Postpartum depression in Singapore is often unnoticed or swept under the carpet until it it is too late. Many of you would have heard about the mum who jumped to death with her baby in November 2016. The reason - postpartum depression.
We live in a strangely paradoxical society which doesn't hesitate to discuss physical health and wellness but often refuses to view issues regarding emotional and mental well-being in the same light. Someone who is grappling with such issues often chooses to suffer in silence.
But why?
Because they fear judgement. Because they fear being labelled as mad or a psycho. Because they fear being outcast to the fringe of society. Because they fear being dismissed, brushed off or told that they are overthinking and that they should get a grip.
Postpartum depression is not a weakness. Postpartum depression does not signal a problem with your personality or character. Postpartum depression is just one of those things that happen after childbirth. You can look at it as a complication.
Some people bleed excessively after having a baby. Some people get an infection. And some people, whose hormones don't settle as well, end up with postpartum depression. Postpartum depression in Singapore affects about 8% of all women who have given birth.
If you notice that something is amiss and seek help promptly, you can take control of the symptoms and continue to have a happy and healthy relationship with your baby. But if you fail to do so, the depression prolongs and becomes more severe.
It could lead to you harming yourself or your baby. It could lead to the loss of your life or your child's life. Yes, that's how serious postpartum depression in Singapore is.
We want you to know that postpartum depression in Singapore is not a taboo. Importantly, we want you to know that you are not alone. We want you to be strong enough to take that step to acknowledging that you have a problem that needs fixing and then to go ahead and fix that problem.
To help you to better understand why postpartum depression in Singapore is not talked about enough, the symptoms of this condition and the treatment options that you have, we consulted the expertise of Silvia Wetherell, lead counsellor, The Choolani Clinic, Mount Elizabeth Novena Medical Centre.
Why do Singaporean women shy away from help?
One of the things that Silvia repeatedly emphasised is the lack of willingness among mums to seek help for postpartum depression in Singapore. As compared to the Western parts of the world, the women here fear judgment and labelling.
Silvia says that there is a huge stigma about therapy and help. It is viewed as a taboo and we keep perpetuating this idea, which is not helping.
Women who need help have to be helped.
Postpartum depression in Singapore is often unnoticed because mums dismiss what they are experiencing as normal or attribute everything to hormones and baby blues that will be fine in no time.
You find yourself crying in the bathroom floor at 3am. You don't understand why you feel as if you hate being a mum. It happens once, twice, then every other night. You have a hunch that this is not right and you confide in a trusted family member or relative.
They tell you not to overthink. They tell you that every other woman experiences this. They tell you to stop talking nonsense.Eventually you chant this mantra to yourself that you are ok, everything is going to be ok.
But is it really ok?
Another commonly heard phrase - be strong. Silvia wishes for mums to know that being strong does not equate to suffering in silence.
"Women suffering in silence, we need to stop this."
Part of being strong means acknowledging that there is a problem and taking the necessary steps to rectifying that problem.
Many mums here are also terrified that their baby will be taken away from them. Silvia assures mums that unless it is a case where there is a serious risk of the mother harming the baby, or a mother is diagnosed with postnatal psychosis, the baby will not be taken away.
RELATED: Postnatal Psychosis
So please, do not fear seeking help. I cannot emphasise this enough. Rest assured, when you speak to a psychiatrist or a therapist, everything is kept confidential unless you pose a threat to yourself or your baby. In such an unfortunate scenario, it's only best for you and your baby that someone trained and in the right position decides what the best course of action is.
Intrusive thoughts are another reason that women are afraid to seek help. Intrusive thoughts are negative, repetitive and scary.
What if I burn the baby while giving her a bath? What if I suddenly drop my baby? What if I accidentally kill my baby? These are examples of intrusive thoughts.
Singaporean mums are afraid that speaking out about these thoughts might land them in the mental hospital.
Silvia wishes to emphasise to all mums in this situation that these intrusive thoughts are extremely common. The very fact that a woman feels disturbed by such thoughts shows that she is healthy. Women need to be able to speak of and manage those intrusive thoughts.
Intrusive thoughts do not necessarily mean that you are suffering from postpartum depression. Most of the time, these thoughts are normal.
Now that you understand why postpartum depression in Singapore is not openly discussed, please, do your part to break this stigma. If you think you are at risk, seek help. When in doubt, it is always best to err on the side of caution.
If you notice that someone else may be in need of help, advise them, convince them, do whatever it takes to make them seek the help that they need.
We need more women who are willing to say, "I've been there and I'm here. You can always talk to me without judgment".
Make them seek the help that they deserve. It is every mum's right to be helped without being judged.
Before we tell you how and where to get help for postpartum depression in Singapore, here are some typical symptoms of the condition:
Symptoms of Postpartum Depression
Contrary to popular belief, postpartum depression symptoms do not only occur shortly after you have given birth. It doesn’t mean that if for the first three months everything seemed fine, you are in the clear.
You can be diagnosed with postpartum depression anytime in the first year after you have given birth. Things can take a dramatic turn when you return to work. Caring for you newborn in the comfort of home with only your newborn to worry about is a challenge. Juggling work and trying to be the best mum that you can to your little one is another challenge altogether.
Here are the symptoms:
Emotional Extremes
Silvia describes that mums suffering from postpartum depression swing between extremes. At times they may find themselves feeling overly emotional. At times they may feel a certain kind of numbness or disconnect, as if they are there but not quite there.
Social isolation
Another symptom listed by Silvia is that of mums cooping themselves up at home. It is not healthy for a mother to be avoiding socialising with her friends.
Of course, when the baby arrives you can expect a woman’s priorities to change. It’s not uncommon for you to occasionally take a rain check on your girls’ night out or Saturday night party.
However, if you notice yourself increasingly moving away from people and not wanting to leave your home, it might be time to seek help. It is never a good idea to hide within the four walls of your home and to refuse interaction.
Changes in appetite
Silvia cautions that mums should not dismiss any change in their appetite, as it is a telltale sign of postpartum depression. Some women completely lose their appetite. The loss of appetite coupled with breastfeeding causes them to lose weight at an unhealthy rate.
While you may expect this to be a happy problem, mums who are suffering from postnatal depression feel worse about themselves when people point out that they have become too thin.
Then there is the other extreme of over eating. Some mums gain more weight than they did during pregnancy due to binge eating caused by postpartum depression. Sometimes they seek comfort in food. Sometimes food is the only thing that lifts their spirits.
Women who land themselves in this situation end up feeling really low. It is difficult enough for most women to deal with their post baby body, let alone a post baby body that goes through binge eating.
Insomnia
Silvia shares that women suffering from postpartum depression also have difficulties falling asleep. If a woman is not sleeping enough, it makes it even harder to cope emotionally.
Feeling Overwhelmed
Mums suffering from postpartum depression have difficulties managing their emotions. They may feel guilty, sad or that everything that is happening is just too much for them to handle.
Some women find themselves getting moody and irritable. They shout, scream and snap at the slightest trigger.
If you find yourself behaving in this manner, don’t tear yourself up with guilt or label yourself as a failure. What you should be doing is taking that step to seek help, stresses Silvia.
Also, if someone that you know is experiencing any of these symptoms, please encourage them to seek help. The last thing you should be doing is making them feel worse by saying unkind things to them.
Treatment Options
The first and most common option for treatment is at the public hospitals. The National University Hospital's (NUH)The Women's Emotional Health Service provides screening and referral services for mums with postpartum depression in Singapore. They also have medical social workers to help in following up. You do not have to be a patient of NUH to engage this service centre.
Similarly, KK Women's and Children's Hospital offers a postnatal depression intervention programme. They too use a screening method to aid in identifying women suffering from postpartum depression in Singapore. They also provide phone follow-ups and counselling services. Again, you do not have to be a patient of the hospital to engage these services.
Advantages of going to a public hospital are that these hospitals see a wide range of such cases on a daily basis and have staff who are specially trained in handling maternal mental health issues. The cost is of course much more affordable and there are subsidies for mums suffering from postpartum depression in Singapore.
The disadvantage of going to a public hospital is that you do not get to choose who attends to your case. Silvia advises that for cases regarding postpartum depression in Singapore, it is important for a woman to get the right fit.
You need to feel comfortable to whom you are talking to in order to be able to open up.
For private practice, you can consider making an appointment with Dr. Calvin Fones or Dr. Adrian Wang. They are well renowned private psychiatrists.
There is a difference between therapists and psychologists. Therapists talk you through the challenges you are facing while psychiatrists are for when medical attention is needed.
There is no hard and fast rule about the order of your treatment. If you want to talk to someone first, then you go to a therapist. If the therapist decides that medication is necessary, she will definitely refer you to a psychiatrist.
If you think that you want a medical opinion first, then go ahead and make an appointment with a psychiatrist. Alternatively, and especially if you want to reduce the cost incurred, go to the polyclinic and see a general practitioner there. They will provide you with a referral if needed.
Psychiatrists are likely to prescribe antidepressants if you need medication. Even if you are breastfeeding, there are certain types of antidepressants that you can still take.
However, please do not assume that medication is the best cure. Silvia cautions that medication is necessary at times but medication is only a temporary solution. It helps to keep you calm and grounded but you need to think about what happens when you are weaned off the medication.
What to expect during a therapy session
The therapist will sit with you and find about you. They are curious to know what you are struggling with and how they can help you. Do not be afraid. Silvia reassures that your therapist will be listening compassionately.
Some therapists use screening tools and assessment methods such as the Edinburgh Postnatal Depression Scale. Some patients find this rather off putting so many therapists these days just prefer to talk.
Typically they want to find out how much support you have or lack for that matter, the family background and so on.
Upon knowing more about you, they will try to put together a treatment plan for you. Silvia says that the prescriptive days are over and these days therapists are consultative and non-judgmental. You are part of the work and your opinions are treated with respect.
And if you’re worried about feeling self-conscious or awkward, Silvia wants you to know that therapists know very well what it is like to be on the other seat.
By talking to you and through therapy, your therapist will aid you to find the best coping mechanisms. He will take you through the process of coping with your feelings, goal setting, ways to solve your problems and guide you on how to respond to situations.
Support groups
Apart from professionals, you can seek solace or find comfort in support groups. Silvia recommends www.postpartum.net postpartumprogress.org and https://www.moremindful.me/mindful-mums/.
For those who prefer face to face contact, here are some options available for mums with postpartum depression in Singapore:
- Association for Women for Action and Research (AWARE). Aware has a phone helpline (1800-774-5935) and they also provide counselling services. For more information, visit their website www.aware.org.sg/.
- Mindful Mums. For all issues pertaining to becoming a mum and motherhood itself, you can turn to their support groups which are free of charge.
Do remember mums, that you cannot solely rely on support groups. Support groups come in handy after you have had yourself diagnosed by a professional. This comes in especially useful to complement or follow up the treatment that you are receiving.
From the expert
Here are three simple things that Silvia has to say to mums experiencing postpartum depression in Singapore:
1. Acknowledge that you are suffering instead of saying that it's normal and that things will get better on their own.
2. Confide in a close friend, family member or relative instead of bottling it all up.
3. Take the first step to get professional support.
Mums, being strong does not mean denying that you need help. There is absolutely nothing wrong in acknowledging that you need help. It is ok not to be ok.
When you seek help, you start to realise that you are never alone. And when you know that you aren't alone, it's half the battle won.
Remember, "The only thing more exhausting than being depressed is pretending you're not."
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