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Postpartum Depression: New Mothers’ Nightmare

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For certain reasons which do not exclude the strain and stress of labour, new mothers experience varied challenges which include postpartum depression. LEADERSHIP Weekend reports.

On a three-seater sofa is a good-looking, fair, slim woman gazing into space. She is surrounded by four other women. The women who are much older than her are appealing to her to go inside the bedroom and nurse her four-day old baby boy crying his head off. But 28-year-old Mariam does not budge. She is disinterested about everything around her and wants absolutely nothing to do with the new-born.

Mariam has not always been like this. She used to be a bubbly, vivacious young woman who wields a contagious sense of humour. Things have, however, been as this since her return from the hospital three days ago after a rather prolonged labour which eventually produced the baby now being cradled by his grandmother who is trying to force him suck from the feeding bottle.

At a small town in the South-western part of the country, Alake is tied hands and feet. Her mother is carrying a four-week old baby and weeping silently while interjecting her action with small talks to Alake. She is telling Alake to have mercy on her new baby and respond to treatment.

Alake is, however, in her own world muttering inaudible and incoherent words to herself and picking imaginable dirt from her rough hair. She is about to be taken to Baba Onisegun who treated her when she had a similar challenge after her first childbirth. Her husband just stepped out to employ the help of some relatives who will help carry her into the waiting car for onward transfer to Baba where they believe she will be normal again.

The Yoruba call Alake’s ailment “Abisiwin” which literally translates into “madness after childbirth”. The Igbo call it “Obi ida mba” and to the Hausa it is called “Matsanancin ciki”

Hafsat, a mother of two, who resides in the nation’s capital, went into depression after childbirth. And it took a horrendous effort from family and friends before she recovered. Today, she tells her story.

The middle-aged Hafsat takes LEADERSHIP Weekend correspondent down memory lane. Her story.

“After suffering a heart-breaking miscarriage, four years ago and discovering that God has finally answered my prayers a year after, there were no words to describe the excitement as we anxiously awaited the birth of our little baby.

Hafsat told correspondent. “Though there were times we had fears, we put our trust in God. At the third trimester, my husband, a businessman, decided to limit his travels to avoid any unforeseen situation. The baby arrived and we were flooded with joy and gratitude to God that one would think we had waited years to conceive.

‘‘I had a normal delivery and was discharged, and from there the unpleasant journey began. Weeks later I would get angry and nag over nothing. Sometimes I found myself crying for no reason and to make it worse, I didn’t have enough sleep. I didn’t know what got over me then. Sometimes, when my baby was hungry and crying, I would refuse to breastfeed her and preferred lying down pretending to be asleep until my husband or sister carried and gave her to me,’’ she recounted.

She went further to say that she lost her biological mother a few years before her marriage, and she believed that the experience would have been less if she was alive.

She added that her mother in-law was not strong enough to tend to her due to old age.

Did she seek medical help our correspondent asked.

“Then I didn’t see it as a mental sickness, because I spoke to a nurse at the hospital and all she could say was that, I was yet to adjust into motherhood and the responsibilities that come with it. But she assured me that it would pass. I remember her telling me to ensure I take my drugs,” Hafsat answered.

This nightmare, she told LEADERSHIP Weekend continued for weeks or a month, before it ended.

‘‘I got to know that what I went through after the birth of my first daughter is termed postpartum depression. About a year ago when I stumbled on a write-up online, I read through and discovered I was in a difficult place and till today it remains a miracle how I survived it, because I have read of women who couldn’t pull through and have also spoken to some who overcame and are looking out for possible signs in the future’’.

She added, ‘‘Luckily for me, I did not have a re-occurrence after the second delivery and in case I do, I will not hesitate to seek professional help’’.

According to the President, Postpartum Support Network (PSN) Africa, Dr. Onyedikachi Ekwerike, sufferers of postpartum depression, who fail to receive treatment are most likely to develop postpartum psychosis, which puts their lives and that of their babies at risk. A woman that is down with postpartum psychosis faces the risk of committing suicide and infanticide. Ekwerike said it was necessary for the Federal Government to employ psychologists in public hospitals to provide medical assistance to pregnant women and nursing mothers, stressing that the continuous increase in the number of women living with the condition and the number of untreated cases put mothers and children at constant risk of death by suicide.

Ekwerike, a clinical psychologist, lamented that the absence of psychologists in government-owned hospitals was greatly affecting the level of awareness and care given to sufferers of postpartum depression.

“What the Federal Government through the Ministry of Health should be doing to address postpartum depression is to employ psychologists in government hospitals as we do not have psychologists in our public hospitals and those available in psychiatric hospitals are just a handful.

Also shedding some light on post-natal depression, Chief Executive Officer of Ninekay Maternity, and founder of First Time Mums Academy, Mrs. Nkem Adediran-Adedokun said, “The condition can be minor and fade away within the first two weeks post-delivery, while severe ones will require medical attention. Adediran-Adedokun said those afflicted with the ailment also suffer “from headaches, crankiness, anger for no specific reason, crying, shouting, regrets and sudden irritation when their spouses come close, thinking that what is happening is caused by their husbands or babies.

“Sometimes, people with this condition feel like running away and refusing to breastfeed their babies as a form of punishment. However,  it is normal to experience two or three of these signs immediately after delivery because of loss of sleep, delayed breast milk flow, sudden change of normal routine,” she added.

Adediran-Adedokun said that if not well managed, the condition could even reduce or stop the new mother from lactating.

She said: “Every new mom has her own experience. For instance, in my first two pregnancies, I felt fat and unattractive. I was always cranky and angry for no reason. I wanted more out of everything. I was tired at work and exhausted coming home to care for my three-year-old and an infant, and to go to work the next day. There were days I just wanted to run away or even be sick, so I can be admitted in the hospital so that I will be the one being taken care of. This is not to scare you but to make you aware of this possibility and work towards preventing or controlling it.”

She continued: “To handle this situation before the baby comes, you have to start by organising all those things around you that constitute additional stress; get someone who will assist you when you deliver; organise your home- from food to sanitary materials, and then get at least 90 per cent ready two weeks to your Expected Delivery Date (EDD).

“It is very important to get adequate rest and you have to be selfish about it; relax physically, emotionally and mentally before delivery. Ensure your hospital bag is packed at 36 weeks; treat yourself to a fun photo-shoot and massage; go to a professional spa that can handle a pregnant woman; go out with your friends; just be determined to have fun,” she said.

“Then when baby comes, try not to get worked up because lack of sleep will make you cranky and may even cause a fever. This is normal and will pass if you have a clear mindset; be determined to come out strong and filter all the advices and recommendations that will be flying in if you get confused,” she said.

Adediran-Adedokun advised new mothers to “find time to sleep, and if there is help, they should express breast milk and allow their mothers, mother in-laws or nannies to feed their babies while they catch some sleep as lack of sleep increases the likelihood of getting depressed after childbirth. Women should also learn to take things one at a time and not allow anyone put them under undue pressure. Importantly, they should work at getting back their shapes by adopting a healthy lifestyle, and involve their spouses, to help rock baby to sleep, especially at night.

“Finally, new mothers should not be shy or afraid to seek medical or professional help. They should understand that this situation is not peculiar to them, and does not make them any less women or mothers but brave mothers, who want the best for themselves and their babies’’

Dr Joy Malle Dogo, a medical practitioner and registrar at the Jos University Teaching Hospital  says that the birth of a new baby is a major developmental transition as it affects not only the woman, but also her entire family.

“It is a serious public health concern and is associated with numerous medical and psycho-social problems in both mother and child. The cause of PPD is unknown.”

However, the level of oestrogen and progesterone in a pregnant woman’s body is usually very high, and a sudden drop to normalcy after childbirth doesn’t leave some women the same.

Indicators of PPD he says are mostly the loss of appetite, eating way more than usual, overwhelming fatigue, reduced interest in activities enjoyed before birth, insomnia or excessive sleeping, severe mood swing, intense irritability, anger, panic attacks, feelings of guilt, inadequacy which tends to lead to excessive crying, difficulty bonding with the baby, thoughts of self-harm and thoughts of harming the baby.

He said, ‘‘Although moms are the ones who mostly suffer from PPD, everyone around them can get affected, which is why it is advised that they get help as soon as possible’’.

Dogo said that mothers, should reduce stressful activities before and after birth, and for those who have a history of postpartum depression or have a loved one who does, he advised they inform their doctors for treatment, monitoring during pregnancy and therapy in some cases. “The earlier it is detected, the earlier treatment can begin. Postpartum depression also leads to increased costs of medical care, inappropriate medical care and discontinuation of breastfeeding,” he added.

A psychologist, Solomon Dapal, explained that PPD isn’t a character flaw or a weakness as the society paints it but rather a complication experienced after delivery. The feeling he added, doesn’t make the mother a bad person, neither does it make her less of a woman. ‘‘I always encourage people to watch out for each other because when they do, there is tendency of noticing a change in character in a person, especially in new mothers. We as a society that is quick to judge these women need to understand that they may not know that they’re depressed. The right thing to do, when we notice a change in behaviour, is to help and encourage them to seek medical attention immediately. Delay is dangerous, we should not wait, hoping for improvement because things might get out of hand if not addressed with urgency. Getting help and treatment will make one heal faster and feeling awesome in no time’’.

Counselling, he said, is the best medicine but it has to be with a professional in the field, where they can talk about their concerns, and general wellbeing without holding back or feeling judged. Having people who can share their feelings and experiences may also help them feel better.

Speaking further, he said, PPD usually disturbs the attachment and bonding between mother and child by affecting the infant’s development. If it remains untreated, such women are unlikely to be responsive to intervention over time and it goes as far as affecting family relationship thus, leading to neglect, child abuse, frequent disagreement, divorce and violence.

“With proper action, the symptoms usually improve and, in some cases, it grows to become chronic depression. It is important for a survivor to continue treatment, even after better because a stop, too early may lead to a relapse.’’

Based on random questions posed by correspondents to both young and older women, findings revealed that, only a small number of older women know of the existence of the ailment while younger women, who are aware of it, got to read about it online, and do not have an in-depth knowledge.

According to Mentally Aware Nigeria Initiatives (MANI), when postpartum depression is severe and sufferer experiences postpartum psychosis, electroconvulsive therapy (ECT) may be recommended if symptoms do not respond to medication.

ECT is a procedure in which small electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reduce the symptoms of psychosis and depression, especially when other treatments have been unsuccessful. Treatment for postpartum psychosis can challenge a mother’s ability to breastfeed. Separation from the baby makes breastfeeding difficult, and some medications used to treat postpartum psychosis aren’t recommended for women who are breastfeeding.

Postpartum Depression is prevalent on one out of seven women in Nigeria.

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