The report of a first-time young Malaysian mum falling to her death from the balcony of her apartment shocked and horrified us.
No one is sure what really happened. One thing is clear: the young mum was reportedly stressed because of her inability to breastfeed her baby.
This tragic death brings our attention to the topics of postnatal depression and breastfeeding.
We all know that breast is best, especially in the first six months of a baby’s life and up to two years if possible as stated by the World Health Organization.
But sometimes, with this knowledge comes pressure on new mums to persist with nursing, even if they are struggling with common issues such as establishing a proper latch and hold.
If the appropriate support is not provided to mums who might be dealing with such problems, then a serious condition such as postnatal depression might be triggered or made worse if the mum is already experiencing it.
With this in mind, we spoke to psychiatrist Dr Susan Zachariah and lactation nurse Jophia Bok to bring solid information on postnatal depression (PND), as well as how to deal with breastfeeding issues before they become out-of-hand problems.
Postpartum psychiatric illness
PND is one of the categories of postpartum psychiatric illness, the other two being postpartum blues (or “baby blues”) and postpartum psychosis.
Dr Zachariah describes the symptoms and treatment methods for each condition:
Postpartum blues or “the baby blues”
The “baby blues” usually occurs within the first week of delivery in 50-85% women and subsides by the second week.
Typical symptoms
- Tearfulness
- Irritability
- Anxiety
- Mood fluctuations.
These symptoms peak in the first week and improve gradually, says Dr Zachariah.
Treatment
The symptoms normally subside with sufficient support, rest, sleep and exercise.
Postnatal Depression
Breastfeeding issues and postnatal depression: Sometimes, breastfeeding problems (if not addressed) can trigger PND in a mum.
This condition is usually observed in the first three months after delivery. In Singapore, approximately 12% of mothers are reported to have PND, according to KK Women’s and Children’s hospital.
Typical symptoms
- Feelings of persistent sadness and irritability
- Anxiety
- Lack of interest
- Negative thoughts
- Insomnia
- Changes in appetite
- Inability to care for herself
- Doubt or concerns regarding caring for her baby
Dr Zachariah cautions that PND “may lead to suicidal ideation, although suicide rates are low in women during the postpartum period.”
Treatment
PND may require treatment with drugs* called SSRIs (Selective Serotonin Reuptake Inhibitors) such as Prozac, Zoloft and Lexapro, to name a few.
Postnatal Psychosis (puerperal psychosis)
This is a very severe psychiatric disorder, which occurs in 0.1-0.2% or about 1-2 per thousand women after childbirth. It needs immediate intervention.
Symptoms begin a few days after delivery.
Typical symptoms
- Confusion
- Disorientation
- Irritability
- Mood swings
- Insomnia
- Irrational and delusional thoughts
Sometimes, mothers with this condition may believe that the child does not belong to her and is evil. Also, the risk of infanticide or suicide is high, says Dr Zachariah. A woman with postpartum psychosis needs close supervision or hospitalization and immediate medical attention.
Treatment
This condition needs treatment with newer antipsychotics* such as Zyprexa. A severely depressed and suicidal mother may need hospitalization due to high risk to both her own and her baby’s health.
Proper postpartum care reduces the risk
During postpartum visits, obstetricians typically screen for symptoms for postpartum psychiatric illness using the Edinburgh Post Natal Depression Scale.
Dr Zachariah comments that the period immediately after a woman gives birth provides a good opportunity for healthcare personnel to educate the mother and her partner about postpartum mood disorders such as those described in this article.
Other than this, support from family and friends forms a crucial part of caring for the mother and child.
When a mum has this support, any unusual symptoms become immediately apparent and can be brought to the attention of the obstetrician, general practitioner, or other responsible healthcare provider without delay.
Please seek immediate professional help if you think you are suffering from PND
Who is mostly at risk?
According to Dr Zachariah, Postpartum Psychiatric illness is more common when there is:
- high-risk pregnancy
- forceps delivery
- adjusting to the discomforts of breast feeding
- following a complication during delivery
- past history of Postpartum Mood Disorders
- past history of Major Depression or Bipolar disorder
- hormonal dysregulation (for example, shifts in estrogen and progesterone levels may contribute to mood changes)
- marital discord
Where to seek professional support?
KK Women’s and Children’s Hospital’s Perinatal Depression Support Group provides support for mums who experience depression and anxiety during pregnancy and the postnatal period.
This group gives mums the chance to talk about their experiences and share practical information and coping tips.
Sessions are conducted in English and are facilitated by case managers. They are held on the 1st Tuesday of the month.
For more information, you may call 6394 2205.
Dr Zachariah points out that “adjusting to the discomforts of breastfeeding” may, in some women, trigger postpartum psychiatric illness. Why supporting mums in their breastfeeding efforts is so important, and what you can do if you encounter breastfeeding issues:
Breastfeeding may not be as easy as it looks…
You might have seen “that mum” who makes breastfeeding look so simple. But the truth is that nursing an infant, especially if you’re a first-time mum, may be harder than you think it is.
Getting the appropriate breastfeeding support at the correct time can heavily influence a mum’s decision to continue nursing her child or not. It can also ease some of the pressure and stress she may experience as a result of breastfeeding issues.
Preparing to breastfeed: Be pro-active
Here are some ways mums- and parents-to-be can prepare themselves for breastfeeding prior to having their baby, according to lactation nurse Jophia Bok.
Remember: if you are equipped with proper information about breastfeeding, then you are empowering yourself to tackle breastfeeding problems confidently if and when they arise.
- Sign up for a pre-natal course that has a breastfeeding component. The information you receive here will help you prepare for breastfeeding immediately after you deliver your baby.
- During your stay in hospital for the delivery of your baby, use the lactation services within the hospital. The lactation consultants (LCs) are there to help. Make sure you ask the ward nurses to help you place an appointment to see the LC before you are discharged. Alternatively, you can look for other LCs from other hospitals if you are not comfortable with the LCs from your own hospital.
- If you face any kind of breastfeeding issue, seek help without delay from lactation consultants, lactation nurses or pro-breastfeeding doctors. These medical professionals and personnel are trained to help in common breastfeeding problems. They will also know to whom and when to refer you for further specialised help, if necessary.
If you decide to stop breastfeeding, please don’t come down hard on yourself because of your decision.
What if you don’t want to continue with breastfeeding?
The most important aspect of stopping breastfeeding that you should be aware of is not the physical aspect but the emotional and psychological aspects.
If your decision is to stop breastfeeding, talk to your LC or a lactation nurse about this and how to wean your baby off your breast gradually, advises Jophia.
An experienced LC or lactation nurse will let you talk freely about your decision to stop breastfeeding. She might even be able to work through the underlying reasons for your decision.
For example, let’s imagine that a mum wants to stop breastfeeding because she feels she is not producing enough milk for her little one. Jophia explains that this is when the knowledge of the LC or lactation nurse can help the mum understand why this is happening, while at the same time lending a listening ear or a shoulder to cry on.
An experienced LC or lactation nurse can also suggest ways of increasing breastmilk supply that may encourage the mum to persist with nursing for a bit longer.
If you stop…
If you decide to stop breastfeeding for whatever reason, there is absolutely no need to beat yourself up about it.
Know that you have made a calculated decision with your baby’s, family’s, and your best interests at heart. With this in mind, it is important to look forward and not have any regrets about your decision, says Jophia.
You may feel like a bad mother, but breastfeeding is not a measure of how good you are as a mother, neither can it replace the relationship you have with your baby.
Mums and mums-to-be: motherhood is an incredible experience without a doubt. But at the same time, it comes with immense challenges and responsibilities. All mums can do with a helping hand at times.
So, if you find yourself struggling with breastfeeding issues or are feeling low after giving birth, please don’t stay silent. Speak to your partner, your mother, your sister, your friend – and get the support you so rightly need and deserve.
You are never alone.
*Dr Zachariah cautions that medications should be used carefully in a breastfeeding mother. Dosages are tailored to the needs of the mother and the nursing infant.
How have you coped with breastfeeding issues? And have you ever experienced PND? How did you cope? Please share your experiences in a comment below.