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“Baccha hi paida kiya hai, koi maarka nahin mara [Just because you've given birth to a child doesn't mean you've achieved something extraordinary],” said the mother in law, as she moaned and groaned over her pain of postpartum stitches.

“I can’t deal with the baby crying all through the night, I have to go to work in the morning”, said the husband as he picked up his pillow and made an exit from the bedroom.

“Ham to delivery ke aglay din se hi kitchen sambhaal rahey thay, mehmaanon ki khidmat kar rahey thay, aur yahan tum se uth ke kaprhey bhi nahin badlay jaa rahey [We were back in the kitchen and looking after guests only a day after our delivery. And here you can't even change your own clothes]” said her own mother, as she cried due to the excruciating pain of cracked nipples.

Although pains of various types, in addition to postpartum depression (PPD) after giving birth, are realities — neither the pain is recognised in our desi culture, nor the depression understood.

However, the fact is that while some mothers don’t even experience ‘baby blues’ and feel joyful and positive post-delivery, many women feel sad or anxious.

In order to get first-hand information on what Pakistani mothers go through after giving birth, I conducted a small survey on my blog. One of the participants of the survey said: “When I gave birth, I felt nothing for my baby and I couldn’t believe that what I waited for desperately for 9 months only gave me emptiness and fright."

"My lack of ability to love my child like a mother made me cry for hours. I felt irritable and even the sight of my husband disgusted me! My guilt about my feelings ate me up like termites. I wish someone had told me that it’s normal to experience such symptoms of PPD after childbirth because it wasn’t me. It was the depression”.

In our culture, expressing sadness or anxiety after having a baby is not welcome — many mums are admonished for being ungrateful, as one must thank Allah for His blessing, not complain.

Consequently, they are not given room to voice their true feelings. If they express that they are rather overwhelmed, they are made to feel inadequate; they are made to feel bad for the emotions that are not just normal or natural, they are also beyond her control.

Having a baby is no small deal; in addition to the physical toll it takes on the mother, it alters life as she knew it. Her time is not hers anymore. Simple daily tasks don’t remain simple anymore. Getting the time to shower or have a cup of tea without having to re-heat it multiple times becomes a luxury.

There is fatigue, sleepless nights, and a general feeling of being overwhelmed with a duty which is complex and demanding.

If it’s her first baby, being a first-timer seems daunting. If it is her second or third, more is being added to her already brimming plate.

Many women in our society feel largely misunderstood and overburdened by the idea of immediate recovery during their postnatal days. They are expected to be active and social.

If they are not ready to do all that, it is either considered to be a ‘drama’, ‘nakhra’, or ‘nashukrapan’.

What is Postpartum Depression?

PPD is a feeling of extreme sadness and anxiety after giving birth, which begins to interfere with a new mother’s ability to take care of herself, her family and the newborn.

According to my blog survey (2500 women participated in the survey), while 77% of women knew what PPD is, a staggering 82% felt it was NOT easy to get help to overcome their depressive feelings.

Although pains of various types, in addition to postpartum depression (PPD) after giving birth, are realities — neither the pain is recognized in our desi culture, nor the depression understood.

That clearly shows that the lack of awareness in the people that are supposed to form the support system of a new mother about the biological, psychological and sociological changes that a woman goes through after childbirth.

Post-delivery, a woman experiences a rapid decline in the levels of hormones (estrogen and progesterone). This contributes to chemical changes in her brain that may trigger mood swings.

Plus, many mothers are unable to get the rest they need to fully recover from after having a baby. Hence, constant sleep deprivation can lead to exhaustion, which in turn, can contribute to symptoms of PPD.

In order to spread awareness about PPD, I felt it necessary to understand it more myself, for which I decided to seek the help of Dr Hena Haq, who is a general practitioner based in the UK.

She explained that PPD doesn’t have a single cause and results from a combination of physical and emotional factors. It does not occur because of a new mother doing or not doing something — meaning, what she experiences is neither her fault nor in her control.

She adds that “the one suffering from it can have a range of feelings, such as sadness unhappiness, hopelessness, or lack of interest in work/social life after childbirth.”

New mothers may experience decreased energy levels, sleep problems at night, sleepiness during the day, difficulty in bonding with the newborn, difficulty in concentrating or making decisions and even frightening thoughts such as hurting their own baby.

Likely causes and risk factors

Dr Haq explains that there is a range of factors which put you at a higher risk of developing PPD. One of such factors is recent stressful events i.e. complicated delivery or giving birth to a baby suffering from a health condition.

One of my survey participants shared, “I had a traumatic delivery and I was almost on my death bed. At a certain point, even the doctors had lost hope. While I did survive and gave birth to a beautiful baby girl, it took me months to leave the operation theatre behind. Nightmares gave me sleepless nights and I had no appetite. It was difficult to socialize and act normal in front of people.”

Another cause that may lead to PPD is the lack of friends and family support.

For a lot of women, a poor relationship with their partner may also become the cause, especially when he fails to play his role as a father. One participant explained that “when I shared my inner feelings with my husband and cried in front of him, he made fun of me and called me ‘nafsiyaati’ in a very derogatory manner. That broke my heart”.

“I was all alone in the UK after giving birth. My mother couldn’t come because of visa issues. The loneliness killed me. I didn’t feel capable of taking care of my baby and avoided going out for months. I felt I can’t deal with it all by myself”, said another participant.

On the contrary, another woman said “while I did have a lot of physical support around in terms of members of the family being present, the ‘hujoom’ got to me. I wanted space, rest and a chance to bond with my child. But the constant unsolicited advice made me feel like I am incapable of being a good mother. That instilled guilt, in turn causing depression.”

81% of the women participating in my survey felt that harsh comments made by guests and others around them contributed to them feeling overwhelmed and anxious.

For a lot of women, a poor relationship with their partner may also become the cause, especially when he fails to play his role as a father.

“After I had a baby, my husband started sleeping in the guest room. There was no physical intimacy for months. All I wanted was to sit by his side, hear him say some comforting words, get a hug and have more of his presence in my life. But I got nothing of that, which made me feel extremely lonely,” said a participant.

Another one also explained that “when I shared my inner feelings with my husband and cried in front of him, he made fun of me and called me ‘nafsiyaati’ in a very derogatory manner. That broke my heart”.

To this list of possible causes, Dr Haq added that those who have already had a history of depression are at a higher risk of experiencing PPD.

It should be noted that the more common and not-so-serious ‘baby blues’ (which affect 80% of women after childbirth) may too turn into full-fledged PPD if the mother is not given the support and space to recover from childbirth.

Dr Haq explained that “while the symptoms of both conditions overlap, the critical point is the duration. The more usual baby blues are usually mild and last 10-14 days, but PPD stretches beyond this.”

If not treated, it can go on for months, crippling the mother psychologically.

The treatment of PPD is two-pronged — there are things that the woman suffering from it can do to help herself and there are things that the friends and family can do for her to support her in a difficult time. The aim is to minimize triggers that can prolong the already existing depression.

What you can do

Seek the help of your doctor

Remember that this is a real condition and just like you would visit your doctor for fever or indigestion, you need professional support to deal with this as well. Doctors are trained to help patients see things in a different light, hence, they can help tremendously.

“In my family, seeking psychological help means you are a ‘zeheni mareez’. I started having panic attacks after childbirth, but my husband felt this is ‘just in my head’. So, I decided to get myself professional help without telling anyone. Seeing a psychotherapist helped me a lot,” said one of the participants while sharing her PPD experience.

Resort to self-help books or even bloggers who are going through a similar situation.

Knowing that you are not alone makes a difference. On the same note, if there is a culture of support groups in the country you live in, try out one! Maybe unknown people can have you feel more heard and understood than closer family members.

Ask for help

There is no shame in accepting and voicing you need support. On days you feel weak, request someone you trust to come and help with the children or housework.

What friends and family can do

Do more than just offer to help — do it practically and proactively.

Show up and take care of the kids so the mother can shower, rest, or step out. Assist in the daily tasks by bringing cooked food or doing grocery shopping for her.

Try to keep the unsolicited advice to a minimum

Keep in mind that a new mother is extremely exhausted and emotional, so a harsh comment can break her — from the baby’s head shape to the colour of his skin, the mother’s body weight or her milk supply — please refrain from attacking things which are beyond her control.

Ask her how she is doing and listen more than talking

A participant from my survey shared that “all I wanted was for someone to just listen. Not offer solutions, not say ‘this too shall pass’ and not say ‘himmat karo’. I just needed a channel to vent my emotions.”

Manage unannounced guests and set visiting hours

The constant influx of guests can come in the way of the mother resting, breastfeeding and developing a bond with her newborn. In a situation where an unexpected guest does turn up without prior notice, allow the new mother to stay in her room while dealing with the situation yourself, politely explaining that the mother and child are resting.

“I came home after a C-section and the very next day my in-laws wanted me to dress up and receive guests. I was in extreme pain and wanted to run off to my mother’s. But they didn’t give me permission or respite. I wish my postnatal days didn’t have to be like that” said a participant from the survey.

Give the mother the chance to heal at her own pace

Just because 'Razia ki bhaanji ki nand' was up and about the minute her child popped out doesn’t mean your daughter-in-law/sister/friend will also be able to as well. Understand that every woman is different and possesses varying coping mechanisms.

Please don’t rush her by saying “you’re not the only one experiencing this. That’s how everyone does it”. By making her feel that she is weaker than the rest, you put her at the risk of feeling inadequate and sad.

If you are the father, be hands-on because the newborn belongs to BOTH the parents

If a mother is made to feel that she’s not solely responsible for the new life, she will definitely feel less scared.

From taking turns in feeding (in case the baby is bottle-fed or takes expressed milk) to being rocked to sleep and changing diapers, fathers should not expect to be exempted from baby duties.

“I feel that I was able to nip my PPD in the bud because of my husband’s support. He would give me a lot of baby-free time and encourage me to just go and grab a coffee at the mall even when I didn’t ask for a break. He would babysit all this while. He asked me to find mummy groups and join them. Following his suggestions really helped. Sometimes, one doesn’t understand what she wants, and when a family member shows the light, it changes everything”.

To sum things up, postpartum depression is an actual condition that affects many women after childbirth. Because it's not a condition that is ‘visible’, it is discounted as something being nonserious or non-existent.

Women are told to get a grip over themselves without understanding that they cannot succeed without the support of their family and the guidance of a health caregiver. A woman who is seen to be caring for her newborn and chatting with guests may be dealing with a rollercoaster of emotions, having sleepless nights and not eating properly. If she is not heard, her invisible struggles will for sure become more serious with time.

As a friend or a family member, don’t wait for her pain to become visible before you take her seriously.

If you really love a family member that has given birth, be kind to her. Tell her “I hear you”. Tell her “I am here to help” and prove that by practically easing her day to day burdens.

Of course, if symptoms persist, take her to see a doctor. Just because mental struggles and illnesses cannot be seen, doesn’t mean that they don’t cripple the patient from the inside.