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Maternal Mental Health: Depression In A Pregnant Woman Should Not Be Ignored As Unimportant

  • IWB Post
  •  October 10, 2019

A glowing smile on her face, a breeze in her steps and immense happiness at holding that bundle of joy in her arms – that’s how we expect a pregnant woman and a new mother to behave like. But what we tend to forget is that she too is human and is not always going to be a positive ray of sunshine- pregnancy blues, as we like to term them lightly.

“Whenever we talk about the health of a pregnant woman, physical health tends to dominate and more often than not, mental health is overlooked as it is considered insignificant. Anxiety, feelings of inadequacy, excessive worry- these are some things which can be extremely disruptive for a pregnant woman or a new mom’s health,” says Dr. Nozer Sheriar, a Gynecologist and Obstetrician in Khar West, Mumbai.

Why don’t we finally appreciate the importance of paying attention to maternal mental health and give due credit to a mother for overcoming the odds to be our unlimited treasure trove of love and care?

Excerpts from our conversation with Dr. Nozer Sheriar as he sheds light on the neglected topic of maternal mental health in India:

Please throw some light on the topic of maternal mental health.

Not every woman is completely prepared when it comes to dealing with their pregnancy. They are often left worrying about how they will cope, already afraid from the complicated-delivery stories they have heard. Many suffer from fertility issues plus the hormone, progesterone, which is released during pregnancy also contributes to depression.

A woman has to balance it all- the pressures of a today’s hectic lifestyle, her job, her family, herself and then there is the pregnancy and the hormones start making her feel low. And to top that, there are all the physical changes like feeling sick, nauseous and bloated which makes her not feel good about herself. Due to such complications, a few women suffer a miscarriage in the first three months which can be another trigger of bringing about a severe bout of depression.

Are there any other factors that affect her mental health apart from the ones mentioned above?

Oh, the unsolicited advices she gets which makes her feel inadequate and anxious. Then there is the body image issues as she starts putting on weight and develops pigmentation. In the third trimester of her pregnancy, she is at her largest, she is very very uncomfortable and to top it off, she starts worrying about the childbirth as people have already filled her head with what all could go wrong.

Plus most women are not told the truth and given a rather glorified version of what delivery looks like, so most of them have confessed that they were not mentally prepared for what actually took place. Everything combined makes her feel unable to handle the role of being a mother, something we call postpartum depression, which can go from mild to moderate to severe. To top that off, the baseless traditional restrictions add to it.

What are the regressive traditions that aggravate the situation?

There are numerous! To name a few- keeping a new mother and her baby confined to her home for a period of 40 days, she has to cover her head, eat this, can’t eat that, wear this not that, oh there just too many! 40 days indoors can depress anyone and she went through a whole hurricane of hormonal imbalance. Her caregivers should allow her to choose if she wants to stay indoors or not- allow her to feel as normal as possible. And if her mental health is still suffering, then they shouldn’t hesitate to contact a mental health care professional.

Exactly, so the constant support and understanding of her family and partner is needed.

If she doesn’t get the support of her husband or her family, this may make things worse. The people around her have to understand that she is already dealing with a lot of things. Her depression is not something she is in control of whether before delivery or after it. The biggest mistake? Caregivers not noticing the signs and telling her that it is normal and it happens. So, thus the problem goes on longer and has more severe consequences.

She needs emotional understanding from her caregivers. Firstly they should check if she has a mental health history because then she is more prone to it and also past history of medical problems including complicated pregnancies she had in the past, in order to make the path ahead of her as easy as possible. The next thing to observe is her behavior, as therein lie the symptoms. Like if she is upset, emotional mostly or unable to sleep, and after delivery, the added reactions of her when she is with her baby.

Observe them and without any prejudice or judgement, talk with her, let her trust you, provide her with the help she wants.

When it comes to parenting, the responsibilities majorly fall on the woman. Do you think that it should be shared equally between the mother and the father?

I think the time has come when we start involving Papa more and let go of the traditional system where a child is a woman’s responsibility. On the brighter side, I have already started noticing a positive change in this case as fathers are themselves expressing the desire to get involved. In the last few years of my practice, I have observed that at least in the urban sector at least 95% men are more inclined towards being a responsible partner for their wife which wasn’t the case 15 to 20 years ago.

I think the husband should be in the delivery room when his wife is giving birth to a baby and even prior to that when women are being prepped about the entire pregnancy-then-labor scenario, men should take equal participation.

You earlier talked about how a woman starts to feel low about her body image in the duration of the pregnancy.

Well, apart from a woman naturally gaining weight due to pregnancy, she is fed the psychology that now she has to eat for two people instead of telling her she needs to increase the healthy portion in her diet. She either gains a lot of weight and starts feeling conscious of her body shape or is already freaked out about how pregnancy has changed her body stature. She doesn’t like what she has to wear, doesn’t like how she looks and it only upsets her.

She needs good dietary advice for the duration, she should seek the help of a dietician who plans a diet for her that neither curbs what she desires to eat nor compromises on the health front.

Well, apart from being told what to eat, there are others decisions concerning herself that she is not allowed to make. Do you think it triggers depression?

When your decisions are made by someone else and you are the one to suffer the consequences, it’s like a stage is being set up for her to be thrown into depression. When a woman is pregnant, it’s almost like you’ve to become a co-conspirator, help her get what she wants, gain her trust so that she confides in you- a big part of her battle against depression is won in this manner.

Forcing her to eat certain things, confining her to the house or deciding for her what type of delivery she will get is basically snatching the power of making decisions from her- a recipe to lead her to postpartum depression when we refuse to let her have a say. It’s is her life, after all, something we forget thinking that she is unable to make sound decisions.

Agreed. What about rural women though, is the issue of maternal mental health even more severe for them?

Well, when it comes to urban women in this era they can up their knowledge with the help of Internet and media but rural women rarely have that liberty. They have their own myths and traditions, far more restrictive than urban ones, that make pregnancy all the more risky for them.

What we need is a well-executed national campaign to make women in rural areas aware of maternal mental health, so that not only women but others around her start to recognize what the issues are. We need campaigns to bust the health-related myths that surround this topic as some of them are bordering on being downright dangerous.

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