A self-described “happy person”, Tan says she suffered from depression and anxiety for years after giving birth to her son. What Tan, now 47, didn’t know was that she was then suffering from postnatal depression (PND).

What’s worse, her then-husband was involved in extramarital affairs and didn’t help with childcare duties, even when their child was ill — leaving her alone to tend to him around the clock.

It all came to a head one day.

Tan recalls, “I was shivering. I didn’t know what I could do. The pain was there but I couldn’t do anything. I felt like I had no one to turn to.” So, she took a stool to the window, wanting to jump.

She would have, too, had the police not arrived at the scene in time. It was the words of one policeman that changed her mind, she notes.

“He told me that he was divorced, too. His wife walked away from him and left their three kids behind. He said, ‘Your child already has a dad who doesn't love him. If you’re going to do this, you are no different from his father.’”

“Your child already has a dad who doesn't love him. If you’re going to do this, you are no different from his father.”

Tan adds that the policeman’s words made her realise that if she died, her son — who recently turned 21 — would be an orphan and “that’s not fair to him”. Soon after the incident, Tan divorced her husband of 10 years and got help at KK Women’s and Children’s Hospital (KKH). She eventually returned to work in the retail industry.

If you think Tan’s experience is uncommon — think again. Dr Helen Chen, KKH's head of the Department of Psychological Medicine, points out that depression affects some six to eight per cent of postnatal women in Singapore — or one out of every 12 to 16 women.

“There are usually many factors that contribute to the development of postnatal depression in women: Hormonal, biological, psychosocial and emotional changes,” Dr Chen said, adding that some of the causes are distress about weight gain, sleep deprivation, marital discord and financial difficulties.

She notes that our fast-paced lives and high stress levels can contribute to a greater risk of depression. “Many mothers also wear multiple hats. They care for their children and organise the household, in addition to holding down jobs. Some also need to tend to their elderly parents and support their husbands. Having to meet all these demands may wear mothers out.”

However, Dr Chen notes that while suicidal feelings are not uncommon among those who go through treatment for postnatal depression, actual suicides are rare. “This is because most mothers who struggle with dark thoughts are actually greatly distressed and the thought of their babies often gives them strength to fight the dark thoughts.”

Dr Chen lists the risk factors for postnatal depression:

- A family history of postnatal depression, pregnancy complications and difficult deliveries.

- Both young mothers under 21 years of age and mature mothers, especially if the pregnancy was unplanned, are also at a higher risk.

She adds, “During the postnatal period, breastfeeding and confinement may become significant stressors if they do not progress smoothly.”

In November 2016, Koh Suan Ping, 29, jumped from her 12th storey flat in Bukit Panjang with her two-month-old daughter in her arms. She did so five days after she had searched online for “what to do when there is no way out”.

Koh’s husband and colleagues say she was upset she could not produce enough breastmilk to feed her daughter. At the same time, she also felt stressed at having to find a replacement domestic helper and concerned that her company — where she worked as a sales manager — was not doing well. Her death was ruled a suicide.

Koh’s tragic story struck a chord, as many women shared their personal stories on social media about being plagued by worries and pressure from different sources as new mothers. A woman, who only wanted to be known as Ms Goh, said she struggled under the pressures that come with motherhood to a point where she was “stretched beyond [her] capacity to stay sane”.

Five years ago, the first-time mum nearly drowned her newborn. Pushed to her limit, she held her son under water for two seconds before snapping out of it. She held her baby close to her in bed, crying, for hours.

“I was that close to driving into the wall, wanting to end it all.”

“At that time, I had all kinds of s**t thrown at me ― overdue credit card bills, irregular income, lack of support, my savings were running dry. I had all kinds of negativity thrown at me for my choices as a new mum, and it was the toughest time I ever had.”

The stress of mothering an infant did not let up when she gave birth to her daughter, now age 3. After her return to work and losing a $2,000 business deal, she found herself driving 120kmh along the Central Expressway, bawling her eyes out.

“I was that close to driving into the wall, wanting to end it all.” But instead, she drove to KKH, “shaking badly and incoherent”, and started her three-year journey to recover from postnatal depression.

KKH runs a Postnatal Depression Intervention Programme (PDIP), which screens mothers for postnatal depression four to six weeks after delivery. These checks — which help in identifying those who need early treatment — are carried out when they return to the hospital for routine obstetric check-ups.

Noting that the clinical outcomes for PDIP have been “very encouraging”, Dr Chen advises that women who did not deliver at KKH may wish to make an appointment to consult a psychiatrist for assessment within three months of delivery.

She says, “If they have previously received mental health care, it is recommended that they return to see their care provider for a postnatal review, especially within the first three months of delivery when a relapse is most likely to occur.”

Dr Chen notes many mothers experience some tearfulness and feelings of worry soon after delivery, but if these resolve after a few days it is likely to be a milder case of “baby blues”, for which medical help is generally not required.

PND symptoms, on the other hand, such as a persistent low mood and lack of positive emotions, tend to last beyond two weeks and can affect the mother’s ability to function.

Signs of PND include a low mood, irritability, poor sleep and appetite, loss of confidence and feeling guilty for no good reason.

If you or a loved one is showing these signs, consult your obstetrician, ask your family doctor to recommend a psychiatric referral, or seek psychiatric help directly. Supportive counselling and therapy have also been found to be effective and acceptable means of intervention, Dr Chen adds.

“For mothers who are apprehensive about getting help for fear that they might be prescribed medications that are unsafe to take while breastfeeding, they can be assured that there are other alternatives that can be used safely,” she assures.

Besides KKH, the Association of Women for Action and Research (Aware) also provides counselling support for women who are in need of support or a listening ear. You can contact its helpline at 1800-774-5935 from 3pm to 9.30pm on weekdays.

Jolene Tan, Aware’s head of Advocacy and Research, points out, “Motherhood is not easy, but there is a lot of societal pressure to be a ‘perfect’ mother and barriers to asking for more help.” Both Dr Chen and Tan agree that aside from medical help, family members play a crucial role in helping mothers recover from postnatal depression.

“Motherhood is not easy, but there is a lot of societal pressure to be a ‘perfect’ mother and barriers to asking for more help.”

Dr Chen points out, “This is a time that is spent mostly at home when life revolves primarily around family.” If you have a new mother in your family, Dr Chen suggests how you can help the newbie mum steer clear of developing PND:

* Give reassurance that the new mother is not alone and that she will get better.

* Provide a listening ear without making any judgment.

* Do not offer solutions or advice, unless requested.

* Ask how you can help.

* Understand that her mood may be unpredictable.

* Understand that her depression is not a sign of weakness or unsoundness of mind, but that she is ill and would benefit from support and intervention.

* Instead of reacting instinctively by retaliation and scolding, stay calm and communicate to her that you would like to help.

* Offer help with household chores and childcare needs before she asks for it, as she may find it difficult to request any assistance.

* Provide assistance and encouragement to help her build confidence about looking after the baby.

* Encourage her to rest, to go out for a walk, have couple time, meet her friends and engage in relaxing activities.

* Encourage and help her to seek professional help when needed.

Dr Chen also shares that employers can also support a mother’s recovery by allowing her to return to work at a pace that is comfortable. “If possible, provision of a quiet and clean corner to support breastfeeding mothers would be very helpful to enable a working mother to feel empowered that she is still able to do her best for her baby and alleviate any feelings of guilt as a result of leaving her baby at home.”

Tan also notes that having hands-on partners and other family members who help with caregiving tasks and domestic chores can improve a mum’s well-being as they will have more time to sleep and “charge their psychological batteries”.

“When we support, empathise and offer resources to mothers who are struggling, instead of shaming or pressuring them, or brushing off their feelings as ‘baby blues’, we can help alleviate their struggles and get them on the road to recovery.”

Call AWARE’s counselling helpline at 1800-777-5555 on weekdays from 3pm to 9.30pm. Find out more about KKH’s Postnatal Depression Intervention Programme (PDIP) by sending an e-mail to pnd@kkh.com.sg.

A version of this story by Melissa Zhu first appeared on Channel NewsAsia.

Photos: iStock

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