When it’s more than just baby blues

Parents are under enormous pressure to live up to societal expectations. Fathers are stereotypically seen as breadwinners and providers, while mothers should be devoted to their children wholeheartedly and this often entails navigating motherhood with a brave face, no matter what they’re going through.

It’s no wonder some mothers find it difficult to express any negative emotions. If they are struggling, does this mean they are bad mothers? If they don’t feel immediately bonded to their newborn, does this mean they are failing?

The answer, of course, is no. While common mental disorders, including anxiety and depression, are experienced by one in five women globally, post-partum (or postnatal) depression is one of the less spoken about forms of mental illness struggles discussed openly. Post-partum depression, according to a study conducted by Kebogile Mokwena and Perpetua Modjadji in the African Journal of Primary Health Care and Family Medicine, is “a type of clinical depression that can affect women after childbirth”. The 2022 study focused on how post-partum depression affects women in different communities around Gauteng and the Free State, depending on social factors.

Tiffany Miguel, 36, a swimming teacher, has had three children and experienced post-partum depression to varying degrees after all three births. Miguel has refused the option to go by an alias as she says she believes this will perpetuate the shame cycle that many women go through, reinforcing the idea that struggling with mental illness after having a child is something to be ashamed of. The reality, however, is that the fear of being named comes from the prevalent habit of shaming mothers for not being “perfect”.

Due to a lack of information on the condition, she was puzzled by her symptoms. “After I had my first child in 2016, I had no idea that what I was going through was post-partum depression. I had my first child when I was 30 so up until that point, I was living my life spontaneously, doing what I wanted to do, partying and going on holiday a lot and suddenly, you have this responsibility that is placed on you. I didn’t know or still don’t know what actually causes post-partum depression.”

There are many recorded causes of post-partum depression. According to the National Institute of Mental Health, hormone (oestrogen and progesterone) levels can drop quickly after childbirth. This may lead to chemical changes in the brain that could potentially trigger mood swings. The lack of rest following childbirth can also be a large contributing factor.

Miguel says she experienced symptoms that were inexplicable to her, such as dissociation from her son. “I couldn’t form a bond with him and this has happened with all three of my kids. I didn’t feel anything when I looked at them. They’re cute, but it doesn’t feel like my child. I didn’t feel like a mother to them.”

She continues: “With my first two kids, my first one especially, because I didn’t know it was post-partum and didn’t seek help, I’ve never told anyone the dark thoughts that come with it. You actually have these thoughts of hurting your child, not to hurt them, but thinking about how terrible the world is and we’d both be better off dead. Then there was sleeplessness. I had no interest in getting to know the child — so as much as I didn’t feel a bond I had no interest [in feeling] a bond; I had no interest in doing anything any more.”

According to another post-partum depression study conducted in 2023 by Garapati et al, the symptoms that Miguel experienced are those most typically associated with the condition. “While many women experience various emotions, some may develop more severe and persistent mood disorders, such as post-partum depression, anxiety and psychosis. Post-partum mood disorders refer to a spectrum of mental health conditions that can occur following childbirth.

“These disorders are distinct from the commonly experienced ‘baby blues’, which are mild and transient mood changes. Post-partum depression, the most prevalent form of post-partum mood disorder, is characterised by persistent sadness, worthlessness, and loss of interest or pleasure in daily activities. Post-partum anxiety involves excessive worry, restlessness and intrusive thoughts, while post-partum psychosis is a rare but severe condition characterised by hallucinations, delusions and disorganised thinking.”

Though post-partum translates to immediately after birth, the clinical depression that takes place in mothers can last far longer than a few weeks, especially if they do not seek help. “It lasted over a year with my first child,” Miguel says.

Relationships between the mother and her partner can also be negatively affected by post-partum depression. Miguel says her relationship took major strain as neither she nor her husband knew why she had sunken into such a dark place. “We were together for 10 years at that time, and we actually broke up and he moved out. He thought I had lost my mind. We were co-parenting but due to the lack of interest in the child, he actually saw the child more than I did.”

Miguel says she experienced post-partum depression again after giving birth to her second child, a girl, within two years of her first birth. “There were the same symptoms but I sort of realised that it was depression and not just ‘life sucks’. I had gone through depression and then felt better, so when it happened again, I didn’t necessarily think post-partum depression at the time, but I felt that something was not right. I then sought help and saw a psychiatrist and received medication. As a result, I now have a much closer bond with my daughter. Unfortunately, seven years later, I feel that my son still feels that distance between us.”

SA still experiences stigma around mental health struggles, even more so when it comes to post-partum depression. Due to cultural norms, the person facing the mental illness may be told to simply get over it and just be happy.

Garapati’s post-partum study confirms that this is prevalent in certain communities. “Cultural norms related to expressing emotions, seeking help and seeking treatment for mental health issues can impact how individuals perceive and cope with post-partum mood disorders. In some cultures, stigmatisation or taboo may be associated with acknowledging and discussing mental health concerns, including post-partum mood disorders. This stigma can prevent women from seeking help or openly discussing their experiences, leading to underreporting and delayed intervention.”

Miguel emphasises the amount of guilt a mother can feel due to post-partum depression. “I felt like I was incompetent and that I didn’t know how to be a mother and I felt like it was something that I was doing wrong that I couldn’t bond with my child because everyone says that it’s a natural instinct to bond with your child and it’s unconditional love. Not only did I not feel love but I felt nothing — a void. And even worse, with my daughter, I felt resentment. I felt like I am a horrible person and that’s when the thoughts came that they’d be better off if I were gone.”

There is a solution: seeking help if you feel low for a prolonged period after birth. It’s not you, it’s your hormones.

Miguel shares her advice for women who may be going through a similar experience: “I think that what would help a lot of people is to normalise post-partum depression, so family and friends can help spot the symptoms, because [often] you can’t see the symptoms for yourself. It took me three times of me thinking that something was off for me to realise that it really was off but if one of my family members asked me if I’m feeling OK because they’ve noticed x, y and z, it might have helped me acknowledge that I had a problem a lot sooner than I did.”

There is help. And it’s freely available through the SA Depression and Anxiety Group, which can be contacted at 0800 567 567.