By Najwa Awad
Becoming a new mother can be one the most rewarding experiences a woman can have in life, but it can also be incredibly challenging and overwhelming. New motherhood is typically associated with feeling incredibly blessed, a new sense of fulfillment and family bonding. There is a general expectation that new mothers should be happy and when they are not everyone is left bewildered as to why. What is a new mom supposed to do when there is a piercing angst wedged deep within her chest that won’t go away? Or when mixed clouds of frustration and sadness follow her everywhere she goes? How can a new mom tell anyone about her difficult feelings when she is supposed to be joyful? Well, the answer is- she doesn’t. New mothers often times keep their struggles to themselves and some end up falling into Postpartum Depression.
Getting help for depression has become more acceptable in the Muslim community over the past few years, however, Postpartum Depression (PPD) still flies mostly under the radar because of lack of knowledge about the subject and the associated shame. Myths about what causes PPD lead women to isolate and not reach out for help when family and community support can be exactly what new mothers need.
What is Postpartum Disorder?
Postpartum disorder is when a new mother experiences clinical levels of depression after having a baby; such as sadness, crying, major changes in appetite, sleep, irritability, feelings of no motivation, and hopelessness. Many research articles quote that depression affects 11% of women during pregnancy and 10-14% of women postpartum, but the range can be anywhere from 9-25% depending on risk factors and circumstances. Women from minority backgrounds, which many Muslim women fall into, can have postpartum rates as high as 23%.
It is assumed that PPD is caused by a woman not wanting to have a child, however, for the majority of women, it’s caused by a combination of physiological changes (e.g. falling hormone levels), being overwhelmed and not enough support. PPD doesn’t just happen for new mothers but can happen after any pregnancy or even during pregnancy (Perinatal Depression).
One of the biggest reasons PPD is not talked about by new mothers is shame and guilt. Around the world, and especially in Muslim communities, having a baby is expected to be a time of joy and celebration. It’s an encouraged sunnah, rite of passage and expected social norm- there is an expectation of experiencing a “magical feeling” due to the birth of this wonderful gift. When a woman feels that everyone around her expects her to be happy and she isn’t, that can cause shame, guilt, and self-doubt.
No woman wants to be labeled as ungrateful, unhappy or incompetent, and when a woman feels like she can’t talk to anyone about her vulnerable feelings without being shamed or belittled, her negative feelings are further compounded. A woman might be accused of being unappreciative for her child or life in general when she brings up her thoughts of PPD to family members. Confused spouses may grossly misunderstand PPD and turn on their wife calling her lazy or indoctrinated by Western or feminist values when the new mom says she needs a break from the house. When the new mother has nowhere to turn, she suffers alone in silence. Sometimes this suffering is well hidden behind fake smiles and at other times the pain cannot be contained and results in outbursts, chronic agitation or a complete emotional shutdown.
PPD symptoms are also many times overlooked because people have a hard time recognizing what symptoms are. A woman is expected to behave and feel differently when pregnant or after having a baby, but what is the difference between normal adjustment issues and clinical Adjustment Disorder? Does a mother have high agitation because her baby wakes up at all hours of the night, or because she is depressed? Does a first-time mother have a normal amount of anxiety because she isn’t experienced, or because she might have clinical Postpartum Anxiety?
When the new mother doesn’t know what signs to look out for then she misses opportunities to identify and address potential issues. Here are some signs to look for concerning PPD:
- Persistent sadness, anxiety, agitation, or distress for chunks of time throughout the week that lasts at least a couple weeks.
- Impaired functioning. This is tricky because many new moms will not be able to take care of certain aspects of her life like before, but when a new mom can’t keep up with the house, basic day to day activities, hygiene or friendships, etc. it could be a sign that she is struggling.
- Appearance that there is a big change in personality. Personality is innate and doesn’t tend to change over time. If someone seems like their personality has changed especially in a negative way this is likely because of a bigger issue at hand. It’s not that a once happy and social person is now pessimistic and solitary, it’s that the happy and social person is now depressed.
Why is Postpartum Depression Relevant to the Muslim Community?
Postpartum Depression is an important health and wellness issue for all communities but should be particularly noteworthy for Muslim communities as we place a lot of importance on respecting mothers and treating them well. When most people think about the significance of motherhood in Islam, immediate thoughts come up of taking care of one’s own mother – usually, the picture emerges of an old mother cared for by her now-grown children. But what about the significance of the role of motherhood itself? If we are to hold motherhood highly than we should also provide the support and resources needed for women to be able to fulfill their roles in the best way possible. When new mothers are supported, it not only helps them but also their children – the next generation of the Ummah. Healthy moms help make healthy homes and healthy communities.
In addition to giving mothers the appropriate support they need, we as a community also need to make sure that we are not giving mixed and contradictory messages to new moms about their contribution to the Ummah. Motherhood is simultaneously one of the most treasured and disrespected roles of our time. On the one hand, Islam puts mothers on the pedestal, while on the other hand modern day society indirectly disrespects motherhood all the time- especially for those who decide to stay home and take care of their children. It’s not unusual for some people to serve their mothers in a heartbeat yet go to their wife, daughter or friend and say the following:
“What do you do all day with the baby (or kids)?”
“It must be nice to stay at home and not go to work.”
“Why don’t you put your college degree to use?”
“Anyone can be a mother- you don’t need an education or any special qualities.”
As Muslims, it’s important for us to monitor our own healthy subconscious views about motherhood as we live in a global culture that promotes the opposite. How society views motherhood contributes to how mothers feel about themselves, and how they feel about the big responsibility of raising children entrusted to them.
Addressing PPD from a Multi-Level Perspective
Addressing the issue of postpartum depression comprehensively and systematically would be better suited for a longer publication, however for the purpose of this article, here are some simple strategies on an individual, family and community level that can help address PPD.
New moms are overwhelmed with many physiological, psychological and logistical changes, however, there are ways to get help if it’s getting too difficult to manage day to day functioning. One of the first places a new mom can turn to is her doctor. Obstetricians are very familiar with the ins and outs of regular adjustment versus clinical depression. If a new mom is not sure about Perinatal or Postpartum Depression, she can run it by her obstetrician at one of her pregnancy check-ups, at the hospital after delivery, or at the 6 week follow up visit.
Having supportive family and friends also makes a big difference. Many new moms are uncomfortable talking about their difficult feelings in social circles because of perceptions that they may be less than their peers. If one doesn’t have supportive friends or family members there are many new mom groups that can be a good substitute. These support groups can be found online, at hospitals and through OB/GYN groups. In the absence of a supportive network, new moms can reach out to a therapist to help them sort through feelings and identify local resources.
Self-care is extremely important. There are expectations by new mothers and those around her that she has to selflessly give herself and time to her child unconditionally. Motherhood is a never-ending job, but this doesn’t mean that a new mom shouldn’t carve out time in her schedule for herself. As a psychotherapist who has worked with countless new moms over the years, I truly believe you can not take care of someone else if you can’t take care of yourself. Getting alone time, uninterrupted spiritual time, taking naps, eating healthy food, getting exercise, being in nature and spending time with friends shouldn’t be looked at as luxuries, but as necessities for long-term wellbeing.
It’s important for a woman to look after her mental health, however, this is not her responsibility alone. Families are meant to be interdependent and so husbands, grandparents, and siblings should also keep an eye on the new mom to ensure that she is taking care of herself while she cares for the new baby. If a husband notices that his wife has not been feeling well for some time, as the shepherd of his family, it’s his responsibility to assist her in getting the help she needs; mothers of adult daughters, aunts and sisters should do the same.
Families can help by being emotionally and logistically supportive. Kind words go a long way, but so does giving a helping hand. Assistance should be given freely with no intention of making the mother feel incompetent, or that she is failing. Letting new mom take a break without baby can do wonders for her and is not “selfish” of her.
Obstetricians provide postpartum screenings in their office, but this is not nearly enough. Prevention and intervention on a community level is needed and masajid should promote support groups for new mothers and mothers in general. Having support groups takes minimal effort or upkeep as all that is usually needed is a space where new moms can meet consistently and a person to facilitate.
Additionally, masajid should make consistent efforts to make their spaces kid friendly. A new mother who previously attended many events at the masjid can find herself completely cut-off from the community if she cannot bring her baby or kids – likely worsening her depression. Kid-friendly components to masjid activities can be critical to a new mother and form one of the key pillars of community support she needs.
In summary, Postpartum Depression can be preventable and treatable with simple interventions like providing new mothers adequate emotional, social and community support. When we open up the conversation about PPD we take away harmful assumptions about why it exists and can help address the issue from a multi-dimensional perspective. When PPD can’t be prevented or managed by community and family intervention, it’s important to help a new mother in getting the support she needs from her doctor or a psychotherapist without feeling like she is a bad mother.
Najwa Awad is a licensed clinical social worker (LCSW-C) that has provided psychotherapy to individuals and families in the Baltimore-Washington metropolitan area for over 10 years. She obtained a Bachelors degree in Psychology at George Mason University in 2005. In 2007 she received a Masters in Social Work at Virginia Commonwealth University specializing in the clinical treatment of individuals and families. Najwa also has post graduate education in the treatment of complex psychiatric trauma and telemental health (online counseling). Her experience in the field is diverse and includes providing services at group homes, schools and in the foster cares system. Most recently Najwa has been working and supervising in outpatient mental health settings providing psychotherapy to women, children and families. Commonly treated issues include trauma, mood disorders, behavioral disorders and anxiety. In addition to giving regular mental health workshops in the community, Najwa is also Fellow at the Yaqeen Institute for Islamic Research.
 Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T.(2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology, 106 (5, Pt 1):1071-1083