How motherhood can affect mental health

The narrative around postpartum depression has changed considerably with the rise of awareness of mental health issues. But what about the myriad of other problems a new mom hides, worried that she will be judged? Unfortunately, the taboo around mental health in general, and particularly postpartum mental health, often deprives the new mother of much-needed medical aid. Postpartum mental health disorders need prompt redressal as two innocent lives are at stake here. Ideally, at the 2-week and 6-week mark post-delivery, it should be made imperative that all new mothers get screened for mental disorders. 

It is important to remember that mental health disorders are not set in stone but a part of a spectrum. About 20% of new mothers face mental health issues after childbirth that just don’t go away with time. All moms have hormonal changes and face sleep deprivation after delivery. But not all of them face mental illness. It is, therefore, imperative that you speak about your concerns with your obstetrician or psychiatrist; expert help is mandatory, so don’t just follow what worked for your next-door neighbour.

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Postpartum anxiety

Every other new mother has her sleep-deprived head reeling with dangerous scenarios for her newborn. What if I smother my baby in sleep?What if the baby dies inexplicably in her cot? The rapid breathing and fluttering eyes of a newborn just add to the worries.

Postpartum anxiety manifests like any other sort of anxiety: with palpitations, racing thoughts, and intrusive worries depriving the already sleep-deprived mother of those precious moments of shut-eye. She is likely to wake up over and over again in the night to check on the baby’s breathing, uncalled-for scenarios replaying in her foggy mind,  including thoughts of her or her baby's death. The fatigue caused by postpartum anxiety is multiplied by sleep deprivation and the burden of responsibilities on the shoulders of the new mother. And this doesn't include the physical manifestations of anxiety.

 Breathlessness and hyperventilation are two sides of the same coin of physical symptoms of postpartum anxiety. Other symptoms include chest tightness, palpitations, sweating, nausea and trembling. 

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Panic attacks

Often, postpartum anxiety leads to a draining postpartum panic attack. Often, postpartum panic attacks and postpartum anxiety go hand in hand. Chest tightness, inability to take a deep enough breath, a racing heart (medically called palpitations), and a feeling of impending doom are the symptoms of panic attacks. Postpartum panic attacks, like most mental health disorders, are not something you can just get over with time. In fact, the opposite is true. The patient can just keep going down the rabbit hole. Panic attacks can be a one-off thing or a progression of postpartum anxiety. 

Paranoia

 A new mother is not free from the paranoia that accompanies motherhood. This can translate in some patients to postpartum obsessive-compulsive disorder. Frequent hand washing, irrational rituals to ensure the safety of the baby and uncontrollable urges to ensure cleanliness for the baby. Yes, we all are super mindful of hygiene after the baby is born. But OCD takes it a couple of notches up and is often accompanied by haunting thoughts of worst-case scenarios when it comes to the baby’s well-being or the mother herself.

Also read: How, when, and where to seek mental health care

Postpartum psychosis

The next kind of mental illness I’d like to touch on is the most dangerous:  postpartum psychosis (PPP). The mother loses rationality and may also lose touch with reality. She will not complain of symptoms as such, but a bystander can surely spot the mania that accompanies PPP. She will have delusions which she will firmly believe in, and her ill mind will find a way to see them as true. The more you talk to engage the patient or try to rationalize with her, the more unshakeable the beliefs could get. She could believe that there is someone out there trying to persecute her or her baby or develop hallucinations in which she sees things that are not there and hear voices in her head. Often these voices will tell her to harm herself or her baby. Remember, she is not aware of reality and firmly believes that this is for her own good and that of her child. The portrayal of the mother in the movie Shutter Island isn’t far from what a psychotic breakdown looks like.

Dr Farah Adam Mukadam is a Bengaluru-based family physician and author of Newborns and New Moms. She vlogs on Instagram and YouTube as Dr Farah_Momstein