Postpartum depression, also known as postnatal depression, is the name given to a disorder that nursing mothers may face when dealing with their newborn child. According to the Mayo Clinic, symptoms include, “loss of appetite, insomnia, intense irritability and anger, overwhelming fatigue, loss of interest in sex, lack of joy in life, feelings of shame, guilt or inadequacy, severe mood swings, difficulty bonding with your baby, withdrawal from family and friends, or thoughts of harming yourself or your baby,”(Mayo Clinic Staff 1).
Although postpartum depression was classified as a disorder in the 1850’s, it has been written in history as far back as the times of Hippocrates; in 700 BC, Hippocrates wrote about women who were afflicted with depression during their postpartum period. Even though the disorder was medically evaluated and classified in the nineteenth century, many women were still afraid to speak out about their thoughts and feelings on depression because they were considered neurotic and often treated with either shock-therapy or valium.
The thought of others perceiving them as crazy was enough to hold them back on bringing their issue of postpartum depression about. In first world countries like the U. S. , postpartum depression can be acknowledged as an actual chemical imbalance in the brain, thus, considering it a disorder. Even though the information is relevant to all walks of life, some cultures, like the Indian culture,still uphold traditional cultural values when it comes to diagnosing illnesses like depression.
By creating an awareness video and website on postpartum depression in Malayalam and English, the primary languages spoken in Kerala, India, I hope to expand knowledge on postnatal disorder to mothers, fathers, and families so that the depression can be treated accurately and efficiently. There are many types of postpartum mental illness’ besides postpartum depression, and I plan to mention most of the illnesses in my website to inform the reader. One of them is postpartum anxiety.
A woman with PPA may experience extreme worries and fears, often over the health and safety of the baby. Some women have panic attacks and might feel shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling. Another illness is postpartum obsessive-compulsive disorder. Women with PPOCD can have repetitive, upsetting and unwanted thoughts or mental images (obsessions), and sometimes they need to do certain things over and over (compulsions) to reduce the anxiety caused by those thoughts.
These moms find these thoughts very scary and unusual and are very unlikely to ever act on them. The next postpartum illness is postpartum post-traumatic stress disorder. PPTSD is often caused by a traumatic or frightening childbirth, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event. The last postpartum illness is postpartum psychosis. PPP sufferers sometimes see and hear voices or images that others can’t, called hallucinations.
They may believe things that aren’t true and distrust those around them. They may also have periods of confusion and memory loss, and seem manic. This severe condition is dangerous so it is important to seek help immediately. I chose to research with this matter of healthcare because of my innate love for kids. Ever since I could remember, I have loved taking care and being around kids. The problem of postpartum depression not only affects the mother, but also the child.
According to an article on CBSNews. com by Ryan Jaslow, “.. ostpartum depression has been linked to a shorter duration of breast-feeding, attachment issues along and increased stress in kids, all of which all could affect growth,” (1). Postnatal depression in the mother has numerous consequences for the child later on in life. Since I want to become a pediatric nurse practitioner while minoring in psychology, I wanted to do a project which incorporated the two fields which I will be entering into. By helping the mothers with postpartum depression, I will be indirectly helping the kids later on down the road.
It is uncertain what causes postpartum depression, although there are many contributing factors. It is known that there are physical changes following childbirth, including a drastic drop in hormone levels. This change in itself can leave a person feeling tired, sluggish and depressed. Additionally, there are changes in a person’s blood pressure, immune system and metabolism. These changes can further stress the body and contribute to mood swings and fatigue. Genetically, some women may be more predisposed toward developing postpartum depression.
Other factors that all increase after giving birth that could lead to the development of postpartum depression include stressful events such as financial problems, loss of a loved one, illness, pregnancy complications, moving to a new home, relational problems, lack of social support and sleep deprivation. There are many women who experienced postpartum depression and live in a state of anxiety and hopelessness, without seeking help. Later, when asked why they never sought help, the number one reason people cite is that they felt guilty about what they were feeling and experiencing.
They had expected to feel happy and excited about being a new mother, and instead they felt depressed. As a result, people worry that they are a disappointment, failure or a bad mother. In actuality, it is not the person who is the problem, but the depression that is affecting the person at that time. Overcoming depression allows women to be themselves again and to be the person and parent they want to be. One vital piece of information that women who suffer from postpartum depression need to know is that they are not alone.
While many women experience some mild mood changes during or after the birth of a child, 15 to 20% of women experience,” something bigger than an occasional mood swing or feeling of guilt and shame, (PSI-Get The Facts 1). Numerous mothers in the United States suffer from a disorder that affects not only their own lives, but also all those around them. A few barriers that surround mothers of certain ethnicities may be the views which were presented in the first paragraph. Some cultures still see disorders like postpartum depression as signs that a woman is neurotic, and will often treat them by admitting them into a mental institute.
The knowledge needed to treat patients on the disorder is available, but skewed prescriptions tend to steer women away from telling a doctor or clinician about how they feel. Postpartum depression is an actual disorder, which means that it is not a curse by the gods or atonement; it is brought on by, “the changes in hormone levels that occur after pregnancy,” (“What is Postpartum Depression? ” 1). Although any woman can go through the disorder, there are a few women who are more susceptible to getting postpartum disorder.
Those are mothers who have type one or two diabetes, premenstrual dysphoric disorder, insufficient help in the caring of the child, financial or marital stress, a major recent life event i. e. loss of a house, spouse, family member, etc. , complications in birth, breastfeeding, or pregnancy, a family history of depression, a child in Neonatal Intensive Care, multiple children, gone through infertility treatments, and a thyroid imbalance are increasingly susceptible in getting postpartum depression, (“Depression During Pregnancy” 1).
Since certain women are more at risk when it comes to diagnosing the disorder, doctors, and even some hospitals, are required to check up on the mothers who fit into the above criteria about one week after they are discharged to see if they display any signs of postnatal depression. Just because some women are increasingly prone to get depressed after pregnancy, checking for the warning signs is not a one hundred percent, full-proof way in finding all the patients of postpartum depression, which is why it should be the priority of the doctors and hospitals to check up with all post pregnant women.
It is actually recommended by the American College of Obstetricians and Gynecologists to screen all new mothers for postpartum depression, but they often just keep up with those who are more at risk. All mothers deserve to be checked up on, whether they have a child in the Neonatal Intensive Care Unit or not. Yes, precautionary actions must be upheld when dealing with mothers who have an elevated likelihood of assimilating PPD, but someone who may not fit into the list above may have postpartum depression and never get the help they deserve and need.
The two common forms of treatment for postnatal depression are counseling and medication. Because of how the medicine can affect the mother’s body, and thus the breast milk, medication is often withheld unless the depression is a bit more severe. The doctor must consider the safety of the child since the mother is usually breastfeeding when the signs of depression emerge, which is during the pregnancy or first year of postpartum. Counseling is a proven may to help patients with depression, as talking about how the mother feels with either a private psychiatrist or in a group will help cope with their feelings.
Setting realistic goals, solving problems, and finding better ways to cope with feelings help women in the long run, which is why it is important for all counseling attendees to complete the full course even after they feel as if they have overcome the depression. Relapse is potential if treatment is stopped. Antidepressants will only be prescribed if the doctor deems it fit for the situation; in other words, if the potential benefits outweigh the disadvantages, then the medicine will be used to treat depression.
There is now medicine which has minimal effects on the breast milk, so it will produce fewer side effects for the baby. There is one last treatment which may be used in the United States, which is hormone therapy. Hormone therapy replaces the estrogen lost, which accompanies childbirth, which may compress or diminish the signs of depression for some women, (Mayo Clinic-Postpartum Depression Treatment, pgph. 3). When dealing with the treatment, the doctor must look at more than the patient’s history or what they say. Ethnicity, socio-economic status, and even culture play an abundant role in how you should treat a patient.
According to a study published by the Center for Disease Control and Prevention in 2008, postpartum depression was most often reported by teenage mothers, mothers with less than twelve years of schooling, Medicaid patients, smokers, victims of physical abuse before or during pregnancy, or women under financial stress, (Stone 1). Over the same study, the Wall Street Journal for Health said that the results were obtained from seventeen different states, and that from all seventeen states, the marital status, age, income level, Medicaid coverage, and maternal education were all associated with postpartum depression.
In 2011, Women’s Health USA published a study which read that, “The proportion of mothers reporting postpartum depressive symptoms exceeded twenty percent among non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic mothers of multiple race and was lowest among non-Hispanic White mothers (eleven point nine percent),”(“Postpartum Depressive Symptoms” 1). Even though the Women’s Health USA article says that there is a pattern in the women who are diagnosed with postpartum depression, the arrangement mainly comes from the socioeconomic status and the criteria listed above in paragraph three.
Some other risk factors are present when examining postpartum depression, like the vitamins and minerals, which one consumes. A combined series of studies from The MEDLINE, PubMed, and Web of Science were used to extract the information concerning serotonin transporter (5-HTT) genotype and omega-3 polyunsaturated fatty acid (n-3 PUFA) status in a woman after she has given birth. From the preliminary evidence given in these three studies, “…there could be an interaction between these two emerging risk factors.
However, further studies are required to confirm such an interaction and to elucidate the underlying mechanisms,”(Shapiro, Frasier, and Seguin 1). 5-HTT may be what differs postpartum depression from other forms of depression, and research on the n-2 PUFA display that, “Patients with depression show increased cardiovascular mortality, and depression is a frequent comorbidity in patients with coronary artery disease,” which may suggest that patients with any type of depression may harbor a chance to inherit cardiovascular disease, (Shapiro, Frasier, and Seguin 4).
With the Patient Protection and Affordable Care Act, coined “Obamacare”, it may now be easier for women to receive help in America if they think that they might have postpartum depression. Previously, the cost of going to the doctor for a routine check-up or even to the hospital was more for women than men. This may have held many women back from receiving the help that they needed in dealing with any illness or disorder. With a healthcare plan like the Patient Protection and Affordable Care Act, women are guaranteed that their procedures will cost no more than it will if a man was going through the same predicament.
This will lessen the cost of going to get help, and since healthcare is mandatory and assured for every person in the U. S. with this plan, more people will be likely to actually visit the doctor for routine check-ups and visits because the price is lessened. Because there is limited studies over how culture affects individual cases of postpartum depression, the best research can be done when looking at blogs or small case studies with women who were diagnosed with postpartum depression. For example, as an Indian I know that there are many cultural boundaries which justify my actions that some may not understand.
One offset may be that it is a very conservative culture, and it is not common for anyone, especially a woman, to speak out on a topic which is still thought to originate from evil spirits. Although there are not many who speak out on the subject, there are a few women who have conducted small case studies or wrote about their experience with PPD. That in itself is an advancement towards sharing the truth behind disorders like depression to cultures who do not really accept these concepts. If a woman were to say that she felt like harming herself or her baby, the only clear solution would be to enter er into a mental institute.
Coming from a culture like this would explain why so many Indian women are hesitant to speak up about depression to doctors than in a more developed first-world country like the United States. In several studies conducted in India and Europe, giving birth to a female infant was directly related to postpartum depression. There is great pressure on women to produce a male heir, especially for women who already have one girl child, the studies concluded. There is usually a yearning to have a boy first and then maybe some girls later on, but that one male is needed to carry on the family name.
In some parts of India, if the first child turns out to be a baby girl, the child will be killed because of the pressure to have a male heir. The stress to produce a male first only adds to the pressure on the women of the family, because whether or not they can conceive a male will also reflect on how the husband treats them. Another huge aspect of the Indian culture is family. Having family for support in everyday experiences, whether they are big or small, is vital. If a woman speaks out about having anxiety or depression, it might be considered as shaming your family and dishonoring those you love.
Many Indian women do not speak out about their feelings, but the, ““Immigrant Asian Indian Women and Postpartum Depression,” published in 2007 in the Journal of Obstetrics and Gynecology, concluded that twenty-eight percent of Indian American women suffered mild symptoms of postpartum depression and twenty-four percent suffered major symptoms,” (Sohrabji1). This is about thirteen point five percent greater than the average percent of women who have postpartum depression in the United States. The study was conducted on Indian American women who were the first generation to come to the US to start a new life.
Studies suggest that new immigrants, “may be at a higher risk for PPD, because of difficulties adjusting to a new culture, loneliness, isolation, and the lack of a traditional Indian support system,” (Sohrabji 1). In south India, the women are taught not to discuss cultural distress because of how others might perceive the family. Dr. Nirmaljit Dhami, medical director of the new Maternal Outreach Mood Services program at El Camino Hospital in Mountain View, California says that “The stigma of having a mental illness is huge in the South Asian community and it keeps women away from getting the care they need.
Many women fail to come forward when they realize that they have depression, which may lead to the mother hurting herself, the child, or someone around her. Poornima Jayaraman, a San Francisco Bay area homemaker, realized that she had to get help for her postpartum depression when she one day “uncontrollably shook” her baby, Esha, after she would not stop crying. For fear of the babies’ safety, Jayaraman had to lock herself in a separate room from the child until her spouse came home from work.
The reason why Poornima had suppressed the feelings she had inside was because of the social stigmas present in her homeland of India. Although resources were present and ready to help her in San Francisco, she was hesitant to retrieve help at the first signs of PPD because of how she was taught to be conservative and quiet when it came to emotions. This emotional suppression needs to be kept in mind while analyzing Indians, particularly from the south, because it determines how they will react to certain treatments like counseling.
They may not want to discuss their issue with a lot of other people, but when it is with a one-on-one psychiatrist, the women may feel more free to discuss their issues because of the confidentiality. The information development rate is rapidly increasing in India, and doctors’ and hospitals’ knowledge on the topic of postpartum depression is on the same page as the United States, yet the everyday citizens will still resort to mental institutes before considering postpartum depression as an actual chemical imbalance.
There is a science behind postnatal depression that many do not know of. It is necessary to educate the people as a whole so that everyone will be more accepting of women with postpartum depression. A huge force in the lives of married women in India is their spouse because of the belief that the man is the head of the household. Another issue with that is that many husbands are abusive and it is not considered a crime. The government or the head of the state will not stop any abuse going on within homes because of their lack of concern with the individual household.
They do not want to get involved and will not because of the view that men run the house and can ideally do whatever they want. In order to change the view on depression, especially when concerning postpartum depression, every person should be targeted to receive news on the truth. Because of the huge technological advancements in India within the past ten years, computers, TV’s, and cell phones have become commonplace. That makes it easier to communicate and spread news to others, when just a decade ago the only electronic that would be at the verage Indians house was a house phone.
A potential way to reach people now would be to make a video concerning postpartum depression and how it is not something brought down as a curse from the Gods. By making a video, I would also be able to reach out to those who are illiterate because only seventy four percent of the population is literate compared to the eighty six percent in the US, (Britt1). The plan I have is to make a video both in English and in my native language, Malayalam, so that it can mainly be used in India but in any English speaking countries as well.
The video will feature Indian woman who have actually gone through postpartum depression so that they can speak from experience. It will not just be a presentation of facts because I want those who see the video to connect at a deeper level. There has already been a doctor who has accepted my offer to show the video to the women who come into his clinic in Kerala, India. He will further help me in my pursuit to inform the citizens of India about a disorder which affects twenty-four to twenty-six percent of the women in one of the most populated countries in the world.