Having a baby is a momentous event.
A new life is born and this creates immense emotions in parents and lives around the child. However joyous it appears to be, the dark side of childbirth may emanate just days after.
Some mothers start to feel anxious and depressed and may find themselves in a mire of appetite loss, anger and inability to sleep.
These negative symptoms may dissipate after a few weeks, but for some, they linger on to be characteristic of Postpartum Depression.
Symptoms develop on an average of 1 to 3 weeks after childbirth, but the onset can be anytime within the first year after childbirth.
Postpartum, or sometimes known as postnatal depression, is estimated to affect 10% of women in wealthier countries and an even higher percentage in countries that are less wealthy.
Babies and attachment to mom
No one contests the strong bond between mother and child. Joined in blood, body and spirit, there is little wonder that babies have a deep emotional attachment to their mothers.
This ‘secure attachment’ forms when a mother responds to her baby’s needs, be it holding or breast-feeding.
The cradling of a mother is what gives the baby safety and security in an unknown world outside the womb.
A mother who is struggling with depression may be unable to provide that for her child. She may be loving one minute and withdrawn the next. Her fluctuating mood coincides with the intermittent love and care for the baby, and this insidiously but definitely impacts the child.
A systematic review showed that, up to one year of age, four domains of a child’s development (behaviour, psychomotor, cognitive, and social–emotional) can be adversely affected by maternal mood.
Moreover, a mother’s depression could interfere with breastfeeding, sleep routines, safety and prevention practices or even the maternal capacity to identify child medical needs.
How are babies affected?
“The challenges of recovering from delivery while taking care of a newborn can be a harrowing and lonely experience, especially for first-time mums.
It is very common to experience fleeting ‘baby blues’, but some mothers may slip into a more serious and lengthy depression. A depressed mum may not be able to fully nurture and nourish her baby.
If there are no other caregivers in the home, this might result in a neglected baby who fails to thrive,” comments Yvonne Yeow, certified coach and counsellor based in Singapore.
The inability to develop a healthy mother-child relationship can be classified as Bonding Impairment.
Deleterious to a child’s personal growth, the child may develop skills later than others, and become withdrawn and passive. Failing to recognise that mother is a safe concept, they may also have trouble interacting with them.
Postpartum depression has a history of lasting for years, if not treated. When the child has become a toddler or preschooler, they may also demonstrate behavioural challenges, such as defiance and being more aggressive and destructive.
They may not do so as well in school and are less likely to interact with others. When they mature into school-age, they are at higher risk of attaining mental problems including deficit and hyperactivity disorder.
Various studies have shown that school-age children of depressed mothers may also display impaired adaptive functioning, including internalising and externalising problems.
Physically, research has also garnered some staggering statistics. Maternal depressive symptoms at 5 months seemed to predict more overall physical health concerns for infants at 9 months and a greater proportion of childhood illnesses.
A study conducted in Bangladesh showed that symptoms of maternal PPD that were present at 2–3 months predicted impaired motor development in infants at 6–8 months.
Another study included Greek mothers in Crete and demonstrated that symptoms of maternal PPD were associated with lower fine motor scores in infants at 18 months of age.
Stepping forward for treatment
Mothers are often worried that seeking treatment would mean taking antidepressants which may be threatening for the baby, especially when they are still breast-feeding. Antidepressants have not caused ill-harm to infants or the pregnant mother.
In fact, if the mother had been taking antidepressants during pregnancy, it is important to continue the course while breast-feeding to prevent a relapse. This will conjure negative consequences on the emotional and behavioural development of the infant.
Even though all antidepressants are excreted in breast milk, many studies have been made and no neurological or developmental abnormalities have yet been demonstrated in children exposed SSRIs or tricyclic antidepressants through breast milk.
Therapy has been found to be helpful in altering the mother’s mood state, increasing her sensitivity to or awareness of the infant’s cues and diminishing the negative perceptions about the infant’s behaviours.
Therapists often aim to improve the quality of mother-infant interactions, either by instructing over-stimulating intrusive mothers to imitate their infants or by showing withdrawn mothers how to attract and maintain their infants’ attention.
One approach is psychotherapy. A psychodynamic treatment that focuses on the mother’s image of her infant and their relationship, delves into the mother’s own childhood and early attachment history.
This method seeks to identify positive caregiving behaviours and to suggest alternative translations of the child’s behaviour.
Interpersonal therapy narrows into interpersonal relationships and problems experienced by depressed postpartum mothers. A study made on 120 depressed postpartum women showed that their depressive symptoms improved.
Yvonne has used cognitive behavioural therapy as one of the methods. “I help depressed mothers to pinpoint unhelpful thinking patterns and automatic assumptions.
We then work together to correct these flawed beliefs and behaviours, while create new healthy thought habits.”
“I have also used solution-focused brief therapy in my work with mothers to identify their strengths and utilise past successful coping strategies to manage their current difficulties,” contributes Yvonne.
She also employs mindfulness techniques to help her clients achieve clarity and tranquillity.
Family therapy sessions may also serve to be helpful, especially when the children or children are older. Therapy sessions will often focus on communication within the family and children tend to understand their parents’ affective illness better.
“I am optimistic that things can get better and relationships can improve, given the right interventions and the willingness to try. Just acknowledging that there is a problem and asking for help is a huge first step toward recovery and healing,” encourages Yvonne.
Yvonne Yeow is a certified coach and counsellor with 22 years of experience under her belt. Also an MOE-registered instructor, she has worked with many adults and youths throughout her career. Yvonne specialises in a spectrum of areas, that ranges from anxiety and panic disorders to general relationship challenges amongst family, friends and co-workers.
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Singer JM, Fagen JW. Negative affect, emotional expression, and forgetting in young infants. Dev Psychol. 1992;28:48–57
Known as Nate, I am someone who cannot quit wielding the pen or punching the QWERTY, no matter where life brings me. Writing has always been the most effective conduit for channeling my wanted or unwanted opinions since I was an undergraduate at NUS. Naturally, I used this skill as a means of sustenance after working as a writer and editor for many years until I decided to start a business in music. That did not put a halt to my marriage with the vernacular.
In October 2016, I graduated with my Masters in Visual and Media Anthropology, which is the study of cultures through films and photography, at Freie Universität Berlin. This transitory period of residing in two cities has pushed the boundaries of my creativity and my battles with word count have not ceased.
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