When a new baby brings no joy

Such women are said to be suffering from ‘baby blues’ or post-natal depression. This is a very real condition that, unfortunately, many do not understand. This means the necessary support is often lacking.

For Mary Muthoni Musau, 37, giving birth has always taken an unusually big toll on her. Mary has had three children and says she has lost consciousness a few days after the births of all three.

Her husband, John Musau Mutuku, 43, has had to act as both father and mother every time a new baby arrives in the family.
John says that when their first child, Grace, was born was born 15 years ago, Muthoni withdrew and went wild.

“This really shocked me. We were a young couple, first-time parents and at some point I did not know what to do. I couldn’t just sit and watch her run mad. It tore me apart to see the baby suffer so much. But I also could not just stop operating my business, as that was where we got money to live on,” he recalls.

Desperate, he asked one of his younger sisters to come in and help monitor his wife and take care of the baby. “There were times Mary did not want to see me or the baby. It was a really difficult time for us.”

Meanwhile, his family was trying to convince him to chase away his ‘mad’ wife; some cousins ‘helpfully’ offered that perhaps his wife had been bewitched.

“But because I love her, I did not chase her. I did believe, however, that some malicious and jealous man had bewitched her so that we could separate. It was a very painful and embarrassing experience for me,” John says.

Seated quietly on a wooden stool and listening to her husband talk in their home in Mlolongo, Mary, a tall, strongly built woman, smiles broadly. She says much to everyone’s relief, she was back to her old capable self after a few months.

“The baby was about three months old when she got well and became a very good mother. I was surprised,” John says. That scary time was relegated to the bad memory bin and life went on.

Three years later, Mary was again pregnant. Soon after their son, Allan, was born, she went wild again. This sent the family into a panic for a second time and as the nightmare re-visited them, relatives again warned Musau that if he didn’t heed their advice to chase away his ‘mad’ wife, they would cut him off because “to have such a person in the family is a curse”.

“They told me that one of our children would be mad – Mary could not be the only mad person in the family,” says John.
But he did not chase her away. “Instead, this led me to think a lot about the previous incident and I made a connection – she went berserk a few days after giving birth.”

So John approached a nursing officer at the hospital where his wife had been attending ante-natal clinics and was told what the problem was.

“I was told she was suffering from a medical condition that could be managed. I blamed myself for not seeking medical attention earlier. I had wasted a lot of money on witchdoctors who promised excellent results, but did literally nothing,” he says.

“She was put on anti-depressant medication and saw a doctor and a counsellor once a week. After about two months, I could see the results. My wife came back to her senses and could now look after the baby herself, save for the headaches. Our relationship grew,” explains John.

It was then that he made the decision to cut close ties with any of his family members who were not happy with his decision to keep a ‘mad’ wife.

“They were curious to know how my wife was cured of her ‘madness’ but I was not ready to discuss it.”

When their last child, son Tonny, was born seven years ago, John allowed his wife to stay in hospital for a while and as soon as she sank into the delirium, doctors were able to contain her.

“Anti-depressants were administered and within one-and-a-half weeks, my wife was at home cuddling our new baby. She was able to enjoy being a new mother for the first time and the baby was the first one lucky enough to enjoy the affection of his mother in the first days of his life.

It was very exciting. I also enjoyed having my wife around. The label of madness had damaged my ego and I found it hard to socialise with my friends from the neighbourhood whose wives were not ‘mad’,” John admits.

Family history

There are many pre-birth factors that come into play in post-natal depression (an illness characterised by a low mood that occurs after having a baby).

According to Dr Stephen Wahome, a psychologist and the director of Psychological Health, a psychotherapy and counselling training institution, the reception a pregnancy gets and how it is handled psychologically can be either stressful or a walk-over.

Dr Wahome adds that any psychological disorders related to a pregnancy are usually detected in the first trimester. This is because it is the most pronounced phase in which most women become anxious and sink into depression, especially with unwanted pregnancies.

“In addition, the first trimester involves a lot of physical, emotional and hormonal readjustments in the woman’s body and this can be very stressful.”

And it is not only teenage girls who have unwanted pregnancies, Dr Wahome says. “Many women in marriages get pregnant while not expecting it to happen.”

He adds that if the family, husband or partner is supportive, then a woman will easily get through this period in a good state of mind and go into the second trimester, which is a bit more comfortable as she would by then have adjusted physically and psychologically.

“But come the third trimester when the pregnancy is advanced, and there is the fear of delivery and any malformations in the foetus. The financial implications of a delivery are getting real, there are reactions on the body, which cause discomfort while sleeping or moving.”

Post-natal depression is one of the three post-partum disorders that affect mothers, and women who have a documented evidence of a family history of mental illness are very vulnerable to it.

Maternity blues disorder: this manifests itself within the first week after birth. It is the most common, as “it affects nearly half or two-thirds of all women who have delivered, but it is not serious”. It is characterised by irritability, mood swings and episodes of crying.

“It reaches its peak on the fourth day after birth but after one week it is gone. It is a time when some mothers complain that they are confused,” Dr Wahome explains.

This is common in first-time mothers, women who are affected by pre-menstrual tension and the abrupt fall of oestrogen and progesterone hormone levels during delivery, he adds.

Mothers who have been stressed during pregnancy are prone to maternity blues. Fathers also play a role in this: “The comments men make when they go to hospital to see the new baby are very important and greatly influence the mental state of the woman,” says Dr Wahome.

Post-partum psychosis: this is the most serious post-natal disorder, although not very common. “It is the disorder that afflicts those women who claim that they go mad when they deliver,” Dr Wahome explains, adding that it is common among those mothers with past psychiatric illness, have a history of family mental illness and are going through the after-birth process alone. “It occurs within one to two weeks after delivery,” he says.

The disorder presents itself in an acute organic state, affective depression and schizophrenic psychosis. In the acute organic state, the condition is arrested by the use of antibiotics, while affective depression is dealt with through psychological care in a hospital environment.

The doctor says schizophrenic psychosis is less common but has serious after-effects. “The mother has delusions about the baby, thinking it is malformed or otherwise imperfect. Sometimes she attempts to kill the baby or even refuses to breast-feed it. Some mothers, if not monitored, have strangled their babies and then committed suicide.”

Dr Wahome says this disorder is treatable by use of electro-convulsive treatment (ECT) and anti-depressants. Many patients have recovered and gone on to lead normal lives “but with subsequent pregnancies, there is a 15 to 20 per cent chance that it can recur,” he explains.

Puerperal depression: this is a less severe post-natal disorder and the most common. “It occurs in 10 to 15 per cent of women after delivery and is triggered by psychological adjustment and hormonal imbalances that occur after birth,” says Dr Wahome.

He adds that after delivery, a mother is usually overwhelmed by the lack of sleep and the hard work required to care for a new baby.

“It is common in mothers who do not get any support from the family or partner after birth, and who are also experiencing stressful events and reactions. Also, if a mother has a past history of psychiatric illness, she too, is vulnerable.”

Symptoms include tiredness, irritability, anxiety and phobic symptoms that come just after maternity blues. “Most patients recover after two months,” he says.

Society’s role

If a mother is accorded the necessary psychological support, she can recover without any treatment. The disorder can also be managed through psychological and social interventions, including counselling the new mother together with the family or people around her. “If not treated, post-natal depression can be a major suppressive illness,” Dr Wahome says.

He adds that society should stop stigmatising and labelling mothers with the disorder. “People should instead understand and support them.” Dr Wahome recalls a case in which a man was forced to walk out on his wife by his extended family because she suffered post-natal psychosis and they had labelled her mad.

Habits such as drinking and smoking during pregnancy are unhealthy, as they can cause stress that can trigger the disorder. And this stress, if not caught in time, can be passed on to the baby.

“The mother will give birth to a stressed baby.”

Husbands should also support their wives when they are giving birth, while mothers who have lost their babies need psychological support and treatment.

Women who lacked maternal care more prone

In addition to a past history of psychiatric problems, post-natal depression can also be experienced by new mothers who themselves were denied maternal care or who grew up without their mothers. This is according to Dr Geoffrey Kazungu Koba, a gynaecologist at the Vihiga District Hospital.

This is a key contributor to the condition because these women do not know what it means or entails to be a mother.

“They have no insight on motherhood, hence they are caught off-guard, not knowing what to do after giving birth,” he says. “They are not psychologically prepared to be mothers.”

Unstable marriages also come to the fore – marital problems contribute to the onset of post-natal disorders. In addition, a difficult labour or a difficult pregnancy could cause a post-natal disorder.

“Women who have difficulty conceiving or while giving birth, have miscarried or experienced foetal death are very vulnerable to post-natal disorder,” Dr Kazungu adds.

Mothers affected by post-natal depression have suicidal tendencies. “Some do actually attempt to take their own lives and must, therefore, be closely monitored.”

Worse still, these mothers also get ideas about harming their infant. “Some even go to the extent of killing the baby,” he says. “And if a mother has experienced post-natal depression before, chances are very high that she will experience a replay in subsequent pregnancies.”

If this condition is not addressed clinically and psychologically, chances are that such a mother might develop psychiatric illness in future and episodes of psychosis or depression itself.

How can this disorder be managed?

• Support: Dr Kazungu says support and understanding are key to the management of the disorder. It is vital for the husband, family, medical personnel and other people around the mother to have an insight into her problem.

• Psychotherapy: the mother should be placed under the care of a psychiatrist so that her mental status can be assessed frequently. During this time, other people should take care of the baby.

• Anti-depressants: these should be administered in order to avert the symptoms of depression and care should be observed, as there are those that are not meant for breast-feeding mothers. If prescribed, a mother should not breast-feed.

• Hospitalisation: this is especially in cases where the mother is suicidal. This ensures she is not a risk to herself or to the people around her.