By Arman I. Rashid, PhD
PPD: Impacts on Wo(Men)
Women experience complex feelings of happiness, anxiety and confusion after childbirth 70-80% of women face transitory ‘baby blues’ subsiding within two weeks (1), while 10-15% women worldwide develop postpartum depression (PPD) with a severely depressed mood for a protracted period (2). In Malaysia, the prevalence of PPD in women ranges from 14.3-31.7% (3). Motherhood is consequently an emotional rollercoaster for many women – highly gratifying yet demanding, akin to “to suffer in paradise” (4)
Though PPD is commonly seen through a maternal mental health lens, fathers are not immune to this condition. Some men may be at risk of experiencing PPD themselves after childbirth, while others help their partners cope with symptoms (5). 8-10% of men suffer from PPD resulting in indecisiveness, irritability and blunted emotions after childbirth, while there is a greater risk for those whose partners are going through the same condition (6,7).
PPD has been associated with marital conflict, separation and divorce between couples (8). It could also lead to chronic depression, suicide and life-threatening conditions like postpartum psychosis for women, if untreated (9,10). Since PPD directly or indirectly affects the entire family unit, what can men do to help reduce the risk of this condition?
Role of Men: Eight Tips
In conjunction with the Maternal Mental Health Month, here are eight suggestions for men to help their partners (and themselves) cope with PPD:
1. Learn ABCs of PPD
Help familiarize your partner and yourself with ‘baby blues’ potentially leading to PPD, including symptoms, risks and treatment options. The main barriers preventing women from seeking help include lack of awareness about PPD, perceptions of stigma and shame, and perceived treatment ineffectiveness (10,11). Given unhelpful social constructs about ‘picture perfect’ motherhood, you can help your partner manage expectations better and learn about available resources after childbirth.
2. Provide Emotional Support
Be there for your partner to help her navigate stress and anxiety after childbirth, including fears of losing her identity and failing to be a good mother. A partner’s emotional availability can positively contribute to a woman’s functioning, self-appraisal and wellbeing during PPD (12). You can help your partner by listening to her emotional ordeals, showing empathy, and reassuring her life will eventually come back to (a new) normal again.
3. Make (Quality) Time for Her
Dedicate more time for helping your partner cope with physical and emotional challenges following childbirth. A partner can help by making himself physically and cognitively available to her (12). After the COVID-19 pandemic, you may be able to negotiate a more flexible workplace arrangement for yourself despite limited paternal leave options. You can make a difference by sitting beside her even if you are working on office deadlines, for instance, helping her attend to emergencies and ensuring she does not feel alone.
Moreover, spend more quality time by taking her on occasional date nights after arranging a babysitter for the child. This is important to rekindle your relationship as newborn parents rarely find exclusive time for each other amidst childbearing responsibilities, which may affect their marital satisfaction (13).
4. Encourage Social Engagement
Support your partner in maintaining social relationships with friends, family and colleagues, recognizing she may find it difficult to keep in touch after childbirth. Positive social interactions and affectionate support may reduce the risk of PPD (14), in fact, the larger the social network of a mother, the lesser likelihood of developing this condition. (15). If your partner cannot receive calls, help her take messages to reconnect with her support systems. Suggest organizing small-scale social visits and outings with your partner, albeit being mindful to set time boundaries with guests to avoid overwhelming her.
5. Share Household Responsibilities
Do your own bit (and more) in sharing household responsibilities to help your partner have more rest and relaxation after childbirth. A decline in sleep quality is associated with deteriorating depressive symptoms (16), while fatigue is one of the most important predictors of PPD in women (17). Give a hand where you can to help her sleep better and reduce fatigue, perhaps cooking dinner, cleaning the house, changing diapers or nurturing the child from time to time. If needed, order food or hire a cleaner to help minimize pressure on her further. Step up your game by helping her, even if not asked to do so.
6. Support Professional Help-seeking by Her
If your partner is suffering from prolonged ‘baby blues’ with some PPD symptoms lasting over two weeks, encourage her to consult a psychologist or counsellor for professional help. Early detection and treatment can help her cope with PPD better (18), whereas avoidance may lead to more chronic conditions and risky behaviour (10). You can be a source of strength to break out of the silence and stigma associated with PPD by sensitizing her about professional help and treatment options available.
Additionally, help your partner find a support group for new mothers in-person or online in order to share experiences, learn coping strategies and realize she is not alone in a safe space.
7. … and Yourself
Given men are also vulnerable to PPD, don’t forget to seek professional help for yourself if you have depressive symptoms after childbirth. Financial instability, poor work-life balance, marital problems and sleep deprivation may increase the risk of PPD amongst men, which can adversely affect the entire family if untreated (19). Help your partner by helping yourself first in coping with PPD – remember, always ‘put on your own oxygen mask first’ if you want to support her better.
In addition, join an in-person or online support group to share coping mechanisms with new fathers like yourself. If you can’t find it, create one yourself inviting other men transitioning to fatherhood!
8. Inspire Self-Compassion
Motivate your partner for self-compassion, including being more kind, sympathetic and understanding towards herself after childbirth. This will help her recognize the fallacy of idyllic social expectations about motherhood, thereby lessening self-judgement and situating sufferings as part of larger imperfect human experience. More self-compassion reduces PPD risks by decreasing depression, anxiety and self-criticism, while promoting healthier behaviour and interpersonal relationships after childbirth (20). You can inspire her by applying more self-compassion yourself, including meditation, journaling and challenging negative thoughts, translating to more empathy for both partners.
Last Word: Involving Men
Childbirth can be a momentous yet confronting life experience for women and men alike.
Given men are vulnerable to both undergoing PPD themselves and helping their partners cope with symptoms, they are critical stakeholders who need to have a greater voice in the public health discourse, policymaking and clinical interventions addressing this condition. This is particularly important as maternal and paternal mental health are interrelated, while together affecting the child and family unit.
As responsible partners, men have an obligation to women (and themselves) for playing a more proactive role instead of a passing bystander in helping reduce the prevalence of PPD. This involves not only offering her a shoulder to cry on, but also providing practical assistance, helping break the stigma, and improving resilience against depressive symptoms after childbirth.
Most importantly, PPD needs to be seen with a wider lens beyond maternal mental health in Malaysia and beyond. We cannot ignore the role of men in helping their partners and themselves ensure a smooth landing in the emotional rollercoaster after childbirth.
(Arman I Rashid, PhD is a Counsellor-in-Training in the Monash University Master of Professional Counselling program, currently doing his placement in SOLS Health. He worked as a political and security analyst for international organizations before a mid-career switch to mental health, recognizing ‘world peace needs inner peace’ for sustainable societies. He can be reached at arman@sols247.org).
References
1. American Psychological Association (2008). Postpartum Depression. APA Women’s Program Office. https://www.apa.org/pi/women/resources/reports/postpartum-depression-brochure-2007.pdf
2. Andrews-Fike C (1999). A Review of Postpartum Depression. Primary Care Companion to the Journal of Clinical Psychiatry. 1(1).
3. Kang P, Mohazmi, M, Ng Y & Liew S (2019). Postpartum depression in maternal and child health clinics: A cross-sectional survey. Malaysian Family Physician. 14(1).
4. Cesar F, Costa P, Oliveira A & Fontaine, AM (2018). “To Suffer in Paradise”: Feelings Mothers Share on Portuguese Facebook Sites. Frontiers in Psychology, 9.
5. Paulson J & Bazemore S (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A menta-analysis. Journal of the American Medical Association. 303(19).
6. Scarff J (2019). Postpartum Depression in Men. Innovations in Clinical Neuroscience. 16(5-6).
7. Eddy B, Poll V, Whiting J & Clevesy M (2019). Forgotten Fathers: Postpartum Depression in Men. Journal of Family Issues.
8. Letoureneau N, Denni C, Benzies K, Duffett-Leger L, Stewart M, Tryphonopoulos P, Este D & Watson W (2012), Postpartum Depression is a Family Affairs: Addressing the Impact on Mothers, Fathers and Children. Issues in Mental Health Nursing. 33(7).
9. Harvard Medical School (2011). Beyond “Baby Blues”. Harvard Mental Health Letter. Harvard Health Publishing. https://www.health.harvard.edu/newsletter_article/beyond-the-baby-blues
10. Hadi H & Hadi S (2015). Uncovering the Concealed Part of Motherhood-Postpartum Depression in Mothers. Clinics in Mother and Child Health. 12:1.
11. Zauderer C (2009). Postpartum Depression: How Chidlbirth Educators Can Help Break the Silence. Journal of Perinatal Education. 18(2)
12. Montgomery P, Bailey P, Purdon S, Snelling S & Kauppi C (2009). Women with postpartum depression: “my husband” stories. BMC Nursing. 8(8).
13. Kruden L (1993). Nature and prediction of changes in marital quality for first-time parent and nonparent husband and wife. Journal of Family Psychology. 6(3).
14. Corrigan C, Kwasky A & Groh C (2015). Social Support, Postpartum Depression and Professional Assistance: A Survey of Mothers in the Midwestern United States. Journal of Perinatal Education. 24(1).
17. Vaezi A, Soojoodi F, Banihashemi A & Nojomi M (2019). The Association between Social Support and Postpartum Depression in Women: A Cross Sectional Study. Women and Birth. 32 (2).
16. Postmontier B (2008). Sleep Quality in Women with and without Postpartum Depression. Journal of Obstetric, Gynecologic & Neonatal Nursing. 37(6)
17. Corwin E, Brownstead J, Barton N, Heckard S & Morin K (2005). The Impact of Fatigue on the Development of Postpartum Depression. Journal of Obstetric, Gynecologic & Neonatal Nursing. 34(5).
18. American Psychological Association (2008). Postpartum Depression. APA Women’s Program Office. https://www.apa.org/pi/women/resources/reports/postpartum-depression-brochure-2007.pdf
19. Kumar S, Oliffe J & Telly M (2018). Promoting Postpartum Mental Health in Fathers: Recommendations for Nurse Practitioners. American Journal of Men’s Health. 12(2).
20. Monteiro F, Fonseca A, Pereira M, Alves S & Canavarro M (2019). What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion. Journal of Affective Disorders. 246.
Maternal mental health issues are significant challenges that may affect women before and during pregnancy, and after childbirth. Studies have shown that better awareness, and timely assistance, can help increase the chances of full recovery for mothers affected by these conditions.
SOLS Health is currently conducting research into how existing identification and treatment services may be improved for women affected by postpartum depression in Selangor. If you are a woman of childbearing age residing in Selangor, please do take some time to share your thoughts with us by filling up a short survey at one of the links below. It will only take less than 10 minutes, and your insights would contribute to improving the quality of services, and access to care for mothers affected by these conditions.
We are just 20 responses shy of collecting our target response numbers, and would truly value your support to help us reach our goal.
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