Everyone talks openly about how wonderful and rewarding motherhood is. They might even talk about its many challenges; the sleepless nights, the lack of time for oneself, the loss of personal identity, the sheer enormity of the responsibility of caring for another human being and keeping them alive. But no one really talks about depression.
While most new mothers suffer from baby blues (which usually lasts for a few weeks after childbirth), an increasingly growing percentage (around one in five women in the United States) suffer from a much more serious mood disorder called postpartum depression (PPD) or postnatal depression (PND). It is mainly caused by a severe drop in hormones (estrogen, progesterone and other hormones produced by the thyroid gland), resulting in a feeling of sluggishness and depression.
I had my baby early last year in the UK, after a difficult delivery and an emergency caesarian. Despite having help from my mother-in-law and my husband, I was completely overwhelmed with the demands of a colicky baby who consumed every ounce of my being. From the very beginning, I noticed something was wrong. I was unable to bond with my baby, and there was a deep feeling of sadness that seemed to well up from my very core. I simply chalked it up to sleep deprivation and convinced myself that in a few weeks’ time, I would be back to my old self.
During my three-week postpartum stay in the UK, my physical and mental health was closely monitored by midwives, health visitors and my doctor. Every one of them asked me how I was coping emotionally, and assured me that there is a recourse to treatment if things took a turn for the worse. A health visitor even gave me a questionnaire to fill out called ‘the Edinburgh Postnatal Depression Scale’, which is a 10-question psychological self-rating scale used by health professionals to measure the severity of postnatal depression in new mothers. Initially, I only scored a few points on that scale because at the time it was mild. It was only when I flew back to Egypt that it got worse.
I spoke to my doctor in Egypt about how I was feeling. He immediately recommended medication. Just like that. No referral to a therapist to diagnose me, no survey to screen me for postpartum depression, nothing. When I told him I’d rather not take medication (which comes with its own side effects) right away, he blithely, and insensitively, suggested that I cheer up. Just like that.
It was only after I visited a midwife here who administered a homeopathic remedy that rebalanced my hormones that I started feeling marginally better, at least for a while.
Over the following months, I found myself in an emotional rollercoaster as my mind was caught up in a constant negative loop of sadness, fear and guilt. I experienced moments of joy and stability interspersed with soul-crushing lows.
On the outside I was a fully functional human being. I went about taking care of my baby. I even played with her, and told her that I loved her even when sometimes I didn’t feel the love.
On the inside, I was drowning. The weight of the responsibilities from one developmental stage to the next grew heavier and heavier. I was looking for that light at the end of the tunnel, a life raft, an anchor. I felt miserable and trapped. I started wondering if I was ever happy. I even questioned my own competency as a mother and whether my baby would be better off without me. But that’s what depression does. It lies to you and deceives you into thinking that you’re not good enough, that there is no way out.
As a survival mechanism I tried to hold on to anything: a job working from home, writing in my blog, anything really, to get me through the day. I was literally taking it moment by moment. I felt I was holding on tenaciously to my dreams with one hand and letting them go with the other. Through it all, I was just trying to hold on to me. Ironically, it was my daughter who turned out to be my safe harbor.
As the months rolled by, I started slowly bonding with her. After a long struggle with breastfeeding fraught with tears, blood and self-doubt, a year later and I am still breastfeeding and loving it. So I suppose that there are good days and bad days, but that’s life.
Why isn’t postpartum depression discussed, let alone screened for in Egypt? Or in the Arab world in general? Why is there such a stigma surrounding it?
Maybe our mothers never really experienced it. Maybe it’s because our mothers were surrounded by their tribe, a community of family members, friends, and neighbours each one ready to lend a hand and help raise the child, so that the mother keep her head above water. Maybe it’s because depression is really a disease of the modern age, or that it’s more prevalent in the West where the notion of extended family or “village” is a myth. Maybe it’s because our parent’s generation simply accepted the way things were and stoically got on with life. Maybe it’s because we are a society that revers children, or maybe our mothers experienced it, if only for a short time, but they repressed the memory. I’m not sure.
While postpartum depression in the West is instantly screened for and treated with medication, (notwithstanding some patients that fall through the cracks because of the pressure placed on doctors to treat a large number of patients in a conveyor belt fashion), in the non-Western world, it is not even acknowledged.
However, we live in an increasingly globalized world where traditional bonds of community and the extended family often contend with the more Western model of the nuclear family, especially in a megalopolis like Cairo. Working mothers find that the three-month maternity leave is hardly enough and professional caregivers and nurseries are costly and not always up to par. Some are foreigners (like me) with no close family to lend a helping hand.
But we need to do more than lend the occasional helping hand.
As a society, comprised of our own mothers, mothers-in-law, relatives, husbands and partners, friends and health professionals, we need to recognize that mental disease is real and new mothers are just as at risk as anyone else. Probably even more so because of the incredible amount of pressure placed on them.
We need to destigmatize mental disease and initiate an ongoing dialogue about postpartum depression before the numbers and statistics rise even more.
We need to stop shaming mothers by telling them to be grateful and just suck it up and get used to the new “normal”. It’s okay to miss the old normal, I miss it everyday.
We need to require doctors to be on the alert for the symptoms and ask the questions that matter so that PPD can be effectively screened for, diagnosed and treated. Also, alternatives to medication (such as homeopathy, mindfulness, support groups…etc) have to be presented as viable options.
We need to encourage and normalize the proactive involvement of husbands and partners in child-rearing so that tasks and household chores are equally divided rather than holding on tooth and nail to the old patriarchal model of making women do everything while the man simply brings home the bacon. Men need to put in the time, not just with their babies but with their wives as well. After all, they’re in this together, their support is probably the most crucial.
We need to stop with the inane and frankly, passive aggressive insinuations of when the second and third baby is coming when the mother can barely remember what she ate 15 minutes ago.
We need to stop placing unreasonable expectations on new mothers. They need to take care of themselves and their babies first. Everything and everyone else can wait.
We cannot dismiss their silent suffering as unwarranted, or self-induced, or an inability (even worse), a refusal to think positively. We need to stop making them feel selfish for wanting time for themselves. We need to stop making them feel like they don’t matter.
I once remarked to my mother with hint of awe that it’s a wonder my daughter turned out happy despite me, that my darkness didn’t taint her. To which she replied, “No, she turned out happy BECAUSE of you.” I felt a measure of pride and triumph that someone finally understood and acknowledged all my efforts. And the fact that it was my mother was not only fitting but incredibly moving.
So if you know of someone who’s just had a baby, take the time to ask her how she is feeling. Don’t be afraid to dig a little deeper. She will appreciate it. That’s what a mother suffering from postpartum depression needs; to know that there’s someone out there who while they may never quite understand what she’s going through, will be there for her, nonetheless. That she’s a warrior and one day this battle will soon be over and she’ll reach the finish line, she’ll get to the promised land.
One day, she’ll find herself again. And when she does, she can look back and finally know her own strength, that her depression didn’t negate her love for her child, it just hid it for a while. And through it all, she was never alone.