P is for Postpartum Depression
By Malika Noor Mehta
Tina* was 33 when she gave birth to a beautiful baby boy, Kabir*. She had been married to her husband, Akash*, for 3 years and this was their first child. They were excited. Elated. They were ready to be parents. Tina, in particular, was ready to take on the highs and lows of parenthood, to adjust her routine to accommodate the baby’s feeding and sleep schedule, and to take time off work to ensure she was present for her child. Tina knew that she had the support of Akash, her family and a night nurse, and never worried about how she would handle this wonderful new addition to her life. In fact, Tina had proactively chalked out of a 3-month plan for herself with her therapist, someone she had been seeing consistently for 2 years because of chronic depression.
Tina had always been open to seeking help from mental health professionals. When she began experiencing mood swings, fatigue and insomnia in her early 20s, she used social media as well as friends and family connections to search for mental health professionals, clinics and self-help tools. When it came to identifying a steady therapist, Tina remained persistent and open to the longevity of the process. She cycled through 6 therapists before finally finding someone who matched her personality and understood her communication style.
A combination of self-help tools such as meditation, regular exercise, healthy eating, and schedule setting, alongside consistent Cognitive Behavioral Therapy, helped Tina manage her depression. Tina also saw a psychiatrist upon the recommendation of her therapist in order to ensure she had a network of professionals around her who could help with her depression if she needed it. She did not fear taking medication and felt open to the possibility if required.
In all regards, Tina was prepared for Kabir’s arrival. Yet, somehow, post her pregnancy, she felt like the ground had caved in beneath her, and she was in a never-ending free-fall. This, she said, was what Postpartum Depression (PPD) felt like.
Postpartum Depression (PPD) occurs at different levels of severity. A mother might experience “baby blues” after giving birth. This commonly includes difficulty sleeping, low moods, and general anxiety. Baby blues begin a few days after delivery and generally last up to two weeks. PPD, however, is a longer-lasting, more severe form of depression. It involves mood swings, excessive crying, a possible loss of appetite, difficulty connecting with your baby, withdrawing from social situations, insomnia or too much sleeping, severe fatigue, irritability, and fear of being a bad mother (among the many symptoms and sensations). PPD can also lead to a rare condition cause Postpartum Psychosis (PPP), which develops within the first week of delivery. Here, the symptoms are much more serious and include disorientation, hallucinations and delusions, insomnia, paranoia, attempts at self-harm, and obsessions about the baby.
Tina described Postpartum Depression as nothing she had ever felt before because it was linked, inextricably, to her child. A little being she cherished more than anyone else in the world. Yet, tied to this love was also a feeling of being a failure. Despite her immense preparation and multiple support systems, Tina still felt like she could not handle the unpredictability of a baby. The constant, inconsolable crying. The need for breastfeeding at regular intervals, and Kabir’s occasional inability to latch on. The lack of a sleep schedule; Tina was scared something might happen to Kabir while he was asleep, so even when he slept, Tina remained awake, worrying.
This constant anxiety clouded Tina’s judgment. She grew irritable with Akash and her family. At times she wanted them gone, but then felt alone when they took her words literally and left for some time. Occasionally, she wished Akash could handle the feeding but then felt guilty when Akash or the nurse fed Kabir from a bottle. At times, she craved a regular work schedule and felt frustrated that her career was on hold even though she had planned on this break with the full support of her supervisors and colleagues. Tina’s emotions oscillated constantly. The dramatic highs and lows drained her of energy. She felt like she was spiralling.
What I found so fascinating and critical about Tina’s story was how she prepared herself for Postpartum Depression and understood that her history of depression might indeed become a risk factor for her.
She educated herself, remained acutely aware, and was proactive in creating systems around her before the birth of her child so that she was fully equipped to handle whatever came her way.
This preparation did not fix the condition, but it certainly did lessen the severity of the issue and helped Tina recover quicker. One of the most important mediating factors in Tina’s management structure was her support system. Akash and their extended family understood PPD as much as Tina did (because she asked them to read and learn about it actively). Therefore, when Tina experienced mood swings, her family understood the possible cause and remained deeply empathetic. In particular, Akash ensured that he took paternity leave to not only care for his new baby but to also ensure that he supported his wife’s mental health. There was a deep sense of equality and responsibility permeating through the language and tone of our discussions; Akash felt the need to be equally present, aware, and thoughtful about child-care in all regards. This included PPD.
Another factor that lessened the severity of PPD for Tina was her active approach to therapy. She was lucky to have the financial means to access both, a psychologist and a psychiatrist. When she began to feel low after the delivery, she reached out to both professionals and was put on a regulated and short-term medication plan. It was monitored weekly and adjusted according to Tina’s requirements. Tina’s lack of fear around the topic of medication was a critical factor in her management of PPD. So long as the mental health professionals could explain why the medication was required in a detailed and thoughtful way, Tina remained open to taking them. Akash also made sure to educate himself about his wife’s medication to ensure he understood the reason for each medication, the time period for which it was prescribed, and any possible side effects.
Approximately three months after Kabir’s birth, Tina began to feel better. Her constant anxiety about Kabir’s safety diminished to what she describes as a “normal” amount of concern that any parent would feel. She was able to sleep through the night with the help of a night nurse who ensured Kabir was fed and taken care of at night. Tina even began to do part-time, remote work in the afternoons because she felt that she could balance both, child-care and a bit of work (the plan was to go back to work after 6-month maternity leave. Akash took a 3-month paternity leave). She began to feel more balanced and happy, and could more fully enjoy the wonders of parenthood now. Tina continued to see her therapist regularly but eventually weaned herself off the medication with the help of her psychiatrist.
Of course, Akash and Tina are, by no means, a regular couple. Not only are they financially well off, but they are also deeply aware of their mental health, and very open to seeking help. None of this is typical, especially in India. Yet, Tina and Akash are a wonderful example of mental health management and what it takes to get through something like Postpartum Depression. They demonstrate the need for a community-based approach to the condition – tackling it through both, self-help (such as exercise, sleep and health eating), but also through external help (family, therapists). They also exemplify the importance of asking for help, and not falling prey to social stigma around the topic of mental well-being.
*All names have been changed to protect the identity of the family.
About the author
Malika Noor Mehta is a mental health entrepreneur. Before the pandemic, she was engaged in creating a fellowship program that placed mental health counsellors in low-cost schools in Mumbai. Her interest in mental health stems from her teaching experience at Teach for India and her time in Jordan and Greece, creating trauma-sensitive education programs for Syrian refugees. She holds a Master in Public Policy from the Harvard Kennedy School of Government. In her free time, she loves to write and take photographs.