Inside the mind of a mother battling depression after childbirth

She was someone people didn’t think they had much to worry about. At the core, Ruth Atieno was a level-headed teacher whose passion for her job spilled over to her genuine fondness for her students. At home, she was a lovable auntie who got down to play with her nieces and nephews.

And finally, at 26, she became a mother. It was a planned pregnancy and she was ecstatic about the journey. Like most women anticipating motherhood, she did what they do –scour the internet for information and talk to other mothers. 

“I had the basics. How do I care for the umbilical cord? check. How do I soothe my baby? Bring it on. I was ready for a new chapter,” she says.

Her new life as a mother started unfolding, in bits and bits.

By the time Ruth had her baby in November 2022, she knew something about postpartum depression.  At least by definition. It is the kind of term that specialists use to describe strong feelings of sadness, tiredness and anxiety after a birthing experience.  She had come across it in articles and conversations with other pregnant and nursing mothers. 

After all, thousands of women experience it after a birthing experience.  Data from the Centers for Disease and Control Prevention (CDC) show that one in every eight women reports symptoms of depression after giving birth.  

Multiple studies conducted by obstetricians from Aga Khan University Hospital between 2012 and 2017 found that 13 per cent of women surveyed had a positive screen for postpartum depression.

Dr Steve Mutiso, a consultant obstetrician and gynaecologist at Aga

Khan University Hospital, conducted a research study focusing on women after a miscarriage. “These are women who had a pregnancy that was less than 13 weeks and lost the pregnancy.  What we found in that study was a much higher rate of depression, which went up to 33 per cent. 

“So one in three women after miscarriage have postpartum depression and I think what these studies depict to us is that even subtle pregnancy events like a

miscarriage or less subtle like a full-time pregnancy can still lead to worse depressive prevalence as opposed to even a full-time pregnancy,” he offers.

To everyone’s pleasant surprise, Ruth was discharged from the hospital barely 24 hours after she delivered her baby, returning home to begin nursing.

“Then, frustration set in. No matter what position I tried, my son struggled to latch effectively on my breasts. When I consulted people, I was told that it was normal. They said, “Keep trying.” Both myself and the baby were struggling and by the morning of the second day, he was crying excessively. Like, he would sleep for a few hours then cry through the rest of the day and night. There are moments I would look at him and start crying,” she notes. 

Frustration gnawed at Ruth. Despite her sister’s support and her efforts, breastfeeding wasn’t going smoothly. A trip to the doctor exacerbated her fears – not only was there a latching issue but her baby was also diagnosed with jaundice–a condition where the skin and the whites of the eyes turn yellow.  It happens because of a build-up of a yellow substance called bilirubin in the blood.

This meant an unexpected hospital stay for both of them. While the medical staff assured her everything would be alright, Ruth felt utterly lost.  The reality of a sick child and the challenges of breastfeeding were overwhelming, and the promised support at the facility seemed non-existent. Her partner lived in a distant town.  In many ways, this was her cross. And it was incredibly heavy.

“Even after we got discharged, the fussiness and the cries persisted. But with the constant reassurance that this was a common behaviour in newborns, I didn’t seek help,” she says.

At its most benign, many new mothers experience temporary mood swings and tearfulness, which affect at least 50 per cent of new mothers.

“We call it postpartum blues. It’s often mild and can go unnoticed in many women, especially if they receive support, either from loved ones or healthcare professionals,” says Dr Mutiso.

A lot of changes were happening in Ruth’s body, from stretch marks to an increase in shoe size but she surely knew that what she was experiencing was further from just blues.

“It was a strong feeling that I did not want anything to do with the baby. The incessant cries and the refusal to calm down after many lulling moments fostered a primal urge to harm him.  I would have an intense doom that he was a stranger, one who came into my life and took away my happiness,” she remarks.

“If I could give it a distinguishing characteristic, it would be that I felt totally out of sync with the individual I was before motherhood.  The woman staring back at me in the mirror was a stranger. The carefree, joyful person I once knew had vanished, replaced by a hollow shell. Weeks bled into one another, each day a blurry struggle to navigate a life that felt utterly alien. My thought patterns were irrational and there was a voice in my head calling me “a monster.”

“When we go into postpartum depression, it means you are getting much more severe symptoms compared to the blues and in this case, you can have a depressed mood all the time. They might even get physical symptoms like weight loss or weight gain. Also, some experience a feeling of worthlessness or feeling guilty, which might not make sense to other people, ” Dr Mutiso explains.

The cruelty of this, as Ruth explains, is that everyone kept telling her that it was such a special time of her life and she desperately wanted to be the mother who she had pictured. “The one who showered her child with unconditional love and unwavering support. Yet, here I was; retreating behind my bedroom door, a prisoner of my fractured mind. I would express milk and give it to my sister to feed the baby. Whenever she implored me to feed him, I feigned tiredness or a migraine,” she says.

The anxiety was making her a negative partner to her partner and friends. “I didn’t want to see anyone. Whenever they visited, I felt like they were there to mock and make fun of me: ‘See how she is suffering after having a child yet we are living our full lives’. If you asked me then, everyone could see how the baby had stolen my joy,” she says.

When people hear of depression, Ruth says while alluding to her situation, it is pegged on something. “Not a child but money, stress or a partner. It almost feels as if you have brought it upon yourself and you can easily shake it off.”

In that desperate space, Ruth turned to a different kind of solace – prayer. She went on a pilgrimage of sorts, flitting between churches, seeking solace and a different kind of healing; deliverance. The unspoken accusation – “bewitched” – hung heavy in the air. After all, what explanation could there be for a mother wanting to harm her own flesh and blood?

Initially, this brought a brief respite from the storm within and a warped sense of normalcy. But beneath the surface, a nagging unease persisted. “What was happening to her?”

“On a particular day, I anonymously posted on a Facebook group dedicated to pregnant and nursing mothers. I told them about the overwhelming disconnect with my child and the monstrous impulses that plagued me. Before anyone asked, I explained that I hadn’t told anyone about this because I feared judgement and stigma,” she remarks. 

The feedback, however, was a tidal wave of support, a chorus of mothers sharing similar experiences. Dozens of posts spoke of postpartum depression, a term that resonated with a deep, unfamiliar truth within Ruth. Could this be it? The explanation for the storm raging inside her. 

Armed by this knowledge gleaned from the online forum, she walked into hospital doors in January last year in search of treatment.  In reflection, she says that shame still lingered but it was overshadowed by fear. Fear for her well-being, fear for her sanity, and above all, fear for the child she desperately wanted to love. 

“The health specialist diagnosed me with postpartum depression and anxiety and put me under medication. The anxiety manifested physically at times in that I would have had heart palpitations, sweat and get panicky a lot,” she offers.

A 2020 study published in the Journal of Women’s Health (“Underdiagnosis of Postpartum Depression” examines factors contributing to underdiagnosis, including limited screening practices and cultural stigma.

“So, the reason why we don’t recognise it sometimes is because we have made it seem as if it’s normal yet it’s not normal. The good bit of it is that many women tend to have a good support system after delivery and so that aspect, as much as it is the one that numbs down the women who come to us with these concerns, it is also beneficial to them because it also seems to treat the blues,” he offers.

At the extreme of it, Dr Mutiso says one can get postpartum psychosis, a severe form of a spectrum of diseases that one can get after delivery. “ It’s a severe form where symptoms escalate to a level similar to schizophrenia. Women experiencing postpartum psychosis may have hallucinations, thoughts of self-harm, or even harming others. The prevalence is relatively uncommon, affecting one in every 1,000 births annually,” he offers.

 The treatment options, the obstetrician says, depend on the severity of the condition and could be social support, counselling and antidepressant medication to psychiatry usually prescribed under a psychiatrist care.

 Yet, many mothers go untreated due to the medical care and bills required in the course of treatment. 

“Another step I took was to temporarily keep off from the particular social media group. I felt that the more I read other people’s experiences, as much as it helped me realise what was going on, it heightened my anxiety.  The more I read, the more I felt that it could normalise the monstrous thoughts,” says Ruth.

Almost two years after her son’s birth, Ruth finally feels ready to share her story. It’s a story that not many women dare to tell, a raw account of battling postpartum depression (PPD).

“What truly pushed me to open up was the realisation that mild forms of this struggle seem so common. So many women I talked to had dealt with some degree of PPD. Yet, for those experiencing the more severe, pathological thoughts – the whispers that make you question your very sanity – the silence is deafening. It’s a shockingly isolating experience,” she offers.

Tying to her experience, she is keen to encourage women to watch out for triggers and seek support early enough. “I think my trigger was mostly the diagnosis of the medical condition because I worried constantly about not being able to get proper treatment for my child, and to a large extent, losing him,” says the 28-year-old.

“Many women have triggers that push them to this but it is not always the case. If you have a hundred women getting postpartum depression, only less than five of them will not have a trigger. Also, what might be masking this small percentage is that the risk factors are wide and varied. Also, women can experience postpartum blues through more than one pregnancy. Depression, in this context, might be rare because by the time they’re getting into depression, they usually have contact with a clinician and they will put it in place so that it can be prevented in subsequent deliveries,” remarks Dr Mutiso,  the assistant professor at the Aga Khan’s Department of Obstetrics and Gynecology.

For Ruth, the thoughts and fears have mostly cleared now and gotten replaced by her son’s giggles and gurgles. “The bond is beautiful, just like I imagined it before motherhood. I even prioritise self-care now, a concept I barely acknowledged during my lowest moments.  Although there’s a piece of myself that I yearn for and haven’t grasped what it is yet. Does that make me hesitant about having another child? Absolutely.  For now, I’m cherishing this moment and focusing on my healing and my relationship with my child, ” she says.

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