Postpartum depression: ‘Coping through a pandemic’
Dealing with Covid-19 is tough. Add giving birth, a new baby and the baby blues into the mix for a true test
Text: Juli Tan
Ahead of the birth of my daughter in February I worried about postpartum depression. I would browse mummy blogs and read about the signs of baby blues, committing them to memory. Then I gave birth to a healthy 3.9kg baby girl, Singapore shut down because of the Covid-19 pandemic, and all my plans for physical and mental self-care went out the window. Those symptoms of depression, irritability, mood swings and feeling overwhelmed that I had read about seemed pretty normal when it came to looking after a new tiny human, who needed to eat and poop (but apparently not sleep) all the time. As Covid cases soared in April, my new family moved in with my parents to get extra help with the baby. But it was only when we returned home three months later that I realised how detached and anxious I was in those early months.
Unsurprisingly, “detached” and “anxious” are some of the words associated with postpartum depression(PPD). According to Singhealth in 2019, 10-15% of women in Singapore experienced PPD or postnatal depression. Even then, many women I spoke to believed they had it but never got postpartum depressions treatment, which could suggest the percentage is higher.
“It can be hard to distinguish PPD from the common baby blues,” says Silvia Wetherell, a registered counsellor and psychotherapist, specialising in maternal mental wellbeing and clinical director of More Mindful. “Some [symptoms] seem normal for a tough adjustment. Women often can't get perspective because they’re just trying to survive. Sometimes you don’t know until a doctor, friend or partner tells you something is wrong.” She adds, “But untreated PPD can linger on for long after the baby’s infancy, turning into a ‘normal’ major depressive disorder. Untreated mental health issues have a significant negative impact on a woman’s health, the baby’s wellbeing and the whole family unit. For those reasons, it should not be ignored. It’s also possible that PPD recurs in subsequent pregnancies.
Exhaustion versus PPD
Alice*, a 37-year old British woman with three children remembers it took a while for her to realise she needed help after giving birth. “I was diagnosed around six months after [my third child] was born. At first it was difficult to work out what was simply pure exhaustion versus PPD. I would wake up in a foul mood even after a decent sleep. My heart would be racing and I’d have to catch my breath just thinking about all the things I needed to do in one day (which looking back, was very little). I felt completely out of control and lonely, despite having a network of friends and family close by. I also have a very supportive husband but I felt completely misunderstood.”
Mums around the world face common issues that can cause PPD, but here in Singapore there are a few specific symptoms of PPD that come up often. Mok Sin Lai, psychotherapist at Relationship Matters, lists breastfeeding difficulties, conflicts with the confinement nanny, marital discord, family problems (e.g. issues with in-laws), childcare and work-related stress as common problems. Money is another, particularly for the more vulnerable or needy; and time, since most mothers don’t feel they have enough to begin with (let alone enough to spend in a waiting room for a diagnosis).
“Women with a history of depression, relationship problems or financial uncertainty are more prone to suffering from postpartum depression than others,” Sin Lai continues. “These women may not be aware of their potential for PPD. Those most likely to recognise it will be their families and close friends. It would be helpful for gynaecologists to help raise awareness of postpartum depression, get involved in educating women on this topic and check-in with their patients for any possible signs ahead of the child’s birth. But this is not a common practice in Singapore.”
Living with my parents, I was grateful for their help, but also at times resentful and anxious. In some ways it just reinforced that I couldn’t manage the baby alone. “Becoming a mother — from conception, through pregnancy and delivery, to feeding and beyond — these are core experiences that help you build your confidence,” says Silvia. “It’s harder for a mother to develop this through observation and experimentation if there’s always someone there telling you what to do. You’re going to stop looking within, using your intuition to find the answer, and go externally to someone else, which doesn't help.”
The guilt and worry can extend to having a helper. “Watching the helper with the baby can be quite triggering,” Silvia adds, “It can make a mum feel like she’s being selfish. Or worry that the baby is going to bond more with the helper and forget who their mother is.”
‘The New Baby Would Cry and I Wouldn’t Move’
Melissa, a 42-year old Singaporean was diagnosed with PPD after her third child had jaundice and trouble with breastfeeding. “In hindsight I was extremely tired caring for two older children and had expectations of how rearing a third would be. So, when breastfeeding was difficult and he developed jaundice, I took it as a personal failure. I couldn’t understand why it was so hard when I’d already done this twice. It was quite surreal. The new baby would cry, and I wouldn’t move. That was when I realised something was wrong.”
On the advice of her doctor, Melissa saw a psychiatrist along with her partner. “He was very supportive,” she says, “and would accompany me to visits. He stopped travelling for work so he could help out with the older kids.”
“Relationships are so important,” says Silvia. “You need to be able to feel like you can go to your husband and say you're having a tough time; to be able to say, ‘I'm not sure I like the baby’. Lack of support can drive someone to depression, which is why it’s so important to talk through expectations with your partner during your pregnancy. For some couples, having a baby is like throwing a bomb into the middle of a marriage —the first year is brutal. A lot of resentment can build up from those first few months, and really stay with you. Some couples never recover.”
Melissa started feeling better once her son's jaundice improved and breastfeeding got better. Now that he's seven, she looks back on the experience with more empathy for herself; “I wish I was kinder to myself and had the wisdom to know that every pregnancy and every child is different. Ultimately, they all grow up and some of the things I was hung up on doing were inconsequential in the long run.”
For Alice, she only felt she got the headspace she needed through prescribed antidepressants. “Although I was offered loads of support, it didn’t really help the grey cloud that was hanging over me. I was an angry impatient mother who felt like a failure. I feel sad thinking about how much I expected from my children who were so little. I think I recognised that antidepressants were the quick fix that took the edge off of looking after three young children every day. I came off the pills about six to nine months after my diagnosis and now that my youngest is nearly three, I feel more like my old self — probably due to a combination of sleep, not breastfeeding, being back to work and being out of the ‘baby’ phase. I obviously have bad days, but I rarely wake up in a bad mood.”
My daughter is now eight months old. She no longer seems like that fragile newborn who got gassy and uncomfortable after each feed, and her new curiosity about the world means she isn’t attached to my boobs at all hours of the day. Everything, like many wise mums have told me before, is just a phase. Nevertheless, many things still make me panic, and I still haven’t mustered up the courage to take my daughter out on my own. It is something I aim to work towards even as I make plans to work on my own mental wellbeing. A tool for screening PPD is the Edinburgh Postnatal Depression Scale (EPDS), a simple weighted question-and-answer test. To write this story, I decided to do it. For scores over 13, it is recommended you seek out a mental health professional, and I got 18. For me, this is just a start, but eventually, I’ll be taking my daughter out on a coffee date, just the two of us.
*Names have been changed to protect the interviewees privacy
If you think you are suffering from postpartum depression or any of the issues mentioned within this feature, please consult your doctor who will be able to provide specific medical advice and support.
