Tuesday 25 February, 2020

The Weekend Read: Raising the lid on Postpartum Depression

To this day, Joanne* still can’t believe that she tried to kill her son.

The episode haunts her, even though her son is now an adult and they are as close as any parent and child can be.

But back then, when he was just a newborn, she found herself doing the unthinkable. She put a pillow over his tiny body and tried to smother him.

“I can still remember the moment, his body squirming and twisting. I felt disembodied like I was a voyeur, sleep walking, not the person doing this act. Don't ask me why or how I stopped. But I wept for hours afterward. I just wanted to kill myself. He would be so much better off without me.  I was a terrible mother. How could I do that? Am I mad? Am I going crazy?” she recalled as she related her story to Loop, the first time she has ever spoken about the incident to anyone.

Joanne was suffering from Postpartum Depression (PPD).

Earlier this week, PPD became a national topic when a young mother, Abigail Ragobar, fell through a window of a Tobago house. Her sister posted on Facebook that the young jewelry designer was suffering from PPD exacerbated by the deaths of two close relatives.

Psychiatrist Dr Gerard Hutchinson said one in four women in Trinidad and Tobago suffer from PPD.

He told Loop, studies done at Mt Hope and San Fernando General Hospital showed that after two to three weeks post-labour, PPD rates were as high as 35 percent.

He said while nobody knows what causes depression there are factors that make some women more likely to experience PPD.

“People who either had depression before or had depression during the pregnancy are more likely to get it. There is an association with depression and people who have depression in their families are more likely to have it. People who get it independent of that are those who have had a difficult pregnancy and delivery or didn’t want to become pregnant or had a bad relationship with the child’s father,” he explained.

He said hormonal changes also play a role.

“After you deliver your baby there is a sharp drop in the estrogen levels in the body and that is basically what happens during menopause except in that case it is more gradual. There are bodily changes and breastfeeding and the anatomical changes that occur in your body so there are hormonal components and inputs and then most women get postpartum blues which is pretty mild and last a few days but in some people that progress into a full-fledged depression. Nobody knows for sure what causes depression but it is ultimately a chemical thing,” he said.

Signs of PPD, he said, are the lack of excitement and disinterest in the new baby, constant crying, irritability, mother’s complaints about her inability to manage, and constant criticism of herself as a failure as a mother.

“It was a huge reality check,” said Joanne. “After the joy of a safe delivery and a beautiful baby boy, you now get to the work of mothering. Trying to deal with a newborn, learn how to do basic things, meet his needs, breastfeeding was a struggle  and also try to nourish me and nourish him,” she recalled.

She said while her son’s father was around, he was not much help.

“He seemed even more clueless than me although he was already a father. This is the part when you realise that many men's idea of parenting just does not gel with yours,” she said.

Joanne said her son was a great baby who never fussed and had no problems or complications. 

“We settled into a routine in maybe five to eight days but I just couldn't get rid of this nagging feeling that something was wrong, something was missing. 

Where was the excitement, the happiness, the joy of being a Mom? Who was this little person that I brought into the world? I felt isolated, insecure, anxious, frustrated at not being able to manage yet I really didn't have any markers to compare if I was doing a good job managing except all those books that I had read in preparation,” she said.

Dr Hutchinson said most women do not show signs of PPD until they return home from giving birth and the signs should normally be picked up during the doctor’s post-natal visit two weeks later so they could be given therapy which is preferred to medication as it can affect breastfeeding.

There are currently no support groups for women with PPD though Dr Hutchinson believes it is necessary.

Mamatoto, a birthing center in Belmont, ran monthly PPD sessions but changed the name to Post-Natal Support  because people weren’t attending.

“We started it because we saw a real need for it but it is not identified and when it is, it is not acknowledged. We have to sensitise people to the symptoms,” said Debrah Lewis, a Midwife, and Director at Mamatoto.

Stating that there are expectations placed on women so many people don’t understand  why they feel overwhelmed and can’t cope, Lewis said women today do not have the type of support they had years ago.

“There was a time when they said you couldn’t leave your house for nine days. There was some value in that because women got the support from their families and communities. I tell women don’t do anything for nine days, just take care of the baby but everyone does not have that luxury, in some cases the partner has to go back to work or they have no extended family,” she said.

Lewis, who has been advocating for fathers to be present at public hospitals during labour and birth, said there is also need for fathers to be educated and sensitised as many want to help but don’t know how to.

“We need to educate people on parenting, we need support groups for men during pregnancy because while they want to support, they don’t know how. We really don’t acknowledge how much stress a man goes through and they go through depression as well but society does not recognize that. We need more sensitisation on parenting for both parents. More sensitisation in recognising signs and symptoms of depression, there is the baby blues but it is not as serious as depression,” she said.

She also advocated for more maternity and paternity leave, revealing that Trinidad and Tobago is one of the few countries in the region that give maternity leave below the recommended 14 weeks as laid out by the World Health Organisation (WHO). Maternity leave in T&T is 13 weeks.

On the issue of paternity leave, she said there is no national policy and while the bigger companies give as much as four days, several don’t and men are forced to either apply for vacation or, if daily paid, risk losing money to stay at home to support their women.

Lewis also revealed that due to staffing issues, personnel from the District Health Offices no longer do a post-natal home visit which is crucial in helping to detect PPD.

Lewis said at the end of the day it comes down to support.

“A lot of times all it needs is more support.  Take away all the responsibility from her and let her rest, sometimes it is a deeper problem but if we recognize the symptoms we can get her the help she needs before it is too late.”

Below are stories other women shared with us about their PPD experience. It is hoped that by sharing these stories, awareness about PPD would be raised and other women would get the necessary help they need.

Lauren – mother of one

 I have a history of depression since my late teens. Never went to be diagnosed till two years ago but I knew what it was.  I'm high functioning so most people have no idea. Having a baby was hard for me because I didn't plan her at all. I literally got married three months before I found out that I was pregnant. I did not take it well. But after she was born it was another level. For the first eight months of her life I felt like I was walking around in a fog. I wasn't really working, and my husband worked long hours so I was alone with her a lot. I knew that I loved her but it was hard to connect with how I felt about her in my daily life. I felt as if she was a duty rather than that’s my child. I also felt like she had eclipsed who I was and that I would never be as good as I was before. I was lucky that my mother and sister were nearby so that when I felt overwhelmed I would go to Mom's house and sleep. My mother was aware that I was at risk for postpartum and did her best to make sure that I wasn't falling off the edge. My husband didn't know how to deal with me, honestly. When she was eight months I took a full-time job and that helped me to feel better about myself and to feel more connected to her, ironically. But I felt that same fog like overwhelmed feeling after I miscarried my second pregnancy. It took me another year and another traumatic family event to get me to go to a psychiatrist to be treated for clinical depression. I stayed on meds for about 18 months so that I could work through everything, including the postpartum. I'm afraid to have another baby because of that first experience.

Lisa – mother of one

My PPD was also tied into a very difficult period when the father of my child and I were growing apart.

I had this insane belief and fear that one day I would wake up and my daughter would be gone, that someone would take her away from me. I had a C section, she was born early and at the end it was a complicated pregnancy.

I remember one night getting in my car with my daughter and my dog in the middle of winter and calling my mother and telling her that I was going to drive away and leave and not tell anyone where I was going. She had to talk me out of it.

It's hard to explain something like that because your rational self is operating and you know you are being erratic, you know that what you are thinking and feeling is not right but you can't stop yourself.

But hardly anyone really noticed.

My aunt, who was a nurse, was the first to realise and she kept inventing reasons to come over to my house. Honestly, I fought hard with myself, depended on my faith. I am not a crier so it was worse because I didn’t have an outlet. Every day I had to remind myself that my daughter needed me around.

The leader of my church talked to me a lot just in general and knowing that someone would pick up the phone any time of day and listen to me and not judge me made the world of difference.

It's hard to describe PPD unless you have experienced it. It's like trying to explain a visit to Mars to someone who just learned that we are not the only planet in the universe. All the feelings you described- happiness, euphoria etc can exist alongside paranoia, irritability, pain, loneliness and yes anger. Too often we expect Mothers to only feel happy after having a baby- she is supposed to be this pinnacle of womanhood with no faults and no room for the woman she was before becoming a Mother. It's yet another glass house that we should not throw stones at.

Simone – mother of one

I got really sick about the fifth month into the pregnancy. I could not work, was on  bed rest generally for the rest of the pregnancy, couldn't go out, it was tough.

I had two minor procedures during that period so that by the time I got to my scheduled C-section I had spent so much time at the hospital it was just physically and mentally exhausting

On the day of the C-section they realised that the problem was my appendix, so I had an appendectomy on the same day as the C-section.

Added to that when my son was born, the pediatrician found something which they didn’t want to take the chance with so they transferred him to the general hospital so for the first four days of his life, I was at a nursing home and he was at the hospital. His father would visit him because of course, I could not move. That was kinda tough. He was discharged from the hospital and went home with his father whilst I was still hospitalised, that was tough.

So I get discharged and I am busy dealing with trying to feel physically better, my body like it was in shock and I didn’t feel like I had it in me to take care of a child, really. For the first couple of weeks I felt so bad that I was just trying to feel normal whilst his father kinda took up the role of primary caretaker.

I started to suffer from insomnia real bad and during those periods I would cry whole night. If I tell yuh what ah crying for… I cyah take care of the child, my body feeling strange, I cyah perform, meh life change forever, I responsible for a lil child, I cyah take care of mehself much less a child. I start to feel frighten like I will do something that will kill the child. I start to watch how meh body change, how I start to look physically different…is all kinda ting. I didn’t want tell nobody including my husband to know how I was feeling because he was so happy for this child. So I in the dark, by mehself dealing with meh demons and it was BAD. I  USE TO CRY FOR EVERYTHING.

I was always tired and depressed, till the morning when I try my best to put on a good face. Eventually I confided in a friend and she started talking to me every night telling me how to put my feelings in context and really encouraging me to just put one foot in front of the other and I started to pray real hard. It took me a while to connect with small man and to start to feel like myself again.


*Names have been changed to protect the identity of the women who shared their personal stories with us. 





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