Postpartum depression is not just another mental health related issue

Becoming a mother is life changing moment for a woman. But the irony is, that most of the people treat it as just a physical process. There are lots of guidance and care is centered around pregnancy. We talk about gestational hypertension or surgical site infections, but the emotional and cognitive toll is broadly ignored. As WHO stated, about 10% of pregnant women and 13% of women who have just given birth, experience a mental disorder worldwide, primarily depression. In developing countries condition is even worse, i.e. 15.6% during pregnancy and 19.8% after child birth. It is evident by researches, that Postpartum depression (PPD) is a serious mental health disorder. Its prevalence range is form 1.9% to as high as 82%. It depends on socio-economic and diagnostic context.Research published on NCBI (national Center for Biotechnology Information) portal asks about the risk factors of perinatal and postpartum depression. First and major risk factor is psychological. A personal history of depression and anxiety increases the risk higher. Lack of social support, smoking, poor eating habits, decreased physical activity and exercise, vitamin B6 deficiency, and lack of sleep also ups the toll. High-risk pregnancy, hospitalization during pregnancy, and traumatic events during childbirth that include emergency c-section, umbilical cord prolapse, preterm or low birth weight infant are also major risk factors. Myth of perfection is a major ignition of PPD. Societal and organizational setup demands women bouncing back instantly. This instant bouncing back is a ‘fake mask of wellness’ in real terms. It makes the mothers hide their thoughts and emotional exhaustion to avoid stigma of being labelled ‘unfit’. It is also evident that most of the working women handle majority of domestic task with office work. This routine steals their essential recovery time. It pushes them from manageable stress to clinical burnout and PPD. Medical system centered around obstetric care is also the reason. It left the mothers to handle with complex psychiatric landscape herself. PPD doesn’t affects the mother only. It’s a trauma for newborn baby. The mother with PPD suffers a lot and may fail to adequately eat or care for herself in other ways. This may increase the risks of ill health. This affects the newborn baby also. Infants are highly sensitive to the environment and the quality of care. They are likely to be affected by mothers with mental disorders as well. Prolonged or severe mental illness hampers the mother-infant attachment, breastfeeding and infant care.Researches confirm that ‘third trimester’ is the highest risk period for emergence of these issues. If left untreated, it may cause bigger problem. Maternal mental health must be integrated into general health care including women’s health, maternal and child health care, reproductive health care and other relevant services. Use Edinburgh Postnatal Depression Scale (EPDS) or BDI not just once, but multiple touchpoints. Using it at third trimester, 2 weeks, 6 weeks, and 6 months postpartum can make a big difference. Structural workplace support and collaborative care models can also be helpful. We have to accept that maternal mental health is a public health priority, not a personal luxury.Dr Preety Aggarwal, Director Gynecology and Obstetrics, Motherhood hospital Gurgaon