(If you know someone or are personally dealing with postpartum mental health issues, know that you are not alone. Reach out to the NIMHANS Perinatal Mental Health Helpline - 8105711277 )
When Nami, a 32-year-old medical professional gave birth to a baby on 11 March, little did she know that the world would come to a standstill a few days later.
By mid-March, COVID-19 had begun springing up in conversation in India, and fears of this strange, new virus were taking over. On 22 March, PM Modi announced a Janta Curfew, and what would then be the beginning of an almost 7-month lockdown.
Dr Uma Vaidyanathan, a senior consultant of Obstetrics and Gynaecology at Fortis Hospital, New Delhi, adds, that the atmosphere had changed - “Deliveries are a joyful occasion, but everything had and still has mellowed.”
Nami and her husband, both from the medical fraternity, made a routine visit to the doctor and were told they had to have an emergency C-section.
Once they were discharged from the hospital is when the reality of the lockdown began to hit home. “I had planned to ask my mom to stay with us, but now told her not to come and I didn’t see my family - my father or brother. It was very, very hard.”
Nami is a meticulous planner and, like any new mom, she had plans for her baby’s life at home. Instead, she went home to no mom, no domestic help, no cook, no massage lady for the baby. Still, she wasn't completely alone and she and her husband moved to her mother-in-law's house. “We had to leave our baby crib at home, it was a lot of changes for a first-time mom.”
“This lockdown is tough for everyone,” adds Dr Uma, “people have financial stresses, worried about the virus and you are all alone. I call it not only social but emotional distancing as well.”
In fact, according to this study from India, “pandemics, including COVID-19, have been shown to have major effects on mental health resulting in anxiety, depression and high-stress level.”
“No one understood how I was feeling. Even I didn’t and I didn't know why!” adds Nami. But she knew something was wrong, “I felt shitty.”
Dr Uma says that most new mothers experience something called the “baby blues,” where moods fluctuate, you feel exhausted, anxious and overwhelmed. But if this jumble of emotions extends beyond a few weeks, the new mom may have postpartum mental health issues.
There are various postpartum health issues, for example, postpartum psychosis which Dr Uma says is a serious mental illness characterised by hallucinations, sleep issues, anger. Others include postpartum PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder),
Dr Ruksheda Syeda, a psychiatrist from Mumbai, adds that the most common ones are “postpartum depression and postpartum anxiety.”
These issues are common for most mothers, and according to WebMd, almost 1 in 8- women have them. Dr Syeda adds that genetic vulnerability to mental health issues, perinatal depression, hormonal vulnerability and other risk factors like the fears and anxieties associated with a global pandemic can up the chances of postpartum depression. “Often the younger the age, the more the kids, the lack of social support, and the ambivalence of the new mom towards having children, higher the chances of postpartum,” adds Dr Uma, “Besides hormonal changes from childbirth, lack of sleep, anxiety and loss of self-image contribute towards postpartum depression too.”
Dr Uma says that they ask the mom a few questions, and depending on the answer diagnose her and refer her to a psychiatrist who can provide therapy or medications. The point to note is that postpartum mental health issues are treatable.
Some questions can be:
Dr Ruksheda Syeda, adds that since general mental health awareness in India is still burgeoning, many people don’t recognise the signs. “A lot of these feelings can start during the pregnancy, what is known as perinatal depression.”
Awareness of postpartum is rising now, but for a lot of older parents, feeling low or anxious or not-quite-yourself was a way of life after having kids.
Nami adds that parents often don’t understand, but she knew something was wrong within herself, she just couldn't figure out what. “Being from a medical background, I KNOW about postpartum issues, but when it's you going through it, it’s hard to join the dots.”
A new mom is also suddenly juggling a million little things. A lockdown adds a huge burden.
Dr Ruksheda adds that symptom of postpartum is cognitive distortion, where you feel like you are alone when the reality is quite different.
It’s hard to be self-aware when you are always busy, exhausted and have no time for yourself. Still, Nami started reading up about it to get out of feeling “constantly shitty.”
Dr Syeda adds that the 9 month bond between the mother and the baby changes once you deliver. “Simplistically, it’s like making a virtual friend and meeting them in real life. There will be a slight adjustment so allow time for that.”
Once her baby smiled though, Nami told me she started making more of an effort to feel better and like herself again. “I made a Whatsapp chat with myself, where I write notes to myself, I told myself I was in control of my reactions to situations that were out of my control. That helped, and I understood I can’t keep pushing myself down this path.”
Dr Uma says that generally, postpartum treatment depends on how severe the symptoms and “include a combination of antidepressant medication, psychological counselling, or support groups.” For Nami, the latter worked.
It's often hard to ask for help, and Nami found it difficult to reach out to friends too. That’s where her partner stepped in. “At first no one knew what was happening with me, even I didn't. But slowly my husband understood and he messaged my friends and asked them to reach out to me since I wasn't.”
Dr Syeda adds that good spousal support is the number one protective feature. “It’s so, so important to have a partner who supports you psychologically, emotionally and physically. In the lockdown, I have seen a lot of exhausted moms with postpartum because suddenly they have a whole lot of house chores to do as well. Their partners need to step in and help out.”
Another big change in Nami’s life was the eventual Unlock.
Nami adds that she began working from home a little again, and started talking to counsellor friends who then introduced her to mom groups on Whatsapp and Facebook. “I became friends with people from around the world. You need people around you. Talking to other people in similar situations helps you realise you are not alone - that is huge. The moment you realise that, half the battle is won.”
Mom groups are a pillar of support to many women, where women discuss issues they often don’t have space to outside. Nami says women vent, forge friendships, offer advice and are generally aware, supportive and understanding. It’s also easy because many of the women don't know each other outside of the virtual world and “it’s easier to share because you are not afraid of being judged - you don’t know them,” adds Nami.
With growing confidence, Nami realised that she had a lot of people backing her and slowly, she began trusting other people with her baby and letting go. “I realised no one is going to put my child in harm's way. See, now I am talking to you for an hour and my mother-in-law has the baby and I’m fine!” she added.
She began to accept help and her family began to adjust too.
When I mention she pulled herself out of the hole, she says she did so with a support system that stood firmly by her. Still, the first step was all hers.
“I realised I needed to take time out for myself, time to talk and not rush the process of getting better. It still comes up, but now I know and having this insight makes a huge difference.” Nami said she started working from home for a couple of hours in the morning and has adapted to her own new normal.
There’s this new person, totally dependent on you at any time, you had hormones running on high and they are not fluctuating, and now its a lockdown. Everyone is having a tough time in 2020, but for new moms, the stress is astronomical.
There is nothing wrong with asking for help, Nami reiterates. “It really shouldn't be a taboo. You can’t do it alone. But what I want is empathy, I’m not someone bechara.”
Dr Syeda adds that it is important to remember that your identity as an individual continues - but you are a parent too, and it’s prudent to balance both. “I always like to take flowers for the new mom. They are always getting gifts for their baby, but if you know a new mom, remember to make time for just them as well.”
Taking time for self-care needs to be a priority too. Dr Syeda tells me that as a society we have to understand that women are just that - women. “Not goddesses or superhero. This expectation is imposed by society and then the self.” Nami agrees and realises that once she relaxed her expectations and took time for herself, things became better. “I started to enjoy cooking. I started dressing up my baby and doing creative photoshoots. My husband and I took our first independent drive - sans baby - in October, almost 7 months after I delivered.”
“It’s impractical to be self-sacrificial. It’s good for you AND the baby if you take care of yourself,” reminds Dr Syeda.
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Published: 28 Oct 2020,07:24 PM IST