The scourge of postpartum depression

On January 9, a 20-year-old unmarried woman threw her newborn from the window of her washroom in east Delhi’s New Kondli area for the fear of stigma. In light of the news, Patriot spoke to a psychologist who mentioned about the prevalence of post-partum depression in “married or unmarried” pregnant women and new mothers.

Dr Harpreet Kaur highlighted the susceptibility of women to mental health issues due to pregnancy and society’s ignorance about the subject.

In its last survey on the matter in 2018, the World Health Organisation (WHO) had found that about 22% of Indian mothers suffer from postpartum depression (PPD) and the country requires more resources for capacity building in maternal health care. While a mild depression called ‘baby blues’ is common in a new mother, PPD requires medical attention, and if left untreated, affects a woman’s ability to take care of the baby and herself, the report said.

Postpartum depression

Postpartum depression (PPD) is a complex mix of physical, emotional, and behavioural changes that happen in some women after giving birth. The diagnosis of postpartum depression is based not only on the length of time between delivery and onset of depression but also on the severity of the depression.

“Some amount of blues during and after pregnancy is known to happen. Like in every other situation, it is important to distinguish between such blues and depression leading to negative and suicidal thoughts (if at all), loss of appetite. The latter symptoms are that of post-partum depression,” said Dr Nimesh Desai, psychiatrist at Institute of Human Behaviour and Allied Sciences, Delhi.

“During pregnancy, women go through countless hormonal changes and that directly contributes to deterioration of mental health. The chemical changes involve a rapid drop in hormones after delivery,” he added.

The actual link between this drop and depression is still not clear. But what is known is that the levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy. Then, they drop sharply after delivery. By three days after a woman gives birth, the levels of these hormones drop back to what they were before pregnancy.

“Postpartum depression is both biological and psychological. Biological because of significant hormonal changes and the psychological reason is that of stepping into a new role. It takes time to adapt to such roles,” Desai said.

In addition to these chemical changes, the social and psychological changes of having a baby create an increased risk of depression.

“Postpartum is also related to social-cultural factors. Indian research shows that beyond every other factor, it is family and social aspects that lead to the occurrence of postpartum depression. Postpartum depression is prevalent in 40% of postpartum women. Women who are already struggling with chronic depression and bipolar disorder are 100% more vulnerable to PPD,” he said further.

The WHO, in its report, found that the most commonly reported risk factors for PPD include financial difficulties, domestic violence, past history of psychiatric illness in the mother, marital conflict, lack of support from the husband and birth of a female baby.

Other reported risk factors include recent stressful life event, family history of psychiatric illness, sick baby or death of the baby and substance abuse by the husband.
The women Patriot reached out to spoke of similar factors that triggered PPD.

History of psychiatric illness

Thirty-one-year-old Sulagna conceived her first baby in August 2021, five months after she recovered from Covid-19. She was diagnosed with chronic depression and PTSD at 22. While prolonged medication and therapy helped her overcome mental hardships, long Covid dealt a blow to her progress.

“After I recovered from Covid, the doctor had informed me about the effects of long Covid on my mental illnesses. I was told that I would need at least five years to fully recover from long Covid. I developed depression after a traumatic incident in college and it only got worse following the death of my cousin in 2015. With the help of medicines and therapy, I had come a long way and then the Delta variant infected me and my husband,” Sulagna said.

Things were hunky dory during the nine months of pregnancy, but a thick cloud of sorrow shrouded her after the birth of her newborn.

“Within a week of my delivery, I could not stop crying and those were not happy tears. My heart felt heavy all the time and I was bedridden for three weeks straight. While I was physically fine, I could not feel any joy holding my newborn. Infact, I disliked being a mother. It felt like old days when I failed to do basic tasks like brushing and combing,” she said.

Now a mother of an infant, Sulagna said that despite suffering from mental illnesses for almost a decade, she had no idea of postpartum depression.

“Never had I ever heard of it and nor was I warned about it. I feel I should have since I was already reeling from depression. It was only three months after my baby was born that I resumed therapy and was told of it (PPD). The pills were changed and the number of medicines increased. Even now, I don’t fully feel myself and despite loving my baby, I wish I got more time to learn about pregnancy before stepping into it,” said Sulagna, who works as a HR in an IT company in Delhi.

Like Sulagna, Jyoti’s underlying mental illnesses acted against her son after she gave birth. The 29-year-old was diagnosed with bipolar disorder when she was 20.
“Parents don’t encourage psychiatric checkups so it was only in college that I went for one of these pro-bono services and was diagnosed with bipolar disorder. It took me years to accept my illness and I did everything that my doctors asked me to do to live healthier life. From physical activities to medicines, I did it all,” she said.

Last year in January, she gave birth to her baby girl. “I was scared that I would end up harming my own child so most of the times I kept my baby away from me. She wailed, but I was frightened by my own thoughts. I feared that I may end up executing my thoughts. In my head, the thought of futility of birth was recurring. These thoughts are not new to me as I have had them for myself. Only this time, it was for my little one. It frightened me. In fact, my husband was advised to be around the baby most of the time by my therapist until I was in a better shape,” she recalled.

Jyoti survived suicide twice.

“For those who are already suffering from bipolar disorder and chronic depression, the situation is worse because mainly it goes undetected and even when it is detected, they are not given proper care or rehabilitation,” Dr Desai said.

Socio-cultural factors

Since the birth of her baby, Priya has felt a “lack of care and affection” from her husband and in-laws, which has weighed her down. While she is no more a new mother, she claimed to have lost the place in her family.

“It’s been three years since my daughter was born. My husband loves our child, but I can sense my mother-in-law’s disappointment in me for not trying for a son. Besides, I feel like I hardly matter to my husband since I delivered. All that extra love and care that was showered on me during pregnancy is no more there. Not even an ounce. I crave that affection,” said Priya, who was working as a PR but was “advised” to drop work to raise her daughter by her family.

“The resignation from job took a toll on me. I am not disrespecting homemakers, but I don’t want to restrict myself to that because I had spent money on my degree and still want to continue to work, which I cannot at this point because I am continuously discouraged. Even my husband expects me to just be a mother. That’s it. Also, I had to stop my therapy midway because I no more wanted to spend on expensive sessions because I am not earning anymore. It takes a great toll on you,” she said.

Priya lamented that she is often embroiled in arguments with her in-laws for not wishing for another baby.

“I can clearly see that it is for a son that they expect me to be pregnant again. Besides, right now my identity has been reduced to just a mother and all I am expected to do is rear a child. When I was breastfeeding my toddler, I was asked if I ate well because I was nursing and not because I was a human being. It’s extremely hurtful and I feel paralysed,” she said.

Talking about such socio-cultural factors, Dr Desai said that most women who come for psychiatric assistance, speak of similar neglect.

“Women are largely seen as vehicles of reproduction and that depresses them and that inevitably leads to PPD. So, prevention is of utmost significance and that can only happen with proper care from family, who are the first respondents,” he said.

“Suicidal thought should be an immediate caution, along with non-participation in raising the child. Any mother showing such symptoms should immediately be assisted with medical help. A lot of times, women regret being mothers and are occupied with negative and harmful thoughts. That can be both biological due to hormonal changes and socio-cultural because they pick up contents from their surroundings. In that case, there should be rehabilitation as well,” he said.

“There are enough cases where women want to kill their babies and then kill themselves. So, to prevent such tragedies from happening, proper pre and post-natal care must be taken,” he added.

Impact of PPD

“Postpartum period is three months, but its impact can last long. Having said that, if immediate care is taken, then PPD is highly recoverable,” Dr Desai said.

Postpartum depression can predispose to chronic or recurrent depression, which may affect the mother-infant relationship and child growth and development.

“Children of mothers with PPD have greater cognitive, behavioural and interpersonal problems and are at greater risk of being underweight and stunted,” Dr Desai added.

Authors of the WHO report observed: “India is experiencing a steady decline in maternal mortality, which means that the focus of care in the future will shift towards reducing maternal morbidity, including mental health disorders. Despite the growing number of empirical studies on PPD in India, there is a lack of robust systematic evidence that looks not only at the overall burden of PPD but also its associated risk factors. Our current understanding of the epidemiology of postpartum depression is largely dependent on a few regional studies, with very few nationwide data. The current review was done to fill this gap.

“These estimates in low and middle-income countries are similar to ours and, taken together, they support an argument for placing greater importance on maternal mental health as part of overall efforts to improve maternal and child health,” the report pointed out.

PPD in Fathers

Fathers are not immune to postpartum depression. “While mothers are under the noose of PPD due to both biological and socio-cultural factors, in fathers PPD is triggered due to the latter. Men do not undergo hormonal changes like women. However, socio-cultural factors apply to them as much as mothers. For healthy parenting of a child, it is imperative to impart medical help to both men and women who have become new parents,” Dr Desai said.