Postpartum depression (PPD) is a mental condition that can affect women after giving birth. Research suggests that one in ten women is affected by PPD [1] with symptoms ranging from insomnia, lack of appetite, irritability, extreme sadness, anxiety and suicidal tendencies. These symptoms vary in their onset, duration and severity. Integrating maternal mental health into postpartum health care is critical in providing psychosocial support for women who are prone to this condition. How well a woman deals with PPD depends greatly on her social, emotional as well as physical environment and impacts on her transition into the new role of motherhood.
The effects of PPD are not limited to the mother. The newborn, other family members and society as a whole are also affected by extension. Where the mother is unable to breastfeed or to produce enough milk, the infant’s health, growth and cognitive development are at risk. The mother and baby are unable to bond. The mother’s poor nutrition, as a result of appetite loss or comfort eating, can lead to increased risks of diseases such as anemia, malnutrition or obesity and hypertension. The family can be affected through neglect of family duties and financial strain due to the treatment costs for PPD and low productivity at work.
Causes of PPD
While the cause of PPD remains unknown, it is linked to changes that women go through after delivery. These changes include having to juggle a constantly crying baby, painful and cracked nipples, a painful delivery wound (where a caesarian section or an episiotomy was performed), inadequate breast milk, demands from other family members and sleepless nights, among others. The constant fatigue and stress can slowly lead to depression. PPD can progress to postpartum psychosis if not treated in time.
PPD can be triggered by a variety of factors as these two examples demonstrate.
Samoina, a young mother, described her experience with PPD in an article published in the Daily Nation newspaper. She lost her job when she fell pregnant, soon after leaving university. She felt she had failed in life because of the loss of her livelihood. This coupled with a baby she was unprepared for, drove her to feelings of dejection, self-pity and anger. Every attempt to bond with the baby drew her further away. The built-up anger led to her physically assaulting her five-month old baby. Fortunately, she found information from the internet about PPD and as a result she sought counselling.
PPD symptoms can recur if not addressed, as demonstrated in the second story. Dorcas tells the story of how she struggled with PPD through her two deliveries. The isolation in her home environment after each birth triggered her depressive state. With support from her husband and community, she was able to overcome her feelings of depression. The story illustrates the environment’s influence in triggering PPD. Making changes to the home environment can make a difference in how women handle the challenges they face with the new status of motherhood.
What can be done about PPD?
“It’s all starts with self-help,” Nairobi-based obstetrician and gynecologist, Dr. Sang says about remedies for PPD. “Talk to someone…when such feelings creep in, always talk to a close relative or friend and explain what it is you are going through. In addition, make time for yourself to do what you enjoy. Get enough time to rest and sleep and always eat [healthily],” he added. In some cases, counselling as well as antidepressant medication are other ways to treat postpartum depression”.
Research evidence shows that support offered to a mother during pregnancy, at birth and after birth is critical to the health and nutrition of the mother and newborn. APHRC research on improving maternal infant and young child nutrition through home-based counselling in rural and urban settings, has shown that mothers go through many psycho-social challenges that influence their child care practices. Progress has been made in increasing support for mothers at the community level through use of community health volunteers, health visitors and peer counselors, but much still needs to be done at the facility level [2] to offer comprehensive postnatal care that includes psycho-social support according to recommendations from the World Health Organization (WHO) [3].
The WHO guidelines offer 12 recommendations focused on postnatal care for mothers and newborns in resource-limited settings. The guidelines address the timing, number and place for offering postnatal care and the content of postnatal care for mothers and newborns during the six weeks after birth [3]. The guidelines are structured for use by healthcare professionals including physicians, nurses and midwives at primary healthcare level.
After delivery, women tend to get plenty of advice on how to take care of their newborns and much less on how to deal with their changing emotional and psychological state. In order to enable mothers to transition successfully into their new roles, they need support at all levels. Psycho-social support and advice should be a key component at every postnatal visit, as the WHO recommends. This will not only improve maternal mental health, it will also have far reaching effects on infant health and the survival of future generations.
References:
- T. Azale, A. Fekadu, and C. Hanlon, “Treatment gap and help-seeking for postpartum depression in a rural African setting,” BMC Psychiatry, vol. 16, no. 1, p. 196, 2016.
- C. E. Warren, T. Abuya, L. Kanya, F. Obare, R. Njuki, M. Temmerman, and B. Bellows, “A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya.,” BMC Pregnancy Childbirth, vol. 15, p. 153, 2015.
- World Health Organization, “Postnatal care of the mother and newborn 2013,” 2013.