WHEN BABY BLISS TURNS INTO GLOOM

Post­par­tum de­pres­sion, as a re­cent case in TN may have shown, is a se­ri­ous con­di­tion that can cause new moth­ers to ne­glect their child, and in rare cases, even turn vi­o­lent or abusive. Men­tal health ex­perts say there is an acute lack of aware­ness about th

Sunday Express - - SUNDAY STORY - JAYAN­THI PAWAR

One woman started blam­ing her­self for not be­ing a good mother. First, the fam­ily as­sumed it was nor­mal and tried to sup­port her by sleep­ing in the same room just to make sure she did not get phys­i­cally ag­gres­sive, but her de­pres­sion wors­ened. She was treated with med­i­ca­tion

DR MAN­GALA, SCHIZOPHRE­NIA RE­SEARCH FOUN­DA­TION

TWENTY-seven-year-old Uma had been com­plain­ing about ex­pe­ri­enc­ing pain while breast­feed­ing ever since she gave birth to her son a month and a half ago. How­ever, no one in her fam­ily took her com­plaints se­ri­ously. It is al­leged that she fi­nally threw her son into the Velach­ery lake in the wee hours of last Satur­day. Po­lice sus­pect that mount­ing de­pres­sion may have pushed her to this act.

Uma and Venkanna (30), had mi­grated to Chen­nai from Andhra Pradesh five years ago in search of a job. Venkanna found em­ploy­ment at a su­per­mar­ket, while Uma started work­ing at a cloth­ing store. A se­nior po­lice of­fi­cer who con­ducted in­quiries with Uma and mem­bers of the fam­ily said the cou­ple got mar­ried two years ago. “Re­cently, she had a baby and af­ter a few days be­gan com­plain­ing of pain while feed­ing the child. She even told her hus­band to give the baby to her mother to look af­ter but he re­fused and told her to ‘ad­just’. Later, the woman’s sis­ter and mother moved to their house to talk to her about feed­ing the child, but failed,” said the po­lice of­fi­cer. “At one point, a fight blew up and the hus­band ac­cused the wife of be­ing more con­cerned about her health and of ne­glect­ing the child. This added to the mount­ing de­pres­sion which prob­a­bly forced the woman to kill the child,” added the of­fi­cer.

While it is not known if Uma suf­fered from what is known as post­par­tum de­pres­sion (PPD) and if that played a role in her al­leged crime, PPD is a se­ri­ous con­di­tion about which there is lit­tle aware­ness and which can cause new moth­ers to feel anger, frus­tra­tion and great sad­ness which they could ex­press ei­ther through an in­abil­ity to care for the child or even, some­times, vi­o­lence to­wards the child.

Un­for­tu­nately, men­tal health ex­perts say there is an acute lack of aware­ness about post­par­tum de­pres­sion, which lim­its ac­cess to care and sup­port that a woman with PPD needs.

PPD is a com­plex mix of phys­i­cal, emo­tional and be­havioural changes which oc­cur af­ter a woman gives birth. Moth­ers af­fected by post­par­tum de­pres­sion can show im­pair­ments in cog­ni­tive per­for­mance, be­hav­iour dis­tur­bance and at­tach­ment inse­cu­rity. Women may even com­mit sui­cide due to PPD. While doc­tors mainly at­tribute PPD to a hor­monal im­bal­ance in the body af­ter child­birth, some of the other trig­gers of PPD can be painful or com­pli­cated preg­nan­cies, stress, ten­sion with the hus­band or in-laws, fi­nan­cial dif­fi­cul­ties and other health is­sues. Still, most women do show signs of de­pres­sion, but fam­i­lies, due to lack of aware­ness, fail to no­tice or un­der­stand what they are un­der­go­ing.

In fact, even women with PPD can have dif­fi­culty iden­ti­fy­ing the ill­ness. Lawyer Amba Salelkar of the Equals Cen­tre for Pro­mo­tion of So­cial Jus­tice in Chen­nai re­counted her ex­pe­ri­ences with PPD. “Af­ter the baby was born, the in­abil­ity to sleep and other fac­tors, in­clud­ing hor­monal changes, ag­gra­vated my tem­per is­sues. I could feel there were new symp­toms and I was ini­tially blind-sided. It was much lat­ter that I re­alised I had PPD. Of­ten, PPD can be mis­taken as baby blues,” she ex­plained.

“When we stress on the im­por­tance of breast­feed­ing and such, we should also stress that if a woman says she is un­able to breast­feed, she is sup­ported and al­lowed to use for­mula milk in the best in­ter­ests of the mother and child. Doc­tors should cre­ate an at­mo­sphere for women to open up on such is­sues, even if women do not ap­proach them specif­i­cally to dis­cuss these is­sues. Pe­di­a­tri­cians should be roped in to help iden­tify when a woman is go­ing through PPD and in­ter­vene as new moth­ers will def­i­nitely meet pe­di­a­tri­cians,” she added.

Dr R Man­gala of SCARF (Schizophre­nia Re­search Foun­da­tion) in Chen­nai noted that while aware­ness of PPD was in­deed low, the num­ber of such cases seemed fewer com­pared to some other coun­tries, per­haps due to the pres­ence of fam­ily sup­port for new moth­ers in In­dia.

“When a woman has her first child, there is usu­ally fam­ily sup­port to help look af­ter the mother and the child, even if they ex­pe­ri­ence some kind of de­pres­sion. How­ever, there is of­ten less sup­port dur­ing sub­se­quent preg­nan­cies which may cause the signs of PPD to be more pro­nounced,” she said. Fur­ther, women do not ap­proach doc­tors re­gard­ing PPD, the doc­tor said. It is the fam­ily that mostly brought women for treat­ment, that too when they no­ticed changes in be­hav­iour that were un­ac­cept­able, Dr Man­gala pointed out.

In one case, a new mother in Chen­nai, had at­tempted sui­cide and tried to kill her mother af­ter de­vel­op­ing ‘delu­sional guilt’. “This is when the fam­ily brought her for treat­ment. We found she was al­ready be­ing treated for de­pres­sion when she got preg­nant. Also, she had pre­vi­ously un­der­gone a med­i­cal ter­mi­na­tion of preg­nancy (abor­tion). With the fam­ily’s sup­port she was treated with med­i­ca­tion,” she said.

Given the stigma at­tached to seek­ing men­tal health case, there is a long way to go in rais­ing aware­ness about PPD , es­pe­cially in ru­ral ar­eas, doc­tors said. More so, be­cause of the cul­tural im­por­tance we give to the mother-child re­la­tion­ship, which is of­ten ide­alised. This makes it harder for women, bound by so­cial con­straints, to ex­press their feel­ing in In­dia. As they suf­fer in si­lence, without help, many try to harm them­selves.

A city-based gy­ne­col­o­gist de­scribed the symp­toms that fam­ily could no­tice as such: the mother might be­come dull, not feed the baby, not take care of the child, stop eat­ing, throw tantrums, be­come abusive, anx­ious, fear­ful or tense for triv­ial rea­sons. Even if a slight change is no­ticed, they should be taken to a psy­chi­a­trist im­me­di­ately. Doc­tors also noted that the de­pres­sion a new mother may ex­pe­ri­ence rarely be­comes sud­denly ex­treme. Rather, like in the case of any phys­i­cal ill­ness, the de­pres­sion builds up over time. Doc­tors urge fam­i­lies to be alert to even slight changes in be­hav­iour. Of late, doc­tors have started dis­cussing PPD with preg­nant women so they can seek timely help if re­quired. If this be­comes the norm among all doc­tors, aware­ness may en­sure more women are able to ac­cess help. If you are in dis­tress or feel sui­ci­dal, call the Tamil Nadu govern­ment health helpline at 104 or the Sneha Sui­cide helpline at 044-24640050.

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