Postpartum depression in young Indian mothers.

Introduction:

In India, there has been a steady fall in the number of deaths reported of young mothers during their delivery. This huge feat must be accompanied by increased focus on postpartum psychiatric disorders which affect the mother’s mental health and the newborn infant’s development in an undesirable manner.

Many Indian actresses have shared their experiences of postpartum depression. For example, Mandira Bedi has shared her personal experience with postpartum depression (PPD) . She struggled with PPD after delivering her child in 2011. She had her child after 12 years of marriage so, she felt that she had lost her independence and hormonal changes made her feel more sad and lonely.

When to seek professional help for Postpartum disorders (PPD)?

We must ensure that young mothers seek professional help when they experience PPD symptoms. PPD symptoms include severe mood swings, continuous crying, apprehension, persistent sadness, reduced bonding with the baby, loss of appetite, over-eating, panic attacks, insomnia, over-sleeping, suicidal tendencies, etc. PPD affects the mother’s relationship with her baby and increases the risk of the infant becoming underweight and stunted because of lack of attention and support from the young mother.

Types of PPD:

PPD are often differentiated on the idea of severity. This differentiation identifies 3 sorts of postpartum disorders: postpartum blues, postpartum psychosis, and postpartum depression.
Postpartum blues are less serious and they persist for a short duration of time. They require reassurance in order to overcome this state of mind wherein they have negative thoughts, apprehension and emotions which are seen as overwhelming.
Postpartum psychosis is higher in severity and it makes hospital stay a necessity for the safety of the mother and the newborn infant. It’s onset is observed as being within first 4 weeks after birth of the child.
Postpartum depression is the most severe manifestation of PPD which needs proper treatment.

Bio-psycho-social risk factors causing PPDs:

The bio-psycho-social risk factors for PPD must be identified in order to facilitate primary prevention on the community level.

Risk factors involved are as follows :

Financial burden: 

The financial issues begin mainly after the delivery because the hospital hand-overs the hospital bills which may seem to be a burden especially when the mother’s financial status is not good enough. The young mother may imagine herself being flooded with bills because of the infant who needs special care in every respect.

Marital conflicts and Domestic violence: 

Marital conflicts make the young mother question her marriage and her relationship with her life partner. When the child enters their family in such a scenario, then naturally, the mother would be more apprehensive about the decision of bringing the child into this world. It is very common to find domestic violence in Indian households because of the patriarchal social structure which places the man of the house on a pedestal. Intimate partner violence is a huge crime which remains unreported because of the social stigma surrounding it. The trauma inflicted by the spouse on the young mother has profound negative effects on the overall mental health of the young mother.

Past History of illnesses (psychiatric and medical illnesses) : 

If the young mother has been a victim of some kind of physical or mental disorder, then this might show it’s adverse effects after childbirth. This is because there could be some unconscious unresolved conflicts inside her mind which might come to the surface after delivery and deteriorate the mental health of the young mother.

Lack of support from husband:

If the husband doesn’t care or support the young mother and doesn’t care for the child as well then the mother would feel overburdened with a lot of responsibilities. While the young lady is trying to adjust to the role expectations from a mother of a newborn infant, she requires an ample amount of affection, care and support. If she fails to get support from her life partner, she will definitely experience negative thoughts and emotions which will severely impact her mental health and this might reinforce negative behaviours.

Birth of a girl child: 

The expectations of a son would come crashing down when a girl baby is born. These expectations are a result of stereotypical thinking and societal pressures. When these expectations go unfulfilled, they bring in a sense of disappointment in the young mother. This can negatively impact the amount of care and affection given by the mother to the newborn baby. This could also lead to insecure attachment of the mother with the new-born infant which can cause a lot of anxiety in the infant.

No family support:

Family plays a crucial role when a mother brings in her newborn baby as a new member of their family. If the family decides not to support the mother and the child then the mother finds herself in a difficult position. When the family doesn’t accept the child, they may ignore the mother and the child or they may criticise the mother and the child. The negativity from the family members would certainly have negative effects on the young mother’s mental well being. Lack of family support can make it very difficult for the young mother to manage herself and the newborn infant all alone.

Recent stress-inducing situations: 

When disturbing life events take place in the life of a young mother, they tend to negatively impact the mother’s mental health and she may not be able to give the amount of time, attention and support that is asked for by her child. This can negatively impact the child’s well being and the child’s overall development.

Sick baby or death of a baby: 

The sorrow of seeing her ill child or losing her child might take away her attention from the new born baby. If the mother continues to ignore the newborn infant for a long time, the infant would lose its primary caregiver on whom s/he is totally dependent upon. The infant may share the insecure attachment with the mother which would give rise to high levels of unconscious anxiety and conflicts. These conflicts arising from separation anxiety come to surface at a later stage of the child’s development when s/he may showcase maladaptive forms of behaviour.

Substance abuse by the husband:

 

After delivery, the mother expects her spouse to be supportive but instead, if he turns out to be careless and lost in some other world, under the influence of some addictive substance such as alcohol or drugs, then the mother feels that she is left all alone to manage the newborn infant. The mother might get too engaged in taking care of her drowsy husband, such that she might ignore her own newborn baby. This is very detrimental to the child’s growth and development. The mother might feel over-burdened by the responsibility of taking care of an unsupportive husband who can’t give up on his addiction.

Mother is less educated: 

The mother may face self-esteem issues which may severely effect her belief in herself to rake good care of her own child. When the mother is less educated, she may accept some wrong advice given to her by her near and dear ones. This might have some serious repercussions which can negatively impact the mother’s mental health. The mother may not acknowledge the psychological distress she is going through and she may not seek professional help fearing the social stigma attached to help-seeking behaviours.

Mental health of young mothers should be taken more seriously. One important factor to be considered here is that their well being facilitates their child’s development as the infant is fully dependent on the mother for everything. This is the time when the unconditional emotional bond develops between the mother and the new born infant. This bonding fosters trust which is necessary in any long-lasting relationship.

What are the steps to prevent Postpartum disorders (PPD)? 

Motherhood must be a personal choice:

If she is forced into the role of a mother, she won’t do justice to the newborn infant. She may not provide the proper amount of care, affection and support required by the new born baby which may lead to developmental difficulties in the child. The mother should have the right to decide whether or not to bring a new life into this world. When she decides to do so, the decision should not be because of coercion. If the mother assumes that her infant is a burden or an obligation, then she would do injustice to the infant.

Re-shaping expectations from the role of a mother:

The overwhelming expectations from a young mother can negatively impact her mental health. In order to avoid this from happening, expectations from her must be more reasonable and she should be allowed some time to adjust to the new social role. The mother’s burden must be reduced and the mother should be helped to embrace all the changes brought about by the addition of her infant in her family.

Ensuring support from the spouse and the family:

When her life partner and her family are willing to support her in every way possible, it becomes easier for the young mother to accept the baby and adjust in the role of a mother. The support from the family helps her put away her thoughts of self-doubt and avoid dismay.

Less financial pressures:

When the mother knows that she is financially stable, she feels more capable to look after the infant’s needs and believes in herself that she can be a good caregiver to her child. The negative impact of having financial issues on mental health can be avoided which in turn would reduce the young mother’s risk of developing PPD of any kind.

Healthier interpersonal relationships:

When the mother has strong and healthy interpersonal relationships to depend upon, she won’t feel lonely and sad. When she will be surrounded by her loved ones, she will be more cheerful and happy. She can also discuss her inner conflicts with her dear ones and resolve them in a healthy way.

Acceptance of the baby as a new family member:

This includes keeping aside one’s preference for a son and accepting the child irrespective of gender, skin colour, etc. The family must keep aside their stereotypical thoughts and ideologies to make the child and the mother feels more accepted and welcomed in the family. The infant depends totally on the mother and thus, the mother has to ensure that the child develops healthy relationships with the family members.

Equal distribution of responsibilities towards the child:

The responsibilities towards the newborn baby should be equally divided between the mother and the father. The family should also extend their support to help out the couple in managing these added responsibilities. This will ensure that the mother doesn’t feel overwhelmed by the added responsibilities.

Accepting bodily changes and accepting one’s real self:

The young mother should not feel bad about herself after becoming a mother. So, she should receive the support she seeks from her loved ones to help her build more self-esteem. She must acknowledge her fatigue, her sense of loss and her physiological and hormonal changes. She must accept herself as she is in order to move ahead in life.

Reducing the impact of traumatic life events:

Family and friends can help the mother to effectively deal with traumatic life events. Social support can reduce the negative impact of traumatic events because the feeling of belongingness would build our resources to stay resilient.

Increasing self-awareness:

The mother must be aware of her real self and accept herself as she looks and behaves. She should not try to change herself to fit into some ideal image of herself. The bodily changes can severely damage one’s self-image and this effect has to be reversed by increasing self-awareness. The mother should believe in herself that she has what it takes to be a good mother.

Conclusion:

Motherhood should be accepted as a beautiful experience instead of a burden or obligation. It is normal to feel apprehensive before any major life but what really matters is how we choose to overcome these feelings. Leaving behind the social stigma, we must acknowledge the detachment felt by the young mother with the newborn infant. Young mothers who are showing PPD symptoms should be supported by the spouse and the family in order to seek timely professional help.

7. References :

Stewart DE et al. (2003) Postpartum depression: Literature review of risk factors and interventions. Toronto: University Health Network, Women’s Health program.

Surkan PJ, Kennedy CE. Maternal Depression and early childhood growth in developing countries.

 

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