I WANT TO BE ME AGAIN a Case of PPD?

Yeah I want to be me again. So, the other day I was in a meeting of women executives and during the after meeting networking, some of the ladies were in a hurry to get home to take care of their babies. That was when the discussion moved to blending work and family and that was when one of the ladies said – “I want to be me again” and some of those who heard her said what do you mean?.

She said, whenever I deliver it takes me about a year to become myself again; and although my current baby is the third the feeling of not ‘being me’ has persisted with each birth. Now she said “this is my last and I hope to get my life back”. One of the ladies said ‘but you always seem so happy when you have a new baby’ so what is all this about? But it turned out that she was not the only one who feels this way after delivery. Other Executive women present corroborated this feeling of “not being me” after childbirth and said they had not talked about it because they thought people might think they were selfish or they want to put their career before raising a family.

Then the real deal dropped; one lady said that after her first child she actually had to be admitted in the hospital because she was always sad, cried often, will not eat or take care of herself – stay in bed for about two days without bathing and will not feed the baby until someone prodded her or forced her and there were times she wanted to give the baby away or even throw “it” away – she actually used “it” away because she felt it had come to change her life for the worst. That was when her family took her to the hospital and she was admitted. After some medications and what she later came to know as psychotherapy she was discharged but she continued with the therapy for a while. With the birth of her second child she had similar feelings but was much milder and it took only a few weeks to pass.

Well, she said that although she had not acknowledged it, she was not really prepared to be pregnant soon after she got married. For her, she did not really enjoy being with her husband before she got pregnant on her honeymoon!! She had been dating with her fiancé for about two years before they got married but this was a distant relationship and they had had in-person interactions for a maximum of four months over the two year period before they got married and two of those four months were used for preparing for the marriage. So she had always looked forward to “kind of dating in marriage” for a while before getting pregnant and then she got pregnant on her honeymoon!!

She was not excited about the pregnancy but everybody else was so excited and her husband was ecstatic, so she went with the flow; but she always felt her husband married her only for having children looking at the kind of attention he gave her when she got pregnant. On delivery she fell in love with how cute her baby was; but all who came to visit soon after congratulating her turned their attention to the baby. She could not tell when sadness set in and how she came to have all those negative emotions towards the baby and started feeling as though she did not matter anymore.

So the discussion moved to – “are these women selfish or just over educated and so think childbirth is a bother?” Well it turned out that these women are “normal” – they are like any other woman who could develop what is called baby blues or Postpartum Depression after delivery.

What is Postpartum Depression?
Postpartum depression (PPD) also sometimes called postnatal depression is a complex mix of physical, emotional, and behavioural changes that happen in a woman after giving birth. According to the DSM-5, PPD is a form of major depression that has its onset within four weeks after delivery. However, the diagnosis of postpartum depression is based not only on the length of time between delivery and onset, but also on the severity of the depression. It is a type of mood disorder associated with childbirth, and can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns.

It is linked to chemical, social, and psychological changes associated with having a baby. The most common chemical changes are a rapid drop in hormones after delivery; during pregnancy the levels of the female reproductive hormones estrogen and progesterone, increase about tenfold but these drop sharply after delivery and this hormonal drop coupled with social and psychological changes post-delivery can create an increased risk of depression.

Does everyone who experiences mood changes after birth have PPD?
No, according to research there are three types of mood changes women can have after giving birth:
Baby Blues, Postpartum Depression (PPD) and Postpartum Psychosis

Baby blues, which is can occur right after childbirth or a few days after birth, is considered normal. It is characterised by sudden mood swings, such as feeling very happy and then feeling very sad, crying for no reason, feeling irritable, restless, anxious, lonely, and sad. These feelings may last a few hours or as long as one to two weeks after delivery and do not usually require treatment
Postpartum depression (PPD) as indicated earlier can happen a few days or even months after childbirth and the symptoms could be similar to baby blues but these are felt much more strongly than in baby blues. PPD often keeps a woman from doing the things she needs to do every day and requires treatment since without treatment the symptoms can get worse.
Postpartum psychosis on the other hand, is a very serious mental illness that can affect new mothers. This illness can happen quickly, often within the first three months after childbirth. The mother can lose touch with reality, and have auditory and visual hallucinations (that is hearing or seeing things that aren’t actually happening,) and delusions (strongly believing things that are clearly irrational). Other symptoms include inability to sleep, being restless and sometimes suicidal. This will require hospitalization and medication as well as psychotherapy.

Is Postpartum Depression Treatable?
Postpartum depression is often treated with psychotherapy – remember talk therapy? Medication or both. So talk to a psychiatrist, psychologist or other mental health professional. For new mothers or mothers to be stay in touch with their feelings, ask for advice, and seek help when you feel overwhelmed by your emotions. In Ghana it would be good if Pregnancy Schools could include information on PPD or invite psychologists to give psycho education at such meetings, antenatal/postnatal clinics could also invite psychologist to give psycho education on PPD and other related post natal changes.

If you have found this blog helpful let us know. You can also contribute if you have a lived experience, going through a similar experience or you know someone who has and is willing to share her experience. Ensure that as much as possible the individual remains anonymous to protect her dignity and right to privacy. Remember also that this affects some men as well

If you are a student and want to read more check out
1. American Psychiatric Association: Diagnostic and statistical Manual of Mental Disorders, 5th Ed. Washington DC 2013
2. Klainin P, Arthur DG. Postpartum depression in Asian cultures: A literature review. Int J Nurs Stud. 2009;46:1355–73. [PubMed] [Google Scholar
3. Wisner KL, Chambers C, Sit DKY. Postpartum depression: a major public health problem. JAMA. 2006;296:2616–2618. [PubMed] [Google Scholar]

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