Jakarta, IO – Perinatal mental health system is not a priority in developing countries, including Indonesia, even though according to psychiatrist dr. Danti Filiadini, Sp.KJ, in the University of Indonesia Hospital’s “Postpartum Depression: Recognize and Mitigate Immediately” Health Talk held on Thursday (16/11/2023), one out of every four birthing mothers suffer from postpartum depression, with postpartum blues incidence rate being in the 50%-70% range, while that of postpartum depression being in the 22.3% range. The high level of depression incidence among pregnant and newly-birthing women is a serious problem that requires concern from everybody.
“There are differences in the characteristics of baby blues and postpartum depression, which include duration, onset, prevalence, severity, and existence or lack of the idea of suicide. Baby blues occur 2-3 days after birth, lasting at most two weeks, occurring in 80% of birthing mothers, causes mild severity of dysfunction, with no desire to kill oneself appearing. On the other hand, postpartum depression lasts for more than two weeks, occurs anytime between the first month to the first birth after birth, suffered by 5%-7% of birthing mothers, causes medium to severe dysfunction, and might be coupled with suicidal intent,” dr. Danti said.
During pregnancy, the presence of both the estrogen and progesterone hormones in the body will greatly increase, and it will drop after birth. Pregnancy affects the level of the stress hormone cortisol in the body, and consequently, the mother’s mood.
Postpartum depression risk factors include physical factors (risky pregnancy, emergency Caesar procedure, hospitalization during pregnancy, malnutrition, premature and/or low birth weight baby); lifestyle factors (eating habits, sleep cycle, extremely high or low physical activity, smoking tobacco and/or drinking alcohol during pregnancy); psychological factors (a history of depression and anxiety, premenstrual syndrome, negativity towards the baby and/or dissatisfaction towards the baby’s gender, a history of sexual abuse); social risk factors (lack of emotional support from husband and/or family members, suffering from domestic abuse, financial problems and/or problems at work).
Postpartum depression lowers the health of both mother and baby, damages the interactions between mother and baby, and affects other members of the family. Postpartum depression is frequently undiagnosed and untreated, even though it greatly affects the entire process of thinking, feeling, and performing activities.
“The mother will not just suffer from sadness – she might become more sensitive, irritable, or apathetic. Why is it frequently undiagnosed? Because mothers have a tendency to cover up their symptoms because of a real risk of being bullied and/or criticized by her husband and family on top of her depression for ‘ingratitude’, ‘incompetence’, ‘being a failure’, or even worse, ‘crazy’. Therefore, family members must treat newly-birthing mothers gently and be alert for signs of depression, and refrain from putting unnecessary pressures on her,” dr. Danti said.
Mitigating Protective Factors
Postpartum depression is indicated by a subjectively observable mood of depression (of course), loss of interest and/or enjoyment in everything, insomnia or hypersomnia, psychomotoric retardation and/or agitation, a sense of worthlessness and/or guilt, lowered energy levels, repeated appearance of ideas of death and suicide, or even attempts to harm or kill herself or the baby, distraction, difficulty to concentrate and/or make decisions, rising/dropping at least 5% of body weight within a month. These symptoms will last for at least two weeks, causing the mother to suffer from distress and dysfunction, and the onset might occur anytime during the pregnancy or within 4 months after the birth.
How do we prevent it?
By balancing out the risk factors with protective factors: “Pregnant mothers must consult about the birthing, healing, and nursing process with doctors and counselors. She must also routinely undergo antenatal care (ANC), plan for the pregnancy and after-birth care, and live a healthy lifestyle. Naturally, the husband must constantly accompany her during these consultations. The family living together with the couple must also cooperate with them in these endeavors, as it is an unfortunate fact that most maternal depression cases are caused and triggered by the mother’s own husband and family members,” dr. Danti said.
After birth, the mother should also rest at any opportunity she gets, consume balanced nutrition meals, set up a routine exercise regime, have her husband and family provide her with a sense of safety whenever she tries to tell them how she feels, i.e. that she can tell them anything without fear that they would blame or denigrate her, have her husband and family members support her in filtering negative comments from random people, appreciate the efforts that her husband and family makes and have her own feelings and concerns appreciated, and join a healthy, properly supportive peer support group.
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It is extremely important that the mother’s husband and family members help with baby care, ensure that the mother have sufficient nutrition, set time aside to listen to her, and most importantly, refrain from judging and denigrating her. The mother should be encouraged to take part in the postpartum depression screening by accessing the Edinburgh Postnatal Depression Scale (EPDS) at https:// www.mdcalc.com/calc/10466/edinburgh-posnatal-depression-scaleepds#next-steps.
“However, EPDS is just a screening tool. What matters is that the mother, husband, and family must not hesitate to consult professionals, instead of making the mother afraid of being called ‘crazy’ or other negative levels,” dr. Danti warns. (est)