Communication experiences of women surviving postpartum depression in Indonesia
Wahyu Utamidewi, Yanti Tayo, Pamungkas Satya Putra, Mohamad Febrianto, Achmad Naufal Hafidz
12345Universitas Singaperbangsa Karawang [email protected]
Received: 01-02-2023, Revised: 16-04-2023, Acceptance: 29-04-2023
Abstract
The presence of a baby in the family becomes a happy event, but it turns out that the feeling of happiness is not immediately felt by the mother who gave birth. Improper information regarding postnatal mental health makes childbirth a sad thing for a mother. This study aims to construct experiences, feelings, and meanings regarding Postpartum Depression. So that by knowing the experiences, feelings, and meanings about Postpartum Depression, information about the condition of women after giving birth can be better.
This study uses a qualitative research method with a phenomenological approach. This study was conducted on 8 women who experienced Postpartum Depression after giving birth to their first child or second child.
Data was collected by means of unstructured interviews with open-ended questions. The results of this study are that for mothers giving birth is an event that is both very pleasant and frightening, the mother experiences a phase where she feels worried about herself experiencing changes in body shape and the baby's condition so that she is more sensitive, but it is the support from those closest to her that makes them stronger. This research is useful for seekers of information about Postpartum Depression where they will know how to avoid being exposed to Postpartum Depression.
Keywords: Postpartum Depression; Communication Experience; Family Communication; Women Mental Health.
INTRODUCTION
Getting a baby is usually a happy event for a family. Many also describe that giving birth is a pleasant situation, so there is no reason for a mother or family to be sad or suffer. However, it turns out that not all feelings of happiness are felt by mothers who give birth, because the transition to motherhood is a major life event that can be characterized as a crisis with significant stress. Mothers have to adjust and get used to a new way of being in-the-world (Røseth, Binder, & Malt, 2011)
It is during this transition period that a condition usually arises which in the medical world is termed postpartum depression. According to data from
the World Health Organization (WHO), Postpartum Depression itself affects about 13 percent of women in the world. In Indonesia, the rate of postpartum depression reaches 19.8 percent (Kumalasari & Hendawati, 2019). Women are prone to depression, especially during the puerperium. The postpartum period is the period after giving birth which is the return of the reproductive organs and body systems as before pregnancy starting from the baby is born to 6 weeks (40 days) (Johnson, Adam, & McIntosh, 2020)
A mother who experiences postpartum depression usually has a depressed mood, loss of interest or pleasure in activities, appetite disturbances, sleep disturbances, physical agitation or psychomotor slowing, weakness, feeling useless, difficulty concentrating, and even suicidal ideation.
The effects of postpartum depression do not only occur in the mother, but can also occur in the baby of the mother (Thompson & Fox, 2011). Babies will experience delays from various aspects, both in terms of cognitive, psychological, neurological, and motoric. Babies will also tend to be more fussy in response to seeking and getting attention from their mothers (Mollard, 2014).
There is a lot of misinformation about the existence of postpartum mental health problems. For example, misinformation can stop a new mother from realizing that she is suffering or may make a new mother afraid to tell anyone about her feelings. Therefore, it is very important to learn how to recognize and treat women after childbirth. Sometimes women who experience it and their families cannot recognize that such a situation can be prolonged and feelings of injustice and unhappiness as abnormal (Stickel et al., 2021).
The messages often portrayed in the media are that giving birth is a joyous experience and mothers have no reason to be miserable. As a result, mothers may be reluctant to seek help or refuse any intervention offered by family and friends. In some cases mothers may deny their condition and go to extremes to cover up the symptoms to avoid being labeled 'crazy' or a 'bad mother' (Røseth et al., 2011). The condition of "burying" the problem itself can indirectly worsen the situation, because as stated by Fisher's Narrative Paradigm, humans are basically storytellers. With logical considerations that are owned, humans will tell other humans. Humans are basically storytelling creatures with logical considerations, humans will tell stories to other humans (Turner, 2017).
Postpartum depression is depression that occurs after giving birth. This is caused by an imbalance of chemicals in the brain and is experienced by 10% of mothers who give birth. There are those who think that postpartum depression is the same as Postpartum Depression, but it turns out that this statement is not true. Postpartum depression is an emotional change (mood swing) that generally causes mothers to cry continuously, worry, and have difficulty sleeping for a few days to 2 weeks after the baby is born (Dinwiddie, Schillerstrom, & Schillerstrom, 2018). Meanwhile, postpartum depression is a more severe condition than Postpartum Depression. Postpartum depression makes sufferers feel hopeless, don't feel like a good mother, and don't want to take care of their children (Shimao et al., 2021).
Some of the factors that cause postpartum depression, one of which is major changes in reproductive hormones after giving birth. In addition,
changes in a mother's habits after having a baby include lack of sleep, poor nutritional intake, and lack of support from her husband and family (Johansson, Benderix, & Svensson, 2020). Postpartum depression is not only experienced by mothers, but can also be experienced by fathers. Postpartum depression in fathers most often occurs 3-6 months after the baby is born. A father is more susceptible to postpartum depression when his wife also suffers from the condition (van der Zee-van den Berg, Boere-Boonekamp, Groothuis- Oudshoorn, & Reijneveld, 2021).
Research on experiences with postpartum depression or postpartum depression has been carried out by several professionals and academics, especially those who are engaged in nursing and psychology. However, the authors have not found any research that specifically discusses the experience of mothers with postpartum depression after giving birth and from a communication perspective. However, there are studies that discuss the experience of postpartum mothers from a cultural point of view. The research has been published in several journals.
Carter conducted research on an exploratory comparative study that compared two women from different nationalities, namely China and Australia, when each experienced postpartum depression. Sally conducted a study of 35 Chinese and 12 Australian women diagnosed with postpartum depression and found that women in both groups experienced sadness, fear, and anxiety that matched patterns of depressive mood. Both groups of women also expressed a desire to regain control of their lives. Cultural differences and health care are influenced by the meaning that women are assigned according to their experiences and their behavior in seeking help (Carter, Cust, & Boath, 2018).
The family may be characterized as the fundamental unit of society capable of causing, preventing, improving, and influencing family members to enhance the quality of family health (Setyastuti, Suminar, Hadisiwi, & Zubair, 2021). In other words, the family may be viewed as the primary social context for promoting health and sickness prevention, including the prevention of the spread of different illnesses such as postpartum depression.
Family communication is an example of interpersonal communication.
Because 1) the family is where adults and adolescents experience the majority of the most important and intimate interpersonal relationships, and 2) the family is the primary agent of socialization, where communication and relationship skills are acquired, this communication becomes more important to investigate (Nursanti, Tayo, Utamidewi, & Nurhasanah, 2021).
Communication skills are viewed in this case as a way to persuade in order to change knowledge and behavior, such as communication between husbands and spouses after their wives give birth in order to avoid postpartum depression.
The family is the first social group organization that recognized by the subject of organizational communication groups involved in it. Therefore, in the family it is necessary to grow effective communication between each other in order to foster a sense of deep attachment and mutual need. Family communication is a fundamental communication because the existence of the quality of communication within the family will determine how the behavior
of family members in dealing with others outside the family (Nursanti, Utamidewi, & Tayo, 2021).
Maternal and child health is one of the world's concentrations, even the health status of a country is determined based on the success rate in reducing the mortality rate of women during pregnancy, childbirth, and postpartum (post-partum). The issue of maternal health still receives less attention from all parties and even tends to be ignored. Research data on postpartum mortality in several countries show that the main cause of death is fatigue.
The prevalence of death in the two months after giving birth due to fatigue or tiredness in Canada is reported to be 55% and in the United States as much as 76% (Amoah, Phillips, Gyasi, Koduah, & Edusei, 2017). The number of studies linking the incidence of postpartum depression with information literacy is still minimal. Information literacy is the least feasible approach to building knowledge and solving problems (Kingston et al., 2014).
In addition to communication experience, literacy of health information is needed by pregnant women, husbands and families. Health literacy includes knowledge, motivation and community competence to access, understand, assess, and apply health information to make decisions and make decisions in everyday life regarding health care, disease prevention, and health promotion to maintain or improve quality of life (Liu et al., 2020).
Health literacy as a whole is a system that is made systematically, an activity that must be carried out continuously and consistently so that when a disease occurs, people understand how to deal with the problem. Health literacy in general involves a large and broad policy agenda, not just knowledge about health issues (Velardo & Drummond, 2013).
Health care in postpartum depression requires family involvement, where mothers, fathers and families require that adequate information and advice be provided so that individuals know what they need to do (Utamidewi, Tayo, & Putra, 2022). However, various factors affect the ability of citizens to understand the information provided, follow health instructions and guidelines, and ultimately make effective decisions regarding their health and care. While some key aspects seem logical, such as education and socioeconomic status, other influences such as health literacy have received limited attention until now. Health literacy refers to people's ability to access and use information to make decisions regarding their health (Castro- Sánchez, Chang, Vila-Candel, Escobedo, & Holmes, 2016).
Narrative Paradigm, narrative logic is chosen over traditional logic used in argumentation. Narrative logic, or the logic of logical thinking, states that people judge a speaker's credibility by whether the story is coherent (has coherence) and sounds true (has accuracy). Fisher shows the Narrative paradigm as a combination of logic and aesthetics, even emphasizing that narrative logic is different from traditional logic and thought. An important aspect of the assumptions of the Narrative Paradigm is that they contradict the paradigm of the rational world (Settle, 2018).
On this basis, that when a mother who has just given birth does not tell her about the problems she faces, it is suspected that it can increase the mother's stress level. Therefore, it is necessary to conduct research on the experience of postnatal women with postpartum depression in the perspective of communication science. By conducting research on the experiences of
mothers with postpartum depression, they can better understand their condition and can anticipate or take problem-solving efforts. Research on experiences with postpartum depression has been carried out by several professionals and academics, especially those working in the fields of nursing and psychology. However, the authors have not found any research that specifically discusses the experience of mothers with postpartum depression from a communication perspective. This research is important to do considering the psychological condition of the mother greatly influences the health condition of the mother, if the mother is not in good condition to raise and look after her baby then this will affect the condition of the baby who from birth to the next 40 days the baby is still in a vulnerable condition and really needs the presence and strength of his mother considering that babies must be exclusively breastfed so that babies grow strong and great. Until now, there has not been any research journal which states that there are other nutrients besides mother's milk that are better. Therefore it is important to make various efforts to create a comfortable and safe environment for mothers and newborns.
METHODOLOGY
This research is a study to explore the experiences and meanings of mothers who experience postpartum depression from the perspective of communication science. Phenomenology studies describe the general meaning of a number of individuals towards their life experiences related to concepts or phenomena. The study of phenomenology pioneered by Edmund Husserl is the science of something that appears (phenomenon). Thus every research or every work that discusses the appearance of anything is a phenomenology. Phenomenological studies describe the general meaning of a number of individuals to their life experiences related to concepts or phenomena. Phenomenologists focus on describing what all participants have in common when they experience the phenomenon (Creswell, Plano Clark, Vicki, Gutmann, & Hanson, 2003).
In this study, the researcher used the phenomenological technique with various considerations: (1) The reality revealed via experience or consciousness is the topic of this investigation. In this instance, it will stress the description (description); (2) Researchers will be able to investigate study phenomena more thoroughly; and (3) Researchers will be able to communicate directly with participants. The researchers conducted interviews with 8 women (mothers) who had had postpartum depression in order to have a better understanding of the condition. Interviews were conducted with 8 mothers with postpartum depression cases not only once but were carried out repeatedly until the researchers found no new data from the repeated results of the interviews conducted and the researchers stated that the data had experienced saturation. This research was conducted for one year, apart from conducting interviews the researcher also conducted non-participant observations, made diary notes when visiting mothers and their families and wrote down in the form of diaries needed when processing data in order to obtain comprehensive research results. The majority of the ladies who took part were first-time mothers. Purposive sampling was used to choose research participants, with the caveat that the subjects had knowingly
experienced postpartum depression. The interviews were performed using an unstructured question pattern devised by the researchers. In phenomenology, the researcher sets aside prior knowledge and experience in order to comprehend things at a deeper level (Parastiwi & Darmastuti, 2020).
To analyze the data, the researcher used the procedure from Colaizzi which was illustrated by Moustakas as follows: identifying the phenomenon to be studied, confining his own experience, and collecting data from several people who experienced the phenomenon (Vidyarini, 2020). The writer then analyzes the data by reducing the information to important statements or quotes and integrating these statements into themes. In research on the Phenomenology of Women with Postpartum Depression, the narrative paradigm becomes an analytical tool to discuss efforts to overcome postpartum depression. As stated earlier, that humans are basically storytellers, so that under any circumstances they need other people to tell stories.
Creswell defines resource individuals in qualitative research as those who have firsthand knowledge of the events under investigation (Nursanti, Tayo, et al., 2021). This study's resource people will be shown in the form of a table, as follows:
Table 1. Background of the Resource Person
Name Age Education Postpartum Mother
Characteristics
LA 23 SMA Woman Who Gave Birth For
The First Time
AN 22 SMA Woman Who Gave Birth For
The First Time
GA 25 D3 Woman Who Gave Birth For
The First Time
MT 25 S1 Woman Who Gave Birth For
The First Time
RO 20 SMA Woman Who Gave Birth For
The First Time
RK 22 D3 Woman Who Gave Birth For
The First Time
AR 24 S1 Woman Who Gave Birth For
The First Time
KK 25 S1 Woman Who Gave Birth For
The First Time Source: Processed Research (2021)
Data was gathered through in-depth interviews and a research of the literature. Because the COVID-19 outbreak precluded researchers from conducting in-person interviews, interviews were conducted online utilizing the Zoom.us software. Existing data was sorted and rearranged in preparation for reconstruction, and data sources and family communication theory were triangulated.
DISCUSSION
Communication experiences can occur because of communication activities. Communication is the most central center in maintaining individual survival and establishing relationships between individuals. Frank Dance describes the process of communication by using a spiral. He believes that communication experience is cumulative and influenced by the past. He stated that experience in the present will inevitably affect one's future, so he emphasized that the communication process is not linear. Communication, therefore, can be thought of as a process that changes over time and between people who interact (Turner, 2017). From the results of in-depth interviews conducted with 8 informants, the researcher got about 29 important statements related to the research question. The researcher then extracts the important statements from the interview results as units of meaning, and sets aside the statements that are repeated. Then look for the formulation of the meaning of these important statements. The researcher then organizes the meanings into groups of general themes. The following table contains important statements from mothers' experiences with postpartum depression, important statements from mothers' feelings with postpartum depression and the resulting themes.
Table 1
Important Statements Regarding Postpartum Depression Experience 1. Sad times occur for 40 days after giving
birth
2. Judged as a mother who can't take care of children
3. Can't sleep 4. No appetite
5. Like getting a heavy load 6. Crying for no reason 7. Lack of knowledge
8. Fighting with husband or in-laws 9. Spanking baby
10. Get husband's support 11. Get help from others 12. tell other people 13. Positive thinking
14. Negative opinion from those who look Source: Processed Research (2021)
These statements are then reviewed. For the same After filtering, 9 textural descriptions are obtained which are then compiled with the meaning of the formula, which is described in table 2. An event that contains elements of communication will be a separate communication experience for an individual, and a communication experience that is considered important will be the most memorable experience and have a special impact on that individual. Turner (Turner, 2017) states that decision making in family communication studies examines how family members, in this case husband and wife, make choices, determine judgments, and ultimately draw conclusions that will direct the behavior of both towards a problem solving.
This is an act of communication, where every decision taken will always be
through interaction and meaning that is exchanged with each other packaged in verbal and nonverbal language between the two.
Views on the mother of street children are obtained from how people saw and stated who the mother was in the past, when the mother was said that she was weak and sick then people around her stated that she would not be able to make significant changes to herself. It would be constructed within the mother and how the mother interpret the essence of life to be lived. Berger and Luckman stated that the processes that occur in human activities will be interpreted by individuals, individuals will interpret all activities carried out by themselves (Berger & Luckmann, 2016). In the next stage, the mother will make meaning based on the communication experience she gained when she was in postpartum depression. The following is the mother's interpretation of the condition she is experiencing
Table 2
Important Statements from Mother's Experience with Postpartum Depression and the Meaning of the Formula
No Important Statement
Meaning of the Formula 1. Disorganized sleep
patterns and can't even sleep at all.
Postpartum Depression is a reality that changes the mother's lifestyle
2. Loss of appetite Postpartum Depression makes a mother not want to eat
3. Often cry for no reason Mothers who experience Postpartum Depression are emotionally unstable
4. Judged as a mother who can't take care of
children
The stigma of an unskilled mother
5 Fighting with husband or
other family members There is a conflict 6 Hitting a child for not
stopping crying Unable to express emotions 7 Be the dark times that
must be faced Shadows of failure appear during the Postpartum Depression
8 Get support from
husband or family Postpartum Depression is easy to overcome if there is support from people other 9 positive thinking Ability to solve problems
Source: Processed Research (2021)
Furthermore, table 3 shows conscious experiences related to feelings for mothers with Postpartum Depression
Table 3.
Mother's Feelings with Postpartum Depression
Source: Processed Research (2021)
These statements are then reviewed. For the same After filtering, 13 textural descriptions were obtained which were then compiled into a formula meaning, which is described in table 4.
Table 4.
Important statements about the feelings of mothers with Postpartum Depression
No Important Statement Formulated meaning
1. Sad Mother's emotional decline with
Postpartum Depression 2 Disappointed Inability to solve problems
3 Get angry Unstable emotions
4 Worried Life change
5 Worried about not being
able to raise children pessimistic 6 Worried about the future of
the child
Bad shadows of the future 7 not confident Lack of knowledge in caring for
babies
8 Feeling alone / isolated No attention from others 9 Feeling not free anymore Role change
10 Spirit Problem solving power
1. Useless mother 2. Sad
3. Disappointed 4. Irritable 5. Alone
6. Tired, stressed 7. Anxious
8. I want to kill myself
9. Worried about not being able to raise children 10. Not confident
11. Not free anymore 12. Missing husband 13. Cornered
14. Spirit
15. Sure can overcome
16. It's nice to see a baby's face
11 Sure can overcome optimistic
12 Tired, Stressed Mother's emotional decline with Postpartum Depression
13 Missing my husband the need for the presence of others 14 Nice to see baby Problem solving power
Source: Processed Research (2021)
This structural description of the mother's experiences and feelings with Postpartum Depression is then analyzed, resulting in themes relating to the meaning of Postpartum Depression. The meanings formed are presented in table 5.
Table 5.
Meanings that are formed based on the experiences and feelings of mothers with Postpartum Depression
Mother's Meaning of Postpartum Depression Syndrome Changes in
Lifestyle and Behavior
Conflict Support from the Environme nt
Unstable
emotions Role Change Optimistic
Source: Processed Research (2021)
The description of the mother's definition of postpartum depression is as follows: (1) Changes in Behavior and Lifestyle are changes that occur in mothers who experience postpartum depression after giving birth, with the following forms: messy sleep patterns, loss of appetite, and frequent crying.
without cause; (2) conflict is experienced by mothers with postpartum depression, due to collisions when interacting with the surrounding environment, (3) environmental support is an experience that mothers with postpartum depression get when interacting with their environment, namely when they receive support from their husbands. or family, meeting other people who tell happy things, and positive thoughts from inside and outside themselves, (4) excessive emotions are feelings from mothers with postpartum depression and appear in certain forms such as sadness, anxiety, stress, disappointment, etc., as a result of myths, assumptions of society, the surrounding environment and post-natal hormones, (5) role changes are the feelings of mothers with postpartum depression that arise due to changes in roles after getting a baby. Awareness of the demands of being a mother causes feelings of being no longer free, isolated, and insecure, and (6) optimistic is a feeling that arises because of internal and external urges to be able to overcome this postpartum depression problem.
This research is a study to explore the experiences and meanings of mothers who experience postpartum depression from the perspective of communication science. In this regard, this study uses two theories as analytical tools, namely the narrative paradigm and the symbolic interaction
theory. Postpartum depression is a condition that can be experienced by women after giving birth, regardless of profession, race, or even age. Even though a woman already has knowledge about postpartum depression, the feelings that arise due to postpartum depression are unavoidable. Even if the mother is "ready" it will only reduce the level of "stress" due to postpartum depression. In this study, mothers with postpartum depression experience almost entirely changes in lifestyle and behavior, emotional instability. This is in line with the research of Sally, et al who explained that women in this case were Chinese and Australian who felt sadness, fear, and anxiety in accordance with the pattern of postpartum depression.
These feelings arise because of the awareness of the changing role of motherhood. These mothers interpret postpartum depression as a natural thing and must be experienced by a mother. As AA said:
"Well, this might be called postpartum depression as I've read about it in theory." (Excerpt from interview with LA, March 2021). The reactions that arise from a mother due to postpartum depression are also inseparable from the influence of environmental elements, including the myths that are formed in society. As one participant said "In Javanese tradition, before every eight mothers who have given birth they are forbidden to take a nap, because it can make white blood rise, and make the mother who has given birth pale".
As explained by Mead (Blumer, 1980) that meaning is a product of social interaction, therefore meaning is not attached to objects, but is negotiated through the use of language. Negotiation is possible because humans are able to name everything, not only physical objects, actions or events, but also abstract ideas. However, the name or symbol used to mark the object, action, event, or idea is arbitrary. Symbolic interactionism is based on the following premises: first, the individual responds to a symbolic situation. They respond to the environment including physical objects (objects) and social objects (human behavior) based on the meanings that these environmental components have for them. When they encounter a situation, their response is neither mechanical, nor determined by external factors; individuals who are seen as active to determine their own environment. The second premise of symbolic interactionism as explained that meaning is a product of social interaction, therefore meaning is not attached to objects, but is negotiated through the use of language (Mulyana, 2013). Negotiation is possible because humans are able to name everything, not only physical objects, actions or events, but also abstract ideas. Through the use of symbols, humans can share experiences and knowledge about the world.
One of the initial responses when a mother realizes she is experiencing postpartum depression is to start looking for ways to overcome this. Some Informants realized that the way to overcome this problem was to consult an expert or talk to the closest people about the feelings that arise as a result of Postpartum Depression. Some Informants said that. One of them states the following "Don't keep to yourself. Talking to your husband, parents, siblings or friends can reduce the severity of postpartum depression. Especially to my husband” (Results of interview with GA, July 2021). This confirms that the essence of human nature is telling stories. In Fisher's perspective, narration includes any verbal or nonverbal description with a sequence of events that
listeners give meaning. This can be related to the essence of humans as storytelling creatures such as Fisher's assumption that humans are basically storytelling creatures (Turner, 2017) with logical considerations, humans will tell stories to other humans.
The narrative paradigm put forward by Walter Fisher believes that humans are storytellers and that considerations of values, emotions, and aesthetics are the basis of human beliefs and behavior. In other words, a person is more likely to be persuaded by a good story than by a good argument. So, Fisher, according to West and Turner asserted that the essence of human nature is to tell stories. Alternative problem solving by telling stories, is one of the essences of communication goals. Besides talking to the closest people, meeting other people in different conditions can be an alternative to reduce bad feelings that arise due to postpartum depression. As stated by RK, one of the participants. Meet lots of people. Meeting with many people makes our minds will not focus on ourselves. There will be a lot of information, entertaining jokes, as well as demands to always smile, which reduces the postpartum depression that we feel. (Results of interview with RK, July 2021). This, the communication factor helps overcome the problems of mothers who experience postpartum depression.
CONCLUSION
Postpartum Depression is a conscious experience of women after giving birth due to hormonal factors and changes in the family environment due to new members. Environmental support, in this case family members who can listen and understand women with Postpartum Depression, makes Postpartum Depression a natural experience for Postpartum Mothers.
However, if not addressed can be a bad experience that causes depression.
Women who experience Postpartum Depression often feel sadness, anxiety, feelings of being unappreciated, and often harbor feelings because they are worried about the stigmas of those around them. Whereas harboring feelings can worsen the condition of women after giving birth. Humans are basically storytellers, so under any circumstances they need other people to tell stories.
This research on women with Postpartum Depression syndrome, in the construction of meaning about Postpartum Depression syndrome. The meanings that emerge from women with Postpartum Depression syndrome are influenced by the social environment and the results of communication with those closest to them. The myth that surrounds women after giving birth creates another meaning about this Postpartum Depression.
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