everyone around her expects her to be happy and excited about her baby.
ON THE MEND
Dr Wang notes that about half of his patients need medication, the rest just need counselling. However, Dr Chen points out many women are often reluctant to get help, because of the misconception that medication is dangerous for their babies.
She adds, “But the mainstay of treatment is psychotherapy, and we really only use medication when the woman suffers from depression that is at least of moderate severity.”
There are medicines that are compatible with pregnancy and breastfeeding. After pregnant women or nursing mothers receive treatment, the mother functions normally and is able to bond with her baby.
She sums up, “Our main goal is really for mother to enjoy her baby and motherhood.”
BLUE'S CLUES
Perinatal jitters, anxiety and depression are varying degrees of a similar condition. Dr Christopher Chong explains.
Pregnancy Jitters
The low-down Most women experience bouts of anxiety during pregnancy, since they are concerned about their baby’s health, their relationship with their husband, bodily changes and life after the baby’s birth. Such jitters are transient.
Treatment
Speak up about your anxieties, join forums online and attend a childbirth class. Relax, stay active and spend time as a couple and with your older children.
Perinatal Anxiety
The low-down A step up from pregnancy jitters, its causes are similar, and the mother-to-be may get panic attacks. If not treated, these anxieties can lead into depression.
Treatment
Finding a network of support is important - through friends, family, support groups or forums. Speaking to a psychiatrist may help as he can teach relaxation techniques and devise coping strategies. Mild tranquilisers may be prescribed for cases of panic attacks,
Perinatal Depression
The low-down Perinatal depression is depression that occurs during pregnancy and up to 12 months after childbirth. It can be caused by hormonal changes and the many stresses of being a new mother. Often, the woman’s psychological background plays a part in the condition. If prolonged, it may affect the woman’s ability to function normally and may also lead to post-natal depression.
Treatment
A strong support network is crucial. Join a support group and speak to a professional. In extreme cases, medication may be necessary if the woman is suicidal, although a side effect may be a dopey baby at birth.
I HAD TO OVERCOME THIS MONSTER
Freelance writer Jenny Pereira, 30, mum to 1-year-old Elizabeth, recounts her experience with before-baby blues.
“It should have been one of the happiest moments of my life, but when the pregnancy test kit showed positive, I burst into tears. It was a horrible first few months. Every day after work, I was weepy. I couldn’t cook, didn’t feel like eating. I lost weight and had horrible mood swings, I snapped at everyone. I felt fat and ugly and alienated from the baby that was growing in me. There were times when I didn’t want the baby because people expected me to be a good mother. I wanted my old life back.
My husband persuaded me to talk to my doctor how I felt. I was embarrassed because I felt guilty for having these thoughts. But I knew I needed help. When I spoke up, my doctor was very understanding. He told me I was suffering from depression and monitored my condition. It helped when I saw scans of my baby moving - she became real, so I looked forward to seeing scans each time I went for my check up. I didn’t want medication. I joined a forum online, which was a good avenue to vent my frustrations. I told myself I had to overcome this monster.
My husband was wonderful - he made me go swimming, which made me feel so weightless. With his love and support, I saw the possibilities we could have as a family. I have him and my sister to thank for letting me cry and whinge, and for taking me for the odd manicure! Sometimes, when I look at my daughter, I wonder - what was all that about?”
MOTHER & BABY HELP FOR YOU
Resources you can tap on.
Organisations
aLife (Pregnancy Assistance and Counselling Centre) Tel: 6258-8816
Association for Mental Health Tel: 1800-2837019 (Weekdays, 9am to 6pm)
HealthLine (Health Promotion Board) Tel: 1800-223 1313
Institute of Mental Health Tel: 6389-2222 (24 hours)
KKH Mental Wellness Service Tel: 6394-3739
Samaritans of Singapore Tel: 1800-221 4444 (24 hours)
Books
Book list compiled by Zubaidah Mohsen of the National Library Board
Pregnancy Blues: What Every Woman Needs To Know About Depression During Pregnancy, by Shaila Misri (Call no: 618.76 MIS [HEA])
Understanding Your Moods When You're Expecting: Emotions, Mental Health, And Happiness ? Before, During, And After Pregnancy, by Lucy J
Puryear (Call no: 618.2 PUR [FAM]).
Blooming Beautiful: How To Look Great, Be Healthy And Survive Hormonal Havoc, Throughout Pregnancy And As A New Mum, by Melanie Sykes (Call no: 618.24 SYK [FAM]).
A Deeper Shade Of Blue: A Woman's Guide To Recognizing And Treating Depression In Her Childbearing Years, by Ruta Nonacs (Call no: 616.8527 NON [HEA]).
Beyond The Blues: A Guide To Understanding And Treating Prenatal And Postpartum Depression, by Shoshana S Bennett (Call no: 618.76 BEN [HEA]).
Note: Go to http://www.pl.sg to check title availability. |
If you have any comments or practical suggestions, write to us at editor@family.sg
- Mother & Baby
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