​A new mother’s health is closely linked to her baby’s.

That is why a healthier mother means a healthier tomorrow for both mother and baby. 

Mothers who have mood symptoms may not be able to function normally, or have difficulty bonding with their infants.

Maternal depression can impact an infant’s brain development, and may affect his or her temperament, behaviour and subsequent readiness for school.

The key to preventing these negative effects is early screening and prompt attention for symptoms of depression and anxiety, preferably even before pregnancy.

In this ‘Ask the Specialist’ Q&A forum, Dr Chua Tze-Ern, Head and Senior Consultant from Women’s Mental Wellness Service and the Department of Psychological Medicine at KK Women’s and Children’s Hospital (KKH), answers your questions on ways to optimise mother and infant mental health outcomes. KKH is a member of the SingHealth group.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.

1. Question by Thao Pham
Hi Dr, 
As a new mom, how do I stay positive and stop being overly worried over tiniest things and exhausting myself? The anxiety is so bad that I have no appetite and can't eat every time baby go through a cranky period. I'm so tired of being worried all the time.

Answered by Dr Chua:
Dear Thao Pham,
It is indeed challenging being a new mom. Caring for and being responsible for a baby often means having to navigate new situations while feeling stressed and tired. 

The fact that you are aware of your anxiety and exhaustion is a good start. One possible approach is to recognise when the feeling of anxiety is disproportionate to the triggering event, and find ways to help your mind and body calm down. For instance, when your baby is cranky, try doing a mental review of how you are feeling from head to toe. You might become aware that your teeth are clenched, your muscles are tight and your hands are shaking. Put words to these sensations and say to yourself, this is how I feel when I am anxious. Then, focus on these sensations one by one, and consciously relax each muscle that is tense.

Other techniques of reducing acute anxiety include deep breathing exercises and grounding exercises. These are helpful reminders to stay in the present moment instead of worrying endlessly about what-if situations. 

It can also be helpful to provide yourself with reminders about how your baby is growing bigger and stronger all the time, even if there are periods of crankiness and other problems. Take pictures and videos regularly so that you can enjoy your baby’s development and know that you are on the right track despite day-to-day challenges.

In some cases, anxiety may persist or even worsen despite these measures. If it becomes overwhelming, affecting your sleep and ability to function, please do not hesitate to seek help from a medical professional. Being open and motivated about managing anxiety is the first step to recovery and enables a positive start to motherhood.

2. Question by Anne
Hi Dr Chua, 
Are there early tell-tale signs of postpartum depression, what are they? What can I do to prevent it from worsening? How do I bring up this topic to my spouse without him brushing it off (thinking it will pass with time)? And when is it time for me to seek professional help?

Answered by Dr Chua:
Dear Anne, 
Some common signs and symptoms include: 
◦Low mood, anxiety and/or irritability persisting for two weeks or longer 
◦Inability to enjoy baby 
◦Sleep disturbance unrelated to baby’s needs 
◦Unexpected changes in appetite or weight 
◦Loss of energy 
◦Poor concentration or memory 
◦Excessive self-blame or guilt 
◦Feelings of hopelessness and negativity about the future 
◦Thoughts of harm to self or baby, or suicide

Many mothers do experience some tearfulness and feelings of worry soon after delivery. If these resolve after a few days, this is likely to be a case of baby blues, for which medical intervention is generally not required. 

However, if depressive symptoms - particularly persistent low mood and lack of positive emotions - last beyond two weeks and affect functioning, it is likely that a mother has PND (postnatal depression). It would be advisable for her to consult her obstetrician or family doctor, who might then recommend a psychiatric referral, or she can seek psychiatric help directly.

Family members (including husbands) play a crucial role in helping mothers recover from PND. This is a time that is spent mostly at home, when life revolves primarily around family. Family members are strongly encouraged to understand the illness and learn to provide necessary reassurance and support. 

I would recommend the following ways on how family members can help (which you can show your husband): 

◦Give reassurance that the new mother is not alone and that she can get better 
◦Provide a listening ear without making judgments 
◦Try to refrain from offering solutions or advice unless requested, so that she has a chance to express her feelings 
◦Ask how you can help 
◦Understand that her mood may be unpredictable 
◦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 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 with friends and engage in relaxing activities 
◦Encourage and help her to seek professional help when needed 

3. Question by Val
Dear Dr, 
I’m familiar with the term postnatal depression but unfamiliar with postpartum depression. Is there a difference between the two? Are treatment options different for both as well?

Answered by Dr Chua:
Dear Val, 
Both "natal" and "partum" mean childbirth-related, and can be used interchangeably. Postnatal or postpartum depression refers to depression affecting women after childbirth. In KK Women’s and Children’s Hospital (KKH), we use the term postnatal depression (PND).

KKH offers a screening and intervention programme for PND. Mothers returning for routine post-delivery review are screened using a questionnaire. Those with borderline high scores are counselled and followed up by a psychiatric clinical counsellor. Those who screen positive for PND are encouraged to accept care from a hospital psychiatrist. Mothers who have not been screened at KKH may also be referred directly to our psychiatrists for treatment of PND.  

The psychiatrist will assess each patient and make recommendations according to her needs. Referrals for supportive counselling, psychological therapy, support group therapy and social work intervention are made where appropriate. Breastfeeding mothers who require medication will be advised about safe options, and doses will be kept low to reduce unwanted effects in the baby. Mother-baby bonding is encouraged as far as possible. 

Throughout the treatment process, the patient is seen regularly. Discussions are held at each consultation, to ensure that she is comfortable with her treatment, and to address any new issues in a timely manner. 

With screening and early intervention, 93.4 percent of our patients show symptom improvement, 92.2 percent function better and 88.3 percent have better health-related quality of life.

About Dr Chua Tze-Ern

Dr Chua Tze-Ern is Head and Senior Consultant of the Women’s Mental Wellness Service, Department of Psychological Medicine at KK Women's and Children's Hospital (KKH). 

Her clinical special interest is in mood disorders, particularly in women around the time of pregnancy. She is an active researcher, serving as department Research Lead, and has published numerous scientific papers and book contributions. 

She holds teaching appointments at local medical schools and has lectured at local and international conferences. She is an advocate for patient safety and mental health awareness. 

Dr Chua is a member of the KKH Workgroup that recently developed Singapore’s first Perinatal Mental Health Guidelines to benefit women before, during and after childbirth.

Ref: I23