When you have to step back from your child

BRINGING a child into the world is a humbling experience: You find out how everything in your body works – all at once. There is very little dignity in that process. You have no idea what will hit you. The metamorphosis you have to undergo is enormous.

I remember how blurry life seemed after the birth of my first child, as if I were looking at the world through wax paper: spontaneous tears, an embarrassment to my child and society. This experience is not unique, and not just limited to women either. Parenting is demanding – it changes you. 

I recently sat in a restaurant with Dr Anli Grobler, a paediatrician, when I first heard about shaken baby syndrome. She had to declare a baby brain dead, she tells me at the table. How many such cases have you seen, I want to know? Five, she answers, and all five babies died.

Shaken baby syndrome is a severe form of child abuse where a baby is violently shaken and brain injury is the result. The brain damage, bleeding in and around the brain, retinal bleeding or spinal cord injuries usually lead to death. Even a brief jolt can cause permanent damage or death. Grobler says it mostly occurs with younger parents who don't have a strong support network, and may be studying for an exam, with a baby who cries constantly.

“They lose their minds from fatigue," she says. “One must take medication; Wellbutrin and Eglonyl are safe. And you need to see a psychologist."

Undiagnosed and unaware

The complicating factor of postpartum depression (PPD), a common maternal morbidity, is that you can easily fail to realise you're suffering from it at all, and it remains undiagnosed. Untreated PPD can have a profound and far-reaching, detrimental effect on women's daily functioning and overall quality of life. Perinatal depression, for example, a condition that can develop at any time during pregnancy and up to a year after the child's birth, can become chronic and recurrent. This in turn can lead to psychosis or even suicide. In addition, PPD can reduce a mother's responsiveness to her child's needs, which can negatively affect the child's intellectual and emotional development.

The Diagnostic and Statistical Manual of Mental Disorders describes PPD as a major depressive state, with symptoms appearing within four weeks of childbirth. Mothers often experience postpartum discomfort as a result of physical changes, disrupted sleep patterns and various insecurities around their newborns.

It is estimated that one in seven women in developed countries suffer from PPD, while this figure rises to one in five women in low- and middle-income countries. 

The occurrence of PPD is influenced by several factors. Studies have shown that it varies per geographical location, socioeconomic status and cultural difference. According to the diagnostic criteria, the incidence rate of PPD varies between 10% and 15%, with a maximum of 30%. Globally, it ranges from about 9,5% in high-income countries to 20,8% in middle-income countries to about 25,8% in low-income countries.

The demands of parenthood

PPD looks different from the baby blues that people often talk about. Baby blues shouldn't last more than two weeks, and are usually a kind of depression that comes with little sleep and the enormous challenge of caring for a new baby. Grobler says new mothers have usually formed a bond with their baby by the six-week check-up and experience some joy. If not, there's something wrong.

The demands of parenting can take a toll on anyone on a normal day, even if you don't suffer from PPD. Uncertainty at work, pressure to keep the pot boiling and struggles within a relationship are among the factors that can contribute to parenting becoming overwhelming. One often reads of a parent who out of the blue murders the whole family, or a child, or takes his or her own life.

The haunting question is, how can this be avoided? No one wants to hear that they are an incompetent parent, but the issue is more complex. It takes a village to raise a kid, and that village sometimes includes psychiatrists and psychologists. Unfortunately, those resources are unavailable to most people in South Africa, because most parents battle with getting bread on the table. This leads to children being abused, rejected or even left for dead.

One of the most recent and strangest cases was that of Lauren Dickason, a South African doctor, who was convicted in 2023 in the high court in Christchurch, New Zealand, of the murder of her three little girls. What made the case unique was that Dickason appeared on the surface to be a competent mother; her husband, Graham, was a heart surgeon. But then there is the white picket fence syndrome. On the evening of 16 September 2001 she killed her three daughters with cable ties and tried to take her own life. Although she admitted to taking her children's lives, she pleaded not guilty to three counts of murder, arguing that she was mentally unwell and unaccountable at the time of the incident.

I ask Grobler when she would recommend that you as a parent take a step back, and ask for help. She says that decision usually rests with a social worker. Things must be looking pretty ugly by the time a social worker steps in, and I wonder if there isn't a quicker way. I think parents may live in fear that their children will be taken away from them permanently, and then do not report problems for which solutions do exist.

Mental health is the stepchild

Mental health is the stepchild in our medical setup; it is often not considered serious enough or does not receive enough attention. Maybe you are the frog in the cooking pot, and when you look again, the pot has boiled over and the lid has flipped off. What I am referring to is not only related to PPD. Sometimes you're just not in a condition to look after yourself or your children, and it takes tremendous guts to raise your hand and say: Help, I need help, I can't cope; I have an addiction, a lack of resources, or simply don't have the strength to take care of my children. In the bigger picture, it's perfectly okay to ask for help and just withdraw temporarily so you can get back on your feet.

I talk to Donnée Murray about her experience with postpartum depression. Murray was really looking forward to starting a family. It was a decision well thought through. As a competitive cross-country runner and vivacious farm girl, she believed she would probably want to raise a handful of children. Then her pregnancy went awry and she remained ill until the birth of her little girl.

Murray decided on a caesarean section because she wanted the safest option for her child. This was the only operation she had ever undergone, except for the time when her molars were removed. Her little daughter, Josie, was born on July 13, 2022. Seven weeks later, Murray was hospitalised with PPD, and then once again. The first time there was a struggle to balance her medication.

I ask her about the first three months after her little girl was born.

“To put it mildly, it was a mess. Josie was actually an easy baby, but then I experienced something that went deeper than the normal baby blues. I slowly but surely became more anxious. I was anxious about nutrition. We breastfed, which was great because I know it's not possible for everyone, but it was a mess. I had meltdowns, several times a day, and my husband, Mark, would often ask me what was wrong, to which I could offer no answer. I couldn't sleep later. I would literally check all the time to see if she might have a dirty diaper.

“Then it got to the point where I felt I was doing my child and my husband an injustice, and I didn't want to repeat certain generational things. I wanted to be as far away from her as possible. We realised this was not normal, and suicidal thoughts repeatedly kept coming up. I remember thinking that Mark didn't have a big family, and I promised him that I would be his wife. At seven weeks postpartum I was admitted to a psychiatric facility," Murray recounts.

“That's the funny thing, I never realised there was anything wrong; my husband and a good psychiatrist spotted it. I never realised it – even when I was still going through it, it still felt normal to me. I still live with it every day. It's still a challenge for me today. I can't do all the school drop-offs, I can't do things where I feel I'm treating my relationship with my baby daughter as second-best ... I feel like I'd let her down when she was little, and it stays with you forever. You live in it, you live in this dark hole and you think there's no light at the end of this tunnel.

“People around me noticed it. They kept saying it shouldn't be that hard, and you should be able to enjoy motherhood. I only started appreciating motherhood after she turned two. Before that I was focused on survival. I had enormous anxiety. I was in a really good place when I got pregnant, but found pregnancy very difficult. And that's the thing with postnatal depression, you don't realise you have it."

Grab the hands that reach out to you

Despite the progress in research on the risk factors and incidence of PPD, there is still a significant gap in our understanding of the associated barriers. To bridge this gap, further in-depth investigation is essential to effectively identify and treat the barriers.

There may come a stage when you are doing your children more harm by insisting on taking care of them when in reality you are struggling to keep body and mind together. It seems that an objective perspective is needed to see this because the guilt of parenthood overwhelms one and constrains your insight. Grab the hands that reach out to you.

A friend with a colicky baby told me one day she wished she knew it was okay to take a shower while her baby was crying, that she could close the door and go for a five-minute walk in the garden. Not all of us have the same resources available – the luxury of taking time off or checking yourself into a psychiatric facility for a chance to get professional help.

But even if you confess to a total stranger, I believe someone somewhere will be able to help you. Because we live in South Africa, and we believe in ubuntu.

♦ VWB ♦

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