‘Baby blues’ needs to move up list of infant care priorities
A mother’s mental state is important for an infant’s early development, so advocacy around these issues is growing in SA
During the first few months of Dean Mandim’s pregnancy, she was plagued by extreme anxiety, which manifested in an obsessive-compulsive need to document everything related to her baby boy on a spreadsheet.
“Instead of getting enough sleep, I would sit at the computer googling how much milk I needed to give to my baby and how often he needed to feed. I would write down how many nappies he would have to wear during the day and how many hours of sleep he would need. At the time it felt urgent and necessary and I felt extremely anxious if someone interrupted me.”
Mandim went into preterm labour when she was 32 weeks pregnant and is sure now that this was due to her being anxious and paranoid.
“When my son was born, at full term thanks to medical intervention, the first thing I thought was that he was giving me an evil look. Sadly I didn’t feel a strong connection to him,” said Mandim. Once home from the hospital, things got progressively worse for both mother and son. Mandim tried breastfeeding her baby, but felt that she had to count from 1 to 18 and pray so that the feed would be successful.
She would see shadows on the ceiling and believed that any form of water was dangerous, only because she was convinced she would drown the baby. Because she had social anxiety, she arranged for a nurse to come and weigh her baby and administer vaccinations. It was then discovered that the baby was not thriving and was underweight for his age, because he was not getting enough breast milk.
Mandim eventually went to a psychiatrist who told her that the anxiety and paranoia she was experiencing were a form of postpartum depression with psychosis and that she needed hospitalisation. She chose to recuperate at home so she could be with her son, and in time managed to overcome some of her symptoms. “It did take at least two years to get my medication right and I still have very bad days. I feel like I will have this forever and now need to manage it.”
Mandim is one of many women who suffer from mental illness during and after pregnancy. Stephanie Redinger, whose research is centred on the prevalence of perinatal depression, notes that its incidence is high in SA.
“Between 20% and 30% of SA women get depression during their pregnancy,” she says. One study done in rural KwaZulu-Natal revealed that 47% of pregnant women had diagnosable depression. Consider that in developed countries, perinatal depression is between 10% and 15%, and in developing countries such as Chile, it is 37%.
Even though Mandim had the means to get help, she was no less traumatised and debilitated. The many poor women beset with perinatal depression have to shoulder the additional burdens of financial insecurity and the consequences of systemic violence, poverty and inequality.
Importantly, Mandim’s manifestation of perinatal depression is uncommon, and so when women experience the “baby blues” and lesser feelings of anxiety and depression, they are dismissed. In fact, nonpsychotic mental disorders are the most common in the perinatal period.
The most common symptoms of perinatal depression are persistent low mood, loss of interest in activities once enjoyed, lack of energy and trouble sleeping, difficulty concentrating, feelings of guilt, hopelessness and self-blame, and thoughts of harming their baby or themselves.
Redinger says that without intervention, about 30% of women will continue to feel this way beyond their baby’s first birthday.
Wits University senior psychology lecturer Dr Katherine Bain says that the first 1,000 days of a child’s life (conception to two years of age) are critical for their brain development and future wellbeing. But the health of children is compromised if caregivers are depressed. An infant’s mental health is reliant on its mother’s mental health.
In the Perinatal Mental Health Project, it notes: “Maternal mental disorders are linked to adverse outcomes in children such as poor cognitive development and performance in school, emotional and social behaviour problems, significant psychological difficulties, decreased growth, incomplete immunisations, and higher rates of diarrhoea, stunting, infectious illness and hospital admission … In addition, negative outcomes persist into adolescence.”
However, there is hope: In SA, 97% of pregnant women have some kind of antenatal care, providing an opportunity to intervene where necessary. Redinger says that a third of women who suffer from postnatal depression begin with symptoms while pregnant. These may be subtle, but they should be considered serious nonetheless.
Bain says home-visiting programmes have been effective in reducing perinatal and postpartum depression. A home-visitor or a lay counsellor visits a mother at her home during her pregnancy and for as long as a year after her baby is born, offers supportive and compassionate care (medical care is not part of it). Studies show that mental health care for mothers is most successful when provided by “trained nonspecialist workers”, Redinger confirms.
“With this intervention [home visiting], we see fewer infant emergency care episodes, lowered risk for child abuse, improved brain development in the child and lower rates of maternal anxiety,” says Bain.
However, mother and baby mental health is not at the top of the agenda for policymakers. Home visiting programmes (focused only on mental health care) are carried out by NGOs, often with little money, Bain says. “There are too many competing interests in the context of historical and current trauma and violence.”
Currently, interventions for mothers and babies are focused on physical care because in many ways, mental health interventions are seen as complex and expensive. While advocacy of infant mental health in SA is growing slowly, it becomes lost among the topics of infant mortality, nutrition and cognitive development.
The need to focus on physical care interventions is understandable: according to the SA Child Gauge 2018, 34 children out of every 1,000 live births die before their fifth birthday in SA, with malnutrition cited as an underlying factor in a third of these deaths.
“Greater buy-in with regard to the importance of emotional development is required from the microlevel of community through to macrolevels of government policymakers, especially if the aim is successful scale-up or roll-out of larger programmes promoting improved early infant care,” Bain notes.
• Redinger and Bain are grantees of the DST-NRF Centre of Excellence in Human Development, hosted by Wits University.