Postpartum depression is a topic that is yet to gain proper attention in Nigeria; thankfully, so many women and medical experts are beginning to create more awareness to prepare new mothers and fathers and also how to deal with it.
Even with the awareness, still, it seems disturbing to see or read about nursing mothers, having successfully gone through the stress of pregnancy for nine months, sliding into depression.
In some cases, some hurt themselves, some harm the baby and in some extreme cases, some even kill the baby. This phenomenon is called post-partum depression.
According to WebMD, a site that provides valuable health information and tools for managing the health, PPD is simply described as the emotional and behavioural changes a woman experiences after being delivered of a baby. It is said to start manifesting, oftentimes, from a few days, weeks or months after delivery.
Its symptoms include frequent mood changes, loss of pleasure, feelings of worthlessness, hopelessness and helplessness, excessive fatigue, anxiety, restlessness, decreased libido, difficulty sleeping and thoughts of death or suicide.
However a consultant endocrinologist, Dr. Michael Olamoyegun, said cases are fewer in Nigeria compared to the western world due to availability of social and family support.
WebMD identified other factors causing PPD to include marital conflict, having a history of depression, initial ambivalence about the pregnancy and age, as younger people have been found to be at higher risk of experiencing it. Olamoyegun explained:
“Imagine a woman who lost her job few weeks to her date of delivery; or the husband lost his job; or someone dear to her died; or they changed environment to a place where they don’t know people around and where she is not comfortable with. All these can trigger depression.”
Be that as it may, it’s good news, however, that there is a solution. Apart from the fact that it can be avoided, it can also be managed. Thus, he said the main solution is two-pronged; prevention and management.
Olamoyegun explained that one of the ways to avoid it is for pregnant women to attend ante-natal clinic as findings have shown that those who do are at lower risk of experiencing PPD.
And for those who are already experiencing it, he said such persons need a lot of care and support from their spouses and family members. He said,
“Post-partum depression is common among the first-timers because they are not experienced about childbirth. So, they might not know how to care for the baby, like if the baby is crying all night despite several efforts to pet them.
That is why some women leave the baby in the room alone to go and sleep in another room because of the baby’s cries, especially if they have also not slept.
And that is why we always advise women to go for ante-natal care, because those who do are less likely to have post-partum depression, compared to those who didn’t attend.
If it’s a well organised ante-natal clinic, like in a public hospital and it is managed by an experienced midwife, they would take them through series of topics, the changes they should expect, how the baby tends to behave and they would have been prepared as to how childbirth could change their lives.”
He said part of what could also trigger PPD in women is the fear some women have about their body. He added,
“There are some babies that can suck for a long time, and the woman might be apprehensive of doing that for months, worse still if she has not been feeding well.
Some of them might be apprehensive of their breast sagging and if they don’t have anyone around, like their mother or mother-in-law, to support them, they could slide into depression, whereas they would have been told all of these during the ante-natal. So, pregnant women should appreciate the need to attend pre-natal clinic.”
For women who have the risk factor or those experiencing it already, Olamoyegun said one good way to manage it is for them to have support from their husband, in-laws, friends, colleagues and members of their church or mosque. He added:
“They need people to talk to, like people who have been there. That is why it is not as common in Africa as it is in the developed countries because there is not much social support there, as we have in Africa.”
He noted that those experiencing it could be treated through counselling or medication, which must be prescribed by a doctor.
“For those who develop it, the key is that it must be detected early so it can be managed through psychotherapy and if it is severe, there are drugs that can be recommended by a doctor,” he said.
Olamoyegun cautioned that people around nursing mothers should not downplay the impact PPD could have on either the woman or the baby. He said,
“Depression can lead to infanticide, which is the crime of killing a child. Some women resort to killing the child; they can deliberately sleep on the child, some could drop them on the street or in the well, as we have seen in some reports. Some might starve the baby to death so that people won’t know that they did it deliberately. That’s why we said the effect could be weighty.”
On the symptoms to look out for in such women, he pointed out that some could be crying uncontrollably; some show suicidal tendencies; some look morose all or most of the time while some refuse to take care of themselves, not caring who is offended or not. He said:
“Some even say it that they feel like committing suicide. Some people are prone to depression more than others and there are risk factors for it, such as family history and major life changes, like job loss, accident, death of a loved one, incapacitation among other factors.”
Nursing mothers are therefore encouraged to rest when their baby sleeps, keep in touch with (friendly) family members and friends, observe a good diet, avoid alcohol and caffeine, get out of the house for a break or take a walk, do reasonable exercise, as advised by the doctor, ask for help anytime they need it, especially if the aforementioned symptoms persist beyond two weeks.
Three ways nursing mothers can care for their breasts
Given the physical and hormonal changes that happen to the breasts of a woman who had just been delivered of a baby, it seems helpful to highlight how nursing mothers can care for their breasts, Breast pads should be changed regularly to prevent irritation or painful swelling of the breasts.
Women are also advised to make sure the breasts, especially the nipples, are handled with care as they would have become more sensitive, so as to avoid pain and sore nipples.
Wear the right bra: It is widely believed that breastfeeding causes the breasts to sag, but that may not be true, as it has been found to depend largely on the woman.
According to a gynaecologist, Dr. Bolanle Shukra-Okesina, had said,
“Breastfeeding per se does not make the breasts to sag. If the woman uses the appropriate bra size and she takes enough of fluid, especially water, when breastfeeding, the breasts will not sag, even after breastfeeding.
During pregnancy, the woman is expected to change the size of her bra and use the appropriate size at every stage as the breasts increase in size because the breasts need to be supported by a firm bra.
When the milk stops after breastfeeding, the breasts would on their own go back to their normal size. So, if the woman does the right thing, the breasts have no reason to sag.”
Make sure the baby sucks rightly:
One other way to care for the breasts is to ensure that the positioning of the baby being breastfed is not far below the nipples so they don’t keep dragging the nipples downward, which could cause some pain and perhaps a sagging breast.
And when the baby is done feeding – if they don’t withdraw by themselves – mothers are also advised to gently remove the nipple from their mouth. Hence, they should avoid dragging the baby away from the nipple. Some babies could hold on to the nipples.
Don’t overlook sore nipples or engorged breasts:
From observations and findings, some women tend to see sore nipples or engorged breasts as a norm, especially when they are still breastfeeding, even though engorged breast is expected.
However, women are often advised by medical practitioners to see a doctor if their breasts are full and inflicting severe pain on them or if they notice bumps around the nipples or on the areola. Using the right bra has also been found to reduce soreness and using sleep bras could also help when they are going to bed.