“On one day I went to Bishopscourt [one of Cape Town's wealthiest suburbs], where the butler led me to the mother in a grand suite. She was alone — isolated and deeply depressed. My next visit was to Grassy Park [on the Cape Flats], where the mother lay on the couch, surrounded by aunts and cousins who cared for her,” says midwife Kate Wade, highlighting how social isolation and a lack of support can increase the risk of depression and anxiety for pregnant women and new mothers.
More than one in five pregnant women (22%) experience an anxiety disorder and close to the same number (21%) depression, according to 2017 research led by the University of Cape Town’s Perinatal Mental Health Project (PMHP).
While common, perinatal anxiety and depression are not “normal”.
“I was terrified but I thought it was natural to be a wreck. Everyone said it’s normal,” a mother from Cape Town told the Sunday Times.
For nearly half of women, pregnancy or early motherhood is the first time they experience anxiety or depression, said PMHP director Prof Simone Honikman.
For others, the perinatal period is a time these resurface. They pose a risk to mothers and their babies, but — as the University of Cape Town project has proved for the past 20 years — preventive care and treatment transform lives.
While A-type perfectionists are among the more vulnerable personalities, Honikman emphasises that the socioeconomic environment plays a role in precipitating them. Until diagnosed by health professionals, many new moms — from executives to schoolgirls — are unaware that they suffer perinatal anxiety and/or depression, yet they need support.
Several women who suffered from depression after giving birth spoke to the Sunday Times about their experience. They did not want to be named.
“I had no respite and just wanted to get out of it,” said a Joburg high achiever, who lost her sense of self and became suicidal. A GP admitted her to a psychiatric clinic for life-saving treatment.
Bullied by a militant midwife, her experience left her shattered. “I wanted to have a natural birth at home, and I had a doula as opposed to medical intervention.”
But her baby was upside down, so she had to have an emergency C-section and, afterwards, the baby wouldn’t latch and she couldn’t sleep. “Some people who love to cook are all intuition, but I follow recipes. For me it was hard to have a new baby and no recipe.
“You are led to believe it will feel natural and I couldn’t do it. My midwife was judgmental and would say ‘my moms’ do this, as if I wasn’t one of them ... It felt like life or death, and I didn’t feel like I could tell people,” she said, expressing a sentiment shared by many mothers who feel tearful and overwhelmed — when the world expects them to be celebrating.
An international consultant and mother of two from Cape Town said of her first child: “My baby wasn’t sleeping much and I couldn’t think properly. When I looked at him I felt pure fear and stress, not joy. I would think, ‘Is he OK?’ and ‘Am I doing the right thing?’
“People say to trust your gut, but what do you do if you are so overwhelmed you can’t hear your gut?”
People say to trust your gut, but what do you do if you are so overwhelmed you can’t hear your gut?
Meg Faure, the author of multiple bestsellers on parenting, said that prolonged and severe anxiety and depression differ from the “baby blues” — a temporary, emotional state, usually about three to five days after birth, which subsides in weeks.
Up to 80% of new mothers experience “baby blues”, mostly due to hormonal changes and exhaustion. In contrast, said Faure, “postpartum depression can [deepen into psychosis that threatens the moms’ or babies’ lives”.
“Every couple of years we hear about these cases. If a mom is not sleeping for weeks, wants to run away, and is fractious with her partner despite trying to control herself, these are red flags,” she warned.
Faure got a glimpse of how this could feel a few weeks after the birth of her first child, but her experience passed. “I had the sensation of going into a terrible dark tunnel and couldn’t face the day ahead. Luckily I had my mom’s support.”
High expectations of the birth and breastfeeding also shape how the postpartum period unfolds, or unravels, said Faure.
Wade, with decades of clinical experience, said the birth experience has a huge effect on how moms feel and bond to their infants. She initiated a “labour companion” project at Khayelitsha District Hospital, where she launched the NGO Friends of Khayelitsha District Hospital.
“Young girls were coming in unsupported to give birth on their own. We trained volunteers from the Khayelitsha community to be companions to them, and we’ve had nothing but positive feedback,” said Wade, who wants to start a birthing unit that embraces mothers.
Faure said social media was cruel with its unrealistic portrayals of babies and parents where “most people look like they are absolutely together”, however untrue.
The Cape Town mother said moms in her baby group and studies had influenced her expectations of motherhood. Her family lived overseas, she had just moved to Cape Town and lacked social support beyond her husband. “I had no reference point and I relied too much on research data on norms, so my anxiety spiralled around every milestone, rather than trusting my child would develop in his own time,” she said.
Every parent’s experience and needs are unique, said Faure. “We have to give them the freedom to validate their choices.”
From the home to health clinics, women need better support, she said, encouraging the idea of “good enough parenting” — to protect the wellbeing of mothers, babies and families.
Cape Town-based mental health-care professional Lindiwe Marepula said: “When women are well, families and communities grow stronger too ... I’ve spent years walking alongside mothers navigating the emotional terrain of perinatal and postpartum challenges, and I’ve seen how the right support at the right time can change everything.”
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