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.
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 Some mothers may also become more withdrawn and prefer to isolate themselves.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.
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.
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.
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.