Postnatal Mood Disorders


Title:Postnatal Mood Disorders

Heading: Postnatal Mood Disorders

Scene : Mother Ah Fong is having antenatal ultrasonic examination in the hospital. She then goes shopping with husband for their baby’s clothes. Mother-in-law of Ah Fong prepares soup for her. Mother Ah Fong attends parenting class to learn baby care.

Scene: In the delivery room, the parents are very happy when they see their newborn baby.

Nurse: Here comes the head.

Baby: It's bright. Why are these people going round and round? What are they doing? They all look busy.

Nurse: Ah Fong, is the baby a boy or a girl?

Mother Fong: It's a boy.

Baby: So this's my mother, no wonder she sounds familiar, I've lived in your tummy for ten months.

Father kwan : Hi, baby!

Baby: And who is this? Hey, why are you sweating? So this is my Daddy.

Father kwan: Come here baby, let Daddy hold you.

Scene: Relatives and friends express their happiness when they see the newborn baby coming home. Auntie helps to change the diaper when the baby cries.

Father Kwan: Baby's home.

Auntie: Baby's home.

Mother Fong: Do be careful, will you...

Grandma: How cute...

Baby: Hey, take it easy, I'm dizzy. I know you're overwhelmed with joy, but you still have to care about how I feel.

Auntie: I want to hold him too.

Mother Fong: Let me smooth the clothes first.

Auntie: No, I am sure he's wet himself, Auntie will change your nappy.

Mother Fong: Can you?

Auntie: I can manage. Come on... Baby's crying. Auntie will change for you.

Uncle: Babies' wee are good

Baby: I am sorry.

Mother Fong: Don't cry.... Don't cry baby.

Scene: Mother is alone at home. She has to look after her baby, change diapers as well as doing housework. Her mood is becoming unstable.

Baby: Why are you sad, Mummy? Am I too naughty? Let me give you a kiss.

Scene: Mrs. Kwan is having an interview.

Mrs. Kwan: I hadn't any rest since the baby's born. I am tired. I have to breast feed him, and I worried that he's hungry. Because my breast-feeding technique is not good, I'm not confident, I don't even dare to bath him. Why? Because I'm afraid of hurting him. I didn't know I could talk to friends or go shopping. My life riveted on the child health centre, my home and my baby, I was always ina bad mood. I didn't know why I always wanted to cry. Everytime I head my baby cry, I was afraid, I didn't realize it was postnatal depression. I thought postnatal depression meant being suicidal. I spoke to the nurse about my emotional problems. Then I discovered I had postnatal depression. The nurse helped me a lot, my husband and family supported me too. Then my problems were gradually dissolved.

Scene: Mrs. Chan is having an interview.

Mrs.Chan: I didn't sleep well when the baby was born, I was languid and lost my temper easily. I was very emotional and cried easily, I didn't have any experience in looking aftr a baby, I always worried about not taking good care of him, especially at night, I worried that the baby was not warm enough, or that he would suffocate under the quilt. Luckily my mother help me to look after him, especially in the first few months. I had more time to rest and relax. Before the baby was born, my husband and I had already noticed the problems of postnatal depression. We did a lot of research, looked up websites and books. So When it happened my husband was quick to notice. He gave me more care and attention. So I could have someone to talk to. And I adapted very quickly.

Scene: Chan Man Yee gives an introduction on postnatal mood disorders.

Chan Man Yee: There are three types of Postnatal Mood Disorders: Postnatal Blues, Postnatal Depression and Postnatal Psychosis. The first type is Postnatal Blues, which affects about 50% of postnatal women. It usually occurs on around day 3 to 5 after childbirth. These women will have mood swings, irritabilly and tearfulness. Sometimes they will have sleeplessness. With sympathetic understanding and empathic listening from family members, most affected women will recover within a few days. The second type is Postnatal Depression. If a Woman has depressed mood for 2 weeks or more, which makes her less able to carry out everyday activities like housework or taking care of her baby, then her condition would probably be considered diagnosable clinical depression. We will discuss Postnatal Depression later in this video. The third type is a rare condition known as Postnatal Psychosis which affects about 1 to 2 postnatal mothers per 1,000 birth, it usually occurs within 14 days after delivery. The most prominent symptoms are hearing voices, having bizarre thoughts of being harmed by others and suicidal and infanticidal ideas. This is a psychiatric emergency which needs specialist consultation. Urgent referral to a psychiatrist or attending an emergency ward is necessary. Let's look into the problem of Postnatal Depression.

Scene: Newborn baby is crying the whole night through. Although mother Ah Fong is busy calming the baby, baby’s Father kwan is still waken up by the cry.

Mother Fong: Why are you crying, darling?

Father Kwan: Baby cries again.

Mother Fong: Is there something wrong?

Father kwan : He's like that every night, I have to go to work tomorrow.

Mother Fong: Be a good boy darling. Let's go out and look at the stars. Be a good boy darling. Don't a good boy.... Let's look at the stars. Don't cry, darling.

Scene: Baby’s father comes home from work. He notices his wife is crying and shows no response to baby’s crying.

Father Kwan: I'm back. He's crying badly and you're not even take a look?

Mother Fong: Why don't you take a look at him yourself? I've taken care of him all day I need a rest.

Father Kwan: Why are you crying? And why are you crying, Honey? Let dad hold you...don't cry...

Scene: Mother Ah Fong is crying in the living room, becoming irritable and throwing cushions to photo holder.

Scene: Chan Man Yee explains the features of postnatal depression.

Chan Man Yee: According to studies, about 10% of postnatal women are affected by Postnatal Depression like Ah Fong. The onset is usually within 6 weeks after delivery but it can occur anytime within a year after childbirth. The symptoms include tearfulness, irritability, anxiety or even the feeling of having a baby is a punishment. Some will have sleeplessness, loss of appetite and backache. These women will lose their normal interest, ignore their appearance, avoid social gatherings, over concern or have no feelings for the baby. The more serious ones will even have thoughts of harming themselves. Sometimes, it is difficult to distinguish symptoms of postnatal depression from the fatigue and mood swings experienced by most mothers as they adjust to the changes and demands in life after childbirth. Even if these women sense anything unusual in their emotions, they might not seek help because they think that they will recover soon, or that they are afraid of being called an unfit mother, or even a mad
woman. So very few will seek midical help, and hence very few get proper treatment. Postnatal Depression is not madness. With timely treatment, these women will recover.

Scene: Mother Ah Fong is talking in the phone. Mother-in-Law pressed the door bell and Ah Fong opens the door for her.

Mother Fong: I know. Okay, that's all. Okay, Bye.

Mother Fong: Mom.

Grandma: Ah Fong. What's going on? Have you been crying?

Mother Fong: I haven't.

Grandma: If the baby sees that you're unhappy, he'll be unhappy too. I've made you some nice soup. Drink it while it is still warm, I'll look at the baby. My darling, Granny's here.

Scene: Mother-in-law helps to take the baby to the living room.

Grandma: Why is he so scantily clad? He'll catch a cold, I've told you to move closer to me. We old people have more experience when it comes to taking care of babies. Darling, granny loves you.

Scene: Father, Ah Kwan, comes back home.

Father Kwan: Honey I'm home.

Grandma: Hush, she's asleep, come in.

Father Kwan: What's the matter, mom?

Grandma: Why don't you talk it over with your wife and move closer to me? Then I can come more often and bring you more nutritious soups.

Father Kwan: She's just had the baby. Why not wait till she's feeling better?

Grandma: I sometimes see her cry. May be looking after a baby is too hard for her.

Father Kwan: I think she can manage.

Grandma: If you don't want to move, why not bring the baby over for me to take care?

Father Kwan: Mom, I know you care about us, but we don't want you to over burden yourself. Don't worry. If we've any problem, we'll ask the nurses in the maternal and Child Health Centre.

Grandma: As you like then, I offer help because I care for my grandson. It's late. You should go to bed now, I'll go after I've tidied up everything. Get some rest.

Scene: Father Kwan is chatting with his colleagues in office.

Colleague: Everybody's gone for lunch. Why are you still here? What's the matter? Why are you so tired?

Father Kwan: Couldn't sleep at night. How can I be not tired?

Colleague: The baby has just arrived. It takes time for both adults and baby to adjust.

Father Kwan: I never knew being a father could be so stressful. No sleep at night and work the next day, and housework when I get home. I can't stand it anymore.

Colleague: I was like you when my daugther was born. Your wife needs more rest after giving birth to a baby, so you have to be more tolerant.

Father Kwan: All my wife cares is the baby, she doesn't realize how hard I work.

Colleague: Jealous already?

Father Kwan: I used to think that we'll be happier with a baby, but now there's no peace at home.

Colleague: I thought the two of you get along very well.

Father Kwan: I don't know why after having the baby, my wife is always anxious, she easily looses her temper and cries all the time, I don't know what's wrong with her.

Colleague: Could it be...Postnatal Depression?

Father: Postnatal Depression? It can't be...

Scene: Chan Man Yee continues to explain postnatal depression.

Chan Man Yee: To every family, the birth of a baby is worth rejoicing. But if the delivery affects the mental health of the mother, this would be most regrettable. Medics are still not sure about the causes of Postnatal Depression, and in fact this can happen without obvious reasons. The following are some of the possible causes of Postnatal Depression: Drastic hormaonal changes after delivery,The need to adjust to all sorts of changes in life after delivery (such as baby sitting), Lack of support after childbirth and lack of adequate rest, Unsatisfactory relationship with family members (such as differences in child care practice between the mother and her mother-in-law), Financial difficulty (such as under-estimated expenditure). Taking care of babies can be exhausting. Therefore, a lot mothers' emotions can be affected by the above mentioned factors.

Scene: Father Kwan comes home from work and notices mother Ah Fong sitting alone. The room is dark. Baby starts to cry when the parents quarrel with each other.

Father Kwan: I'm home. Why don't you switch on the light? it's late.

Mother Fong: So you know it's late after all. Where have you been?

Father Kwan: I have to work overtime. There's a lot to do. How's the baby?

Mother Fong: All you care about is the baby, how about me?

Father Kwan: Of course I care about you.

Mother Fong: Then why are you working late every night?

Father Kwan: There's one more member in our family. Our expenseshave increased. The economy is not good, and layoffs are everywhere. If don't work harder, I might even lose my job. The baby cries all night, and that affects my work too.

Mother Fong: The baby is yours too, and you're not the only one that works hard. I'm working hard too. The feeding and napkin changing have occupied most of my time, but there're still the household chores. I don't have enough sleep either. And my cut still hurts sometimes. All you know is to blow up. Don't you know how hard I work?

Baby: It's tough work looking after me

Father Kwan: Look who's blowing up now?

Mother Fong: I am not, I'm just talking to you.

Baby: You are quarrelling again, why don't you count me in too.

Scene: Mother Ah Fong is idling at home. Mother-in-law opens the door for Miss Lo, who comes to visit Ah Fong.

Grandma: Miss Lo.

Kathy: I haven't seen you for a long time.

Grandma: Oh,yes.

Kathy: How are you?

Grandma: I'm fine.

Kathy: I happen to drop by, so I come to see Ah Fong.

Grandma: Please make yourself at home. Ah Fong, Miss Lo is here.

Kathy: Thank you.

Kathy: It's for you. Why do you look so dull, are you okay? Look at you! The baby isn't everything. How about yourself?

Mother Fong: Kathy.

Kathy: Are you all right? Are you unwell?

Mother Fong: It's so hard...

Kathy: What's going on? Please tell me, I will help you

Mother Fong: It's just so hard.

Kathy: Ok, I understand. It's better to release your emotions. We'll talk over it.

Mother Fong: I'm afraid to meet people, and I don't want to go out, and I don't want to do anything.

Kathy: No wonder I have not heard from you for so long, I thought you're busy looking after the baby so I didn't want to disturb you.

Mother Fong: I feel so useless.... I can't take good care of the baby. I'm not a good wife.... My husband comes home and blows up at me, I don't know what to do.

Kathy: Why don't we go for a walk? You have to relax somethimes.

Scene: Miss Lo and Ah Fong go out together. Mother-in-law helps to take care of the baby.

Grandma: Darling.

Baby: Don't be silly Mummy, you've been taking very good care of me.

Scene: Chan Man Yee continues to explain postnatal depression.

Chan Man Yee: A friend's concern is very helpful moments like this. Like Kathy, she can help Ah Fong relax. The treatment of Postnatal Depression, depends upon the seriousness of the condition and the underlying causes. Understanding and help from family members can solve or ease some basic problems. With early and appropriate treatment, most patients can fully recover. Only a minority are serious and require long term treatment. Studies show that without proper treatment, half of the patients are still tormented by Postnatal Depression two years after childbirth, and the more serious ones will even become suicidal. These sufferers have a higher risk of depression in the future. When they're pregnant again, they'll have a higher risk of Antenatal or Postnatal Depression. Postnatal Depression affects the relationship between the patient and her family members, like the couple in the film, their marital relationship turned sour. The patient will have difficulty to attach to the baby. Due to a lack of proper care, the baby will feel insecure and short-tempered, and this worsen the mother's depression. This forms a vicious circle. So, Postnatal Depression should not be neglected.

Scene: Father Kwan comes home from work and sees mother Ah Fong holding her baby sitting in the sofa. Ah Fong feels happy because she realizes that her husband cares about her.

Father Kwan: I'm back, dear, I bought your favourite egg tarts. You've been working really hard looking after the baby. Let me help. Come over here. I've thought it over, work is important, but you and the baby are ever more important to me. You are so weary and unhappy lately. Let's seek advice from the health professionals in the Maternal and Child Health Centre. I'm sure they can help.

Mother Fong: I don't know how long I can stand this

Father: Don't worry, we'll go tomorrow. That's good. How's it going? Have you been a good boy?

Scene: Chan Man Yee continues to explain postnatal depression.

Chan Man Yee: Postnatal Depression can be prevented. Before the baby is born, parents should have comprehensive preparation on matters such as finance, accommodation and other arrangements in terms of daily life. Better anticipation prevents helplessness. It'll be helpful for coules to attend more antenatal health talks and workshops, or read more books on the subject to reduce the apprehension about pregnancy, childbirth and childcare. Communication between couples and their family members is vital as this enhances mutual understanding. If it is affordable, early arrangement of after-birth assistance and support is also important. Employ a domestic helper 1 to 2 months before delivery, so that everyone will have sufficient time to adjust and get used to the changes. During pregnancy and after childbirth, people should avoid drastic changes in life such as taking up new jobs or moving houses, because these changes may make it more stressful for the mother.

Scene: Chan Man Yee introduces Miss Wan, the nursing officer of Maternal and Child Health Centre.

Chan Man Yee: Nurse Wan.

Nurse Wan: Man Yee. To adapt to life childbirth, it is very important for the woman to have plenty of rest because feeling down and depressed, could due to physiological factors. If the baby is having its nap, the mother can take a nap too. If there's no one else to help with the housework, the couple should rearrange or share their chores, so that the mother will have less to do. One example is to keep the dirty dishes for day and to wash them altogether. Then there'll be more time to rest. Women after childbirth should also have a balanced and nutritious diet. If the appetite is not good, they can have small but frequent meals. When help is needed, for example, when having difficultyin breast feeding, seek help from the Maternal & Child Heal th Centres. Never remain silent about your problems. Husbands and family members should spend more time with the women. Be more caring understanding. If possible, take time off to accompany the wives and babies.

Scene: Father Kwan and mother Ah Fong have meal in the restaurant.

Mother Fong: This restaurant has been renovated.

Father Kwan: Yes.

Mother Fong: This didn't use to be there.

Father Kwan: This is brand new.

Mother Fong: Thank you, Honey. Its's not anyone's birthday today. Why are we eating out?

Father Kwan: Do I need an excuse to dine out with my wife? We used to come here all the time.

Mother Fong: You're right, but since the baby's born...

Father Kwan: Exactly, I can see that you are exhausted recently, so I take you out. People say that don't stay at home all day after childbirth. You should go out with your friends more often and leave the baby to mother.

Mother Fong: Do you and mom think that I'm an unfit mother?

Father Kwan: This is your first time. We should learn to appreciate ourselves. Don't be upset at our imperfections, that only makes ourselves more stressful.

Mother Fong: You are so...talkative today.

Father Kwan: I think we should talk more.

Mother Fong: Sure. Communication is important for a couple. But I'm very hungry.

Father Kwan: What do you want to eat?

Mother Fong: Let's have a look.

Father Kwan: There's no egg tarts here.

Mother Fong: Can we eat something else?

Father Kwan: Sure.

Scene: Chan Man Yee continues to explain postnatal depression.

Chan Man Yee: The truth is, husbands are under a lot of pressure too. Husbands should take time to relax or do some exercises to relieve stress. Talking to friends like the husband in our story, can also relieve stress. Couples might experience a lot of hardship after the birth of a baby. They might even quarrel. But if they deal with the hardships with a positive mind, understand and support each other, things will always turn better. Even though they may not be ready to have their sex life back to normal, they can still be intimate by kissing and caressing each other. They will help them to return to a normal sex life earlier.

Scene: Father Kwan and mother Ah Fong is taking a walk in the park with their baby in a stroller.

Mother Fong: I'm so happy now, I think I'm having the happiest days of my life.

Father Kwan: You're satisfied so easily, then the baby and I can always make you happy.

Baby: Sure. As long as as the two of you do not quarrel, we'll be happy wherever we are.

Scene: Chan Man Yee and Miss Wan introduce the services and support by Maternal and Child Health Centres for mothers with postnatal depression.

Chan Man Yee: What kind of service does a Maternal and Child Health Centre provide to mothers?

Nurse Wan: We hold different kinds of health talks, workshops, and support groups to teach pregnant women and mothers knowledge and skills about taking care of babies. This will increase their confidence in childcare. They can also meet other mothers to share their experiences and feelings. Through sharing and discussion, these women can get support and sympathy. Apprehension about childcare can also be reduced by talking to nursing staff.

Chan Man Yee: If they have emotional problems, can they get help from the Maternal and Child Health Centres?

Nurse Wan: If they have emotional problems, they can talk to health prefessionals who will advise them. The centres will also refer individual cases to psychiatrists. If necessary, some women may need in-depth counseling of longer duration or even medication. Assistance can also be sought from Family Services Centres under the Social Welfare Department or some voluntary organizations that provide counseling services.

Scene: Father Kwan and mother Ah Fong have meal at home.

Father Kwan: Smells nice.

Mother Fong: It's okay.

Father Kwan: Let's eat. Have a prawn, honey.

Mother Fong: Honey. We didn't understand these emotional problems. That's why we suffered unnecessarily. Had we noted the seriousness earlier, we wouldn't have suffered for so long.

Father Kwan: Fortunately, we managed to find out in time. Or else I don't know what will happen to us.

Chan Man Yee: Remember. Care for the women who have just given birth. Pay attention to their emotional conditions and seek help if necessary as soon as possible. We hope you will have a happy family. Are you happy now? Let's eat.

Father Kwan: Let's eat.

Scene: Father Kwan, mother Ah Fong and their baby enjoy taking photos together.

Subheading: Counseling Services and Hotlines
Department of Health: Maternal and Child Health Centres BreastFeeding Hotline 2961 8868

Social Welfare Department 24 Hour Hotline 2343 2255

Yang Memorial Methodist Social Service: Counseling Service 2171 4111

Emotional Support Hotline for Married Women 2780 9723

The Samaritan Befrienders Hong Kong 2389 2222

Hospital Authority - Mental Health Hotline 2466 7350

Your Family Doctor or attend the A & E Department of a hospital in case of emergency


Acknowledgement: Centre of Research & Promotion of Women's Health, The Chinses University of Hong Kong

Produced by: Department of Health Central Health Education Unit Family Health Service

If you want to know more health information, you can dial the 24-hour health education hotline of the Department of Health or visit our website: ,Hotline: 2833 0111