TWB in Review: Breastfeeding & Postpartum Mental Wellness (Part 2)

By BMSG Editorial Committee

While Dr Elizabeth Siak’s sharing was focused on the symptoms of PND and what sort of treatments are available for mothers, Cindy Khong, a counsellor of mental health at Clarity Singapore, highlighted the importance of social support that a mother needs during the postpartum period. She also spoke at great length about the need for self-care and how family members can be sensitive and support mothers appropriately.

Cindy Khong (top right), counsellor in mental health from Clarity Singapore, spoke at great length about social support and coping measures to help mothers find peace during postpartum. [Credits: BMSG Singapore]

Pressures of Societal Expectations

Cindy shared that the main struggle of mothers lies in the fact there is a difference between what society expects of motherhood with what mothers really experience for themselves. In popular culture, motherhood is often portrayed as natural, instinctive and enjoyable while in reality, mothers go through a lot of changes of which many are not prepared for. It is natural for new mothers to feel overwhelmed with the many new responsibilities on her shoulders. Cindy gave the analogy she received from her client about motherhood: that it is like filling up a fruit basket to the brim which then overflows. 

Wellness & Importance of Self-Care

When this happens, a typical mother then overlooks the need for her own self-care as she struggles to complete her tasks and duties. With guilt and the difficulty to find time, it was enlightening to hear from Cindy that self-care actually allows a new mother (or any mother for that matter) to cope with a new baby. “You need to care for yourself before you can care for others” was a quote that Cindy shared about the importance of mothers taking care of their own physical and emotional needs. 

One often overlooked aspect of self-care is that it allows a mother to be more emotionally present for her children and also allows her to build a strong connection with their partner.  This then allows her to turn to her partners for support and comfort, which then decreases the probability of depression in the mother. 

Self-care also prepares a mother for a secure attachment bond with her baby, which is a good foundation for child development. When a parent takes care of herself, she will be able to better respond to her child’s verbal cues. Such interactions optimize the baby’s nervous system and brain development, which are necessary for a child’s cognitive development. Babies with a history of secure attachment patterns have greater sense of self-agency, have higher self-esteem as teens and adults, and are better at regulating themselves emotionally.

One often overlooked aspect of self-care is that it allows a mother to be more emotionally present for her children and also allows her to build a strong connection with their partner.  This then allows her to turn to her partners for support and comfort, which then decreases the probability of depression in the mother. 

Recognising the Obstacles to Self-Care

Cindy then conducted a poll on the audience to understand what the audience felt about mothers taking time off for self-care. She then went on to explore the various reasons why mothers avoid taking the time to care for her well-being. 

It was interesting to note several reasons that mothers avoid finding time for self-care, among them being:

What Mothers Feel About Self-CareWhy They Feel this WayWhat Can Mothers Do to Overcome This
GuiltMothers do not find their needs as important as their children’sThey feel they are weak if they request for it as their parents were able to care for many children without needing itAsking for help and time to rest are not signs of weaknessAsking partners to be more involved actually increases their confidence to build strong relationships with the childrenUnderstand that self-care has positive side effects on caring for babyMake it a habit to put yourself first at least one a dayTake short breaks such as having 10 minutes of deep breathing or doing something you enjoyHave smaller tasks in a day to give you a semblance of control
Finding the need to be perfectExpecting ourselves to be as productive at home and work as before we had children is unrealisticWanting to do things in a specific, rigid wayBut nobody has it all togetherBe prepared to let some things go and prioritise what is critical and importantDo one thing well at a time instead of moreTell yourself there are good and bad days; don’t concentrate on the negative all the timeCelebrate small achievementsIf there are changes that need to be made, break up small steps into smaller plans to move towards that changeAllow yourself to feel sad, angry and irritable and get your partner to validate you; this may mean that you no longer have to put up a front
‘I don’t deserve it.’Mothers devalue themselves and think that ‘I am just a mother’These mothers may have issues with their self-worth and belittle themselvesMothers should avoid putting themselves down as they should recognise that their babies deserve the best mother and hence, mothers deserve to be cared forBe kind to yourself and give time to recover emotionally and physically after birthSeek professional help to make sense of these beliefs

Cindy also encouraged mothers to do several other things to help their recovery and adaptation during the postpartum period:

  • Seek suitable social support to share similar concerns and needs
  • When we see other mums who struggle with the same problem, we feel validated and not alone
  • Spend time with our partners to nurture the relationship and to understand that we are not alone in the struggle
  • Couple time is challenging to implement but promotes open communication and marital harmony
  • Couple time also lowers the risks for PND
  • Practise gratitude instead of comparing with other mothers or even our spouses; it can fuel loss of motivation, confidence and self-esteem 
  • Understand that every mother is different and we have different starting points, resources and capacities

How Spouses, Family Members & Friends Can Support New Mums

If you are supporting a new mother, Cindy reminds us that mums are looking for someone to listen and find out what they need help with without judgment or sympathy. When a mother expresses her struggles, our reactions matter very much in what she feels after. 

  • Judgment vs Validating

    When we validate a mother instead of judging her abilities, she feels understood and will be more open to receiving help for her anxiety. When we judge a mother, she feels shame and not good enough and may perpetuate the behaviour she displays when having anxiety
Cindy shares with the audience how partners and even family and friends can better word their conversations with new mothers to respect her feelings and space. [Credits: BMSG Singapore]

Cindy shares how spouses and other people around a new mother can be more mindful in how they speak to her.

  • Partner Support

    Partners are one of the key contributing factors in the recovery of a mother’s postpartum well-being. For mothers who are not depressed, having good partner support shields the mother and her baby against stressors during this period.

    Spouses may find it helpful to praise a mother and validate her, and provide constant encouragement. Show appreciation instead of thanking her and encourage her to talk about her feelings. Understand that a mother wants to be understood so partners should try to reflect back her feelings.

    Being familiar with signs of postpartum stress and where to seek help are also important especially if her condition turns serious. It would be helpful for everyone if partners encourage mothers to seek treatment and support especially if symptoms get overwhelming and persistent over time.

Lastly, being active in the household can lay off a lot of the burdens on the mother. Be clear about your roles to avoid misunderstanding and conflicts with the mother.

  • Family Members & Friends

    Many of us would fawn over newborn babies but never ask about the mother. For a start, showing care for a new mother would do well to help her feel appreciated and validated. Being available to talk to her and spending time to listen to her struggles, especially without comparing yourself or others to her, would be valuable for her well-being.

    Be very careful of appearing to be an “expert” as it can affect her confidence. Cindy suggested that it would be better instead to show more understanding and ask how you can help.

It Takes a Village

A lot of us would be familiar with the saying ‘It takes a village to raise a child’. But Cindy reminded us a village is also required to support parents, especially new mothers. Nurturing a strong circle of support will be valuable both for mother and baby to grow and thrive in the community that they are in. Mothers should also remind themselves that when they focus on their personal well-being, they will have more energy and peace of mind to care for their children.

Look out for Part 3 soon!

TWB in Review: Breastfeeding & Postpartum Mental Wellness (Part 1)

By BMSG Editorial Team

In November 2020, BMSG’s signature forum event, Tea with Breastmilk (TWB),  made a comeback after almost 2 years since it was first started. TWB aims to provide a platform for breastfeeding mothers, advocates and experts to converse about breastfeeding-related topics with more depth.

This year, BMSG spotlighted the topic of postpartum mental wellness during the TWB forum. Over the years, our BMSG counsellors have met mothers who have struggled mentally either due to breastfeeding or juggling new roles as mothers. BMSG sees this topic as a long overdue topic that needs inter-organizational support and education for the community to better support mothers in their journey, especially if they are breastfeeding.

The event did not disappoint. Together with speakers from the KK Women’s & Children’s Hospital (KKH) and Clarity Singapore, a charity that provides support and services in mental health, TWB provided wider insights, solutions and knowledge to the wider community about the impact of good or lack of support can bring on breastfeeding mothers.

Our speakers at the panel discussion. [Credits: BMSG Singapore]

Postnatal Depression & Baby Blues: What’s the Difference?

Many of us would have heard about Postnatal Depression (PND) happening to women during the postpartum period. Dr Elizabeth Siak, Consultant Psychiatrist from KKH, provided a very detailed overview of what constitutes PND and how to differentiate it from postnatal blues.

Dr Siak clarified that baby blues most commonly occur immediately after birth and is a result of adjusting to motherhood. Feeling sad or blue may occur to mothers for a few hours to a few days but it usually resolves with reassurance, good support from the people around the mother as well as familiarity with her role. 

A local studies done on mothers in Singapore have show that PND afflicts about 7% of mothers, with many developing symptoms during pregnancy itself. According to Dr Siak, PND usually occurs two to three months after birth and mothers who suffer from PND will usually display anhedonia, or a pervasive loss of interest to feel joy or pleasure for the whole day or most part of the day for a period of about two weeks or more. Some mothers will also show increased irritability. Some mothers may also become more withdrawn and prefer to isolate themselves.

PND may also manifest itself in physical and mental symptoms in the mother. Some mothers may show changes in sleep and appetite. Some mothers may not be able to sleep or sleep longer than usual but do not get refreshed when they wake up. In terms of eating, some may have significantly reduced appetites while others may eat excessively. These symptoms may include negative thoughts and attitudes, and possibly even suicidality or psychosis in more serious cases. Professional treatment may also become necessary upon diagnosis by a medical personnel. 

“…mothers who suffer from PND will usually display anhedonia, or a pervasive loss of interest to feel joy or pleasure for the whole day or most part of the day for a period of about two weeks or more.”

One thing is for sure, PND is something that is difficult for the mother because it is disabling, and especially so during a period of time where babies may need more care. Mothers may also have reduced energy and lots of fatigue, and are not able to concentrate well, making it challenging both at home or at work. 

Sadly, many mothers with PND will also have lots of negative thoughts and may become pessimistic, suffer from debilitating guilt and self-blame. 

What Causes Depression?

According to Dr Siak, it is hard to pinpoint to a single cause and instead, multiple stressors may contribute to it. Mothers who have a past psychiatric history or family history of PND may be more prone to be diagnosed with PND. Some women may also be more susceptible to fluctuation in hormonal levels, making it easy for them to be tipped with PND. Mothers who have had traumatic childhood events may also find it difficult to cope with PND. 

The arrival of a new child is naturally overwhelming; mothers with PND and their family members require their support. Additional strains on the family such as financial challenges or strained relationships can further worsen the situation. If a mother becomes so overwhelmed to the point of losing touch with reality such as having hallucinations or wanting to harm herself and others, she must be brought to A&E for urgent treatment.

Mothers with postnatal depression may feel disabled by their overwhelming anxiety, thoughts and emotions.
[Stock Photo]

Perinatal Anxiety

Another common and frequent occurrence in new mothers is perinatal anxiety, which is characterised by becoming excessively worried to the point of becoming overwhelmed. Mothers may become overprotective of their babies as they feel a strong sense of inadequacy as a mother to care for their babies’ well-being. As a result, they overcompensate with being overly protective and are inflicted with repetitive and intrusive thoughts about baby falling sick or being exposed to germs. Some of these mothers may also have obsessive thoughts about dropping their babies or constantly bringing their babies to see a doctor. Fortunately, there are treatments that can work for such mothers.

Receiving Treatment

Dr Siak rightly pointed out that a lot of women may feel afraid of the stigmatization that comes with reaching out for help. However, seeking early treatment is crucial for the well-being of mothers and their babies.

Treatment-wise, mothers who have been diagnosed with PND will be able to receive psychiatric treatment in the forms of supportive counselling and case management as well as medication. Mothers will be able to talk to psychiatrists and counsellors to explore the transition to motherhood as well as discuss practical suggestions to overcome this challenging period. Most importantly, mothers will be given a safe place to express difficult feelings and thoughts. At KKH, there are also support groups where mothers with PND can participate in for further support.

It is important to receive prompt treatment for PND as the well-being of mums and their babies are at stake. [Stock Photo]

Dr Siak also emphasised that mothers are still able to continue breastfeeding even with treatment and medication, and breastfeeding should not be a reason to stop going for treatment. Antidepressants and medication given for treatment are compatible with breastfeeding. People around the mother should also encourage her to seek help if they feel that she needs it. Dr Siak reports that 98% of mothers report improved functional status after treatment and 89% reported better quality of life. 

Where to Seek Help

If a mother or her family member believes that she needs to receive medical care, especially if mothers report uncontrollable suicidal thoughts, then bringing the mother to the nearest Accident & Emergency department of any public hospitals or at the National Institute of Mental Health (IMH) would be advantageous. For less urgent cases, mothers can consider three perinatal psychiatry services located at KKH, National University Hospital (NUH) and NIMH. If a mother prefers to obtain the subsidised route, she can walk into any polyclinics to obtain a referral to see a psychiatrist. Mothers are also free to approach these three institutions to set an appointment to see a private psychiatrist.

For Part 2 of TWB, please click here.