Women Uninterrupted is an inter-generational podcast bringing you difficult, different and uninterrupted conversations about being a woman.
The first two years of human life are also the first two years of motherhood for the woman. For help navigating these oft-tumultuous years, we turn to a paediatrician and discuss sleep training, co-sleeping, mental health, milestones and other maternal matters.
Host: Anna Thomas Guests: Dr Lakshmy Menon and Soumya
Title music - The Carpet Beat:Maya Dwarka
Production:Anna Thomas
Email: editor@thehindu.co.in
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Of honey, gold and horseshoe pillows
In her book Parenting Preemies, paediatric neonatologist Dr Deepa Hariharan emphasises that lifestyle can be a key factor in the occurrence of premature childbirths. Women Uninterrupted spoke to her on the different kinds of advice a pregnant woman receives.
Honey and gold for the new-born
There’s a ritual in some parts of our country to place a bit of honey mixed with a miniscule gold shaving on the new-born’s tongue when it’s born. It’s auspicious. It strengthens the baby. “It does not interfere with human physiology.”
Medical literature is strongly against prelacteal feeds. Prelacteal feeds are foods given to new-borns before breastfeeding is established. Giving anything other than breast milk is discouraged for a number of reasons.
The first thing that should be given to the baby is colostrum, which is the initial milk produced by the breast during pregnancy. If colostrum is given within a few hours of birth, there are both short term and long term - even life long - benefits. The earlier it is given, the greater the benefits are. Giving heavy metals may sometimes have a toxic effect on the kidney. In addition, it alters the bacterial profile of the baby. If they are not given anything other than breast milk, friendly bacteria develop in the gut which protect the baby from infections and allergies. There are possible positive effects on cognition and brain development as well. So, the balance of healthy versus unhealthy bacteria is tilted when you give anything other than breast milk. Any prelacteal feeds, even if it is a bit of gold or honey, have to be avoided.
Baby massage
Many families hire a masseur for the new-born and the mother.
Massages are very, very good for the baby. It is good for the mother as well.
For the baby, it has a lot of psychological effects, like better parental bonding. Babies who have been frequently handled with tender loving care and massages tend to be emotionally stronger. They have better brain development and cognition. Massages relax the baby so they have fewer digestive problems. It also increases the blood supply and oxygen, so they have better weight gain.
There are psychological benefits for the new mother as well when she massages the baby. She is able to understand her baby’s personality better - like, what the baby likes - and discovers the tiny things that the baby does that are not verbal expressions, yet have some meaning. A mother is able to better understand those when she massages the baby. For this purpose, massage should be ideally done by a parent and not by a therapist. Part of the purpose of massages - personalised bonding - is defeated if somebody else does it.
You can’t really go wrong with massage unless you’re using too much force or you’re trying something extraordinary. Gentle strokes, stretching the limbs - people can’t really go wrong with that. Parents can learn massage from either doctors or nurses, or they can look at good websites. Good massage includes stroking, rubbing, gentle loving and touching the babies. When we rely on therapists, the frequency of massages will come down, so it’s better that parents start getting comfortable about it from birth.
The baby isn’t feeding enough
We must make up if a baby misses a feed.
There is no minimum number of feeds. On average, it will vary between 8 to 12 feeds in the first two to three months of life. The World Health Organization has not specified a number. But in general, babies nurse every two hours as well as on demand. Sometimes, they will do cluster feeding: maybe for one or two hours a day, they would demand a feed every 15-20 minutes or every half an hour. Occasionally, the baby may feed less frequently, usually if she is taking a very long nap that extends four to five hours.
If the nursing mother is not sick, and has to step out, she can express her breast milk and keep it for six hours at room temperature and 24 hours in the fridge. That will be the first option. If not, the second-best thing would be a formula - highly sterilised and properly prepared. We don’t recommend giving cow’s milk till the age of one.
Shape the skull
Keep pillows on either side of the baby’s head
The baby should sleep on a relatively firm mattress with no pillow. The head could be slightly elevated. The American Academy of Pediatrics recommends babies sleep without pillows and on their backs to avoid the risk of suffocation. Horseshoe pillows have no benefits on the shape of the skull. The skull will remodel itself and we do not have to worry that one side will get flat if the baby sleeps on her side. We are more worried about the baby choking and we tell parents that babies should not sleep on their tummies.
Lifestyle factors lead to premature childbirths
The exact percentage has not been really quantified because nobody has done large-scale studies on it - which is actually the need of the hour. The most common causes of prematurity are high blood pressure in the mother, high sugar levels, gestational diabetes, or infections in the mother, or all of these. I have done microstudies of my own and found at least 50% of premature child births are related to lifestyle. Lifestyle changes should target the alleviation of maternal stress, an unhealthy diet, too much physical exertion, a sedentary lifestyle, obesity and poor nutrition.
The biggest change in paediatrics this century
I think rather than a lot of technologies that have helped babies - like vaccines that protect from infections, advances in diarrhoea treatment with oral rehydration and zinc probiotics - the phenomenon that has had a big impact is the dissemination of information by social media. It’s a double-edged sword. People find a lot of information online, but get scared reading social media, imagining their babies have all kinds of diseases. In my opinion, the ubiquitousness of social media is the biggest change in paediatrics from the last century, compared to any medicine or technology or investigation. Older generations still grapple with this new onslaught of unfiltered information.
Transcript
Anna: Hello, I’m your host Anna Thomas on Women Uninterrupted and with me I have Dr Lakshmy Menon, a paediatrician and a neonatologist with 23 years of experience. In this episode of Women Uninterrupted, we are talking about the first two years of life for both mother and baby. So, I’ve invited Soumya Shukla who has a 14-month-old and has left her behind with her family to join us today. Thank you for coming, Soumya, and welcome! I’m sure you have a lot of questions but can I begin by asking: Dr Lakshmy, have there been any significant changes from the time you started your career and now in approaches to baby care, for instance, in breastfeeding and weaning? Are we all wiser now than then?
Dr Lakshmy: I remember when I graduated, or when I finished my MD Paediatrics in 2000 - so you can literally imagine: at the turn of the century, I was a full-fledged professional doctor, ready to go. I have seen across 23 years of my practice the change in parenting style, the change in the way we look at children overall, from before, when the concept was that they are best to be seen and not heard and now we have graduated to the time when “your voice counts too.” So, there is that distinct shift that has come. Plus this entire thing about “children grow up by themselves” - that concept has gone. We invest a whole lot more into their mental progress, mental health and there is a significant difference in the way that we look at nutrition. So, we went from where we wanted these nice chubby-looking babies to children who are maintaining their centiles and more milestone-centric approach, from making sure that development is fine versus how they look physically. We are allowing for all kinds of leeway to happen now and I think it’s a very good start.
Anna: As well as the emphasis on maternal mental health.
Dr Lakshmy: Absolutely, absolutely yes. For sure, that’s been very, very disregarded in the past. Everybody used to say to these new mothers to just, you know, bear it and get on with it. Now there is a lot more empathy and sympathy and trying to understand where are the issues or where is the angst coming from.
Anna: Soumya, sleep training - I think that’s a burning issue for you.
Dr Lakshmy and Soumya
Soumya: Yeah, definitely. My daughter doesn’t sleep for more than two hours, even now at 14 months. So that’s definitely something I would love to probably have - a good night’s sleep. Maybe longer than two hours.
Dr Lakshmy: The entire concept of sleep is a very protective mode of your human body. That is when your body heals, repairs itself and new connections are formed especially in the brain. This is very, very important for the baby. When we’re talking about sleep, number of hours and things like that, it varies anywhere from 12-16 hours to 8-10 hours as the child keeps growing. Understand that it is a range. It’s not that my child has had only 15 hours today and where is the one hour that I have lost? That’s not important. What is important is that the child needs to be rested, playful, attaining the milestones the baby has to. And the child should be physically growing on the chart the way that we want them to, in terms of the centile curves. It’s not about the number of hours that the baby sleeps; it’s also the quality of sleep that the baby sleeps.
Second, understanding that as they grow from infant to toddler to child, you will find that they are getting more and more receptive to the environment around them. It’s very important to understand that, and allow those. A child who used to sleep two hours mid-morning and two hours mid-afternoon and then used to sleep for a solid 8-10 hours in the night is not the same child at one year. Now he must have lost his mid-morning nap and may have a max of half an hour nap in the afternoon and prefers to sleep the bulk of his sleep only at night - which is also fine.
What we need to understand is the sleep training thing is mostly about trying to cater to the normal family routine. We need to tailor the baby’s sleep so that it suits your needs. For example, if you are a working mom from 8 o’clock to 5 o’clock in the daytime, and for the better part of the day if the baby is going to sleep, you will have a fresh, lovely baby - when you are bone-tired and come back - ready to just rev and go. And that’s not what you want. You need to be a little bit smarter and perhaps a little wiser about this and try to sort of regulate the sleep pattern a little early on in life. And it is very easy to do that When they are smaller babies all you need to take care of is the audio-visual ambience around them. If it’s a baby of three months or a two-month old baby, you can start by having a little bit more brighter environment in the daytime, so the day/night circadian rhythms kicks in, so you have a quieter night…the lights are dimmer, everybody talks in hushed tones, there is not a lot of fuss about diaper changing and all of that - it’s done more seamlessly in the night, whereas in the daytime you can afford to play with the baby a bit more. So now the baby gets a sense of the day/night and that sort of translates into better sleep as the baby progresses. It’s easier said than done, I know, but it’s mostly a lot about discipline. It works for us when the baby sleeps in the daytime because you can get your work done but unfortunately that bites you in the night. Therefore, you need to balance this approach out and see what works for you. There’s no set formula, but believe me when I say that the baby will catch how much sleep they want to. It just doesn’t suit us: that’s why you keep worrying that, oh, my baby is not sleeping enough. The baby has slept enough, the baby has slept enough in the daytime. So, all we need to be is a little smarter about this and sort of, you know, flip it. That’s all. I’m not sure how helpful that is. I’m hoping that was absolutely helpful.
Anna: I think from that I understood that you kind of give it a very bedroom environment, the quiet time…That’s what you said. How about sharing a bed?
Dr Lakshmy: Sharing a bed is a very controversial concept. We went from sharing a bed being absolutely fine to not allowing the baby to co-sleep. Now we are back to “it’s OK to co-sleep.” What I have understood in my 23 years is that babies who co-sleep or babies who don’t co-sleep - there is no difference in the way that they sleep. The only thing is that if you are the kind who are a light sleeper and if you are tossing and turning a lot. Or let’s say that you have a partner who comes in and goes out at night because of certain work timings or certain calls or whatever - those kinds of disturbances you don’t need. If that is going to be a reality for you, then perhaps the baby needs a crib of its own. But if that’s not the case, and you know that once everybody hits the bed, you are in the bed and that is it - then it is fine for the baby to co-sleep.
The third thing I wanted to say is the angle of co-sleeping and whether the baby is safer in the crib than on the bed: there is no yes or no about it. If the baby is comfortable in the crib environment and that has been happening right from the word go like, right from when the baby was an infant - then it is possible for the baby to sort of keep thriving in that environment. But one fine day you wake up a baby who was co-sleeping, they are put in the crib - there is a lot of difficulty in that sort of, you know, detaching from the parent right away and that becomes a little bit challenging to do. It is not that it is undoable, but there is a whole lot of crying and trauma and all of that which will take a while for you to settle unless you are very strong. But if you are OK with the baby sleeping with you from the word go, then let the baby sleep like that for at least three to four years of their life. After the third year, they understand the concept of me, myself, my place, my toy…that’s when you can encourage the concept of having their own space, having their own bed.
And then there’s an entire thing that I encourage parents to do: ask the child for permission. Can I come in here? Can I sit here? Is it OK if I play with you? It helps the child to say, “I also can make the rules.” There are clues that your baby gives you. Sometimes there are children who don’t want to play with the parent. They are very happy doing something on their own. The parent comes right next to them and they want to play - and they shove the parent away. It is very possible. There are times where I have seen even small infants whom the mother keeps trying to breastfeed and the child pushes away the mother because they do not want to breastfeed at that time. The baby is giving you a clue here what the baby needs. Read that and then go for it.
So even if you are trying to sleep, train them into not sleeping with you. The first time that you try these things is with the smaller naps that the baby takes. Try to see if they were comfortable in the crib. When they get up, do they have that anxious look on their face because they don’t see anyone? Do they cry a lot in between? How is a child behaving? And then you can gradually go on to a full sleep at night in a crib. Most of the time, I am very careful when I say that. In India we have not yet evolved to that concept of having a child in a crib in a separate room with the baby monitor on it. We are not there yet and I sometimes feel that the anxiety in the parent is so much that I think the parent - one of the parents - is going to be permanently parked near the crib in the next room rather than having a sound sleep. We are very afraid of missing the clue, when the baby cried, or had a problem or anything like that. It’s best - even if you want to give the baby a crib - it’s best if the baby is right next to your bedside in a crib if you want to, or see how the baby tells you if the baby is ready. Perhaps by three years, it’s for sure OK to have a separate room.
Soumya: You talked about trauma in kids. Is it possible for me to traumatise my kids early at like, two years or three years of age?
Dr Lakshmy: Oh, you would be surprised to know, Soumya, that even an infant can get traumatised. And the way that it happens is: there is an act of commission that means you are doing something. Or there is an act of omission. That means you’re just plain neglecting, right. An extreme case would be parents who do not have the time for the child and the child lies in a soiled nappy crying away, crying, crying, crying. There is a point where the baby is going to get exhausted and go back to sleep. So, what happens in that sleep? There are these neural networks which develop within the brain where the child is learning with trauma, “What is it going to take for anybody to notice me?”
There are a lot of these feedback mechanisms that are there in your brain because every experience teaches you. There is a positive reinforcement and there is a negative reinforcement. When it is a negative reinforcement, like, you have parents who do not get along with each other, they are shouting at each other; there is an abusive relationship going on. Even an infant absorbs those cues that are being given by the parent. There is a parent who smokes or the parent who has other issues in terms of drug addictions and things. These things the baby does register and you will find that such a baby has problems of - how do I put it - you know, mechanisms which allow them to cope later on or perhaps even stress. Stress is higher in them. That is not very conducive to changes in their lives. You will have a problem with their cognition, which means understanding of concepts. Everything gets rewired or haywired, if I may put it, in their brain. Trauma is stress and trauma is a reality from the word Go.
What happens is, even if you might not have realized this, Soumya, I am not sure whether you have a colicky baby or not. But if your baby was colicky and there is this entire anxiety which the family has, “Oh my god, the child is crying. Do something, do something, do something.” And if it is a person who is the kind whose anxiety spirals up because of so many suggestions around them and they start rocking the baby more violently, you will realize that the baby’s hysteria goes up. Whereas if there is a person who speaks to the baby with a calm voice, with gentle pats on the stomach, you will realize the baby’s crying pitch comes down, there is a little bit of a hiccup and then gradually you may be able to make the baby go to sleep. Now you realise that it’s the anxiety which affects the child.
So there is no such thing as at what age you can traumatise. You could, at any age. That is the bottom line there. But not to say that any kind of discipline - or any kind of trigger factor - everything is going to have a negative impact, no. We are talking about sustained negative impact. It is not a single incident which affects them. It will be like a sustained thing that goes on in the family. That is how the child will get affected.
Soumya: Going on to a much - not easier - but a different topic. Basically, all the mothers, I think everybody I’ve met till now is like, my baby doesn’t eat. Any solution to that? Is that even a problem?
Dr Lakshmy: Yeah, well, I agree, and to me it has been one of the most exasperating questions in my career: that my baby does not eat. There are a couple of things that you need to understand when you say your baby is not eating. So, your baby is not eating because the baby is sick. Which makes sense, right? You do not eat three square meals or three course meals when you are sick. Second, is your baby not eating because the baby is full already? We forget that your child is being given micro meals throughout the day. Every two hours somebody is putting something in the child’s mouth, not allowing the baby to develop the hunger cue at all and therefore they are constantly satiated. There is no way that the child is perceiving that hunger feeling at all. The third thing is we also need to see whether all these things that you are inferring or assuming: does that actually translate into growth centile curves? Is the child falling off the trajectory? Is the child not having enough stamina; is the child genuinely not doing very well because of the lack of energy throughout the day. If those three things are true, then for sure we need to fix it. But at the end of the day, I always go back to my growth charts. If the baby is still growing, yet the mother says that the baby is not eating, I usually look for simple things like: what’s the quantity of milk that the baby consumes.
A lot of Indian parents, especially, have this strong belief that when you drink milk only, you grow big and strong. That’s a very, you know, founding belief that we all grew up with and that unfortunately does not work for babies because, you know, I have tried this as an adult as well. You try a glass of milk in the morning - see at what time you get hungry. You can go the better part of the day without a meal because milk is very, very tough to digest. For the first six months of their life, that’s all that they need. But beyond that, when they are going on to the solids, it’s a very important thing that we switch that as well and not give them the same amount of milk like, “OK, the child is not eating lunch, let’s just give them another bottle of milk.” 250 mill gone there and then the child is absolutely happy all the way till evening. The baby looks chubby, and the baby looks healthy. But do these calories actually translate into good nutrition? Perhaps not, because where will you get your vitamins and minerals from? Milk is good for calcium and protein. What about the rest of it? So, look at the diet you are giving, look at what are the micro meals that are going into the baby and then take a decision on whether there is a problem.
The second thing is - the harder thing to do - let the baby feel hungry. It’s a huge thing to ask a mother to decide that it’s either this meal or nothing at all. You know, that’s a tough thing to sell to the baby and the family, but it works. There will be like, a tantrum thrown an hour later, two hours later, and if everybody sticks to their guns, either the baby comes back or then the baby learns that the next time I throw a tantrum, nobody is giving me any other option. So that can be perhaps reinforced once the baby crosses the one-year mark. Not before that. Before that they are unable to express whatever it is. How much ever chubby I demonstrate to them that the baby is, how much ever is the weight centile and the height, a parent is never happy. And we’ve got the opposite end of the under-nutrition factor which is going on now, especially post pandemic, everybody is hitting the 95th centile and the 100th centile and I have to tell them, “Please stop feeding your kid.” Look at it objectively and perhaps take the cue from your paediatrician to ask if this is actually relating to poor health. If it translates to that, sure, we have to do something, but if it is not, then don’t.
Anna: It could be like, when you have two babies and one baby has a very good appetite. And your second baby has decided not to eat as much. And then what do you do? Do you worry? And the second baby is actually growing, reaching the milestones, but not growing as well as the first baby.
Dr Lakshmy: Just understand genetics, that’s it. You have a mother and a father who you know have the two babies, and then they both decide to be something else altogether. So, it’s fine for them to behave completely differently. I have parents who come with both charts. See, this is my older one at one year. See, this is my younger one at one year, look at the difference. I say, yeah, but, you know, it’s happened.
Anna: Soumya has now officially entered the Terrible Twos. Do you have any advice for her?
Soumya: I think we were talking about tantrums, right? So, my daughter has a temper. If you don’t listen to her, it’s very difficult. Like, she’ll start throwing things and she’ll cry on top of her voice.
Anna: Has she ever turned blue yet?
Soumya (laughs): No, not yet. She’ll sit on the floor and then put her head between her legs, which is like a very weird position. like a yoga position - I don’t think I can ever repeat that - but that’s the maximum she’s done till now.
Dr Lakshmy: No, terrible twos is an absolutely correct concept. They understand they’re part of the family, right. So now they also understand what their place is and now they are trying to sort of elbow their place in. They are trying to see what it is I have to do to make them do what I want. So, they try everything. Another thing that affects this entire thing is the lack of speech and communication. They are just learning to speak and so they are not able to sort of express their anger or why they want it or they are not ready to decide why they should not get it as well. Both of these things are a challenge. I always say: empower them with speech. Tell them what is the word they are looking for. They say, “Yes, I want that.” So, then you say, “No, you can’t have that” and - why you can’t have that? You say, “This is sharp, this is this, this is that.” You tell them in their own way and then you need to demonstrate what happens if they do it. Second is, it’s all right for you not to explain as well, but just in a firm, calm voice, say, “No, you can’t have it.” Next thing you know, the child is rolling on the floor banging the head, or perhaps even beating the parent - that too happens. Again, a firm voice which says No. And sometimes I encourage, when the child is having a royal tantrum, to even walk away from there because the moment they realise there is no audience, they stop doing it. They just look up and say, “Oh, OK.” And then they go behind whoever it is, the mother or the father, and they say, “Oh, my god, please love me” kind of thing. So, that is a typical thing, that a child seeks recognition. A child seeks love, so yeah, that’s OK. It’s part of their psychological makeup now to try all these things.
Anna: Doctor, there’s always a cold or a cough going around these days. At what point do we decide to take the child to the doctor? Do home remedies work? They can’t possibly work on infants.
Dr Lakshmy: No. We don’t encourage anything in terms of a home remedy at less than a year. Unless you are talking about just giving them a little bit of humidifier or things like that, which is fine, but again not really known to work sometimes. For kids who have very bad chesty coughs, even when they are infants, a nice good steam bath also works. We encourage you to use a lot of nasal drops and perhaps a fever medication is required. If the cold is such that the child is not able to feed, is not able to sleep, and is hugely irritated the whole day, you might want to approach the paediatrician after three days. Put the nasal drops, give a good steam bath, keep the baby warm, lots of warm liquids - all of these things you try, and then after three days if it’s not working, you need to check because sometimes colds have a nasty habit of seeping into the ear and sometimes the poor oral intake also can be because the throat is congested. We do occasionally prescribe decongestants or antihistamines for babies if they are so much of a problem. But understand this: if they are viral in nature, in three to five days, it clears from the system. But if it is bacterial, which is also very likely in India, the point of intervention with the doctor would be: three days of fever not reducing at all, or the child seems to be breathless and having a hacking cough. That’s a bad sign, so you definitely need to go. A running nose or a common cold - I would still wait, so I wouldn’t really rush in for medical health at that point.
Soumya: How about getting hurt? Like, kids fall down, they get hurt…
Dr Lakshmy: For an injury to the head which has happened from a height or if there is a break of skin with a lot of gushing of blood, if you have done your temporary measures of applying ice and pressure and it’s still not stopping, for sure go to the doc. For head injury: If the child has fallen from a height or with great momentum, you must go to the doctor to get it checked out. Also, I say when they are walking, learning to walk, there are a lot of head bumps that they get. That’s not what I am talking about. That is normal. In the process of learning to walk, this is going to happen. That’s not something that really is worrying. You know, surprisingly, nature has made them in such a way that the brain has a buffer of liquid around it. Generally, it’s not a problem, but however, I would say that if there is an injury with momentum and from a height, I would not take it lightly. I would keep an eye on this kid. Yeah, so you mentioned cuts anywhere else. If it is something that does not stop bleeding, for sure go to the doc. If the child is not able to move the limb after that, for sure, otherwise not.
Anna: Can we quickly run through the stages of development, right from infancy, as a new-born, and then to the next stage? Do we go to the paediatrician, get a chart and then look out for those milestones?
Dr Lakshmy: At every stage of infancy, like a baby to an infant to a child, there are a set of milestones which come broadly into the category of physical: fine motor and gross motor. You have the social skills. And you look at your cognition, which is the response to the environment. When you look at all these four parameters, at every stage there is a different milestone to be achieved. For example, the child has to hold up the neck by the time they are three to four months. The child has to learn to roll over by the time they are 6 to 8 months. So, there is always a broad range. You have a point where the milestone starts and you have a point by which the child must absolutely have got it.
There are a lot of variations because there are children who skip milestones. I have loads of kids I have seen who skip crawling altogether. They just, from directly on their tummy, they are creeping, to straight away standing up. And there are children who will not learn to clap until they are one year and two months. They are supposed to be learning to clap by the time they are nine months. If it doesn’t happen, we say keep a note, keep an eye out on that. That’s it. We have a bar graph which tells you that this is when you should achieve, this is when you should have absolutely achieved and if it goes beyond that, that is when we flag the red flag, sometimes even a month earlier, for example, a child who has to learn to walk independently would start anywhere from 10-11 months to 20 months. We have that much of a leeway. So, by 20 months…I would not wait till then…but by the 18th month, when I am seeing the child for shots and the mother says the child is still not walking, I would definitely look a little bit more in detail to see the development of the muscles. Does the child need physiotherapy? Does the child need any other supplements, things like that, whether there is any intervention to be done. We don’t wait till the end point but somewhere just before it. But all of the parents would have their vaccination books which has this list of milestones. Broadly, bring it to the notice of your paediatrician if you think that the child is not doing something on the checklist. Mostly, 90% of the time, unless there are any other risk factors, the paediatrician will say it’s fine, we can wait, so yeah.
Anna: I think listening to you, probably if we knew all this before the baby was born, it would have been really helpful, because it looks like you have to set patterns right from day one. It’d really help if the mother was a paediatrician as well!
Dr Lakshmy: My belief is that the baby is the best teacher, because I always say that whatever anybody says, your baby decides to behave in an absolutely different manner, which may still be normal. No textbooks can teach you that, so don’t worry, you’re all fine.
Anna: What about the mother? How do we recognise symptoms of postpartum depression? And whom do we take the mother to? Does she go on her own?
Dr Lakshmy: There is a post postpartum depression scale and this is usually done by the gynae, but we have often seen mothers breaking down in our chambers as well when they come with a new-born baby because they just feel unable to cope. Postpartum depression is not a single entity; it’s an umbrella, right? You have from postpartum blues to postpartum psychosis. There are varying grades of issues that may happen anywhere between these two extremes. So, the blues are more or less what most of us have felt: you have a feeling of generally not being able to cope. There is that entire sense of things going out of your hand and you are not a good mother and you are not doing anything right and everything is going wrong kind of a feeling, but that is shorter, self-limiting and once you see your baby, or somebody comes in from your family to have a chat with you, you are absolutely fine. There are moments of funk that you have in the day but there are times where you’re not able to connect to your baby. You don’t care if the baby’s crying. You’re not able to register that the baby needs you. That is certainly a worrisome problem. Sometimes the mothers are aware of it and they say to the doctor, “I don’t want to pick up my baby. Is that abnormal?”
That’s when the small little flag signs go up that say she may need help and you have a chat with the spouse, you have a chat with the family to make sure that she is always having people around her and that she is not the only person who is in charge of the baby. It’s a simple thing. You just need to reach out and ask her, can somebody go and change the diaper of the baby? That’s all you need. When you decide to do it by yourself, you are setting yourself up for a far more challenging time as a mother, so if you have a good family who is supportive around you, please use them. And that’s perhaps my advice to new mothers, but depression and psychosis? These are serious terms which I hesitate to discuss in this podcast, but usually there is a preceding event. Some of these mothers show these signs even before they deliver, and some of them have long term illnesses for which they may have been on medication, but they have to go off it because of the pregnancy itself. The situation worsens after the baby is born. The blues part: most of us feel. And it’s OK to tell your doctor that I’m not feeling so good about this and usually the doctor will tell you it’s a temporary phase or what you can do to solve that problem.
Soumya: The root cause for all these things: is it like a hormonal thing or is it just because you are overwhelmed with all of this extra work?
Dr Lakshmy: Both, actually. The hormones are what makes the entire maternal thing go on an overdrive, right. You are full of prolactin; you are full of lactational hormones and perhaps you have given birth naturally. And you are having physical issues because of it. You may have had a C-section, you have terrible back aches, you are having long, endless nights; there is suddenly no time for yourself and there is no time that you are able to even have a decent meal. All these things add on and the entire sense of being overwhelmed, and you do not know how to fix it, becomes so paramount then. It’s a natural human feeling. That is another thing that I have noticed: from the time that I started to practice to now, 20 years later, I have realised that that entire element of empathy and sympathy with the mother is now more important because a happy mother always rears a happy child. It cannot come from a place of sadness.
Anna: Thank you so much, Dr Lakshmy. And thank you, Soumya. If you are a new mother and have more questions, write to editor@thehindu.co.in with the subject line Women Uninterrupted. Signing off on this episode of Women Uninterrupted, a podcast for difficult and different conversations, brought to you by The Hindu.
