Post-natal depression is more common than you’d think, yet women still feel unable to seek help. Health psychologist Dr Melanie Schlatter and GP Dr Shereen Habib at the Well Woman Clinic Dubai, tell us more
Why does it happen?
Dr Shereen Habib: It happens for many different reasons – lots of factors coming together. The hormonal changes involved in pregnancy and afterwards play a large part, as well as sleep deprivation, and often vitamin and mineral deficiency can play a role and be under-recognised. Add to that a feeling of being unsupported or a lack of social network, plus a change in body image and other psychological factors and you have a recipe for depression. A personal or family history of depression makes post-natal depression (PND) more likely, as do a problematic pregnancy or traumatic delivery.
How is it different to just feeling down after giving birth?
Dr Shereen Habib: The baby blues are short-lived, while PND lasts much longer and is associated with feeling worthless and helpless – not just being teary or sad. Any woman with the baby blues lasting more than a few weeks needs to be assessed for PND.
Dr Melanie Schlatter: There are four areas to assess in order to diagnose PND. The most important risk factors are from a number of causes: a history of psychiatric illness and social stressors (which may include financial difficulties, a lack of supportive relationships), poor coping skills, personality (particularly high-trait anxiety); and physiological stressors (such as hormones or fatigue).
Then we look at antenatal indicators: is there a chronic history of PMS, previous pregnancy issues (miscarriages, stillbirths), obstetric complications, stressful life events (illness, job changes, bereavement) or depression in pregnancy?
The third set of factors are the postnatal indicators, including: delivery complications or changes to anticipated delivery plans which cause distress to the mother, a handicapped or ill baby or a baby that is not of the sex the parents wanted.
Finally, we consider postnatal indicators associated with the mood and behaviour of mother and child. For example, if the woman often expresses a feeling of detachment from the baby; she feels like a bad mother, may have thoughts of harming the baby, or herself, and doesn’t want to hold the baby or feed it. She may have difficulty breastfeeding and feel incompetent. She will also likely be exhausted, overwhelmed, and unwilling to have visitors or leave the home.
Concentration will be low, and anxiety will often be high. The baby may also be difficult, with colic, reflux, or sleeping issues such as hourly waking. If she has other children, she may also experience guilt for neglecting them due to the new baby.
How essential is it to seek treatment for PND?
Dr Melanie Schlatter: It’s essential to monitor and intervene, else it will become chronic, and if the mother goes on to have further children, you may be able to prevent a recurrence in the future. You also want to provide the best coping strategies so that the mother can bond with her baby, and so that a secure attachment can be formed.
Is there a bit of a stigma surrounding PND here?
Dr Melanie Schlatter: Seeking help for psychological issues is still a grey area for many people here in the Middle East, but regardless, women are diagnosed with PND all over the world. Across the board they simply don’t speak up because they don’t want to feel abnormal, or to admit their perceived failing as a mother – especially when it comes to admitting thoughts of wanting to harm themselves or their new born baby.
You would be surprised as to how many women (regardless of culture) hold onto their ‘secret’, having no idea that their thoughts and feelings are common with PND. Most women generally want to be like ‘the other mothers’, or respected elders in their family who are coping perfectly (or so they perceive). There may also be greater levels of self-deprecation if the woman was (for instance) previously successful in the working world and who now feels like a complete failure as a mother (which many feel should ‘just come naturally’).
It’s hard to reconcile and they beat themselves up. In fact, women will often come to me saying they have felt like this for the last one to two years, having no idea that they really don’t need to feel this way at all.
Are women living away from their family and friends more likely to suffer from PND?
Dr Melanie Schlatter: Not unless they are also experiencing a whole host of other factors (social, financial, biological), have a particularly small social network, are not forthcoming with the ability to ask for help, or
if they are experiencing a negative or unsupportive relationship with their partner.
What’s the recovery time, once treatment begins?
Dr Shereen Habib: Recovery varies from a few weeks to years and depends on consistent treatment, psychological and social support and on the woman’s history of depression. You can’t necessarily avoid getting PND, but you should seek help at the first signs of depression so that treatment can start straight away. Furthermore, PND doesn’t just happen with a first baby. It can happen with any baby – even if you’ve had children before and not experienced it. Sometimes it can run in families, too, but not always.
Where can women get help in Dubai?
Dr Melanie Schlatter: Talk to your obstetrician or gynaecologist as they may have a psychologist on their list. General practitioners experienced in women’s health will help and may even be able to prescribe medication if necessary (if they are unsympathetic and you still feel concerned, please don’t give up and get a second opinion). And, of course, psychologists can help but check first whether this is an area they are able to cover.
For more information contact Dr Melanie Schlatter and Dr Shereen Habib at the Well Woman Clinic, Dubai, www.wellwomanclinic.ae (04 332 7117).