POST-PARTUM DEPRESSION: WHAT GIVES?

Two weeks ago, I spent an afternoon with real life heroines. Moms who were brave enough to go on daytime television and tell the world their real life struggles in raising premature babies. Celeste, Jackline and Ruby may have walked the same path in having their babies born too early but they had vastly different stories to tell on how they arrived here.

Jackline, for instance, had her babies come early because they were quadruplets. It may have been four times the joy of parenting but it was also four times the challenges of raising them, having been delivered at only 32 weeks gestation. Ruby struggled with pre-eclampsia (pregnancy-induced high blood pressure that can be life-threatening) that led to early delivery of her babies to preserve her life and prevent complications.

Celeste however made me literally shed a tear. A young mom who thought all was well until she woke up to the cervix opening silently way before her baby was due to make an entrance into this world. The little one came anyway, despite every trick in the book to make her wait just a little longer. Two more months in the newborn unit, just to get to a weight of 1800g and have a shot at life and her resilience was wearing thin.

While all new moms start motherhood with a lot of anxiety, for Celeste, it was a rollercoster. She was young, without a strong social support system and had a baby the size of her palm to take care of. It is no wonder she sunk into depression. Motherhood became a daily struggle.

Post-partum depression is one of the most damning conditions that cause such severe morbidity and yet easily go untreated. The signs are glaringly present but completely ignored by the patient and those around them because they are veiled behind the motherhood excuse.

The new mother will start experiencing feelings of inadequacy as a mom; that she isn’t up to the task. She loses ability to nurture her little one yet deep down it is all she wants but cannot figure out how to. Imagine a 22-year old mother without a helping hand at home, with a three-week old infant with incessant colic.  The inability to sooth her own baby creates a monumental frustration that may lead to acting out.

Babies in such a scenario are at high risk of harm. They are shaken, beaten or completely ignored. The mom involuntarily learns to switch off the sound of the baby crying and he may end up unattended for hours, unfed and in soiled diapers. They lack affection and there is no mother-baby bonding.

The extreme spectrum of post-partum depression manifests as post-partum psychosis. The poor mother exhibits complete bipolar symptoms. Their moods swing from low depressed states to extreme manic behavior.

Anyango* was one such mother. A young 18-year old mother who was sexually assaulted by her employer. It wasn’t enough that she was an orphan, but the encounter left her pregnant and in due course, the employer turned her out of his home where she worked as a nanny to his children.

She went through a harrowing pregnancy, alone, unsure of her next meal and literally living on the streets, She gave birth alone and unattended and eventually she reached the end of her rope. With nowhere to go, she completely lost it. She was discovered three days after delivery by a good Samaritan, starved and confused, clutching her baby while shouting mindlessly.

It took the intervention of the local area chief and the askaris to get her to hospital. She was amazingly violent whenever anyone tried to touch her baby and it took four men to restrain her. She was bound by ropes and brought to the hospital at night.

It took heavy sedation to calm her down and send her to sleep while her baby was whisked away to the care of the neonatologists in the paediatric unit to receive emergency care. She was cold, dehydrated and soiled but miraculously stable. Her mother on the other hand was out of it for 48 hours before the sedation would be allowed to wear off.

It is not an easy journey to recovery. The mother needs care by qualified psychiatrists to help restore her mental health as a matter of emergency so as not to deprive her young one of a mother’s nurture. This may be done by the use of drugs or a combination of drugs an electroconvulsive therapy (passage of an electric current though the patient’s brain). As she settles down, she can then undergo psychotherapy as part of her treatment.

One should never underestimate the power of a solid social support system. As her mind is treated, there is need to ensure that her self-confidence as a mom is restored and she is not overwhelmed with the care of her baby.

It is critical for all of us to understand this and mind how we perceive moms and the huge responsibility they bear, of raising a little one. It is not acceptable to ask them to get over their unexplained feelings. Suicidal ideation should raise a red flag. An overwhelmed mother needs all of us to extend a solid hand of support without judgement.

Anyango and her baby are alive and well today because we got to her in time and she got the help she needed. Many are not so lucky. Sometimes, the only time we know there is a problem is when the struggling mother makes news headlines for killing their babies. A little diligence goes a long way in keeping everyone alive!