16 HEALTH Post­par­tum de­pres­sion isn’t just in women’s heads

Weekly Trust - - News - Judd-Leonard Okafor

Grace Ajuma has had three chil­dren, and the third time wasn’t merry. The sep­a­ra­tion of the new in­fant from her body brought on some­thing known as the baby blues-the feel­ing of mood­i­ness and un­hap­pi­ness that makes new moth­ers want to cry af­ter hav­ing a baby.

But it was more than just the blues. “I hated my­self, my child. I kept feel­ing like I wasn’t do­ing enough,” the mother of three re­calls.

“My whole life had changed in the twin­kle of an eye. I be­came re­spon­si­ble for some­one and that some­one de­fined all that con­cerned my life.

“My child de­cided when I would sleep, wake up, and eat, when I go out, where I go too. My time and how I spent it, re­volved around him. It was like I was go­ing nuts.”

She couldn’t talk to any­one about her state of mind, not even her mother. But she went back to the pri­vate clinic where she had given birth and sat down with her doc­tor.

“He was the one who told me I was suf­fer­ing from post­par­tum de­pres­sion,” Ajuma says of the mo­ment she was di­ag­nosed with PPD.

“But he couldn’t help me be­cause he is not a psy­chol­o­gist; he just ad­vised that I shake it off.”

Therein lies the dif­fi­cult part. Many women at­tend­ing an­te­na­tal clinic get told about post­par­tum de­pres­sion, but noth­ing re­ally pre­pares them for when the con­di­tion ac­tu­ally hits. As with many men­tal health prob­lems, the heights and lows of PPD are not well un­der­stood or com­mu­ni­cated.

“The ques­tion now was, how do I shake it off, it was so bur­den­ing that I con­tem­plated tak­ing my own life.”

Her con­clu­sion today is that PPD is real, not just a con­di­tion that’s all in the mind. By hind­sight, med­i­cal work­ers know it is com­mon among women who end up with de­pres­sion, says clin­i­cal psy­chol­o­gist Dr Sa­muel Ji­nadu, who deals in men­tal health.

“Most women who have de­pres­sion later in life are most likely to have had post­par­tum de­pres­sion which wasn’t treated.”

PPD risk lies in three fac­tors: hor­mones, stress and so­cial en­vi­ron­ment. They are the biopsy­choso­cial fac­tors that de­ter­mine whether a woman could come down with de­pres­sion, says Ji­nadu.

It be­gins from preg­nancy. When a woman is preg­nant, her body is flooded nat­u­rally with hor­mones that pre­pares her to go the nine-month haul car­ry­ing an­other life in­side her.

“The hor­mones and ev­ery­thing ad­just them­selves to ac­com­mo­date the baby,” ex­plains Ji­nadu. “Af­ter child­birth, there is a sig­nif­i­cant drop, an im­bal­ance. Such changes can trig­ger the hor­mone im­bal­ance in the sys­tem.”

The hor­mone flood dry­ing up af­ter a baby’s birth is the bi­o­log­i­cal fac­tor. Psy­cho­log­i­cal fac­tors in­clude stress.

“You have been liv­ing a life, car­ry­ing a baby, and sud­denly the baby is not there,” says Ji­nadu. “You are hav­ing a new role to play as a mother, breast­feed­ing, tak­ing care of the baby and all that. That’s a big stress.”

On the so­cial front, the sort of so­cial net­work and sup­port around a woman count, and com­bined with the other fac­tors, their ab­sence in­crease the prob­a­bil­ity of her com­ing down with PPD, says Ji­nadu.

Hal­ima Adamu’s child turns one this Fe­bru­ary. She re­calls feel­ing re­lief she mo­ment her baby came out of her, fol­lowed by a deep feel­ing of in­stant loss.

“I would look at him and ask my­self, did I re­ally just give birth to that?” In the com­ing weeks of baby blues, her life changed. Long days of bat­tling fa­tigue and nights bat­tling a cry­ing in­fant.

“I re­gret­ted hav­ing my baby, and it was a baby I al­ways wanted. I didn’t un­der­stand what was wrong with me. I would just sit and cry. My mother was on ma­ter­nity visit then, and she would talk to me, tell me to not think neg­a­tive thoughts. Maybe it was just the blues, but I am much bet­ter now,” Adamu says.

First-time mother Eloho Roy had more than just the blues, and got even more scared when she lost her ap­petite for food.

“I thought I was go­ing to die, I felt my world was crum­bling and com­ing to an end. I didn’t hate my child but felt he changed my life. I cried un­con­trol­lably, my emo­tions be­came a roller coaster,” Roy re­calls.

“The most an­noy­ing part of it all was that, when I tried talk­ing to old moth­ers of what I was ex­pe­ri­enc­ing, they sim­ply said, it’s nor­mal, you will get over it. But sin­cerely, it didn’t feel nor­mal, I felt like I was go­ing to lose it one day.

“Some­times I thought I wasn’t do­ing enough for my child, not feed­ing him well and not be­ing a good mother. It be­came so bad I started with­draw­ing from my re­spon­si­bil­i­ties and push­ing them to my mum. I didn’t want to carry him and feed him be­cause I had to.

“It was a try­ing time for me, till I met a friend who had the same ex­pe­ri­ence, she told me how she over­came it and ad­vised that I avoid alone times. She said I should min­gle with peo­ple, go out, join ac­tiv­i­ties in church and gen­er­ally keep my­self busy. That it helped her a lot. I heeded her ad­vice and sin­cerely I have started see­ing the changes. I am cur­rently learn­ing to drive, some­thing I had con­sis­tently pro­cras­ti­nated.”

Three ex­perts found sig­nif­i­cant ev­i­dence that women who have given birth had more chances of de­pres­sion than women who haven’t.

Their re­search di­ag­nosed de­pres­sion in 128 post­par­tum women, com­pared with 55 non-post­par­tum women, they re­ported in the In­ter­na­tional Jour­nal of Psy­chi­a­try and Clin­i­cal Prac­tice.

In gen­eral pop­u­la­tion, up to four in 20 women could suf­fer de­pres­sion of any sort. Among those four, a large num­ber may have ex­pe­ri­enced PPD or child­birth may have trig­gered some form of men­tal health is­sue, ex­perts say.

PPD is only among a range of de­pres­sive dis­or­ders, but it strikes af­ter a woman gives birth-hence the name post­par­tum (af­ter birth). It strikes men too-oh, yes it ab­so­lutely does.

And it has also been dif­fi­cult to di­ag­nose in some cases. A sep­a­rate hos­pi­tal study in­volv­ing 72 ob­stet­ric staff, in­clud­ing mid­wives and doc­tors, backs the find­ings.

At least 43% of the staff ad­mit­ted “dif­fi­cult to rec­og­nize PPD” and 19% of them doubted their ob­stet­ric team’s abil­ity to man­age it, the re­searchers re­ported in the East Africa Med­i­cal Jour­nal.

Nearly nine in 10 of them would rather re­fer PPD cases to a psy­chi­a­trist, but saw stigma as a mil­i­tat­ing fac­tor.

Get­ting help is im­por­tant. Psy­chol­o­gists use the biopsy­choso­cial treat­ment model which con­sid­ers how dif­fer­ent fac­tors re­spon­si­ble for PPD.

“If there are bi­o­log­i­cal fac­tors, we use med­i­ca­tion; if there are psy­cho­log­i­cal fac­tors, we use psy­chother­apy; if there are so­cial fac­tors, we use fam­ily ther­apy or cou­ples’ ther­apy,” says Ji­nadu. “We com­bine biopsy­chosoical mod­els for treat­ment and it has been very ef­fec­tive.”

Re­search is help­ing to sim­plify di­ag­no­sis of PPD to the point where a sim­ple blood test can pre­dict a woman’s risk of de­vel­op­ing the con­di­tion.

One is based on the level of a hor­mone, known as cor­ti­cotropin-re­leas­ing hor­mone, pro­duced by the pla­centa (the bag that holds the baby) around the 25th week of preg­nancy.

Us­ing a blood test, re­searchers in a study cor­rectly iden­ti­fied 75% of women who had fu­ture PPD symp­toms, ac­cord­ing to find­ings pub­lished in the Ar­chives of Gen­eral Psy­chi­a­try.

Ajuma didn’t see it com­ing, even with her third preg­nancy and third baby. “I cried when he cried, I couldn’t just control my emo­tions any­more. It was a very hard time for me, un­til one day I looked at my child, thought of how I had longed for him and how much I loved him. Then I de­cided to help my­self,” she re­mem­bers.

“I started go­ing out, do­ing things to shape both me and my child’s time, I talked more and did things that would make me laugh more. It wasn’t easy, but I over­came it.

“I think nurs­ing moth­ers, es­pe­cially first time mums, should be ed­u­cated on post­par­tum de­pres­sion and its ef­fects. The hos­pi­tals dur­ing an­te­na­tal can use the medium to preach it. In short I don’t know if there is pro­vi­sion for psy­chol­o­gists in Nige­ria who could help moth­ers, be­cause it is a se­ri­ous is­sue and should be treated as such.”

Post­par­tum de­pres­sion is more than just ‘baby blues’.

“I hated my­self and my child and I cried when he cried.” The un­seen pain of women with post­par­tum de­pres­sion.

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