“I don’t think I knew for sure that what I was experiencing was beyond the ‘baby blues’. But I knew I wasn’t feeling like myself anymore. I was crying at night without really knowing why. I became anxious and paranoid over little things, constantly worrying that something might happen to my baby. I also had a constant fear of what would happen to my baby if I were to collapse or if something happened to me. Eventually, I started having very dark thoughts, including thoughts of hurting myself. I’m usually quite an optimistic person, but at that point, I couldn’t seem to feel positive or hopeful about anything. More than knowing exactly what was happening to me, I just knew that I wanted to feel better again—and that I needed help to get there.”
After you give birth, people start to say things like your baby is a ‘bundle of joy’ or that becoming a mother is ‘the happiest time in a woman’s life’. But what if you don’t necessarily feel that way?
‘Bundle of joy’
For Paige Lee, illustrator, educator and mental wellness advocate, after her son was born, congratulatory messages and sentiments like ‘enjoy every moment’ and ‘the nights are long, but the years are short’ did pour in, but while well intentioned, they reinforced the idea that motherhood should be relished all the time. She was also notably affected by the unspoken expectations of what a mother should be. Things like being loving, caring, perpetually patient, responsible and somehow instinctively understanding and executing the correct sequence of actions, merely because of her new found maternal status. She noticed a dialectical situation. “What I found particularly difficult to hear were things like, ‘you should be grateful for what you have.’ I believe two things can exist at the same time. I can be deeply grateful for my child and for many things in my life, while also struggling.” She continues, “sometimes, rather than being reminded of what we should be thankful for, we just need someone to sit with us in what we’re feeling and listen.” Lee felt like she had almost no one to talk to.
According to Dr. Kamini Rajaratnam, Senior Consultant Psychiatrist at Dr. Kamini Clinic, societal expectations can often compound the shame for mums dealing with postnatal mental health disorders, making them feel the need to mask and conform. “A lot of new mothers I see with postpartum depression (PPD) normalise the suffering as something that anyone who just had a baby would go through and they often question why they cannot manage motherhood despite its stressors.” She elucidates, “another common feeling mums with PPD bring up is guilt, and that guilt is the main barrier to them seeking help. They constantly compare themselves to their family members and friends who seem to be coping well after having a baby and feel guilty that they cannot do the same.”
“There was also this irony that I personally felt—if you weren’t diagnosed, there could be an assumption that you must be coping okay. But if you were diagnosed, there could then be a perception that your condition must be very serious, or that you might not be capable of caring for your child.”
What is postpartum depression?
Dr. Kamini says the ‘baby blues’ typically resolve within a fortnight post-birth in around 80 percent of mothers. It can usually present as being tearful, emotional, irritable and overwhelmed. Conversely, postpartum depression can commence anytime within the first year after delivery. With PPD, she describes things like persistent sadness, emptiness, anxiety or loss of pleasure, symptoms of which can interfere considerably with bonding and looking after baby, but also a mother’s functionality.
As outlined in patient education resources by National University Hospital Women’s Emotional Health Service (WEHS), in Singapore, about one in ten women suffers from PPD. Furthermore, some might be more susceptible to it—women with a history of depression, bipolar or other mental illnesses, sleep disturbances, insufficient psychosocial support from interpersonal networks, financial instability, career strain, relationship discord or difficulties in pregnancy, labour and birth complications.
Then there’s postpartum psychosis. Dr. Kamini explains that the differentiator here is reality testing. While one might experience extremely distressing thoughts, in depression, they are still connected to reality. Psychosis, on the other hand, is considered a psychiatric emergency requiring inpatient care and can involve hallucinations, delusions, mania or severe confusion.
Far beyond the baby blues
Just this month, the trial of Lindsay Clancy, a Massachusetts mother who was accused of killing her own young children—Cora, five, Dawson, three, and Callan, eight months—was declared a mistrial after the jury failed to reach a unanimous verdict. The defense claimed that Clancy, who was a former labor and delivery nurse, was suffering from postpartum psychosis, hence entering a plea of not guilty by reason of insanity. Clancy didn’t deny taking her children’s lives or a suicide attempt, which resulted in her paralysis from the waist down. However, prosecutors argued severe postpartum psychosis, overmedication and apparent general failure of the healthcare system meant that she wasn’t criminally responsible. The court of public opinion has been divided, but there has been noticeable female backing for Clancy—sympathisers online and those in pink outside the courthouse.
Dr. Kamini highlights “this is an extraordinarily tragic case, first and foremost because three children have died. It is also important that we don’t allow one horrific case to define our understanding of postpartum mental illness. The overwhelming majority of women who experience postpartum depression, anxiety or even psychosis do not harm their children.”
Although Dr. Kamini wasn’t particularly surprised by the support, as women could potentially identify with aspects of their own lived experience: profound sleep deprivation, anxiety, intrusive thoughts, feeling overwhelmed, and difficulty getting the right help, she hopes what comes out of this case is “not that mothers are viewed as dangerous, but that postpartum mental illness is taken seriously. Women need to feel safe disclosing frightening symptoms to healthcare professionals, because the worst possible outcome would be for a woman experiencing psychosis to hide her symptoms because she fears being judged or having her children taken away.”
“A lot of new mothers I see with PPD normalise the suffering as something that anyone who just had a baby would go through and they often question why they cannot manage motherhood despite its stressors.”
Overcoming stigma
Another story spotlit in the media recently was that of actress Hayden Panettiere, who passed away in August at just 36. Earlier in the year on Jay Shetty’s On Purpose podcast, she detailed how helping break the silence on PPD in a 2015 Live! with Kelly and Michael interview cost her an endorsement deal with Neutrogena, which has been a decade long partnership. In the talkshow she clarified a common misconception about PPD—that it means wanting to harm your child. She also explained the experience of PPD was wide-ranging. After her passing, this clip and her subsequent interview with Shetty did the internet rounds, with many revisiting her plight and candidness with a more compassionate lens.
Despite the ongoing conversations, Lee thinks that the stigma hasn’t necessarily abated. She notes, “there was also this irony that I personally felt—if you weren’t diagnosed, there could be an assumption that you must be coping okay. But if you were diagnosed, there could then be a perception that your condition must be very serious, or that you might not be capable of caring for your child. But I think there is a whole spectrum in between where mothers who are struggling, but still trying their best to cope, perhaps not knowing whether what they are experiencing is ‘serious enough’ to seek help.” Lee says reaching out shouldn’t mean you’ve failed or that you’re inept.
It takes a village
Dr. Kamini shares the sentiment that postpartum depression is not a failure of motherhood and nor is appealing for help. She says “this is the toughest battle a lot of new mothers fight. Mothering now involves a lot more mental load and less practical help from the village our mums had before us.” Carrying cognitive burdens, exacerbated by a barrage of opinion online upholding unrealistic standards and conflicting perspectives, Dr. Kamini advises her pregnant patients to cultivate their own village before delivering. This could look like an understanding lactation consultant, a reassuring paediatrician and a postpartum doula or midwife to visit them after delivery. She says while the knowledge and awareness of PPD is definitely growing, “nevertheless, new mothers are still falling through the gaps in the system and we still do have a long way to go with raising more awareness and making PPD part of routine screening for mothers.”
“I once read the phrase, ‘it takes a village to support a mum too,’ and that really resonated with me.” While Lee is all for advocating about mental wellness, she believes more can be done to assist women with PPD. She questions whether mothers are aware of existing support and whether it actually reaches them when they need it most. From an information standpoint, Lee discovered a plethora of parenting accounts, teaching one to be a better mother, however, found resources on how to cope with challenges as a first-time parent, lacking. “There is so much focus on how to care for the baby, which of course is important. But I think we could talk much more about how to care for the person who has suddenly become responsible for that baby too. Perhaps it’s not only about having more resources, but making conversations about parental mental health more visible and accessible, so that struggling parents know where to turn before they reach a breaking point.”
“I know saying ‘ask for help’ is much easier than actually doing it, especially when you’re already struggling… which is exactly why the people around a mother matter too.”
A dark cloud lifts
The headline is that PPD and postpartum psychosis are treatable and reversible. It is often a temporary condition that allows for a full recovery. Dr. Kamini reassures patients that PPD is a medical diagnosis that “with appropriate medical treatment, psychotherapy and support, most women improve significantly.” In terms of resources? A few years ago, the Psychological Resilience in Antenatal Management (PRAM) programme was introduced by KK Women’s and Children’s Hospital (KKH) to screen expectant women for antenatal depression, which is a high risk factor for postnatal depression. Both KKH and National University Hospital (NUH) are armed with psychiatrists, psychologists and case managers. For a confidential crisis call, Samaritans of Singapore (SOS) hotline is open 24 hours. If faced with the need of immediate assistance, or if there is risk of imminent harm, emergency medical services are on 995, around the clock.
While there wasn’t one particular day that the cloud suddenly lifted, Lee slowly started to come back to herself again. She found drawing was a way to process her feelings. She set up A Kinder Space as an outlet, not just around motherhood and PPD but also the messy, complex emotions we may harbour, but struggle to articulate. Her illustrations have resonated with others and encouraged mutual healing. “We don’t have to do everything ourselves. We don’t have to prove that we can cope just because we’re mothers. I know saying ‘ask for help’ is much easier than actually doing it, especially when you’re already struggling… which is exactly why the people around a mother matter too. Sometimes the village needs to notice, check in and offer help before she even knows how to ask for it,” says Lee.
“Perhaps it really does take a village to raise a child… but that village needs to take care of the mother too.”
You are not alone. If you suspect you or someone you love is struggling with postpartum depression or psychosis, contact KKH Postnatal Depression Intervention Programme (PNDIP). Email: [email protected] or call the appointments & specialist outpatient clinic hotline on 6294 4050. You can also reach out to NUH’s Women’s Emotional Health Service (WEHS), which offers specialised support for postnatal mental health on 6772 2037. A 24 hour crisis hotline is available via Samaritans of Singapore (SOS) at 1767. Your GP can recommend you to a therapist or counsellor.
