In Depth Society, 27/07/2020

Battling Postnatal Depression: You are not Alone

Advertising creates an image of joyful and cloudless maternity, glossy publications claim that motherhood is an ideal shape and beautiful hair, and grandparents who dreamt about grandchildren a year ago are surprised, “What did you expect? Kids are a hard job!” No doubt it’s hard!

According to the Worldwide Health Organization survey, about 10 percent of pregnant women and 13 percent of women who have just given birth experience a mental health disorder, primarily depression. In developing countries this is even higher, it comprises 15.6 percent during pregnancy and 19.8 percent after childbirth.

“Postnatal Depression among Women with Depression and Anxiety during Pregnancy” survey conducted by Danylo Halytsky Lviv National Medical University gives statistics on postnatal depression cases in Ukraine. A study of 90 pregnant women found depressive and anxiety disorders of non-psychotic levels in 34 cases (37.7percent). Overall, 23 (25.5 percent) of women suffered from anxiety disorders in the prenatal period. The frequency of occurrence postpartum depression on days 3-6 after childbirth was 25 (27.7 percent). The results of the study in dynamics showed that the presence of depressive and anxiety disorders among women during pregnancy is a predictor of depressive disorders during the postpartum period.

Postpartum depression affects women from various countries and different walks of life.

But the frequency of cases can vary from country to country. For example, the rate of postpartum depression in Singapore is about 3-5 percent while in Chile it reaches 38 percent.

Definition of postnatal depression

The World Health Organization defines postpartum depression as “a condition characterized by a permanent depression and a loss of interest in activities that are usually rewarding, as well as an inability to do daily activities for at least two weeks.”

British National Health Care defines postnatal depression as a type of depression that many parents experience after having a baby.

It’s a common problem, affecting more than one in every 10 women within a year of giving birth. It can also affect fathers and partners.

How postnatal depression can be diagnosed?

Only a healthcare professional can diagnose postnatal depression. The symptoms are so broad and varied that it can really be difficult for other people to distinguish fatigue from a serious illness.

“You can’t tell by looking” – that was the slogan of the campaign to raise awareness about perinatal mental disorders.

The campaign’s goal was to break down the myth that a diagnosis of postpartum depression can be made without a clinical examination.

One of the effective tools for diagnosing postpartum depression is the Edinburgh Postpartum Depression Scale (EPDS).

Symptoms of postnatal depression

Many women feel a bit down, tearful or anxious in the first week after giving birth. This is often called the “baby blues” and is so common that it’s considered normal. “Baby blues” do not last for more than 2 weeks after giving birth.

If woman’s symptoms last longer or start later, she could have postnatal depression. It can start at any time in the first year after giving birth.

British National Health Care surveys give the following symptoms of postnatal depression:

–              a persistent feeling of sadness and low mood;

–              lack of enjoyment and loss of interest in the wider world;

–              lack of energy and feeling tired all the time;

–              trouble sleeping at night and feeling sleepy during the day;

–              difficulty bonding with your baby;

–              withdrawing from contact with other people;

–              problems concentrating and making decisions;

–              frightening thoughts – for example, about hurting your baby;

Many women do not realize they have postnatal depression, because it can develop gradually.

How to prevent postpartum depression?

According to Uliana Suprun, Ukrainian ex-healthcare minister, with reference to “Identification and Management of Peripartum Depression” created by St. Luke’s University Hospital Family Medicine Residency, Bethlehem, Pennsylvania, the following steps can prevent postnatal depression:

– pregnant women should not only have their blood pressure taken and checked protein level in their urine but also be screened for a depressive disorder, study their family history of depressive episodes;

– educational programs for young mothers (teenagers);

– home visits by nurses, telephone consultations, support, early cognitive-behavioral therapy in case of traumatic childbirth;

– it’s crucial that a parent/partner helps with childcare and in everyday life. The example of Sweden shows that regular parental care helps reduce the need for antibiotics and anti-anxiety drugs in the first three months after birth.

What help to women with postnatal depression is provided in Ukraine?

Tetiana Rodina, the psychologist from Cherkasy, co-founder of the “Dbaylyvo do Sebe” (Care for yourself) project, considers that it is necessary to change the medical system, which does not pay enough attention to women’s mental state after childbirth. Now everything is based on activists – volunteers and mothers who are ready to share experiences and help others.

Tetiana Rodina

Yulia Kulik, the perinatal psychologist from Kharkiv, co-founder of the “Dbaylyvo do Sebe” project, kindly agreed to answer the questions of Kharkiv Observer correspondent on postnatal depression issues.

Yulia Kulik

Kharkiv Observer: Yulia, tell us a little about yourself.

Yulia Kulik: I’m a mother of two kids: my son is 14 and my daughter is 3. I’m a perinatal psychologist and art therapist by profession and a curator of the “Dbaylyvo do Sebe” project which helps women with postnatal depression problems. I’m graduating from the Karazin Kharkiv National University, medical faculty, this year.

Kh.O.: Why are you interested in postnatal depression issues?

Y.K.: I have not faced it myself but I came across this problem at work while I was collecting information for the project concerning obstetric aggression issues in 2015-2016. Being a volunteer of two organizations – British organization called “Association for Post-Natal Illness and Post Natal Depression” and American “Postpartum Support International” – I was interested in how things are with postnatal depression issues in our country and found out that this problem is neglected in Ukraine.

Kh.O.: Yulia, how did you come up with the idea to create the “Dbaylyvo do Sebe” project?

Inna Yurakh

Y.K.: I came across a Russian group called “Berezhno k Sebe” (Care for yourself) which was created by Daria Utkina, a psychologist-doula, in 2016. [Kh.O.: Doula is a woman who provides guidance and support to the mother of a newborn baby.] Its goal is to support women who face postpartum depression. By the time I came across this group, it had had about 5 million subscribers. There were three members from Ukraine: from Odesa, Cherkasy and Kharkiv and we decided to virtualize this group and conduct meetings in Ukraine.

Last year, my colleague from Cherkasy Tetiana Rodina and I made the first step to create this project in Ukraine. We developed a questionnaire on the postanal depression issues in social media which reached 1,700 people.

Kh.O.: When was the project created?

Y.K.: Around August 2019, we established a homepage and a closed group on Facebook which aim to provide support to women who face postpartum depression.

Kh.O.: What forms of meetings do you provide for interested parties?

Y.K.: Since August 2019 we conducted two personal meetings in Kharkiv and three in Cherkasy but it was very complicated as it’s very hard for a woman to make a decision to join such a group. Women in our country aren’t used to asking for help and they think it will sort itself out. Due to quarantine restrictions, our meetings were declined.

Kh.O.: Are there any organizations in Ukraine apart from your project that deal with postnatal depression issues?

Y.K.: “Lada,” “Ranni Ptashky” (Early birds), ”Svidome Maybutnye” (Conscious future) in Kyiv, “Terytoriya Mum” (Mums’ territory) from Vinnytsia, “International Leadership and Development Center” deal with mental health in the natal and postnatal period.

Kh.O.: Yulia, who funds the project?

Y.K.: From April 2020 “Dbaylyvo do Sebe” mini-project is implemented by “Terytoriya Tvorchosti” (Territory of creativity) charity fund as part of the project “Center for Gender Culture as a Platform for Empowerment of Women and Youth,” funded by the European Union. #GenderCultureCentre.

We won a mini-grant which gives us the opportunity to hold meetings and consultations. Since April we have conducted six personal consultations, nine live broadcasts and a few interactive meetings on Zoom.

Kh.O.: How many members are there in your project?

Y.K.: Approximately 1,700 persons subscribed on our Facebook page. If we count the members who watched our videos and left comments, I can say that there are about 500 active members.

Kh.O.: In what way does your project provide assistance?

Y.K.: We hold check-in of women’s mental health. If a woman posts a heart emotion that she needs support, we contact her via private message. After getting a response from the woman we can hold a free private consultation during which we define what sort of help she needs.

Kh.O.: Yulia, how many people work in your project on an ongoing basis?

Y.K.: There are four of us who work on a regular basis. I’m a project coordinator. I work as a psychologist and a psychotherapist. I also create materials and give private consultations. Tetiana Rodina, a psychologist from Cherkasy, holds on consultations and assists in compiling information leaflet, Inna Yurakh, a psychologist from Kyiv, deals with perinatal loss, Olha Andrushchenko, a technical specialist from Kharkiv, is responsible for the promotion and calls herself our connector. Olena Yampolska, a physiatrist from Svatovo, and Oleksiy Helukh, a psychologist from Severodonetsk, participate in our project as involved specialists.

Olha Andrushchenko

Kh.O.: It is not customary to talk frankly about maternal mental and emotional wellbeing. Many consider the problem far-fetched; they say that in the past “women gave birth in the field and everything was fine.” How does such neglect harm women, children, and families generally?

Y.K.: Women aren’t encouraged to talk about the problem as society label stereotypes which work against them: “If you gave birth to a child you knew what to expect,” “You are a mother,” “You must love your child,” “You can’t feel tired.” Due to stereotypes a woman faces negative feelings, feels guilty if she doesn’t meet the standards imposed by society. As a result, she will experience postnatal anxiety which will turn into depression later. A woman shouldn’t ignore depression, it won’t sort itself out and could lead to suicide in advanced cases.

Kh.O.: Yulia, from your point of view, what are the first signs of postpartum depression?

Y.K.: The first sign is “baby blues.” It’s a short-term period after labor which lasts up to four weeks when hormonal balance varies significantly. Due to this fact, a woman can experience various feelings like tearfulness, food refusal and other feelings that are out of her character.

Kh.O.: What conditions should be created in the family to get rid of mother’s burnout?

Y.K.: According to psychologists, a woman who has just given birth to a child could be compared with an employee whose work requires a constant attention span. Such people work from one to three days without a break and then can have a rest. A woman who takes care of a newborn is constantly in a high concentration condition. To avoid burnout, it’s crucial she has a rest. Close ones should support a woman, give her an opportunity to have a rest, provide her with proper food and nutrition, spend more time outdoors. If a woman is a single mother, she can ask relatives or friends to look after a baby for a short period of time. It lets a mother have a rest. She doesn’t have to hesitate but just ask others for help.

Kh.O.: Yulia, what social strata are most often affected by postpartum depression?

Y.K.: I have not studied such statistics but I can highlight a major factor that can lead to postnatal depression for vulnerable people is financial volatility. If we talk about socially protected ones, we could name health problems during pregnancy and obstructed labor. I can tell that we know more postnatal depression cases among socially protected women because they are more informed about the issue and more willing to share the problem.

Kh.O.: Is postpartum depression more common in two-parent or single-parent families?

Y.K.: Labor is a stressful situation for a family. Sometimes families break up after childbirth. It can lead to postnatal depression. I can say that I have not had any clients among single parents.

Kh.O.: Can psychological abuse lead to postpartum depression?

Y.K.: Definitely. It happens when a man invalidates a woman’s feelings. He can say that she is perfectly OK and problems with depressions are invented by psychotherapists. A man can also blame a woman that she does nothing staying at home and looking after a baby while he goes to work and earns money. A man can also criticize a woman’s body that has changed after labor. A woman with a baby who is financially dependent on her husband may be constantly abused and stay in a high-stress condition which leads to postnatal depression.

Kh.O.: Can women who suffer postnatal depression be subjected to domestic violence?

Y.K.: Depression can be both a consequence and a cause of domestic violence. A woman could become an object of her partner’s violent tendencies. Consequently, a woman can start failing maternal responsibilities and feel nothing for the baby. Eventually, people around might accuse her in breach of the duties and begin bullying her as well.

Kh.O.: Yulia, how often do men suffer from associated postnatal depression?

Y.K.: According to American sources, one of the three men experience postnatal depression by association. It isn’t pure depression but he can feel emotional distress. It’s hard for a man to stay with a constantly crying baby and a wife who is always in a bad mood whilst he escapes to work. So, if a man doesn’t want to return home after work it’s the first sign that something is going wrong.

Kh.O.: There is a stereotype in our society: a good mother cannot mope and complain after childbirth. After all, she has enough worries and joys. And if a woman cannot reach out to her baby, does not have time to bake pies for her husband and cross-stitch, she is lazy. She may be considered a bad mother and wife. How often does a woman experiencing postpartum depression get this label?

Y.K.: It’s a problem as being labeled “bad” a woman experiences feeling guilty constantly. A woman should accept she is not perfect and she is who she is. It’s enough for a baby that she exists. If a woman thinks she doesn’t meet certain standards, that’s the time when she needs psychological help.

Kh.O.: What are the consequences of postpartum depression?

Y.K.: The gravest consequence is suicide. It also can lead to family breakdown, developmental disturbances of a baby, rejection from the mother’s role, alcohol and drug dependency.

Kh.O.: How to break stereotypes attached to the new mom’s role?

Y.K.: The most helpful way is education. A woman should be taken judgment-free. She can express her emotions, there is nothing wrong with it. She can ask her husband or relatives for help. This way she doesn’t show her weakness but her strength.

Kh.O.: Yulia, how can men be involved in parenting and achieve equality in certain roles?

Y.K.: I would like to mention education again. A man should also be delegated some responsibilities. While the feeling of attachment to a baby is in a woman’s nature, a man should cultivate it in himself. A woman should trust a man as it isn’t only her baby but it’s theirs. A man and a woman should constantly communicate and seek common interests.

Kh.O.: How well have the group members overcome postpartum depression?

Y.K.: It’s hard to say as we have only operated for a year. Our goal is to help a woman get through herself. We give support to both women who experience depression and those who were diagnosed with it but they don’t have it. They have emotional disorders and anxiety but they don’t experience postnatal depression.

Thanks to this group with its supporting atmosphere many women admitted they had depression and understood they are not alone. Some women managed to make difficult decisions like breaking up with husbands. A few group members experienced domestic violence and we found specialists who worked with them. To conclude, currently, we provide information. We are looking for additional funding to extend our activity.

Kh.O.: Yulia, what would you wish our readers?

Y.K.: Everyone should care for him or herself and their own mental health. It’s central to physical health and a happy life.

Man’s point of view on postnatal depression issues

If you walk through the parks and streets of Swedish cities, you can see many dads walking with babies. Sweden is a country that respects human rights and pays a lot of attention to involving both parents in a child’s upbringing. Therefore, Swedish men easily take paid parental leave, companies give them an opportunity to work in the offices less, if they want to work from home.

In Ukraine, the picture is somewhat different. Our culture is not completely adapted to the fact that after the childbirth father is actively present in a baby’s life because the stigma that this is a purely female affair is actively cultivated in our society.

So, what exactly can a man do? How to help his wife? How to deal with sleep deprivation and irritability?

Ivan Pukh, a specialist in building a harmonious family, answered these and other questions in his interview with the “Dbaylyvo do Sebe” project.

Why is there not much support from a husband to a wife in marriage?

Ivan Pukh.: In my opinion, care and psychological support should be a prerequisite for marriage. Everyone feels a need to be understood by his or her spouse. But if it wasn’t common in a man’s family, it’s hard for him to understand what sort of support a woman needs. Sometimes even a woman herself can’t answer this question.

Ivan Pukh

How does it work in Ivan’s family?

I.P.: I am fully responsible for my wife. In particular, to be a good husband I should know what goes on inside her head as all person’s difficulties start from a thought. You just need to communicate with each other, conduct a dialogue, take interest in each other’s state. In practice, this turns out to be the most difficult process. In the Slavic tradition, it is not common to talk deeply and heart to heart.

Has your life changed since you found out you would have a baby?

I.P.: Some people who have a newborn child pretend that nothing has changed. It depends on the factor that it isn’t common to plan a baby. When everything is planned and agreed, they understand that their life would change dramatically and they should be ready for these changes. It was like this in my case.

We dated for 6 years and lived together for 6 years and after that, we made a decision to have a baby. Since childbirth, my life schedule has completely changed. I had to help my wife as much as I could as she worked then while I could plan my timetable.

It turned out we were not ready to have a baby as it’s just impossible to be ready for childbirth. We experienced stress, emotional strain, during the first months after childbirth we didn’t sleep enough, felt worried about a baby. But it was our experience and we passed through it.

How to avoid burnout?

I.P.: A person should spend some time on his or her own. Otherwise, it’s easy to hate your close people and it’s hard to love them again.

Why do fathers not spend much time looking after a baby?

I.P.: A process of communication with a baby for a woman is a biological process while a man should develop this capability. It’s very hard in the emotional aspect. Men’s mental state is fragile and unable to cope with such loads.

Is it necessary to receive help from relatives?

I.P.: When a child is born, grandmothers give advice as they know from experiences and can assist with most aspects. They often move to a young parents’ house to help look after a baby. A daughter and her mother become specialists in this issue and they set aside the young father. That’s why he is not successful in this process. In three months, it turned out that a woman can’t entrust a baby to her husband as he doesn’t know how to look after it. In my opinion, he won’t gain skills in childcare if he isn’t involved in this process.

Have you detected any emotional changes in your wife’s behavior after childbirth? How to monitor emotional disorders? What to look for?

I.P.: My wife is a smart and erudite woman with high IQ, a distinctly choleric. Her mood swings are seen at once. Her character has completely changed during pregnancy. She turned into a sanguine person. She cried on my shoulder and was worried a lot before labor.

Anxiety accumulated, illusions and strange desires appeared in her mind and I tried to control this process. The most important thing is to have a good sleep, then most problems can sort themselves out. It’s crucial that a woman spends some time on her own without a baby.

There are lots of sad stories about postnatal depression which is a set of factors related to personality, predisposition to depression, possibly hormonal changes.

What is your main goal?

I.P.: I aim to be a good husband and a good father. Everything else I need is a resource for these two processes.

What would you like to advise our readers?

I.P.: Define your wishes and move to strive to fulfill them.

Often women are unaware of their condition, so close people should pay attention not only to the new family member, but also to take care of the mother. It is relatives who can recognize warning signs in time to seek help.

If you suspect you experience postnatal depression, you should contact the following Ukrainian organization:
1. “Dbaylyvo do Sebe” project: +380 (67) 572 67 05, +380 (93) 213 79 80;

2. Association of Parents of Premature Babies “Ranni Ptashky,” Kyiv: 0-800-50-70-29;

3. Pregnancy and motherhood support club “Lada”, Kyiv: +380 (73) 437-54-52;

4. ”Svidome Maybutnye”, Kyiv: + 380 (96) 373—54-29;

5. “Terytoriya Mum”, Vinnytsa: +380 (97) 547-68-57;

6. “International Leadership and Development Center”: +380 (73) 051-76-16;

Text: Natalia Ivanova

Photo: mamamoldova, Magnus Liam Karlsson, Dbaylyvo do Sebe, Ivan Pukh

The material was prepared as a part of Gender Sensitive Space of Modern Journalism, implemented by the Volyn Press Club in partnership with the Volyn Gender Center, supported by the United States Agency for International Development (USAID) and implemented by Internews international organization.