The birth of a child brings about a myriad of emotions. A woman goes through the demanding yet precarious nine months of pregnancy to give birth to her baby and ascend to motherhood. However, the feeling of pure joy on the arrival of the little one is often accompanied by an impending sense of apprehension.  

Caring for a newborn is challenging, the endless flow of questions and doubts may plague new mothers. Being stressed and feeling anxious are normal and with time one learns to cope and adapt to their new reality. Known as the ‘baby blues’ or ‘post partumblue​s’​ , this emotional sensitivity following childbirth lasts for a maximum of two weeks. Usually, providing reassurance and emotional support is adequate.  

But what happens when these feelings linger on and a mother is unable to cope? Postpartum blues extending beyond two weeks is termed as Postpartum Depressio​n. It can manifest two to​ three months after childbirth and can persist for up to a year. Although both men and women can suffer from postpartum depression, it is far more prevalent in women.  

Seeking help early on is key to prompt diagnosis and adequate treatment. Therefore, it is imperative to be aware and identify the signs of postpartum depression.

The following are the signs​ of Postpartum Depression:​  

1)    Low mood, fatigue, low concentration

2)    Reduced interest and pleasure in doing things

3)    Feeling guilty, worthless, hopelessness about the future

4)    Disturbed sleep and appetite: sleeping for too long, or inadequate sleep

5)    Thoughts about death or suicide

Other than the detrimental effects on maternal mental health, postpartum depression can also negatively impact the newborn's health. It leads to a poor emotional and insecure attachmen​t between the mother and her child, which will have an adverse impact on the infant’s cognitive, behavioral,​ and psychomotor development. Increased risk of depression in the child, difficulty in regulating emotions in early childhood, and symptoms of ADHD have also been linke​d to​ postpartum depression.

Screening for potential postpartum depression in mothers begins during the antenatal period. Just as how a pregnant woman cares for her physical health prior to delivery, it is vital to safeguard her mental health during this period as well.  

The following are the factors that can put a woman at risk for Postpartum Depression:​  

1)    History of depression, postpartum depression, or antenatal depression

2)    Advanced maternal age (age more than 35)

3)    Coming from a culturally and linguistically diverse (CALD) background or low socio-economic status

4)    Maternal experience of childhood abuse

5)    IntimatePartner Violence (psychological or physical)

6)    Gestational Diabetes Mellitus or other pregnancy-related issues 7) Preterm Delivery (live birth before 37 weeks of gestation)  

Even though many women are aware of postpartum depression, it is not uncommon for women to dismiss their current emotional state as the ‘new normal’ or believe that with time they will feel better.  

Therefore, if you have been experiencing the above-mentioned signs for some time now, it is important to reach out to your General Practitioner. Your GP is aware of the postnatal mental health problems and is in an ideal position to detect, diagnose, and treat postpartum depression.  

The Edinburgh Postnatal Depression Scale (EPD​S)​ is a validated and commonly used screening tool used to diagnose postpartum depression. It is a self-reported questionnaire consisting of 10 questions, with a total score of 30. A score of more than 13 is considered diagnostic for postpartum depression. The EPDS can also be used to screen for antenatal distress and depression.  

The treatment plan, which is tailored to each individual, consists of cognitive-behavioural therapy and/orpharmacotherapy. When needed, your GP can refer you to to a psychologist to receive 8 rebatable visits. Communicating and establishing a trusting relationship with your GP is vital to ensuring the good health of you and your child.  

References

1)   Silverman, ME, Reichenberg, A, Savitz, DA,Cnattingius, S, Lichtenstein, P, Hultman, CM, Larsson, H, and Sandin, S. Therisk factors for postpartum depression: A population-based study. Depress Anxiety​.2017; 34: 178– 187. doi: 10.1002/da.22597

2)    Khanlari S, Eastwood J, Barnett B, Naz S, Ogbo FA. Psychosocialand obstetric determinants of women signalling distress during EdinburghPostnatal

DepressionScale (EPDS) screening in Sydney, Australia. ​BMC Pregnancy Childbirth​. 2019;19(1):407. Published 2019 Nov 7.doi:10.1186/s12884-019-2565-3

3)    Oakhill, Ellen. "Postnatal depression." InnovAiT​  ​9, no. 9 (2016): 531-537.

4)    NetsiE, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of Persistent andSevere Postnatal Depression With Child Outcomes. JAMA​  Psychiatry.​2018;75(3):247–253. doi:10.1001/jamapsychiatry.2017.4363

5)    Lefkovics E, Baji I, Rigó J. Impact of maternal depression onpregnancies and on early attachment. ​InfantMent Health J​. 2014;35(4):354-365. doi:10.1002/imhj.21450

6)    Stein A, Pearson RM, Goodman SH, et al. Effects ofperinatal mental disorders on the fetus and child. Lancet​     ​. 2014;384(9956):1800-1819. doi:10.1016/S0140-6736(14)61277-0

7)    Balaram, Kripa, and Raman Marwaha. "PostpartumBlues." StatPearls [Internet]​      ​. StatPearls Publishing, 2020

8)    McKelvey, Michele M. PhD, RN; Espelin, Jill DNP, APRN,CNE, PMHNP-BC Postpartum depression, Nursing Made Incredibly Easy!:May/June 2018 - Volume 16 - Issue 3 - p 28-35 doi:10.1097/01.NME.0000531872.48283.ab  

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