Postnatal depression
The World Health Organisation estimates that 13 per cent of women who have just given birth experience a mental health disorder (predominantly depression). Image Credit: Shutterstock

The tears would not stop running down her face as the door thudded with knocks and the wails of her baby slipped through the cracks. Her ears were ringing with the sound, her head buzzed from a lack of sleep, her hands quivered as she opened the door to sharp, angry eyes. “Take him,” commanded her mother-in-law, handing over the sobbing infant.

“It was always like that,” says Sheryl, who spoke to Gulf News on condition of anonymity. Sheryl, who had lost her parents by the time she became one, was glad when her husband told her his mum was coming to town. Sheryl hoped for a break – she was new to the UAE, minus any pals or house help, and the thought of relief was sweet. Little did she know that she’d be in despair days down the line.

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“It was as if I was a domestic,” she says; she had to look after her child, do the laundry, cook for three and clean the house while her mum-in-law inspected the work and criticised.

When Sheryl’s husband came home, she says, disbelief creeping into her voice, the mum-in-law would grumble about all the work she had done; her husband would tell her off for making an old woman do chores.

By the end of a month, Sheryl was devastated and raging. She had had a tough time of it – the pregnancy and delivery – and she was suffering from the baby blues; a common enough, if often ignored, condition where a woman feels low post delivery.

What are the baby blues and when should you worry?
Dr Summer Fakhro, Clinical Psychologist at Lighthouse Arabia, explains: “With what’s known as baby-blues, we expect a mother to experience mood swings and irritability, which tend to subside a month or so after giving birth. However, if after one month a mother is continuing to experience mood disturbances, overwhelming feelings, sadness, hopelessness, difficulties bonding with the baby, or symptoms of anxiety like panic and excessive fear about the baby’s wellbeing, we would recommend getting professional advice. A good place to start is any of the specialists you are already in touch with, such as your gynecologist, pediatrician, or lactation consultant.”

It seems like a caricature – the evil mum-in-law and the bride locked in a battle of wills as the husband gets on with his day with no clue about what’s going on behind the scenes – which is what made it worse for Sheryl; how could she accept she was trapped in this parody of life?

This may be a cultural fallout – a woman in her country, says Sheryl is expected to pick up the slack and always take care of her elders, even if she’s strained. Mandeep Jassal, Behavioural Therapist, Priory Wellbeing Centre, Dubai, says: “Culture can play an important role for many women struggling with post-partum depression. One of the main contributing factors is that women do not feel empowered to reject traditional rituals that are imposed on them by, for example, caregivers, in-laws and extended family. And unsatisfactory pre-existing relationships can result in feelings of confinement, tension and stress.”

Culture can play an important role for many women struggling with post-partum depression. Unsatisfactory pre-existing relationships can result in feelings of confinement, tension and stress.

- Mandeep Jassal

Like Jassal says, every culture comes with its own post-birth rituals and traditions. Dr Fathima Safa, Laparoscopic Gynaecology - Specialist, Aster Hospital, Al Qusais, explains that’s the postnatal period is universally defined as 40 days. “In most cultures, postpartum customs include a special diet, rest, and assistance for the mother. The emphasis on rest and support for the mother has declined gradually over time,” she adds.

For Sheryl, that period of comfort was cut short as household duties came rushing back.

But even without her mum-in-law in tow, Sheryl was in for a rough time – it’s the unfortunate nature of a nuclear family in a new country; where’s all the support?

“Similar to other big cities, Dubai is a place in which many nuclear family units move without the support of extended family. The saying ‘it takes a village’ is indeed important when thinking about the amount of support needed for a baby and mother in the first year. However, without family around, and with fathers often needing to get back to work quite quickly, many mothers are left feeling alone and overwhelmed,” explains Dr Summer Fakhro.

Dubai is a place in which many nuclear family units move without the support of extended family. The saying ‘it takes a village’ is indeed important when thinking about the amount of support needed for a baby and mother in the first year.

- Dr Summer Fakhro

To help yourself out of that funk, hiring someone may help. “depending on the culture and experiences of the parents, there may be different views about asking for help, like seeking a nanny or nurse to live in with them, or even seeking mental health support at this time”, explains Dr Summer Fakhro.

Sheryl heartily recommends getting all the help you can post-delivery – and arranging it beforehand so you don’t get stuck on the hamster’s wheel of new motherhood. It took her some time to gather the courage to talk to her husband about what was happening.

Risk factors that may mean a tumble into depression
Dr Fathima Safa, Laparoscopic Gynaecology - Specialist, Aster Hospital, Al Qusais, explains that there could be more than one reason a new mum was feeling sad. She says: “In Asian countries, the prevalence of postpartum depression (PPD) ranges from 3.5 per cent - 63.3 per cent, with Malaysia and Pakistan displaying the highest and lowest rates, respectively. Risk factors for PPD were clustered into five major groups:
• Biological / Physical
• Psychological (Antenatal depression )
• Obstetric / Pediatrics (Unwanted pregnancy)
• Socio-Demographic (Poverty)
• Cultural factors (preference of infant’s gender)”

Unfortunately, it didn’t provide any relief. “He’s a good man, my husband,” she says over and over, “I just don’t know what happened to him at that time.”

Whenever it came to a mum versus wife bout, it seemed like it was two against one. For some dads, explains Annette Du Bois, of UK-based confidence and emotions coaching Champs Academy, it’s a question of being stuck in a cultural box. “Even well into the 21st century there are still very strong traditions and expectations in certain cultures post-partum. This can be very confusing for them, living in a very modern world, yet expected to adhere to traditions that create an internal conflict for a new mother. It also largely depends on the attitude, predisposed mindset and cultural conditioning of the male.”

Even well into the 21st century there are still very strong traditions and expectations in certain cultures post-partum. This can be very confusing.

- Annette Du Bois

Still, there are ways to counter it; for one, prevent the problem rather than fire-fight. Jassal says: “It is important for couples to make time to talk about their concerns, fears and hopes from the outset of any pregnancy. Once the baby is born, a new mum will have enough issues to contend with, including sleep deprivation, a change in hormones and a complete change in their life as they have known it. Therefore, open and honest conversations should be had in the very early days of pregnancy in order to avoid any conflict further down the line.

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Parenthood can take a toll on husband-wife bonds; it's important to keep the channels of communication open.

“To help prevent feeling isolated and alone both during pregnancy and after the baby arrives, it is useful to make time to read, research and listen to one another’s needs. This will help one feel validated and supported at a time that can be emotionally and physically exhausting for the woman. Couples may even consider professional support during this time of transition. Dads can use their support network and talk to other dads who have been in similar situations or are in the same boat to feel reassured and confident in their ability in their new role.”

Try these simple tips for better communication
Annette Du Bois, of UK-based confidence and emotions coaching Champs Academy, offers the following tips for a calm and effective conversation:
• Take a few deep breaths to calm the mind and relief any tension.
• Make sure the person you’re speaking with is fully engaged and is aware you’d like to talk. Using their name and making eye contact is helpful to get their full attention.
• Now name and explain your emotion… “I feel {name of emotion} because {and clearly explain what is causing the emotion without getting upset or reactive}.
• Listen to them fully as they reply and then calmly ask for what you need or what can be done to help you/bring the situation to a helpful resolution.
• Finally, sincerely thank and appreciate them for listening and understanding – it goes a long way for a harmonious relationship.
• The response (or reaction) you get is always about the communication you give.

A few months on, Sheryl’s mother-in-law left and she hired some help. And slowly she began to come out of her shell. She found others who were going through something similar online – she built an emotional support system for herself. And slowly, that communication rift between her and her husband began to heal. She says emphatically to other new mums to seek help and support. She says: “You are not alone. Remember that.”


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