Postpartum Depression

Sakshi sat there in front of me, tears rolling down her cheeks as she narrated her past experience. I was surprised that, even 3 years after her childbirth, the wounds were, still so raw. 

I can’t look at photos of my son from his first year. It brings back memories of the darkness I went though. There are unfortunately pieces that still haunt me. Those weeks and months of never-ending moments of pain and inadequacy of being a bad mom. I just can’t focus on his incredible moments while I look back. 

What hurts me today the most, is that due to the Post Partum Depression, I lost out on the joy and happiness that he gives me today, that I should have given him the same in his initial months as a little baby boy.

That was Sakshi and I met her more than 20 years ago. As a doctor I was living in this make-believe world, a fool’s paradise rather I would say. My image of a mother was this giant enveloping pair of wings that loved you, protected you and was ever smiling without a frown on her, herself. Sakshi shook my foundation. How could childbearing be depressing. Isn’t that what a woman always wants? Isn’t that what she feels completes her? Then why the depression? I have learnt a lot in these years as my hair turned grey. I realise that even the strongest of armours have chinks and its our duty to recognise, realize and protect that wonderful creation of god that protects all of us, all our lives.

I have invited my psychologist’s friend for her perspective on this issue. Mrs Shubhika Singh is a Consultant Psychologist, with both her Bachelors and Masters in Psychology from the UK. She has been practicing for over a decade at her private clinic New Leaf: Mental Health & Well-Being, she also consults at various organizations, and has recently launched InnerKraft.com. 

I first met her in a program where we both shared the same dais. I listened to her speak on the mother-in-law, daughter in law relationship and felt that if one counselling session could be gifted free as part of the marriage deal for every couple, we could avoid zillions of such fights in every household 😊😊

I have worked with her closely the last few years and have become a great fan, not only of her professionalism but her eloquence and her innate ability to calm down even the most anxious of people. 

Me: Shubhika before we move forward, tell me a little about Innerkraft… what is it about and how is its motto or function different from New Leaf ?

Shubhika: New Leaf is very dear to my heart, that’s what I first started for my Counselling Practice, with a mission to create a positive impact on people’s emotional health. Counselling involves exploring feelings, beliefs, and relevant events –  sometimes from childhood and personal history… In a structured way with someone trained to help you do it safely without judgement  and provide therapeutic interventions. Over the years I have supported individuals with depression, anxiety, trauma, suicide & self-harm, relationship issues, bereavement, abuse and workplace stress. InnerKraft.com is a digital platform that provides mental health solutions with videos and content. 

Me: Shubhika, what is this Post Partum Depression…. ?
Shubhika: Postpartum depression (PPD) is a serious mood disorder that affects women after childbirth. Postpartum depression creates feelings of sadness, anxiety, depression and exhaustion that can significantly inhibit their ability to care for their newborn child. I’ll describe it sharing a real-life experience of one of my old clients, who I’ve taken consent from –  

I cried all the time hysterically and just could not connect with my beautiful baby. My baby cried all the time and hated being put down. My husband was so busy working that he was hardly available to us. I felt like I was going to break down, like physically fall apart from the exhaustion and mental turmoil. All I wanted was to escape from her… I was never going to be happy again. What was supposed to be a beautiful phase, was suddenly just so negative. I never knew this was possible. I felt too ashamed to ask anyone about these feelings. But one afternoon, I felt a sudden urge to harm my daughter… I immediately called and confessed what I had been going through to my sister. 

Me: That is so overwhelming Shubhika and as a doctor if I hadn’t actually met such patients, I would never believe what you just said to be true. I mean who would ever believe that a mother would want to harm her own child ?

Shubhika: Yes, it is hard to understand it especially more as being a woman is strongly interlinked with love and care. One doesn’t associate this gender with harm. 

Me: I have something to ask at this point. Motherhood is itself a difficult task, giving birth even more so. It’s a whole new world and the huge change its going to bring into someones life will obviously be dramatic. Going back home from the hospital with a tiny newborn, excited yet apprehensive about the changes ahead, lack of sleep, responsibilities. Wont this be anyways depressing for most ? Is this PPD then ?

Shubhika: Yes that’s a pertinent point Doc – The initial days of Motherhood is overwhelming and challenging. However, A new baby is supposed to bring happiness and joy to a family. Everyone is busy celebrating and expecting you to be over the moon, but despite trying, she finds it hard to. It is very confusing when the rush of emotion is worry or sadness instead of happiness. Most women can relate to the emotional roller coaster that dominates the first few weeks after a baby is born.  Add to that, perpetual tiredness, lack of sleep, absolutely no time for self-care and hormonal changes and it comes as no surprise that most women feel a bit down, tearful or anxious in the first week after giving birth. This is referred to as the “baby blues” because it takes time to adjust to this new life change. When the symptoms last longer along with the ones I will be describing shortly, then a person may have postpartum depression.

ME: Are there any underlying reasons why one would have PPD? I was telling someone the other day that I am working on a podcast on PPD and the person asked me….is it because of the woman herself ….was she always depressed to start with? Or is it something that family and circumstances bring her to ?  

Shubhika: I’m not surprised Doc, there is such little awareness on mental health challenges because it is an invisible illness. It’s great that you have chosen to do this awareness podcast. Unfortunately, the exact cause of PPD is unknown. But there are several contributing factors such as 

  • hormonal fluctuations
  • a difficult relationship with the spouse 
  • A stressful life event during pregnancy or soon after – such as, death of a loved one, critical illness, domestic violence
  • In one of my clients, it resulted of her own childhood trauma of sexual abuse. When she gave birth to a daughter, it triggered it off and for her it like her worst fears were going to come true and she was so terrified. 
  • worries regarding finances and life issues 
  • Along with previously diagnosed or underlying depression or bipolar can increase the risk. 

Often with postpartum depression, signs of depression emerge during pregnancy. 

Me: This is interesting Shubhika. If you remember I had sent 2 women to you last week. The first one was in her 2nd month and her husband was telling me how she was getting intensely emotional and depressed and the 2nd lady was in her 5th month and said that she couldn’t stop crying at the smallest pretext. What are the signs in pregnancy that couples should be watching out for that could warn us about impending PPD?

Shubhika: This is such an important question because recovery is also linked with how soon one starts treatment. The initial symptoms differ from person to person, but some common ones that present itself during pregnancy are: 

  • Frequent crying – Like your patient who you referred to me 
  • Worrying constantly about the baby or own body weight changes 
  • Thoughts of being a bad mother / terrible parent
  • Persistent sadness
  • Loss of enjoyment in activities that previously brought joy
  • Changes in sleeping and eating patterns

One of my clients experienced this in her second pregnancy. In her first one she had no depression or anxiety. 

The role of a husband is extremely critical in the way his wife’s happiness, her confidence as well as managing any mental health issues of the mom-to-be. I remember a client telling me her husband saw this time period as Party time to relive his bachelor days – he was going out at night 3-4 times a week by himself. One of my clients became insecure and felt low because her husband would say mean things about the way she looked during pregnancy. 

Shubhika: What advice would you like to give them Dads-to-be? 

Me: Interestingly I became a Gynaecologist after I got married. What my wife Saroj couldn’t train me for, this profession did…..i feel I am far more compassionate as a gynaecologist than even before. I keep telling husbands that if men were to ever experience pregnancy forget about labour, babies would cease to be born. I cant even begin to explain what women have to go through by way of periods, associated problems, infertility, pregnancy, responsibilities of motherhood ….its a lifetime commitment….. and what do we as men need to do…..provide sperms…..we have a very small biological role to play but we could and should compensate by playing a much bigger emotional role. 

Trust me, most of the times it doesn’t take too much to make a pregnant woman happy. I once had a patient tell me, doc I deal with nausea, backache and every other horrible symptom through the day hoping that when my husband comes back in the evening he will sit me down and ask me how my day was, how am feeling and if there is anything that he can do to make me happy. That’s all we women need. A short drive, a little love and a bit of understanding. I felt she has summed up the needs so beautifully.

Another area of conflict I keep encountering is a holiday. Most pregnant women want one because they know they have difficult times ahead once they deliver….from the jaapa torture to 4 years of nappy changing and babysitting, their lives are going to change and how. It’s not too much to ask is it ? If we men just keep this in mind that….. that pregnant woman is making one of the biggest sacrifices in her life to give us that bundle of joy, if we understand that gratitude, I feel the rest of it will fall into place. We men need to really keep our mothers and wives on the highest pedestal possible for all that they willingly suffer for us. 

Me: Lets move onto the sphere of PPD now. What are the symtoms of it, how does one know ?

Shubhika: Sure Doctor. As we have been talking about Pregnancy and birth, they are intensely emotional events and present challenges that make one feel sad tired, and anxious. We mustn’t confuse PPD with baby blues. In Postpartum, her daily functioning is affected, so is her relationship with the baby and other family members, making the new mom feel increasingly isolated. The onset of PPD is usually within the first 2 months or for up to a year after giving birth. The symptoms include: 

Apart from with the ones I mentioned earlier, 

  • Intense irritability or anger
  • Not interested in bonding with the baby or care
  • Depressed mood or severe mood swings
  • Overwhelming fatigue or loss of energy
  • Diminished ability to think clearly, concentrate, or make decisions 
  • Thinking about suicide and self-harm or thoughts of wanting to harm the baby

I remember the description vividly of one new mother, age 28. She had longed to be a mother her whole life. She said, when she would feed her baby, she would doze off and go in-and-out of sleep especially night feeds. She saw herself hurting her baby. As she came out of the shock, she was relieved to see her baby safe in her arms but was engulfed with so much guilt and shame for even having these flashes. When this reoccurred 7-8 times she became suicidal because she thought she was a terrible person, what mother has thoughts of harming her own baby? She felt a strong urge that she didn’t deserve to live and her baby gets another better mother. She felt too ashamed to even share it with anyone for fear of being called a “bad mother” or “unstable person”. Fortunately, she sought help and support. Today she’s in great mental health and on her way to having a second baby. 
Symptoms of postpartum depression vary from person to person. One must seek support & help as early as possible, 1 in 15 mothers go through this, so you are not alone. 

Me: As a doctor, I know that hormones are all over the place during pregnancy. How does a would-be mother deal with it, how can her family be supportive and what do you do when you encounter such a scenario? 
Shubhika: You know Doc, I think the first step to it is to be able to recognize that something is going on. For this we need to create awareness in India, not only for women but for families.  With awareness, women will no longer have to suffer in isolation, shame and silence. Hence, it’s equally also important for new fathers and caregivers to know, so that they can be supportive and ease her. Often, I hear my clients talk about hurtful comments said to them by the women around them – “what kind of a mother are you?” “God should’ve never made you a mother”. The girl is left feeling more inadequate and burdened. Often these harsh comments come from having no understanding of PPD, poor inter-personal relationships or low empathy. If you are a mother, mum-in-law, sis-in-law listening today, be kind to the new mother. Your loving support at this time can really be soothing for her. Remember, her journey and experience is not the same as yours…so avoid comparisons. She needs you.
It’s helpful to seek advise from a trained professional who can guide the family members along with the new mother. At New Leaf, I strive hard to make a client feel comfortable…so they share their innermost sometimes dark thoughts with me; so they can heal with appropriate therapeutic interventions. I even encourage my clients to join Online Support groups for PPD. It’s comforting to know you are not the only one going through this and can talk to those who have been through this.
 

To all the ladies listening in today, Talk to your Gynaecologist, family GP about your concerns and get a referral to a good Psychiatrist and Psychologist.

ME: Thank you for shedding so much light on PPD and the role of family. But how does the new mother cope with it ? How do you deal with this storm when it hits you hard?
Shubhika: The suggestions I am about to give are not an alternative to treatment but more to support yourself to feel better. 

  • A new mother, you must make a lil time for herself. Whether that’s enjoying a soothing cup of tea and listening to music at home, it could be stepping out of home for a walk or meet friends. A lil me-time can be very soothing. Let someone else watch the baby at this time.
  • Get adequate sleep – I know it’s never enough. To get the most, make your routine closest to your baby’s schedule.
  • Be open to taking help – Trust your spouse, parent, in-laws and friends to look after your baby like their own. Let them help in other ways like run errands, watch the baby while you sleep or do things around the house.  
  • Going into Counselling and Therapy can be revolutionary – not only will you feel supported, but will also work through any issues and learn techniques to overcome them. 
  • Most importantly, avoid isolation – Talk to someone you can trust who will be there for you when you want to talk or cry. This is a part where one may need to push oneself through the most. Have some close people do check-ins on you – how are you feeling, etc. so you are bound to respond and stay connected. 

My Concluding Thoughts: Postpartum Depression is real illness. Some people experience milder symptoms, while others have more severe ones. Having PPD is not her fault or a result of poor mental state. The new mother feels so alone and isolated when she’s battling postpartum. Families should be understanding, not shaming and stigmatising her. This can be hugely beneficial for the mom-to-be. It’s affecting her ability to enjoy the baby and potentially impacting the ability to function at all… Seek help and support. The ray of hope here is that, this isn’t permanent. With time and help she can return to normal routines and feeling like herself again. 

To all mom’s listening in, prioritizing some time to look after one’s own well-being is imperative.  As the saying goes, you can’t pour from an empty cup. Remind yourself daily – you are an amazing and loving parent who is doing a wonderful job. 



This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.

This podcast is available on Apple and Google podcast as well as Spotify. Do subscribe and leave your comments and suggestions on the Apple podcast app. That’s the only way we can make this better. 😊 Looking forward to great interactions…. keep listening.

If you get a chance do look up my website www.drrajeevagarwal.co.in and YouTube channel in my name.

Do email me on fertilitywithoutborders@gmail.com if you have any queries or if you want me to create a podcast on any topic of your choice. 



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