The ability to give birth is both a miraculous and fear-inducing experience for many women. Many cultures insist that the worth of a woman is in her ability to give birth, to produce children so that the family can move forward in time. However, while media and social pressure keep on persuading our women that childbirth is the most wonderful thing in the world, childbirth can be quite horrifying especially for first-time mothers. Childbirth can even spell the difference between life and death as many women around the world continue to die in childbirth. The pain that women suffer in childbirth can also be off-putting to many women. Labor pains can last many hours, and complications during delivery are well-known. In many cultures, pregnant women live in a state of anxiety about the gender of their babies. The pressure to produce sons in many Asian cultures, for example, can lead to family and personal conflict. In India and China, women continue to abort female fetuses, preferring male children for economic and status reasons. Women might even feel the loss of control over their own bodies since motherhood is deemed by their culture as the ONLY path that women are allowed to take. There was a beauty queen who won the title of Miss Universe some years ago who declared that “the essence of a woman” was to be a mother. That is quite unfair and untrue. Being a woman is more than being a mother. There are many women who are infertile or who have decided to abort their babies who face discrimination. And yet, they are women who have as much worth as any other woman in the world. Their stories become lost in a world where people deem them as “deviant”. In the field of psychotherapy, we as mental health professionals do not judge. We do not moralize. Instead, we listen to those lost stories and offer healing and comfort to these women.
Infertility and abortion are major topics in themselves in the field of psychology. We know them as powerful issues that impact not only the woman but also her significant other and her family. But what happens to those women who are able to give birth but still feel somewhat sad and uncertain? Many people would label them as ungrateful. Some might say, “What is there for you to be sad about? You are lucky to be a mother! Stop your theatrics and be grateful.” This is an example of an insensitive comment that comes not from strangers but from the family members of many women who suffer from a family of mental health conditions called “Perinatal disorders”.
The term “perinatal disorders” is quite modern. In the past, they were known as “postpartum disorders”. “Post-partum” means “after childbirth”, therefore these disorders are said to occur AFTER a woman has given birth to a child. But more recent researches have shown that the symptoms of many so-called “postpartum” disorders actually occurred BEFORE childbirth. In simpler terms, the disorders began while the woman was still pregnant. Thus, the term “postpartum” is inaccurate. “Perinatal” was elected as a replacement, being more accurate as it means the period of time both just before and right after giving birth.
A serious consideration has to be given also to the fact that fields of healing such as medicine and mental health have traditionally been dominated by men. We have only relatively recently started to focus on the unique health states and functioning of women. Even if an Obstetrician-Gynecologist (OBGYN) is a woman, she is still trained in a predominantly androcentric (male-oriented) medical model. As patients, women with perinatal conditions should make it a point to ask questions if they are unsure of their health professional’s training and continuing education in this sub-field.
Used to be called “postpartum depression” or PPD, Perinatal Depression is NOT the same as the so-called “baby blues”. Perinatal Depression is a full-blown depressive disorder acknowledged in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; the primary diagnostic manual of mental health professionals) as “Major Depressive Disorder, with perinatal onset”. Women with this disorder often present with high levels of sadness, concentration difficulties, fatigue, low self-worth, sleep problems and a difficulty in maintaining self-care and routine. For example, many women forget to shower and even eat. Some forget to feed their babies or change their diapers. Women who have had past depression diagnoses or have relatives diagnosed with mood disorders are more susceptible to developing Perinatal Depression. Women with Perinatal Depression have feelings of disconnection with others, including their babies, and this bothers them so much that they could not bear to be near their babies. Women with Perinatal Depression DO NOT hurt their babies. Instead, they tend to be suicidal.
Especially for first-time mothers, the arrival of their first child changes everything, not just their routine. The new mother’s loyalty is split between her child and her significant other/spouse. Also, her role as a new mother changes her relationship to the extended family. The woman’s parents now become grandparents, and her siblings now become aunts and uncles. Depending on the functionality and health of the family before the baby arrived, these changes can be both daunting and exciting.
Most often, women will not seek mental health help for Perinatal Depression. The reasons are: they are told it is normal for mothers to feel just a bit sad or “under the weather” after giving birth (FACT: not really), society tells them they SHOULD feel happy and grateful that they are now a mother and that it is selfish to feel anything negative, and the fear that they may be labeled as “crazy” for having certain thoughts and feelings. Regardless of situation, any woman who has just recently given birth, whether or not they have Perinatal Depression, needs support as a child changes the structure and dynamics of family and couple systems.
The so-called “baby blues” is a layman’s term for a period of “normal” sadness and fatigue after childbirth. It is said to be felt by 80% of women and will dissipate about 2 to 3 weeks after birth. However, these are warning signs that the woman is feeling overwhelmed. Before the “baby blues” can progress into full-blown depression, mental health professionals advise seeking help immediately.
Perinatal/Postpartum Obsessive-Compulsive Disorder
Also called PPOCD, this condition affects about 3 to 5% of women. Women with PPOCD exhibit uncertainty and insecurity revolving around the safety of their babies. They have very bizarre images of their babies getting hurt such that they no longer approach their babies for fear of hurting them. Unlike Perinatal Depression, sadness is not their primary symptom, but the bizarre thoughts and images of their babies getting hurt. They attempt to stop these bizarre images by constantly checking to see if their babies are still breathing. These women constantly worry and are aware that these thoughts and images are irrational which makes them more anxious. Women with PPOCD DO NOT hurt their babies and do not need to be hospitalized.
Women with PPOCD tend to have a family history of anxiety and/or mood disorders, and the risk for developing this condition rises especially if they have a perfectionistic personality (highly responsible, high morals and values, meticulous). Biochemical disturbances have been found in their serotonin system as well as a brain malfunction in the striatum (putamen and caudate nucleus areas specifically) region which governs repetitive thoughts and behaviors.
Also called PPP, this is the rarest of the perinatal disorders. These women DO hurt their babies and are a threat to themselves and others. However, infanticide (killing their babies) is quite rare. They need to be hospitalized. These women lose touch with reality and are not aware that they are already causing distress in others. They also show high levels of suicidality and even after treatment, they tend to relapse. An interesting thing about women with PPP is that they have high religious thought content which leads them to act out in dangerous ways. For example, a woman exclaimed that her baby was Satan and so she needed to “baptize” (submerging her baby in a bathtub filled with water for lengthened periods) him to save his soul.
Things to consider in seeking help
In the Philippines, it is always advisable to check and countercheck the training and professionalism of the mental health professional who provides treatment and diagnosis services. Most mental health professionals (counselors, therapists, and even psychiatrists) do not have specialty training in perinatal disorders. If necessary, second opinions are highly recommended. It is NOT ADVISABLE TO DO PERSONAL RESEARCH ON THE INTERNET without consulting with a therapist trained to diagnose and treat perinatal mental health disorders.
Mindfulness and Cognitive-Behavioral Therapy have proven to be successful in treating Perinatal Disorders. It is also wise to consider couples therapy or family therapy since there is a subsequent change in the relationships of each member of the family with the arrival of a baby, especially if it is the first child of the couple. Family therapy may even be necessary for adjustment and coping if the child is born to “non-traditional” households or unique circumstances (such as the baby being born to a single mother, being born after a series of miscarriages, the mother had abortion before, the mother is not in good terms with either her own parents or in-laws, loss of the mother’s parents around the time of childbirth, or the baby being born to a woman nearing or already at menopausal age). Couples therapy may also be needed if the spouse is showing odd behaviors and symptoms. Fathers have been known to exhibit paternal perinatal mood disorders independent of their wives’ condition.
In terms of medication, a type of medication called selective serotonin reuptake inhibitors (SSRIs) used to treat depression has been found to take 10 weeks for it to work in treating PPOCD. In other words, no change or benefit can be seen for 10 weeks while taking the drug daily. A medication called Zoloft if taken in 50 mg dose over 1 year by a pregnant woman has been found to pose no risk to infants while in the womb. Babies have been found to absorb only 1 mg of the medication, but more studies need to be made to be sure. Another medication called Depakote has been shown to cause cleft palate in kids when taken by a pregnant woman. Pregnant women should not take Lithium, a drug often given for Bipolar Disorder. Lithium stays in the breastmilk of breastfeeding women and is highly toxic for infants. Pregnant women thinking of taking psychiatric drugs should talk to both their mental health professional and physician to balance the pros and cons of ingesting substances while pregnant. Breastfeeding moms should also do the same. The act of breastfeeding aids in attachment, and stopping it suddenly can cause hormonal imbalance. Also, research has found that it is worse for the mom to be depressed than for a baby to absorb a small amount of the medication either in utero or through breastmilk.