“Having a baby is not always wonderful. Contrary to the clichés still prevalent in our society. It is an extremely demanding experience that deprives young parents of sleep and upsets them. Mathilde Morisod is an assistant doctor at the University Department of Child and Adolescent Psychiatry of the CHUV. She cares for, among other things, women affected by postpartum depression. The condition occurs in the weeks following childbirth and affects about 20% of mothers. While the signals vary, it may manifest as a constant urge to cry, discouragement, anxiety, dark thoughts, or even a sadness that is difficult to explain.”
“Guilt is omnipresent,” the child psychiatrist adds. “These women care for their babies automatically. They often struggle to form an emotional bond with the child, feel unhappy, and ashamed. This sense of being a ‘bad mother’ is reinforced by preconceived ideas that cast birth as a happy moment. But parenthood can constitute a major psychological crisis because of the identity reshuffling it entails. New parents are no longer just the children of their family; they are parents of their own. A change must therefore take place, similar to the transition from childhood to adulthood during adolescence.” Fatigue and lack of sleep reinforce depression. However, the condition should not be confused with the baby blues, which is not considered pathological and manifests as mood instability in the two to three days following childbirth, caused by hormonal fluctuations.
Socio-economic factors influence the risk of postpartum depression. Studies show that one-third of migrant women are affected. Single parenthood and a history of depression or psychiatric disorders may also exacerbate difficulties. In addition, “there is a continuum between pre-partum and post-partum: about 12% of affected women may present with anxiety-depressive disorders already during pregnancy.” A questionnaire intended for the general public, available online – the Edinburgh Postpartum Depression Scale (EPDS) – has been developed to help identify signs of postpartum depression.
Current studies estimate that 12% of fathers are affected by postpartum depression. Unlike women, who often over-invest in caring for the child, men tend to withdraw and take refuge, for example, in work, sports, or social activities.
A PERSISTENT TABOO
Élodie Azoulay experienced postpartum depression. “During my delivery in 2020, there was a problem with the anaesthesia. I had to give birth in absolute pain. This incomprehension and violence caused a traumatic dissociation and a real emotional anaesthesia: I felt nothing, even when my baby was presented to me. Then began a long journey in which depression isolated the young mother. “I could no longer feel anything. I, who had rejoiced so much over this baby, was like a dead woman. I didn’t understand what was happening to me. I was losing my footing, and guilt was eating away at me. I was in the middle of post-traumatic stress. The gap between my expectations and this reality overwhelmed me. I felt as though I would never manage.” The illness can last for months, even several years. For Élodie Azoulay, it lasted two years. Dark thoughts, phobias of committing impulsive acts, or the involuntary fear of injuring the baby, are omnipresent. They are not actually dangerous, but they cause acute stress for the parent.
The native of Lausanne underwent psychotherapy and contacted Periparto Suisse (formerly Dépression Postpartale Suisse), an association of which she is currently the French-speaking Switzerland coordinator. The association offers a helpline, a professional network, speaking groups, and mentoring. “Postpartum depression is a double punishment. Motherhood is already difficult, but depression takes away even the good moments. Only exhaustion and anxiety remain. But one day, we finally get better.”
At 36, Élodie Azoulay advocates for greater recognition of this disease and for the development of units dedicated to the care of mothers and children. "It is essential that caregivers are better trained to recognise and support women with postpartum depression," she says. This view is shared by Mathilde Morisod: “After childbirth, women too often take a back seat. Caregivers, especially paediatricians who regularly see children during this period, should also pay attention to the mother and recognise signs of postpartum depression.”
The child psychiatrist also emphasises the importance of talking. “Support groups are essential for relieving guilt and breaking isolation.” Psychotherapeutic treatments and antidepressant medications can also be part of the management. In August 2023, the US Food and Drug Administration approved, for the first time, a specific treatment for the disease; the treatment is not yet authorised in Switzerland. This pill would work faster than conventional treatments. “However, one should not neglect psychotherapeutic support, which has been shown to be highly effective.”
