‘I was a shell of my normal self’. What a doctor wants you to know about postpartum depression.

In the weeks after my daughter was born, I had plenty of ‘WTF have I done?’ moments. I thought I was isolated in my difficulties adjusting to life as a new parent. Sleep deprivation was killing me, and I was struggling to recover mentally and physically from childbirth. 

Our daughter was born via emergency C-section. To say I was shell-shocked after her birth is an understatement. I was hit for six. Despite being a doctor and also married to one, we had naively assumed we’d have the low-risk pregnancy and labour we desired. 

26 hours of labour later, I found myself in a delivery suite with a team of midwives, an obstetrician (who wasn’t who we had chosen; that one was on leave) and my husband. After extensive discussion, the obstetrician trialled forceps to assist a vaginal delivery; I distinctly recall feeling a tugging sensation deep within my body. I had allowed the epidural to wear off so I could feel the contractions and push more effectively; the attempt with forceps was more distressing than anticipated.

Then I remember the following: 

• The obstetrician turned to the red buzzer on the wall and pressed it firmly. She turned to the senior midwife in the room and said, ‘This is a failed instrumental delivery. This is now an emergency.’ 

• I saw my blood pressure on the monitor just above my left shoulder. Panic rose: ‘Shit, I’m going to have a stroke,’ and my brain whispered, ‘You’re never going to meet your baby, Preeya.’ 

• Our beautiful daughter was pulled from my body in the operating theatre. She was held over the curtain for me to glimpse. [My husband] Will and I cried. I wondered if I would get to know her, or if I would die on that table in her first few hours on Earth. 

• Will and our baby were led out of the operating theatre quickly (against his firm wishes, I could hear the debate) as I waited for the wound to be sutured. 

• In the recovery bay, I sobbed relentlessly to a wonderful nurse because I wanted Will, my baby or, if that wasn’t possible, my mum. 

Watch women discuss the impact of birth traumas on physical and mental health. Post continues below.

Our birth story wasn’t fabulous. It wasn’t one for social media, that’s for sure. And for me, it significantly skewed my postpartum patch. 

My experience of childbirth with my daughter wasn’t the introduction to parenthood I had anticipated. I started on the back foot, emotionally spent and physically exhausted. I think there should be more honesty and openness around the topic of childbirth and postpartum life. In my consulting room, I find that new parents, particularly mothers, suffer silently (and guiltily) thinking their feelings, emotions, thoughts and struggles are an anomaly. Often, they’re not.

Is this what motherhood is meant to look like?

I’ve lost count of how many times patients have sighed with relief with tears in their eyes when I assure them that lots of us have sat in our homes with our newborn in the initial weeks and months, struggling with sore swollen genitals, vaginal bleeding (and pads we forgot to change because, seriously, who remembers that on top of feeds and swaddling?) and ridiculously painful cracked nipples, wondering, 'How on earth did I get here? Is this what motherhood is meant to look like?' 

Lots of us have had moments when we wonder why we did all this; gave up our old life filled with social events, sleep-ins and basic freedoms like being able to leave the house on a whim without a wheelbarrow of items to accompany us. I advise my patients that it doesn’t make us undeserving, ungrateful or less of a parent – it makes us human. Parenthood comes with change, and change can be difficult to deal with, even traumatic at times.

Until we experience the postpartum period, we don’t realise thoughts like this are quite normal. (Please know, you can have thoughts that are more concerning, and we can delve into them during a consult if needed). We’re led to believe that we aren’t built for the job of parenthood. 

Social media shows us images of women wearing flowing dresses and flower crowns, and loving every moment of pregnancy (clearly oblivious to the increased vaginal discharge, pelvic pain and constipation). When you see all these images, you can start to think something is wrong with you and your 'What have I done? Bloody hell, I just wish I could sleep and stop bleeding from my vagina and nipples for a bloody moment' thoughts. It’s like you are the abnormal one; everyone else is rocking this postpartum period, being out and loving every minute of it. I’m here to tell you that you are the normal one. 

I know this because day in, day out, I see people in this patch of life in the consulting room. Most of us have moments early in the journey, or later on, when we’ve had enough, we’re exhausted, we wish we could run away and sleep for five days (preferably in a bed with a puffy white doona), and recharge those very depleted batteries.

In the postpartum period, your mental health is often more important than all the physical stuff going on. My job as a GP at the six-week check is to ensure the brain is okay and screen predominantly for postpartum depression, anxiety and postpartum psychosis. 

If you see a community maternal child health nurse after your child’s birth, they’ll often ask you to fill out an Edinburgh Postnatal Depression Scale (EPDS) – a tool designed to screen women for symptoms of distress in the previous seven days. If you score highly on a questionnaire like this, it doesn’t automatically equate to a diagnosis of postpartum depression, but it might lead to me asking more questions about your mood.

According to the Royal Women’s Hospital in Melbourne, 10 to 15 per cent of women will be diagnosed with depression either during pregnancy or postpartum. It’s a bigger number than many people appreciate. 

There should be no shame or stigma related to any mental health diagnosis, especially not this one. Shame and stigma stop people from seeking help, and I’ve seen the consequences of this in my consulting room.

Listen to this episode The Delivery Room. Post continues after podcast.

As a woman who is also a mother, I understand the fear my patients can harbour related to a mental health diagnosis. Is someone less of a mother if they’re not enjoying every single moment of the day with their child? Are they still a deserving mother if they’re feeling low or hopeless, despite the bundle of joy in their lap? 

The answer, and I tell my patients this all the time, is that you are a wonderful, deserving mother – postpartum depression does not change that. 

I want to take you back to 2016 when my daughter was born. Remember that traumatic delivery I told you about? Well, in the days that followed, I was a shell of my normal self. Constipation, swollen, bruised labia and cracked nipples plagued me. I was a little down in the dumps. On Day 4 postpartum, I cried all day. A physiotherapist kept popping into my hospital room to assess my diastasis recti (or abdominal separation) and offer a rehab plan, but every time she walked in, I was sobbing into my pillow. As a GP, I know about the baby blues, but when you’re in the thick of them with uncontrollable giant tear drops, your medical knowledge and sense of perspective fly out the window. 

What’s the difference between baby blues and postpartum depression?

The ‘baby blues’ affect about 80 per cent of new mothers – it’s common and tends to hit between Days 3 and 5 postpartum. The symptoms can vary, but many can experience: 

• teariness (that was me sobbing relentlessly in the bed!) 

• emotional liability (swinging rapidly from happy to sad) 

• increased worry and anxiety 

• feelings of being overwhelmed. 

Why the baby blues happen is likely multifactorial; there is a hormonal component and the birth experience itself might be a factor. The good news is that the baby blues tend to resolve themselves (sometimes taking 14 days) and supportive care – hugs, talking, being kind to yourself and leaning on any support people around – is the mainstay of management. 

Unlike the baby blues, postpartum depression doesn’t tend to resolve on its own after a few days or weeks. It tends to be more persistent with symptoms present for more than two weeks. 

The symptoms can be different – while low mood and lack of hope often feature, strong feelings of guilt, worthlessness, and lack of motivation and enjoyment in things can also occur. Suicidal ideation (thoughts about suicide) can be present with any form of depression, but in the postpartum period, we ask patients about thoughts of self-harm and thoughts of harming the baby. Keeping everyone safe is a key part of my role as a GP.

If you have postpartum depression, you have many options for managing it. Deciding which paths to take can involve extensive discussion with a health professional (be it your GP, psychiatrist, psychologist or maternal child health nurse). Like with any depression, psychology can be a very effective treatment. Finding the right psychologist for my patients is something I take very seriously; in the postpartum period, it’s even more critical because this is a uniquely vulnerable time in someone’s life. My patients need to have the right ‘juju’ (meaning the vibe or energy) with their psychologist; feeling safe and comfortable is critical.

I personally did CBT when I was diagnosed with generalised anxiety disorder 16 years ago and it helped me immensely. It still does. There's also the MumMoodBooster program, which several of my patients have used and found helpful. For those in remote areas or have difficulty accessing psychology services due to financial reasons, MumMoodBooster is a great option. 

Psychology can be expensive; however, in countries like Australia, the government may subsidise some of the cost in particular circumstances, as can some private health insurance policies. 

Take-home point: psychology can be very effective and finding the right psychologist (either in person or online – whatever works for you) can have a significant positive impact.

Where to find support for birth trauma, baby blues and postnatal depression

According to Perinatal Anxiety and Depression Australia (PANDA), up to one in three mothers will experience their child’s birth as traumatic. Trauma can be physical and/or psychological and both can cause distress. Birth-related trauma can manifest in a range of ways – feelings of shame, anger, grief and disappointment – and it can also be a contributing factor in mood disorders such as postpartum depression. 

If you need help or want to debrief about your birth experience, your GP, midwife or obstetrician, as well as PANDA and the Australasian Birth Trauma Association, are excellent resources. After the birth of our daughter, I spoke to a psychologist and psychiatrist to unpack the physical and psychological traumas I had experienced. Despite it being gruelling at the time, I promise you it was worth it.

This is an edited extract of Dr Preeya Alexander's new book, Eat, Sleep, Pray, Love, out now with Simon & Schuster. Dr Alexander is a GP specialising in preventative health, general medicine, mental health, paediatric and women's medicine and sexual health.

Feature Image: Supplied/Mamamia