For instance, only recently, there was a new mother in her ward who had refused to hold her baby. Many might find this peculiar, but in her two decades plus experience working at the maternity ward, that wasn't the first mother Prajapati had come across who was slightly indifferent about her newborn and she knew, she wouldn't be the last either.
"Postpartum Depression (PPD) is a fact of pregnancy. After delivery it's common for new mothers to feel tired and a little blue. But there are cases that are much more severe. We have around 50-55 deliveries in a month and out of them, we see that a few mothers suffer from PPD," explains Prajapati. So while the patient's family was taken aback by her decision, Prajapati knew it was her responsibility to stand by her. After all, this wasn't her fault.
The National Institute of Mental Health defines PPD as a mood disorder. Mothers with PPD experience feelings of extreme sadness, anxiety, and exhaustion that might make it difficult for them to complete daily care activities for themselves and most importantly, their babies. PPD has become known as the most common complication after childbirth. But Prajapati isn't surprised about the tragically low level of awareness among her patients. She sees it in almost every case, exactly how eager people are to keep the diagnosis under wraps.
Prof Dr Achala Vaidya, Chief Consultant Gynecologist at Norvic International Hospital shares that she has had similar experiences too. So much so, she has even decided against using the proper medical term to explain the situation to her patients.
"Our society's attitude towards any mental health problem is still skewed. There is still a lot of social stigma attached to it. So I worry that labeling the condition as PPD might actually aggravate the situation. I simply move straight to counseling them," says Dr Vaidya.
Despite the hush-hush nature of the subject, Dr Vaidya like Prajapati knows better than to gloss over the joys of being a new mother. As she was taught herself, she has instructed her staff to be wary about the symptoms of PPD among her patients and indeed, every now and then, such cases crop up.
"Having a baby is stressful—no matter how much you've looked forward to it. Baby blues are perfectly normal, but if your symptoms don't go away after a few weeks or get worse, you may have PPD. The rapid hormonal changes after delivery, stress, physical pain can cause some serious emotional trauma to a new mother," explains Dr Vaidya.
She has had a case where a worried husband brought over his utterly distressed wife because she couldn't stop crying after delivering the baby. She has had a new mother confide in her that she has lost all desire to interact with people in her life and with much guilt also confess that she doesn't feel a bond with her new born. In one of the more severe cases of PPD, Dr Vaidya's patient had actually stopped eating and didn't bother feeding her baby as well.
"The degree of PPD clearly varies from mild, moderate to severe but the truth here is it happens to many women. While counseling them, I have seen my patients worry that they are alone in this when that's obviously not true. Even though the majority of women don't suffer from it, this is an issue that needs to be discussed," says Dr Vaidya.
Dr Ananta Prasad Adhikari, Chief Consultant Psychiatrist at Mental Hospital, Lagankhel, also backs the argument. He shares that he has been seeing around one or two varying degrees of PPD cases in a week because 60% of new mothers tend to suffer the blues immediately after delivery and out of them 4% of the cases are quite severe. Almost all maternity wards around town refer such PPD cases to the Mental Hospital and he has witnessed the first hand repercussions of the lack of awareness.
"There are families who initially believed the symptoms of PPD were some mystical evil forces at play. They had visited the witch doctor before coming to us. Though worse than that, might be families or mothers who actually believe such aggressive mood swings after delivery are a norm. So I worry about these scenarios because PPD can be easily dealt with if timely treated. You only need the right medications and for the milder cases, counseling and family support will do," says Dr Adhikari.
But it is challenging to find Nepali women who are open about discussing their tussle with PPD even though this is a topic that is gathering a lot of support and media attention in the west. Though initially they too were guilty of shirking the issue, today, we have nonprofits like Postpartum Progress getting ready to launch the Largest-Ever Study of PPD, and even Apple is
jumping on the bandwagon with an iPhone app to help them. TV panels, conferences and campaigns on PPD are hosted on a regular basis as well.
Further, we not only see celebrities like Brook Shields and Gwenyth Paltrow publicly discussing their experiences with PPD but there are TV series that are actually shinning the light on the matter by writing about it in their scripts. They are doing all this because they have recognized PPD as one of the pressing women's concerns. Clearly, we too would benefit from adopting this perspective and not let the disorder go unrecognized and untreated.
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