I have not slept for one year – she told me with tremulous lips. As usual, the resident had breezed past her antenatal history and not got much detail.  She was now admitted with a postpartum psychiatric disorder.

But there was something in her story which made me ask her questions about her pregnancy.
I did not plan this child, she said. I already had four daughters. With every daughter came concern- what will my in laws say? My poor husband was supportive. He worked hard to support all of us- but another loss of face?  I thought I was letting him down by not having a son. My mother in law’s angry face and taunting remarks- I had no energy to go through all that again.

​She went on- My youngest was just 8 months old and this pregnancy happened. For the longest time, I didn’t even realize I was pregnant and when I did, it was too late. The doctor told me she could not do anything- `go and pray that it will be a male child’- she told me.
Since then, my nights and days are filled with anxiety. I worry and worry. Thoughts circle incessantly around my head- what if it will be a girl? What will people say? how will my husband feel?

I did not want to go to any antenatal care. I did not want a scan. I did not take any supplements. It was pure dread- what if?
All night I would toss and turn. All day I would look at the faces of my lovely daughters and wonder - why this pressure on me – and on them?
I could not care for my infant daughter, who still needed me even though my belly was again full.
When I reached term, one day, I felt giddy and then I lost consciousness. I woke up in the hospital and touched my belly. It was flat. I was told I had two `fits’ and my BP was high.
But they told me I had a boy child. He was just one and half kilos and was in the ICU.
There was relief - but no happiness.
My son is now three months old. And all I do is worry. I shake him when he is sleeping to see if he is breathing or not. I worry that he will fall ill. I have no help. My mother in law for whom I had this child, hardly helps.  I started housework 15 days after my Caesarian section. No postpartum rituals or `banantana’ for me. When he feeds from my breasts there is some joy. He is a good child but I worry that my milk is not enough. That he will not get enough nourishment.
I am angry and anxious and worried all the time.  There are times I wish I could just curl up and sleep for days together- without the dread.
 I slept for the first time in a year after coming to your hospital.

Anxiety in pregnancy is an under recognized and under treated problem. It is much more common than what people think. Anxiety is often specific to pregnancy- about pain, loss, abnormality, sex of the child, labour or the mothers own health.
Untreated anxiety may lead to low birth weight in the infant, pre term delivery and more complications.  The mother may neglect antenatal care leading to pregnancy complications.
Antenatal anxiety is a strong predictor of postpartum depression or anxiety.
Anxiety in pregnancy is treatable so should be detected early
​

                                               While  there is a lot of literature on a new mother’s postpartum mental health concerns, little attention has been paid to the emotional needs of grandmothers during this phase.  Indian grandmothers, are sometimes the main caregivers for the baby and the mum, especially if it is the first baby.

The grandmother is invariably in her forties or fifties and her experience of babies is usually more than twenty years old. The daughter however feels that her mother should have all the answers. Why is the baby crying, how do I burp the baby, is that vomiting or just regurgitation, is my breast milk enough?

The grandmother may not be in top physical form herself. It’s a stage of the woman’s life where her knees are giving way, she is probably having hot flushes and she has a husband who often needs a lot of attention. Very often, the grandmother has to leave her home and hearth and move in with the daughter for a few months.

Especially when the mother has limited maternity leave, the grandmother often has to manage the baby on her own at home.  More than anything she probably wants to do her best for her daughter and the grandchild, so she is often worried and tense that she must do it all just right.

Interestingly, old conflicts often surface between mother and daughter if all is not well. For the mother, her daughter is still her little girl and needs guidance and support. For the new mother, there is a need to assert her own role as a mother which conflicts with her continuing dependence on the grandmother.

The baby’s father may also be quite relieved that the grand mother is around and may expect her to manage. Childbirth being a `womans business’, the father may be hovering in the periphery rather than being in the centre stage especially when it comes to soothing a crying baby at night or changing the diaper.

Grandmother preparation for the postpartum should not be taken for granted.

Maybe it is time to start discussing some of these issues during the pregnancy itself among  mother and grandmother pairs of the current generation. Rather than taking grandmothers for granted as repositories of breastfeeding and burping wisdom, maybe they need to also be educated about babies, breast feeding and how to handle their daughter’s moods and sleep rhythms.

Most Indian grandmothers are wonderful, selfless souls who can be a great boon to new parents and protective to a new mother’s mental health. Let’s make sure we educate and prepare her for taking care of a new mum and her baby. Lets also make sure that she gets acknowledged, appreciated and supported ( especially by her husband and her son in law) for all her efforts! 

I am in the UK on a maternal mental health fellowship. The last two weeks, I have been visiting labs and meeting researchers who study the impact of prenatal mental illness on maternal sensitivity towards the baby.  I have learnt about assessing these children for later emotional and conduct problems. It is obvious to me that a lot of emphasis is on how the woman’s mental state during pregnancy has a role in the child’s future.

However, the last week has seen TV, internet and news media replete with stories about the lack of adequate perinatal mental health services in the UK. The Maternal Mental Health Alliance has started a campaign called Everyone’s Business. The group has mapped perinatal mental health services across UK and bemoaned the lack of mother baby units and specialised services for mothers who have a mental illness.

This is their website-
www.everyonesbusiness.org.uk    and     maternalmentalhealthalliance.org.uk/

We in India are still waking up to the fact that there needs to be special services for mums and babies when there is a postpartum mental illness. There is only one specialised unit in the whole country as of now at NIMHANS and we hear one more is going to start at another tertiary psychiatry centre soon!

Can you imagine how that would look on a map, a small blip in a South Indian city, in a country  where nearly 20 million children are born every year!

 We at NIMHANS started the five bedded unit in 2009 and have admitted around 320 mums and babies. We believe it is possible to run a service of a high standard if you have the motivation, a committed multidisciplinary team and administrative support.  We have trained almost 100 trainee mental health professionals in the last five years and many of them are practising in different parts of the country.

It would be wonderful if in the next five years, every state in India could have a specialised Mother Baby Psychiatry Unit.  We could first start with dedicated outpatient perinatal psychiatry services. We from the NIMHANS team will be happy to share our protocols and training packs and also want to learn from others who might be doing this in their own

                         INDIA TOO NEEDS A PERINATAL PSYCHIATRY CAMPAIGN!!!


  This is a story about generosity, about large heartedness, the power of the collective and the need to ask for things if you want something badly.  Beyond everything else it is an example of  people’s empathy and innate goodness!

Manjula came to us within 11 days of childbirth with a psychotic illness. Bedraggled, tired, anemic with the little infant not even two weeks old, they arrived into the emergency psychiatry services and were then moved to the Mother Baby psychiatry ward.

Manjula was confused, anxious, fearful, the only set of clothes she had were the ones she wore. It was a cold January evening when they arrived. Manjula’s mother herself an elderly woman was trying to take care of both the mother and the little infant.

They had no infant clothes, no blanket, nothing to keep the mother or the little one warm. Manjula had refused to feed the baby and there was no milk substitute for the infant who looked listless.

This is not just Manjula’s story. Most mums and babies who come to our ward, have travelled long distances or have left their homes in a hurry.  The mum’s mental health crisis does not give them time to plan. As a result infants often don’t have clothes.  Sometimes  an older infant who is more active and needs playthings comes in with the mother who is dealing with her own angst and fears and has no time or inclination to play with the baby. Many don’t have the financial resources or supports to buy infant clothes or supplies.  Mothers are often anemic and malnourished.

We at the NIMHANS Mother Baby Psychiatry unit provide infant clothes, diapers, formula ( if the mother can’t breast feed) , breast pumps ( so that the mum can sleep soundly at night)- but we never take these back from the mothers or the babies when they leave the hospital! As a result, we are constantly short of supplies.

On our ward rounds three weeks back  our  nurses looked worried. We didn’t have any more infant clothes or blankets or toys!

As an impulse, I put in a request in a Facebook Group called Second to None! This is a Bangalore based group that believes in recycling, up cycling and not wasting money or resources. They do this by buying and selling usable old items from each other.

But I was not selling or buying anything. My request was for a donation- a plea for baby clothes, prams and diapers and a request for toys and baby blankets.

I sent in the request at 9.30 pm, saw that I had got a few `likes’ within a few hours but was not very hopeful.  However, I had under estimated people’s abilities to give------.

The response was simply overwhelming and blew our minds! The calls and texts started coming within a few hours. I am amazed and touched at the generosity of the people of Bangalore! The calls have never stopped since then!

We have been sending out our jeep everyday in the last one week to collect these items and here are a few pictures of a packed jeep, mountains of diapers, clothes, toys, prams.  Someone thoughtful even sent in nighties for the mums!
The clothes had all been washed and ironed and many were brand new!

Our nurses are delighted and so are the mums and infants.

Thank you Seema Garg, Deepti and other residents from Poorva Panorama apartments, Bannerghatta Road, Ashvini, HSR layout, Pooja,Prestige shanthi nikethan apartment, White Field ; Vydehi, R.T. Nagar ; Pavithra,  Kasturi Nagar ; Avinash, Jayanagar ;  Bhavani, Bannerghatta Road and a donor from Saudi Arabia.

All of us at the Perinatal Psychiatry Service at NIMHANS thank you from the bottom of our hearts and applaud your generosity  and willingness to give.
Thank you Second to None- for providing  this e-space for connections and relationships that go beyond convention!
Personally for me, this has reconfirmed my faith in the goodness of humankind and the people of Bangalore!

A Miracle Twice Over! 

By my guest blogger - Dr. Sabina Rao, a psychiatrist and a mother of twins.

Hearts entwined
Twenty fingers, twenty toes,
two sweet babies with cheeks of rose.
Born on the same day, two gifts from above,
lives entwined, two babies to love.
~Author Unknown

When Dr. Prabha asked me to be a guest blogger on her site, the first thought I had was, would I want other women to hear my “war story”! I know every woman’s experience with child birth, babies and even twin babies is different. My thought was what if pregnant women having twins read this and become more anxious! 

I would want any woman reading this to feel at least a little bit better, so I have to say first off- it gets better, it gets easier. I have been told by several women that I am so lucky to have twins- ‘two birds with one stone’ , you have twins, how cute!’ 
All true and I can hear it now without much of an emotional reaction. I remember the time I found out I was having twins. My daughter was 3 then. I had trouble with that pregnancy, so when I was pregnant again the doctors were already worried. Needless to say, by the 6th month, I was on a 100% bed-rest until the 38th week. I was only allowed to bathe once a day and use the rest room. I had to stay on bed-rest or in my case, a big sofa, downstairs in the family room.  The clincher was that the doctors told me that bed rest would not definitely prevent early, preterm labour, that there was no good evidence for bed rest preventing preterm labour. They told me that since they did not have any thing definite to offer, they advised bed rest!

That was not fun. I was someone who was used to rushing around. I was a psychiatrist on a busy ward with very ill patients. The job was high pressure and I was used to handling it. I did not handle the bed rest well. I was on medications to prevent contractions. These medications gave me a headache. Could I have handled it any different? I am not sure. What can a woman do sitting on a sofa all day?

I thought once I had the babies and I could walk around again, things would be better. And then, the babies arrived. I wondered if there was a fast track cloning of me possible. The innumerable diapers, lack of sleep, feeding schedules, trying to maintain diaries of who had milk when, tears (mom’s and baby’s), doctor visits.  I could go on.

My efficient mom flew down to the States to help me. Even she thought the twins were a challenge.
With my daughter, mom would massage her every single day for the 3 months, for the whole time she stayed with us. With my boys, she tried for a month to give them a massage every day but beyond that it became impossible. 

Most things, mom and I found could not get done the way we would have liked. I’d like to think of myself as a relatively organized person but I found myself running around the house, chasing my own tail, so to speak. Then we moved to India in 2011. It was different.

In the United Sates, I found , going back to work when the babies were 2 months old( I found a nanny to help with them) was the best thing I could have done for myself( the work environment being much better than here, for women with children). In India, other than working, I found staying healthy, exercising, and doing all the things women love to do for themselves, helped me keep my balance. After all, navigating the nanny, maid scenario in India was going to be a life time learning exercise.

I admit, while in medical school, I did not see myself as someone who wanted to have kids. Now, having had 3 of them, I actually find I am a confident mother, a somewhat efficient wife AND a working woman.  I don’t fret the small stuff as much. I find I am a much calmer mom than moms with single kids.

This absolutely did not happen overnight.

 I had months were I looked at myself in the mirror and saw an overweight woman with dark circles under her eyes. It upset me when I stayed tired all the time, when I went to stores and had to shop in the ‘large’ section, nothing less. It upset me that I had no time to relax, no time for myself.  It upset me that I was unable to get things done with my usual efficiency. It upset me that I did not love my kids every waking minute of the day, that there were times when I wished my youngest son (born 4 minutes after his brother) would get his act together and help me get him ready- he was a month old! I want to say, I stayed upset a lot!

One of my friends’ mentioned the other day to me that things must have gotten better now that my kids were older. I stopped, mentally, in my tracks and realized that this was true. My boys play with each other now, they can communicate in words. My daughter can hang out with other little 6 year olds for hours. Give it another few years and my teenage ’kids’ might choose to not see me all day!

As of now, all three of my kids still have that baby smell, they still hug and kiss me all the time and on most days make me feel very special. I believe things will get better, things will be different, I just need to hang on and keep smiling! I doubt the guilt, anxiety over my kids will ever go away, and that is just a part of mother hood. 

Having a baby is a true miracle of nature, having twins- 2 miracles in one go! Not too many people get that lucky!

The baby arrives, the mother is exhausted and the father is still getting used to his new role.  That’s when the well meaning relatives descend with their mandatory comments about the poor little infant which is still trying to find the right way to suckle its mother’s breast.  It is not uncommon for me to have mothers in tears after their baby has been criticized as being too dark, too thin, not as fair as the father or the nose being too blunt. Such comments have even led to depression in some mothers.

The comments usually come from `well meaning’ relatives, who seem to forget that the woman is still vulnerable, has gone through hours of ordeal and is now sleepless and tired.  Every baby is special and beautiful  and I can understand the mother’s distress when someone comments about her.

Unfortunately, one cannot always stop people from talking. The best way for a mum to cope would be to remember that these people don’t really matter. 

For relatives, I have some advice for you. Visiting a mum with her newborn baby is a privilege. To watch that beautiful relationship developing at its earliest phase is a wonderful sight. Remember, that the baby is an extension of the mother, they are one unit- saying anything about the infant, makes the mum feel at fault, inadequate and angry.  She cannot express these feelings to you – but after 9 months of carrying the baby and the long labour, she deserves an applause, not critical comments about her baby!

And dear mother, please learn to ignore such comments. It is another form of bullying – this time , unfortunately, it is through your baby.

Whatever anyone says- Your baby, with her dark eyes, her soft skin and her little fingers and toes is a gift. Remember she is precious and she is perfect!

Not all Superheroes have Capes
My guest blogger is Viba, a colleague who has met several `motherhood’ challenges. I am sure all of us who read this blog will learn a lot from her and we thank her for agreeing to share her story with us. I know that it must have required a lot of courage.
But then as you will see, she is no ordinary mum!

Planning a trip to Italy and discovering you're actually in Holland

When Dr. Chandra invited me to write a guest post on my experience of motherhood, I had a good think about it. I wondered how much of the post-partum experience goes into the whole experience of motherhood. I have been a mother for nearly 5 years now, mum to a nearly 5 year old daughter and a nearly 2 and a half year old son. I wondered which post-partum period I should write about because both had me functioning, in large parts, on “autopilot” – due to various life events acting as significant stressors. In the case of my second born it was due to the grief over the untimely and sudden death of my mother within the first month of my having given birth while in the case of my first born, it was due to the stressors that were part and parcel of an unexpected diagnosis. The first time around, I became not only a ‘mother’, but a ‘special needs mum’….and to this day I find myself wondering how different is it from being a ‘regular mum’.

The post-partum period is probably technically the beginning of the whole experience of motherhood and thus I decided to write about my experience as a first-time mother. Let me begin by setting the stage- my husband and I had been married for a few years, we had reached that stage where we felt ready to start a family. Thriving in our newly found success and comfortable lives, and giddy with the joy of impending parenthood, we were eagerly looking forward to the arrival of our daughter (yes, we knew). Having read all the pregnancy manuals we could lay our hands on, carefully choosing furniture for the nursery, short-listing a rather long list of names, painstakingly selecting her “going home” clothes and all the bits and bobs that go into welcoming a first child, we walked confidently into the open doors of the OT and waited impatiently for my doctor to yank her out. As I was having a cesarean section, I was quite relaxed, happy to be comfortably numb waist down (little did I know that I would be willing my legs to get back their sensation in less than a couple of hours), awake and alert, ears straining for the birth cry.  And then she ‘arrived’ - kicking and screaming the place down with a head full of thick black hair and extremely long finger nails. Ten fingers, ten toes, all in place- and my final cue came from the beaming face of my husband….I breathed a sigh of relief, held her close to me- did the mandatory skin-to-skin and thought “right, stitch me up, I need to take my baby home”. But something didn’t seem right. There was buzz, a negative kind of buzz in the theatre. Within two hours of our daughter’s birth we’d guessed something was not quite right as too many people had walked in to check our little girl. Finally a chirpy, overly cheerful registrar walked in and trying to sound breezy she started off by saying our daughter was beautiful, that she had beautiful hair, beautiful almond shaped eyes….(and we didn’t quite register the rest). My husband and I froze. We clung to each other, not wanting to hear another word. Everything stopped and came to a standstill. This lady was trying to tell us that our daughter had Downs Syndrome. How could that be? When the radiologist who did my NT scan categorically stated “you can safely rule out DS”, this bunch of doctors must have got it wrong, surely? Then began the series of tests…while I lay helpless in bed as my wooden legs were unable to move my husband had to do the painful task of taking our few-hours old baby for blood tests. I just wanted my baby back in my arms – for as long as I held her I seemed incapable of tears- but the minute she was away from me I seemed to collapse into a sobbing heap on my pillow or into my mother’s arms, wallowing in self pity asking seemingly irrelevant questions “how?”, “why?”, “now what?”.  As the day progressed, my little baby-exhausted from all the pricking and prodding lay fast asleep in her crib while I was inconsolable. While my husband was outside making phone calls, I turned to my mother asking “why me, why us?” and all she said in her calm voice was “why not?”. 

That shut me up for a while, forcing me into doing a quick recap of what Downs Syndrome was. My husband and I spent that whole day alternating between sobbing and reading up about Downs Syndrome (I thought we knew it all….how wrong I was!), and then weeping again. Before the day ended, we managed to gather ourselves together and felt terribly guilty that we had forgotten to name our baby….in our grief over the death of an “ideal and perfect baby” that we had expected, we had forgotten to celebrate the arrival of our daughter. We made a conscious decision that from then on, we’d try not to dwell too much on negative feelings stemming from our own expectations- it would just not be fair on our daughter. She was after all our daughter and we were her parents- a very simple equation that should not be diluted by anything other than unconditional love (easier said than done….but definitely worth trying).

 Once her diagnosis was confirmed by a simple blood test, as far as I was concerned, it was time to move on. Having been taken on by the early intervention team, the next few days (in fact the next few months) were a blur of invasive and non-invasive testing to check our daughter for associated medical conditions (the list was so very long!).  While in hospital, I was being watched like a hawk by the ward staff for signs of rejection. I too was watching myself for such signs….but there were clearly none. It is difficult to put in words how it was possible to allow two seemingly contrasting emotions to coexist…both my husband & I were still a bit stunned and tended to get sucked into a sort of existential angst, but at the same time we were overjoyed to be parents. Each time I saw or held our daughter it was with inexplicable joy- here she was our flesh and blood, how could we not love and cherish her? As other mothers walked in and out of the ward with their brand new babies, I was hobbling along long corridors (staples and stitches intact) with mine for her echo, for more blood tests, for all sorts of scans and screening tests, thinking this would last forever. The ‘autopilot’ mode helped us through the medical investigations- each time steeling ourselves for the worst possible outcome, and not really reacting when some tests came back negative, thinking there was more to go through.  

Gradually, congratulatory cards trickled in, people dropped in to see our daughter…..but these social situations were extremely awkward as no one knew what to say and we didn’t know what they should be saying either. As I read somewhere, condolences in the absence of a corpse is just not right- we had several of those. There were others who hid behind medical terminologies and characterized our daughter in terms of symptoms and such. Then there was the blame that I had to deal with from some of the extended family the usual “you left it too late” (I was 30), “you didn’t agree to rituals or ceremonies during the pregnancy”, this is the wrath of God-sort of reaction (I never in my wildest dreams thought I would have to deal with blame and discrimination rooted in something I had absolutely no control over). There were the “they are very happy kids”, “they are extremely loving” sort of comments (who was “they”? how did these people know?). There were people who sent me newspaper clippings, internet links and books on high-functioning people who had Downs Syndrome (I wanted to scream “please stop it”). And then there were those who just disappeared from our lives. Very few actually responded with “congratulations on the birth of your daughter”. In retrospect, I am extremely grateful to all those who took time out to make contact with us for they, in their own way, were trying to reach out. But during those months, I was angry at such reactions. I was angry that most of the people who would be a part of my daughter’s social circle were uncomfortable with disability of any sort. I was angry with the perceived stigma. Along with the anger, there was the tendency to suddenly find tears streaming down my face (especially when I went to toy stores or the local Mothercare). There was a sudden inability to contribute to any conversation with my antenatal group- I could not contribute to discussions on nappy rash and colic, as my concerns were a bit different to theirs, more on the line of  “would the holes in her tiny heart have spontaneously closed in this month’s scan?”, “would she be able to feed today?”. While I watched my friends breastfeed, I would be overcome by a kind of sadness that I find very difficult to put into words. Yes I would humorously compare myself to a cow as all I did was grazed and expressed milk, but deep down I was shattered- I am one who- for good or bad- has always defined herself in roles and in my mind a “good mother” was one who nursed her infant, and there I was struggling to feed my daughter (my daughter had severe hypotonia and could not suckle, and her heart defects probably didn’t help either).  Those close to me went to great lengths to explain that it really didn’t matter but somehow it mattered to me. Fed up of my low morale, my husband put it across rather bluntly: we had many battles to fight, it was up to me how I wanted to use my resources. I told myself that breastfeeding was overrated and tried my hardest to stop this whole ‘issue’ from affecting me (but it clearly made an impact as I found out later- I went overboard with my son nursing him for months after his first birthday, just to prove to myself that I could do it). In those initial months, I sought solace with a group of mothers in the support group I started attending. Here, it was perfectly ‘normal’ to discuss NG feeding, open heart surgery, blood tests for leukemia, the ‘red book’ with the extra pages of separate norms for children with Downs Syndrome.  Just to give an example, in our world a common cold was not ‘common’ at all- it meant more floppiness, reduced feeding, drop in the growth chart, reduced hearing, associated eye infection, possible progression to pneumonia- about 20-30 days for a full recovery. As expected, in those early months I was- for the lack of a better term- overwhelmed. It was as if I was torn by all sorts of conflicting thoughts and emotions, I was worn out physically and emotionally. I noticed that I had stopped eating (surviving on a bit of porridge and toast), stopped sleeping, my back was giving up, and most alarmingly I no longer felt the kind of joy I initially felt when I held my daughter. The final straw that broke the camel’s back came on boxing day 2008, when I had a bit of a meltdown of sorts and that was when I realised I needed help.  We decided it would be good for me to get as far away as possible from the dark dreary winter months, and I headed to my parents’ back in India. Surrendering my daughter to them, I retreated into a dark place- I would still be with my daughter- feed her, bathe her, change her, take her for walks- but as soon as she dozed off (which was quite often) I was back in that cold place. I sought help informally and got convinced to start on antidepressants- “just to take the edge off”- and to this date I feel that was the best decision I took. As a psychologist, I had always been loathe to relying on chemicals to induce change, but I now recognize the value of these drugs when used appropriately. Within a month, I was better- I could “feel” again, I could feel the same visceral gush of ‘mumsy’ emotions each time I looked at my daughter, I was able to concentrate on things I was doing, I regained my appetite and I was sleeping better (as any new mother would tell you, sleep is a luxury in those early days, and the ability to sleep soundly for short bursts is the crucial trick one has to learn to function effectively!). It was as if I could see the different hues of colour again. I guess those few weeks of ‘respite’ helped consolidate my emotions, weigh out rationally the implications of having a child with special needs, and reassign a slightly altered view to events in life. Simply put, it helped me realize that all my daughter was telling me was “this is who I am, accept me as I am” instead, here I was getting bogged down by what should be inconsequential things. Is that not what each child would want? In that one month, my understanding of ‘normality’ underwent a transformation that I feel has helped me for the better. I don’t know if what I experienced was post-partum depression or an affective response to severe stress (my husband told me much later that he and my parents were literally using the ‘handle with care’ placard to communicate to each other about my mood in the first/second month after our daughter was born….it was apparently like treading on egg shells…. I was apparently highly irritable, edgy and restless- I genuinely do not recollect being that way!). It does not matter what the label is, what matters is that it was a period on internal turmoil that got worse due to its lack of fit with my external persona. Its resolution was crucial to determine my future path, and I can confidently vouch for the fact that I came out stronger. It helped that I was able to adopt some aspects of my husband’s take on the situation –of “let’s pick our battles wisely”- to most situations. I learned to turn a blind eye and a deaf ear to those things that had the potential to cause me pain (at the cost of probably upsetting others). By being able to remind myself that I had limited reserves I was able to get by and get through a phase that at one point seemed like a dead end. By allowing myself to use help and support, I was able to get back into a state of equilibrium, both physically and emotionally. My experience of ‘motherhood’ became grounded in this new foundation, and in a way I am glad I had the rough start for now I know the value of Health. Two years on, with the added life event of the loss of the most significant person in my life within a month of my second child’s birth, the finality of death taught me another valuable lesson: the importance of cherishing the here and now. The whole experience of being a mother has thus been about getting in sync with the kids and tuning in to their needs; about striking (what you hope is) the right balance between being fiercely overprotective and learning to let go; About being watchful yet not overbearing, vigilant not smothering, about loving without ‘spoiling’ if you know what I mean…..

I look back on the last 5 years and I wouldn’t be entirely honest if I said it was all peachy. Yes, we’ve had some scary experiences- I have learnt it the hard way that physical health is most important. It was not easy handing over our daughter to teams in scrubs for her surgeries, it was not easy watching her struggle with things that come naturally to most of her peers (feeding, temperature regulation, night-time breathing, crawling, walking, dexterity etc), and it is definitely not easy to see her reaction to perceived rejection (sadly, this world is still inhabited by a few who treat my daughter differently). I continue to get angry when people sometimes talk to her in a high-pitched motherese (she’s not deaf, really!), when they give my nearly five year old daughter toys labeled “for 2-3 year olds”, when friends surreptitiously assess her cognitive skills, when people pathologise her every move (“they” tend to sit in a W position, “they” are visual learners), and most of all when people ask “but didn’t you know during your pregnancy” (does that imply that I should have terminated had I known her diagnosis - why is it that one extra chromosome somehow undermines the value of her life?).  But I have learned to respond to these situations in a slightly better way than before. Largely, it has been the positives that have paved the way to where we are, where I am. It has been wonderful to see my daughter blossom into a confident young girl, full of life. She loves her school (“oh does she go to a mainstream school?”….”YES”) and has quickly shattered a few myths while there (also is quite the star!), Like any other 5 year old she loves disney princesses, fairies and magic wands. She is a ‘girly’ girl (give her lego, and she’ll be building a ‘picnic’ area with pretty flowers while my son will be building towers and rockets). She can be unreasonable with her demands but quick to say “that’s not fair” when we request something that she does not want to do. She is a doting (yet bossy- as need be) older sister who while ensuring she is saving a few goodies for her little brother has clearly established a hierarchy (no doubts left as to who is in charge). It melts my heart when she reminds her brother to say his ‘please’ and ‘thank you’, and when she patiently explains ‘complicated’ terminology in Peppa Pig to him (that “parents is Amma & Pappa”; or “cub is a baby lion”) or teaches him how to use certain aps on the tablet.  The reaction is even more visceral (in a good way!) when at times I can see that my son is allowing himself to be “taught” even though he may know a few of the things his sister is telling him about.

As I sit here typing this post watching one child dressed as Rapunzel, and the other as Spiderman both busy assembling a train-track,  I am thinking once again about the Big question in my mind- how different is it to be a ‘special needs mum’ as against a ‘regular mum’….and the answer is I don’t know.  I don’t know if parenting our son has been easier because he is the second born, or because he doesn’t have Downs Syndrome, or because we are somehow ‘wiser’….I don’t even know if such a division exists or if they are both part of the same continuum. Its all a matter of degree and at the end of the day, what’s in a name? If someone asked me, I’d stick to “I’m just a mum”…..for that’s what its been about.

Motherhood for me has been about getting in touch with my strong need to nurture (and resisting the strong urge to throw both of them in the recycling bin, especially at around 6 pm on a Friday), about learning new skills while character analyzing cartoons, about being patient and firm and yet losing my temper, relaxed lazy weekends when all 4 are huddled together interspersed by frantic praying for quick recoveries and night time trips to the A & E, about tears of joy at school nativities- achievements at nurseries and the usual embarrassment at superstore tantrums, about trying to hold a conversation over the phone or trying to meet a deadline while two under-fives are screaming for attention and at the same time waiting each morning for 2 sleeping angels to wake up and start their demands, about  every 10th utterance being “No!” or “Put that down!” only to be told “say please”…. About exhaustion and frustrations, about prioritizing and time management, about deprived sleep and melting hearts, pride, joy, and inexplicable intensity of love.

My daughter at the age of 5 years has learned to quickly gauge what she can or cannot do in any given situation, and although fiercely independent, she does not mind saying “can you help me, please?” (be it for unscrewing a lid, opening a jammed door, climbing a high step or tying her shoe laces). Why is it then that we, as grown-ups, find it so difficult to reach out when we need to? It took me nearly 6 months to recognize signs of spiraling down (despite all the training or probably due to it?) but I’m ever so glad I had help at hand when I did seek it. The beginning of my journey as a mother was very rocky indeed, but it probably was needed to smooth the path ahead.

Without being patronizing, I’d like to add that no self-help manual or chart-topper book can tell you how to be a mother or what to “really” expect when you are expecting. As far as I know, no child comes with a guarantee. While a large majority of pregnancies and births may be uneventful, there are those who have had to explore the road less travelled due to various reasons.  As Jennifer Groneberg succinctly puts it in her book, “it's like planning a trip to Italy, only to get off the plane and discover you're actually in Holland. You need a new road map, and you need it fast...”. But sketching your own map and “experiencing Holland in its true glory” can be a very enriching experience.

  By Dr. Prabha S Chandra

Her husband brought her to me because she was not caring for the baby. She was fine till the baby was 6 weeks old and then started withdrawing from her, not wanting to hold her or bathe her. She would feed her but that too as if it was a chore. She didn’t appear to be depressed but was definitely distressed.

She was sleeping well and eating fine. She was also doing other household chores. Strangely, she seemed to prefer to do house work rather than baby care! Her husband was at his wits end. He had tried cajoling, sympathizing, scolding and even threatening that he would leave the baby with his parents, but to no avail.

When I met her, she looked ahead, her eyes filling with tears, as her husband described what he felt was `difficult’ and `unnatural behaviour for a new mom’.

I decided to speak to her alone. I had seen this too often and knew the signs. “I know that you really love your baby”, I told her gently. “I also know that sometimes, when you love too much, you also have fears for the baby’s well being and that can be scary”.

She looked at me with grateful eyes. Relief writ on her face, as I carefully  tried to understand the reason for her fears of being with her baby. “I know you are a good mother but sometimes even the most loving mothers can have very difficult thoughts. Thoughts that you can’t talk about or share because they are so scary” I told her.

“Sometimes mothers get thoughts that they might do something to the baby and that it is safer for their baby to be away from them. Can you tell me if such thoughts worry you? “I asked.

She nodded and burst into tears. It was as if a dam had burst. She shared with me how she feared that she might harm the baby or be negligent. How she was plagued with thoughts that her presence in some way would cause the baby an infection or an illness. She had tried her best to care for her baby and knew that her thoughts were not real.  She adored her baby and would never let anything touch her beautiful child but then every time she went near her, the thoughts would take over and she would flee from the room trembling with anxiety.

Anxiety disorders in the postpartum period, may often present as a bonding disorder. Family members may complain that the mother is uncaring and does not love the child. They may get angry and even separate the baby from the mother.

The mother may have severe anxiety related to the infant or may have obsessions about the infant, especially that the baby may get infections, fall down or she might hurt or harm the baby in some way. The anxiety usually comes down with avoiding the baby and this causes double distress to the mother. She is dismayed about getting these unnatural thoughts about her baby and at the same time not being a good mother.

My experience in treating and helping mothers with severe anxiety and obsessions related to the infant has been extremely rewarding. The relief on a mother’s face when she realises that you understand her and are not judging her; the gradual improvement with medication and behaviour therapy; the support they get from their husband once he realises what is amiss and finally the joy on the mother’s face when she is able to bathe and feed her baby, able to cuddle and coo to her precious one and is not a slave to her fears!

You can check out these websites for more information on postpartum OCD and for experiences of mothers who had OCD.

http://www.babble.com/baby/postpartum-ocd-symptoms-anxiety-depression/

http://community.babycenter.com/post/a24466837/postpartum_ocd_who_has_it