2 February 2023

How we can better help Mothers


Kisah minggu ketigabelas

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Let’s craft an ideal 21st century city out of KL

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Ibu bapa pendamping tumbesaran anak-anak zaman digital

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By Qiao Yang and Michael Hoe

Childbirth may be a natural event, but one cannot deny how stressful it is. Perinatal (the short period of time, usually weeks, immediately before and after birth) and postpartum (the six-week period where a mother’s reproductive organs return to their non-pregnant conditions) depression both have significant, yet subtle, detrimental effects on mothers. During these vulnerable periods, maternal emotions and moods are prone to change, and there is even a risk of serious mental disorders. It is vital that we do not ignore these issues and find ways for mothers to deal with postpartum stress in a healthy manner.

The latest data shows that about 50 to 80 percent of mothers experience a short period of mild postpartum depression (PPD) after delivery (and nearly 15 percent will develop it in three months’ time), with symptoms that include crying, mood swings, anxiety, sadness, difficulty sleeping, difficulty concentrating, irritability, etc. In addition, up to 0.2 percent of women will have their conditions worsen into severe postpartum psychosis, with hallucinations and delusions. In particularly severe cases, the mothers may attempt to commit suicide or even harm their newborn. With the incidence of PPD in developing countries being as high as 15 to 28 percent, it has become imperative that researchers and medical workers give more attention to this mental illness, especially given its huge impact on the growth of mothers, their spouses and their children.

Dr. Hashem Salarzadeh Jenatabadi of Universiti Malaya’s (UM) Department of Science and Technology Studies and his team conducted a study to learn more about the factors that play into PPD, utilizing Structural Equation Modeling (SEM) analysis. The participants were largely around 31 years of age or older and most of them were educated and gained an income of over RM3,000 per month with 1 to 10 years of working experience. 26 percent of the participants did not partake in any physical activities and their average sleeping hours were around 7-9 hours, with an 8-9 hour working day. Dr. Hashem’s study found that out of all the participants involved, 20 percent were ‘normal’, 25 percent had a slightly increased risk of depression, 33 percent had an increased risk and 22 percent were likely to suffer from depression.

photo of baby holding person's fingers

As we gain a better understanding of how depression affects people, especially mothers who had recently given birth, it is vital that we turn to screening and intervention for finding and treating perinatal and postpartum depression in order provide essential help for both mothers and their new-borns. Since most parturients (women about to give birth) do not pay much attention to their own depressive symptoms, proper and convenient screening and assessment of parental stress can be an effective method for predicting PPD. Screening for depression during the perinatal period is especially important as some women may be afraid that their symptoms may be mislabelled as a “mental disorder” and refuse to seek help from a doctor even if they know that their mental condition is abnormal. Furthermore, screening can help doctors and other medical workers (especially those with little to no knowledge regarding mental conditions) better prepare themselves as it can be conducted at any time during the perinatal period letting them find abnormalities in time and seek help from experts in a timely manner.

There are many ways to treat perinatal and postpartum depression and it is important that we use some combination of these treatments in order to provide the most effective care to mothers. One such treatment is psychological therapy or psychotherapy for short. Most parturients with PPD are accompanied by anxiety symptoms. Therefore, it is vital that we utilize methods for treating anxiety and depression at the same time to improve mental health. Studies believe that psychological intervention as the most basic preventive method can effectively reduce the occurrence of PPD. Interpersonal psychotherapy and cognitive behavioural therapy can improve mild, moderate, and severe perinatal depression, especially for pregnant and breastfeeding women. At present, it is recommended to use psychotherapy as the first-line treatment for mild and moderate postpartum depression, and to take a combination of psychotherapy and antidepressant drugs for some moderate depression and severe perinatal depression.

Granting the mother full initiative will also help by encouraging them to take proactive behaviours and actively respond to their PPD. These can include simple activities such as reading their favourite positive books, visiting friends, taking care of their children together with their family members, learning to take care of the children while their children are sleeping, resting and taking walks or performing other exercises according to their doctor’s arrangements and guidance to ensure physical health. The care of mothers and new-borns during the perinatal period can maintain their physical and mental health, and at the same time can promote the physical and mental health of mothers and babies.

More and more researchers are also beginning to pay attention to the active role and participation of the male spouse during the whole perinatal period. As such, it is important that we grant the spouse more initiative so that they will be able to lend help to their wives during the postpartum period. It is recommended that the male spouse provide care and support to the parturient from a psychological and physical perspective, including patiently listening to the spouse’s complaints, trusting each other, helping the spouse to realize the importance of maintaining a strong and good attitude, and promoting the parturient’s subjective initiative to maintain mental health.

mother carrying baby

Finally, there is drug therapy. Studies have found that supplementation of oestrogen levels in patients with PPD can effectively alleviate the symptoms of postpartum depression, reduce the score of the maternal depression scale, and have a better clinical effect.

Though we like to think that the medical professionals are the ones solely responsible for treating PPD, the reality is that every party involved should be responsible for providing the necessary aid and care required by mothers suffering from postpartum depression. The mothers themselves should be given the knowledge to recognize the symptoms of depression, take the necessary precautions to ensure their mental conditions do not worsen and seek help from those who are professionally capable of handling and treating mental illnesses. Likewise, the spouses, immediate and extended family members must be well-prepared to handle the stresses of helping someone suffering from depression and providing as much care and attention as possible. Above all else, all parties must be capable of synergizing and working together in order to grant the best care and treatment possible.

Depression is a mental illness with complex causes and symptoms, and postpartum depression is even more so with individual, social, biological, biochemical and other factors all contributing to it. In daily life, it is necessary to give more care, encouragement and understanding to pregnant women, and pregnant women should also have a certain degree of self-regulation and resistance to stress. The prevalence of postpartum women with depression symptoms in this study is considerably high. It is, therefore, imperative that postpartum women seek medical help to prevent postpartum depressive symptoms from worsening.

Women should get more healthcare during and after pregnancy, especially for mental conditions. As such we must provide the most effective and convenient care in order to ensure their health and safety, both physically and mentally.

Qiao Yang is a postgraduate candidate at the Faculty of Science, Universiti Malaya; while Michael Hoe is a Research Assistant at the Institute of Research Management and Services, Universiti Malaya. The authors may be reached at michaelhoe.hoe@gmail.com