Twenty-eight old Aditi Carvalho*, a Mumbai based engineer, was anxious about her baby's delivery even before her due date. The lockdown had been hard on her - she didn't have a baby shower, she wasn't able to go out and celebrate, and she was locked up at home with only her husband for six months of her pregnancy. The frustration turned into a rage once her daughter was born. "I would end up crying for no reason at times; I was worried about not understanding everything that a new mom is supposed to do," she says, adding that her mother was with her only for a month after she delivered. "It was all too much to deal with, coupled with the lockdown and scare of Covid-19," she recalls.
When her rage, which often manifested with her shouting, crying or walking out of the house, continued even three months after delivery, she realised it was more than baby blues. It was only after talking to a therapist that she began learning how to deal with it better.
Mood swings after delivery are common enough: most new mothers deal with baby blues, for instance, while for many, it spirals into a more intense, longer depression. And many young mothers struggling with depression and anxiety often end up feeling angry, something that is often overlooked. While therapists believe that, on average, six out of ten women may deal with some form of postpartum rage, putting an exact number to it is difficult as many women prefer not to talk about it.
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Postpartum Rage (PPR) is a part of the perinatal mood and anxiety disorder spectrum and, if untreated, turns into psychosis. Women with PPR experience rage in different ways. Dr Meghna Singhal, a Clinical Psychologist and an Internationally Certified Positive Parenting Coach explains, "Sometimes rage can be experienced as a wave of simmering, seething anger and sometimes as a physically or verbally explosive lashing out. This can result in violent thoughts and urges, yelling, or physically hurting oneself or one's partner."
However, the primary underlying cause is hormonal imbalance coupled with the mother having a history of depression or anxiety during adolescence or early adulthood. Dr Archana Nirula, a Delhi-based Obstetrician and Gynaecologist who is the India coordinator for Postpartum Support International (USA), explains, "The female body has an array of sex hormones, and especially when a woman is pregnant, estrogen and progesterone levels are very high. When the woman delivers the baby, these levels fall from 10 to 0. In addition, the body produces prolactin and oxytocin, which are the breast milk hormones and their levels keep going up and down during the day. All this creates a chemical imbalance in the mother's brain." All of it triggers a series of events, especially in women who have a C-section. Unlike a normal delivery, the fall in hormonal levels is very sudden during a C-section.
Additionally, circumstances and changes in lifestyle postpartum are also unprecedented and unpredictable. Breastfeeding the baby and baby care leads to a lack of sleep, which mothers aren't used to until then. Mamta Seth*, 30, based in Chennai, says that she was used to sleeping by 10 pm before delivering her baby boy. But after her son's delivery, she was frustrated dealing with minimum to no sleep as her son was colicky. "No matter how hard I tried, he would not fall asleep, and it led to a lot of rage and anxiety in me," recalls Mamta, who finally sought psychiatric help to deal with my anger. "Maternal rage and anxiety are downplayed to a great degree in our society," she says.
Dr Debmita Dutta, a Bengaluru- based parenting consultant, says that anger is the "fight" part of the "fight or flight" mechanism activated when we feel threatened. "The lack of sleep is a direct threat to survival, and so new moms who hardly get sleep feel that their survival is threatened. They are also programmed by nature to fight for their baby's survival thanks to attachment – so when they don't have enough breastmilk, and the baby cries continuously – they fear that the baby's survival may be threatened," she says.
Changing family structures could be exacerbating the issue too. Traditionally, new mothers spent the first 40 days after delivery in their maternal homes, says Dr Nirula. "The woman's mother can support her with baby care, let her get rest, and understand her physical and emotional changes," she says. However, a nuclear family doesn't have room for these traditions to be followed, leading to a new mother feeling helpless and angry due to lack of support. "A woman can feel pressured as she is tied down to the baby, cannot eat whatever she wants, and this can lead to rage as well," adds Dr Nirula. Delhi-based psychotherapist Deepti Divya, a coordinator for Postpartum Support International (USA), elucidates, "There is a lot of anxiety with the changes happening - the mother initially has all the attention during pregnancy, which suddenly goes away and she instead experiences pressure. There are then body image issues, time management problems, and pressure of being the perfect mom as well."
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Another trigger is breastfeeding; the pressure of it could lead to anxiety which can turn into rage. Delhi-based Shikha Shah* recounts the tough time with feeding her daughter, who was also diagnosed with typhoid, a few weeks after delivery. "Firstly, I had low milk supply, and the fact that my daughter was in ICU for a week led to further problems with feeding when she was discharged," says Shah, adding that this led to intense anxiety about feeding and pumping. "Milk supply issues lead to something akin to performance pressure as the baby is hungry all the time. All these thoughts are in the subconscious mind of the mother and if the mother is in denial, it builds frustration, depression and rage, "adds Deepti Divya, a situation not improved by well-meaning relatives giving breastfeeding advice.
However, the disorder can be managed and controlled if diagnosed at the right time. Dr Singhal shares, "The spouse/family can lend support in multiple ways not judging the mother for her parenting choices (e.g., breastfeeding versus bottle), supporting the mother in handling her new role (e.g., offering to take up nightly baby duty some days of the week), and helping her share her feelings (e.g., telling her that her anger and resentment is normal and acknowledging her difficult feelings, instead of dismissing them)." Moreover, when the mother does display rage, family members can help by displaying understanding by helping the mother calm down, instead of launching counter-attacks on her or making her feel that she is 'crazy.'
Dr Singhal adds that an effective strategy is recognising the 'rage triggers'- so that the mother and others around her can be more mindful of the times she starts to spiral into anger. The spouse and family can also help the mother in making and maintaining lifestyle changes for better physical and mental health, such as eating a well-balanced diet, getting rest and exercise, and enabling intentional time to herself.
Dr Dutta who has been conducting prenatal classes for the past 10 years for expecting parents emphasises on the importance of both the mother and the father attending such classes to set the right expectations for the first few months of caring for a baby. She says, "I can assure you that learning about what is normal and understanding what your role is can reduce anxiety considerably. There are also ways to plan to minimise exhaustion through the difficult months – and the prenatal classes teach that as well." She adds that getting help for the mother's physical issues, such as constipation, incontinence, and backaches, is also important.
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Dr Nirula and Deepti Divya both stress the importance of seeking therapy. Deepti Divya shares, "While finding the time and the mental space for therapy is difficult; there is also an element of families not being supportive of the idea and telling the mother that it is unnecessary. It needs to be normalised - just like visiting a gynaecologist is normal, so is seeing a therapist." She adds that both the father and the mother should go for therapy together. "While the mother is the centre of the therapy program, the father and the family's role is equally important. The issue is arising out of the situation, and the entire family is a part of the setup."
*Names changed to protect privacy