The journey into motherhood brings profound changes. It is both joyful and challenging. Many women experience complex emotional and physical transitions during the postpartum period.

In Singapore, where approximately 8 babies are born per 1,000 people, even if this is a decline in the birth rate figure, understanding postpartum depression (PPD) has never been this crucial.

Whether you are a new mother, an expecting parent, or a family member seeking support, this resource will help you understand postpartum depression and many ways to address it.

Remember that seeking help for PPD is not a sign of weakness but a step toward better health for both mother and child.

Understanding Postpartum Mental Health

The postpartum period is marked by significant physical, hormonal, and emotional changes. It is important that you understand these changes in the weeks and months following childbirth.

Physical and Hormonal Transitions

During pregnancy, a woman’s body experiences dramatic hormonal fluctuations, particularly in oestrogen and progesterone levels. After delivery, these hormone levels drop rapidly. This is a change that can impact mood and emotional well-being.

The physical recovery process itself varies among women. Those who underwent natural delivery usually need 6-8 weeks for initial healing, while mothers who had C-sections may need up to 12 weeks.

During this time, the body undergoes numerous changes, including:

• Uterine contractions
• Breast changes for lactation, and the
• Gradual return of pre-pregnancy hormonal balance 

Emotional Transitions and Adjustment

In comparison to the physical changes that happen in the body, the emotional landscape is equally complex. New mothers often experience a range of feelings, from joy and excitement to anxiety and uncertainty.

This emotional variability is natural and expected, reflecting both biological changes and the significant life adjustment that comes with motherhood.

In the fourth trimester (referred to as the three months after childbirth), mothers navigate various challenges:

1. The shift in identity and role expectations
2. Sleep deprivation and physical fatigue
3. Changes in relationship dynamics
4. New responsibilities and learning curves of infant care 

Types of Postpartum Mood Disorders

When an individual, especially a mother, understands the spectrum of postpartum mood disorders, she will be capable of recognising one and taking action as soon as she can.

Baby Blues

It is one of the most common forms of postpartum mood changes. Baby blues occurs in ⅔ of women and usually hits within the first few days after childbirth. The good thing is it subsides within a couple of days to a week, sometimes longer.

Oftentimes, it is experienced by first-time mums and mothers who have poor support.

You may feel the following emotions:

• Irritable or frustrated
• Feeling anxious and overwhelmed
• Worried about your baby’s health
• Cannot focus
• Tired but unable to sleep
• Crying 

This may be caused by the hormonal changes that happen in your body as it adjusts to its pre-pregnancy condition. This is not an illness and will not affect your capability to tend to your baby.

Postpartum Depression, When Blues Deepen

Postpartum depression, sometimes called postnatal depression, affects approximately 1 in 10 women who recently gave birth. PPD is sometimes confused with baby blues, it’s a serious condition that is unlikely to get better as quickly as baby blues.

You may feel the following symptoms that can affect daily functioning and mother-child relationship:

Emotional Changes

• Feeling sad, hopeless, or empty
• Having low self-esteem
• Feeling overwhelmed or anxious
• Experiencing irritability or anger
• Crying more often than usual
• Losing interest in things you used to enjoy 

Behavioural Changes

• Withdrawing from family and friends
• Having trouble sleeping or sleeping too much
• Eating too much or too little
• Having difficulty concentrating or making decisions
• Feeling restless or agitated 
• Having thoughts of harming yourself or your baby 

Physical Changes

• Fatigue or loss of energy
• Headaches or body aches
• Changes in appetite or weight 

Postpartum Psychosis

Postpartum psychosis is another serious mental health condition affecting 1 in a thousand mothers after giving birth (meaning, it’s rare). This is quite different from the symptoms of baby blues and PPD, which people might confuse.

Its symptoms start within the first two weeks after delivery, often within hours or days, and are as follows:

1. Hallucinations
2. Delusions
3. Feeling overactive
4. Feeling down
5. Sometimes a combo of a manic mood and a low mood
6. Confusion 

What are the risk factors of PPD, and how to prevent it?

Any new mum may experience PPD. The risk increases if a mother has:

• A history of depression (whether during pregnancy or before)
• Bipolar disorder
• Had postpartum depression after a previous pregnancy
• Members of the family who have had depression or other mood disorders
• Faced stressful situations recently
• Concerns about her baby’s health (e.g., special needs, illness)
• Multiple births like twins and triplets
• Problems with spouse or partner
• A week support system
• Financial concerns
• Issues, like unwanted pregnancy
  

Prevention

In preventing it, discuss with your doctor if you are planning on becoming pregnant or as soon as you know you’re pregnant and you have a history of depression.

During pregnancy, they can monitor you closely and manage your condition if you experience mild depression.

After childbirth, the gynaecologist may recommend a postpartum check-up to screen for PPD symptoms. Be proactive in visiting your doctor after delivery, so that treatment can begin early.

How are postpartum mood disorders diagnosed?

Many mums can experience baby blues, which are some of the symptoms of postpartum depression. It is normal to have good and bad days, and these emotions are valid.

But if you still feel these symptoms in the next few days and you don’t get any better, you could have postpartum depression. HealthHub has provided a depression scale for you to assess the possibility of having PPD. Take note that the result is not a medical diagnosis.

Only when you visit your gynaecologist or healthcare expert can you properly be evaluated. You will have to discuss your health history and how you have felt since the delivery and undergo a physical exam, pelvic exam and lab tests.

How are these being treated?

Your doctor may refer you to a psychotherapist, a support group, and a counsellor. These are for milder depression cases, and if you are reluctant to use medications.

If the PPD is severe, you might need medication in addition to psychological therapy.

Lifestyle and Self-Care Strategies

There are many ways to help yourself overcome postpartum depression and other forms of postpartum mood disorders.

Get quality sleep at night. Take a nap when your baby is asleep. If this isn’t possible, ask for help from your husband or family members during the night or in the afternoon so you can take enough rest.

Diet also plays an important role in overcoming these kinds of disorders. As much as you can, try not to go through the day without food. Enrich your diet with nutrient-rich foods. We never want you to suffer from dips in energy or feel tired.

Also engage in physical activity. It doesn’t have to be strenuous. Be gentle with your body, and only engage in exercises that you are capable of. We want to keep your heart pumping blood and distributing oxygen and nutrients throughout the body.

And lastly, you might want to meet other mums. By doing this, it will make you feel less isolated. Your mind is conditioned that you are not alone in this journey. And that you’ll get better in no time.

Conclusion

You are a new mum, yes tell it to yourself. And it is okay to acknowledge that any woman can experience mood disorders after childbirth. Also, seeking help does not mean weakness. It is a sign that you are strong enough to overcome whatever challenge that comes your way.

WS Law Women’s Clinic prepared a self-care toolkit for new mothers. We hope this benefits you and your journey towards healing and full postpartum recovery. Ask us anything, and we are more than happy to answer your queries.

[Self-Care Toolkit for New Mums]