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For some women, the stork also delivers the blues

Singapore — Being around her 10-month-old son is the best part of Ms Stacie Henson’s day, but it was not always this way. The maternal bond had not come naturally to the first-time mother, who had recurring thoughts of harming her baby because of postnatal depression.

Studies have shown that pregnant women are as likely as mothers of newborn babies to suffer from depression.As with postnatal depression, it may also adversely affect the unborn child. Photo: The New York Times

Studies have shown that pregnant women are as likely as mothers of newborn babies to suffer from depression.As with postnatal depression, it may also adversely affect the unborn child. Photo: The New York Times

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Singapore — Being around her 10-month-old son is the best part of Ms Stacie Henson’s day, but it was not always this way. The maternal bond had not come naturally to the first-time mother, who had recurring thoughts of harming her baby because of postnatal depression.

“Back then, I could not bring myself to touch or be around him. I couldn’t sleep or I would cry myself to sleep,” said the business development executive, who underwent an emergency C-section after a difficult 27-hour labour.

“At my lowest point, I could not even trust myself to be alone with my own kid. Little things like him crying would set off thoughts of throwing him down from a high place.”

A routine screening during Ms Henson’s postnatal checkup at KK Women’s and Children’s Hospital (KKH) found her to be at high risk of postnatal depression, prompting early treatment. In subsequent months, Ms Henson received counselling and medication to help her cope.

Under KKH’s Postnatal Depression Intervention Programme, mothers are screened for the condition about four to six weeks after childbirth, when they return to the hospital for postnatal checkups. The programme, which screened over 11,000 women from April 2008 to December 2015, aims to provide early intervention to mothers with postnatal depression. It has improved at-risk mothers’ symptom and their quality of life, according to a study by KKH published in the October issue of Annals by the Academy of Medicine, Singapore.

Early intervention is crucial as postnatal depression not only affects the mother’s well-being, but also her ability to bond well with and care for her baby. “Postnatal depression has also been shown to have negative effects on the infant’s development intellectually and emotionally. Research has shown that mothers who are depressed tend to have negative parenting styles such as being over-intrusive in their child’s activities, being more irritable and impatient, or being withdrawn and unresponsive, said Dr Helen Chen, head and senior consultant at KKH’s Department of Psychological Medicine, who is senior author of the study. According to her, depression affects about one in 10 Singaporean women after childbirth.

In the study, about 6 per cent of over 5,000 women screened from April 2008 to April 2012 were found to be at risk of depression, and were offered the options of psychiatric care or counselling by case managers. Seven in 10 of those who received psychiatric care were diagnosed with postnatal depression.

KKH’s screening programme also picks up symptoms of anxiety and psychosis, which some mothers may already have prior to pregnancy, or are triggered for the first time after childbirth, said Dr Chua Tze-Ern, consultant at KKH’s Department of Psychological Medicine.

DEPRESSION CAN also OCCUR DURING PREGNANCY

Studies have shown that pregnant women are as likely as mothers of newborn babies to suffer from depression, and National University Hospital (NUH) has a screening programme to identify women at risk of antenatal depression.

About 10 to 15 per cent of the 3,000 women who have undergone the voluntary screening programme were found to be at risk of anxiety and depression.

As with postnatal depression, depression during pregnancy may also adversely affect the unborn child. A 2008 British study published in BJOG: An International Journal of Obstetrics and Gynaecology found that babies whose mothers had depression during pregnancy tend to develop more slowly than their peers.

Yet stigma often prevents these women from discussing their emotional struggles.

Emotional care is something women need but will rarely voice on their own; a routine screening programme destigmatises the process, said Dr Cornelia Chee, director and senior consultant at NUH’s Women’s Emotional Health Service.

“Everyone around me said I should be happy about my new baby, but I could not (be). They said I would get over (feeling depressed), but … I could (not simply) wake up one morning and just be okay,” said Ms Henson, who had harboured suicidal thoughts.

“It was scary to feel such a big disconnect in my emotions — from that attachment I felt for my son during my pregnancy, to not wanting to be around him after he was born. But no one, including my husband, knew what a dark time it was for me because I didn’t share much with (others) initially,” she added.

NOT A MATTER OF HORMONES

What causes some women to become depressed during what most people expect to be a joyful period? A common misconception is that maternal depression is due to hormonal changes, said experts.

“If it is so, then we should expect to see 100 per cent of mothers getting depressed. Rather, it is because women are more vulnerable at this time when their bodies are going through tremendous physical changes, so any added stress can tip them into depression,” said KKH’s Dr Chen.

The modern lifestyle may increase the risk of depression during and after pregnancy, said NUH’s Dr Chee.

“In less-developed societies, child-rearing was more communal, with many relatives and neighbours available to help out. In addition, women often worked close to their children and did not have to start the ‘second shift’ when they got home, as full-time working mothers now do,” she said.

Other risk factors include pregnancy or delivery complications, and a history of mental health conditions. The mother’s age — especially mothers younger than 21 or mature mothers — as well as breastfeeding, which can be a stressor for inexperienced mothers, are also linked to postnatal depression, said Dr Chen.

While women may experience mild “postnatal blues” and tearfulness a few days after delivery, Dr Chen said it is not normal if the depressive symptoms, notably low mood and loss in pleasure, last beyond two weeks and affect functioning. When that happens, women should seek professional help.

In cases of mild depression, support and reassurance from the doctor and family may be all that is needed, said Ms Ong Li Lian, senior case manager at KKH’s Department of Psychological Medicine.

Ms Ong added that attending a support group can also benefit mothers with mood difficulties. KKH organises monthly support group sessions facilitated by a case manager, where mothers can exchange information about managing depression or anxiety.

In moderate to severe cases, medical attention is strongly recommended. This occurs in about 3 to 5 per cent of women in Singapore, said Dr Chen. Treatment usually involves psychological support and therapy, as well as medication that is compatible with pregnancy and breastfeeding.

“Naturally, some mothers will be concerned about exposing their unborn child or infants to potential side effects of medication. Thus the choice of treatment will be carefully selected to fit their needs,” said Dr Chen.

Had her postnatal depression not been detected early, Ms Henson said her symptoms would probably have worsened. Her turning point came six months after her baby was born.

“I felt so much better and my world was bright again. I’m no longer afraid to hold him and he favours me over everyone else. The bond we have now is remarkable,” said Ms Henson, who hopes to eventually be off medication for good.

She advised other mothers struggling to cope with motherhood not to remain silent, and to be aware that postnatal depression is not normal.

“It is okay to not be all right and seek help when you need it. This episode also made me realise that I have to get well for myself, not just for the people around me.”

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