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Blues’ Clues
When does baby blues become postnatal condition
Baby blues can derail what should be a happy event for new mums, with some women grappling with even more extreme feelings. We take a look at this potentially debilitating postnatal condition.
By Keith G Emuang
Baby blues is often attributed to fatigue from physical stress and lack of sleep, dramatic hormonal changes and having to adjust psychologically to the new role.
Postnatal blues usually tends to sort itself out. But if the postnatal blues symptoms persist beyond a month, the condition may be worsening and could slip into PND.
“Mothers really should be in their optimal state of mental well-being as they embark on their lifetime journey with their babies. Motherhood should be something that is enjoyable and meaningful, and not a constant struggle.” |
Every time I looked at my newborn, I would just start crying for no apparent reason. For almost two weeks, I felt helpless and imagined that everyone was against me,” confides Gloria Chan*, a 34-year old purchaser, whose low feelings cleared up on their own.
Postnatal or baby blues, which usually occur within days of childbirth, is often attributed to fatigue from physical stress and lack of sleep, dramatic hormonal changes and having to adjust psychologically to the new role. As a baby’s arrival often affects the mother’s rest and appetite patterns, her mental state may worsen.
There aren’t accurate figures on the prevalence of baby blues as there are no strict medical criteria to define this condition. However, M&B expert Dr Adrian Wang, a consultant psychiatrist at Mount Elizabeth Medical Centre, reckons that between 50 and 60 per cent of mothers may experience some stress-related and blues-like symptoms.
Dr Ken Ung, a consultant psychiatrist at Adam Road Medical Centre and MD Specialist Healthcare, notes, “This is quite understandable when you consider what mothers go through with delivery and thereafter, looking after their babies. Thankfully for most mums, it eases off after a couple of weeks.”
Some mothers take longer to get over the baby blues, while there are women whose conditions deteriorate into full-blown depression.
DARK THOUGHTS
“Homicidal and suicidal thoughts are not uncommon when a new mum slips into postnatal depression or PND. It can set in a few weeks to a few months after childbirth and the symptoms are similar to clinical depression. It may include the same symptoms seen in postnatal blues, only more severe,” notes Dr Wang.
The exact causes of PND are not known, although many doctors think it is linked to a combination of hormonal changes in the mother's body and external stress-related factors. Symptoms of PND include a persistent sense of gloominess, the inability to feel happy while with the baby, and feelings of guilt or inadequacy. About 10 per cent of mothers suffer from PND.
Dr Helen Chen, senior consultant (Women’s Mental Wellness) and head (Mental Wellness Service) at KK Women’s & Children’s Hospital (KKH), explainss, “In PND, the woman’s ability to function is drastically affected and afflicted mothers also often report difficulty in bonding with their child, in part because of their depressed moods and lack of interest or energy, and in part because they view themselves as bad mothers.”
WOMEN IN RISK
Young mothers, women with obstetric or medical problems, a sick infant or have a family history of depression are in danger of succumbing to PND.
Dr Wang outlines, “Women who are unwed mothers, of lower socio-economic status, with pre-existing anxiety or depression problems, a lack of family support and have an unplanned pregnancy are more vulnerable to postnatal blues and PND.”
Still, PND can strike any woman, regardless of race and educational or social background.
Dr Chen points out that her patients come from all walks of life, from the socially disadvantaged to the wealthy, from the poorly educated to highly-trained professionals, including lawyers, teachers and even doctors.
She says, “Research has shown that hormonal changes only present a vulnerability to the postnatal woman, so that in the face of other stressors, the balance tips her over into clinical depression. PND is not solely due to hormonal changes or else every woman would be afflicted.”
Once a woman is afflicted with PND, the risk that it will recur increases by between 25 and 55 per cent, with the odds swelling if she suffered a serious episode in the past.
SPECIAL TREATMENT
Postnatal blues usually tends to sort itself out. Dr Wang notes that no formal psychiatric treatment is necessary, although counselling from a doctor or family members and friends can help. If the postnatal blues symptoms persist beyond a month, the condition may be worsening and could slip into PND.
“Apart from the depression symptoms, PND can lead to psychotic symptoms such as hallucinations (hearing voices), delusions (paranoid ideas that everyone is talking about or is against her), and abnormal speech and behaviour,” he says.
If a mother exhibits such symptoms, immediate hospitalisation is necessary. PND is managed mainly with psychological support and therapy.
Medication will also be prescribed according to severity of the depression. In very severe cases, electroconvulsive therapy (ECT) - a specialised form of treatment for depression ? may be administered.
While treatment is readily available, women unfortunately do not always seek help. This is why many experts suspect that the actual numbers of PND and baby blues sufferers may be much higher.
Dr Chen notes, “Many women shy away from receiving the help that they need because of the stigma of mental illness, or perhaps, for the fear that others will see them as an incapable mother.”
If PND is untreated for months or even years, it can adversely affect not just the mother, but lead to family stress and conflict, poor parenting, and poor parent-baby bonding, Dr Wang points out.
To prevent a delay in treating the condition, KKH is the first hospital here to launch a programme to screen women who return for their postnatal check-ups for PND.
DON'T SUFFER IN SILENCE
Breastfeeding mothers are often reluctant to take any medication for fear that it would affect their babies, although there are nursing-friendly medications. In fact, Dr Ung points out that less than 5 per cent of selected anti-depressant drugs actually filter into breastmilk.
“The risk is there but it’s very low. Of course, going on medication is still a very personal decision but not seeking treatment and suffering in silence can put mums under further distress and hardship,” he stresses.
Even actresses Brooke Shields and Gwyneth Paltrow have come forward to share their battles with PND in the hope of increasing awareness of this condition. KKH is also doing its part in Singapore to educate women on this condition, so that they will be open to intervention.
Dr Chen sums up, “Mothers really should be in their optimal state of mental well-being as they embark on their lifetime journey with their babies. Motherhood should be something that is enjoyable and meaningful, and not a constant struggle.”
*Name changed to protect privacy
If you have any comments or practical suggestions, write to us at editor@family.sg
- Mother & Baby
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