Mumbai: In women’s life the postnatal period is the most demanding period in terms of physical, mental and emotional health. Primi or a new mother goes through a roller coaster ride of emotions as a new bundle of joy and happiness comes along with exhaustion, anxiety and sobbing. Postpartum or baby blues is different from postpartum depression (PPD) which is a transient depression. It is observed in 50-80 per cent of women after two to three days of delivery and resolves by 10-12 days post-delivery. It is self-limiting and mild with temporary symptoms of negative feelings, tearfulness, mood swings.
While postpartum depression can begin anytime within the first year after childbirth. If baby blues last more than 2 weeks, it can be an indicator of postpartum depression. The cause of PPD is unclear. Hormonal and physical changes after birth and the stress of caring new baby play an important role. There can be several risk factors for PPD such as depression or anxiety during pregnancy, perfectionism or fear of making a mistake, traumatic birth experience, preterm birth, infant admission to neonatal intensive care unit (NICU), breastfeeding problems, among others.
Symptoms of PPD are mood of sadness, anger, guilt, crying, anhedonia (inability to experience pleasure in a normal pleasurable activity), difficulty in sleeping – unrelated to infant care, fatigued, unable to concentrate, hopelessness, and the thought of death.
Breastfeeding can protect a mother’s mental health but breastfeeding problems can increase the risk of depression. When a depressed mother breastfeeds an infant, it protects her baby from the harmful effects of depression and the mental health of a child is protected throughout childhood. Mother is less likely to abuse and neglect her infant. It decreases the mother’s stress and increases the release of oxytocin and prolactin hormone. Oxytocin is a love hormone that helps in reducing maternal anxiety and promotes mother-infant bond. While Prolactin hormone induces and improves sleep as sleep disturbance and depression go hand in hand.
Breastfeeding mothers have the benefit of getting more deep slow-wave sleep which reduces daytime fatigue and they take only a few minutes to fall asleep. Taking a long time to fall asleep can be a high-risk factor or predictor for depression compared to mixed feed or formula feed infants. There is a myth in a family that by providing some formula feed to infant, a mother will get more sleep but the reverse is true.
Milk production, latch issue, nipple pain are a few more common causes for postpartum depression which leads to a cessation of breastfeeding which can have a detrimental impact on mother and child health.
Breastfeeding can be made a pleasurable experience by seeking the help of a Lactation Consultant, who can help to resolve the breastfeeding problems and queries by formulating a simple feeding plan and protect maternal mental health.
If night feeding is quite challenging for a mother for whom interruption of sleep is a major trigger for mood symptoms, then in such cases a caregiver can feed the mother’s own expressed breastmilk to an infant with wati or wati spoon and put the infant back to sleep so that mother can get five to six hours of uninterrupted sleep.
Lifestyle factors can prevent and treat milder symptoms of depression. Encourage the mother to eat healthy foods, do exercise, engage in mindfulness practices, and avoid the consumption of tobacco and alcohol. If a mother is on antidepressants than most of the drugs are compatible with breastfeeding. Building awareness and education can effectively combat the stigma attached to maternal depression and anxiety by dismissing negative labels, reducing personal shame, self-blame and guilt thereby opening pathways for affected women to seek help and treatment.
(Dr. Mansi Shah is a Lactation Consultant at Jaslok Hospital and Research Centre in Mumbai.)
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