The dark side of childbirth: When motherhood causes depression
Giving birth is supposed to be a joyous event and it is, for many. But postpartum depression affects 6 to 8 per cent of new mothers here according to one expert, and can have tragic consequences if neglected.
SINGAPORE: Five years ago, the first-time mother nearly drowned her newborn son.
The woman, who only wanted to be known as Ms Goh, said she was "stretched beyond (her) capacity to stay sane".
"At that time, I had all kinds of s**t thrown at me - overdue credit card bills, irregular income, lack of support, my savings were running dry. I had all kinds of negativity thrown at me for my choices as a new mum, and it was the toughest time I ever had."
Pushed to her limit, she held her son underwater for two seconds before snapping out of it. She held her baby close to her in bed, crying, for hours.
The stress of mothering an infant did not let up when she gave birth to her daughter, now three years old. She was back at work within three months, and after losing a S$2,000 business deal, she found herself driving at 120kmh along the Central Expressway bawling her eyes out.
"I was that close to driving into the wall, wanting to end it all," she said.
Instead, she drove to KK Women's and Children's Hospital (KKH), "shaking badly and incoherent", and started a three-year journey to recover from postnatal depression.
In Singapore's high-pressure society, new mothers face an abundance of possible frustrations - particularly if there is a lack of support at home or in the workplace.
Earlier this month, State Coroner Marvin Bay ruled the death of a new mother at the foot of a block of flats in Bukit Panjang a suicide. The 29-year-old woman jumped down from her flat on the 12th storey with her two-month-old daughter in her arms, five days after she had searched online for “what to do when there is no way out”.
Her husband and colleagues said she was upset she could not produce enough breast milk to feed her daughter, stressed at having to find a replacement domestic helper, and concerned that her company, where she was a sales manager, was not doing well.
Madam Koh Suan Ping's plight struck a chord, as many turned to social media to share their personal stories of being new mothers plagued by worries and pressure from different sources.
Such stories are far more common than one might expect. KKH's head of the Department of Psychological Medicine Helen Chen said depression affects about 6 to 8 per cent of postnatal women in Singapore. To put that in context, that's one out of every 12 to 16 such women.
"There are usually many factors that contribute to the development of postnatal depression in women: Hormonal, biological, psychosocial and emotional changes," Dr Chen said, adding that some of the causes are distress about weight gain, sleep deprivation, marital discord and financial difficulties.
"Our fast-paced lives and high stress levels can contribute towards greater risk of depression," she said.
"Many mothers also wear multiple hats. They care for their children and organise the household in addition to holding down jobs. Some also need to tend to their elderly parents and support their husbands. Having to meet all these demands may wear mothers out."
Head of Advocacy and Research at the Association of Women for Action and Research (AWARE) Jolene Tan added that as postnatal depression is not widely understood in Singapore, many mothers are not able to understand - much less talk about - their experiences.
"Motherhood is not easy, but there is a lot of societal pressure to be a 'perfect' mother and barriers to asking for more help," she said.
"Women caring for newborns can experience feelings of a loss of identity, especially if they are unsure about their prospects of returning to work, as well as feelings of social isolation. The sense of being cooped up at home can be worsened by barriers to breastfeeding in public spaces."
However, Dr Chen noted, while suicidal feelings are not uncommon among those who go through treatment for postnatal depression, actual suicides are rare.
"This is because most mothers who struggle with dark thoughts are actually greatly distressed and the thought of their babies often gives them strength to fight the dark thoughts," she said.
MUMS AT RISK
According to Dr Chen, the risk factors for postnatal depression include previous episodes of major depression, having a family history of postnatal depression, pregnancy complications and difficult deliveries. Both young mothers under 21 years of age and mature mothers, especially if the pregnancy was unplanned, are also at a higher risk.
"During the postnatal period, breastfeeding and confinement may become significant stressors if they do not progress smoothly," she said.
Being aware of these risk factors can be very helpful in identifying women who are likelier to develop postnatal depression, the senior consultant observed.
Care can then be taken to reduce the impact of some of these factors, such as by requesting adequate explanations and pain relief during and after delivery, planning ahead for confinement and sourcing for lactation advice. Mothers and their families can also read up, ahead of time, about how to recognise postnatal depression and where they can go for help should the need arise, Dr Chen said.
She also warned that women most at risk of suicide and infanticide are mothers who suffer from postnatal psychotic illness or have severe depression with dissociative episodes wherein they lapse into states of altered consciousness.
"These mothers are gravely ill and require urgent psychiatric attention."
POSTNATAL DEPRESSION - WHAT ARE THE SIGNS?
KKH runs the Postnatal Depression Intervention Programme (PDIP), which screens mothers for postnatal depression four to six weeks after delivery - when they return to the hospital for routine obstetric check-ups - with the aim of identifying those who need treatment early.
Clinical outcomes for the programme have been "very encouraging", Dr Chen said, adding that women who did not deliver at KKH may wish to make an appointment to consult a psychiatrist for assessment within three months of delivery.
"If they have previously received mental health care, it is recommended that they return to see their care provider for a postnatal review, especially within the first three months of delivery when a relapse is most likely to occur," she added.
The symptoms of postnatal depression include having a low mood, irritability, poor sleep and appetite, loss of confidence and feeling guilty for no good reason.
Dr Chen said many mothers experience some tearfulness and feelings of worry soon after delivery, but if these resolve after a few days this is likely to be a milder case of "baby blues", for which medical intervention is generally not required.
However, if depressive symptoms - particularly a persistent low mood and lack of positive emotions - last beyond two weeks and affect the mother's functioning, it is likely that she has postnatal depression.
In these cases it would be advisable for her to consult her obstetrician or family doctor, who might then recommend a psychiatric referral, or she can seek psychiatric help directly. Supportive counselling and therapy have also been found to be effective and acceptable means of intervention, Dr Chen noted.
"For mothers who are apprehensive about getting help for fear that they might be prescribed medications that are unsafe to take while breastfeeding, they can be assured that there are other alternatives that can be used safely," she added.
AWARE also provides counselling support. Women who are in need of support or a listening ear can contact its helpline at 1800 774 5935 from 3pm to 9.30pm on weekdays.
Having gone through postnatal depression herself, Ms Goh advised other mothers to seek help the moment they notice something is "not right". If not, the depression will "suck you in and spiral down fast", she said.
Another mother who spoke to Channel NewsAsia, Ms Tan, knows this all too well from her experience many years ago.
She described herself as a "happy person" prior to giving birth to her son, but said she suffered from depression and anxiety for years afterwards.
Ms Tan, now 47, said she had no knowledge of psychiatric issues at the time and did not know she had been suffering from postnatal depression.
This was only made worse by the fact that her then-husband was involved in extramarital affairs and did not help care for their son, even when the child was ill - leaving her alone to tend to him around the clock. As her son grew older, he started begging for his father's attention as the latter was rarely home.
It all came to a head one day. “I was shivering. I didn’t know what I could do. The pain was there but I couldn’t do anything. I felt like I had no one to turn to."
So she took a stool to the window, wanting to jump off.
She might have, had the police not arrived at the scene in time. It was the words of one policeman that changed her mind, Ms Tan said.
"He told me that he was divorced too; his wife walked away from him and left their three kids behind. 'Your child already has a dad that doesn't love him,' he said. 'If you’re gonna do this, you are no different from his father.'
"It made me realise that if I go, my son would be an orphan. That’s not fair to him."
Soon after, she divorced her husband of 10 years, sought help at KKH and got back to work in the retail industry. Her son recently turned 21.
IT TAKES A VILLAGE
Both Dr Chen and Ms Jolene Tan agreed that aside from medical intervention, family members play a crucial role in helping mothers recover from postnatal depression.
"This is a time that is spent mostly at home when life revolves primarily around family," Dr Chen said. "Family members are strongly encouraged to understand the illness and learn to provide necessary reassurance and support."
She offered some tips for family members of new mothers:
- Give reassurance that the new mother is not alone and that she will get better.
- Provide a listening ear without making any judgment.
- Do not offer solutions or advice unless requested.
- Ask how you can help.
- Understand that her mood may be unpredictable.
- Understand that her depression is not a sign of weakness or unsoundness of mind, but that she is ill and would benefit from support and intervention.
- Instead of reacting instinctively by retaliation and scolding, stay calm and communicate to her that you would like to help.
- Offer help with household chores and childcare needs before she asks for it, as she may find it difficult to request assistance.
- Provide assistance and encouragement to help her build confidence about looking after the baby.
- Encourage her to rest, to go out for a walk, have couple time, meet her friends and engage in relaxing activities.
- Encourage and help her to seek professional help when needed.
Employers can also support a mother’s recovery by allowing her to return to work at a pace that is comfortable, the psychiatrist added.
"If possible, provision of a quiet and clean corner to support breastfeeding mothers would be very helpful to enable a working mother to feel empowered that she is still able to do her best for her baby and alleviate any feelings of guilt as a result of leaving her baby at home."
AWARE's Jolene Tan also said that having hands-on partners and other family members who help mothers with caregiving tasks and domestic chores can improve women's well-being as they will have more time to sleep and "charge their psychological batteries".
"When we support, empathise and offer resources to mothers who are struggling, instead of shaming or pressuring them, or brushing off their feelings as 'baby blues', we can help alleviate their struggles and get them on the road to recovery."