It feels as though it ought to be the happiest time of your life. And yet, for many women who suffer from post-natal depression (PND) - up to a quarter of new mothers, according to statistics - having a baby can feel like the lowest. What starts as "baby blues" can escalate into full-blown depression. If left untreated, the consequences can be catastrophic, as evidenced in a recent case in the UK where a mother suffering from a severe form of PND suffocated her two young children, who were 14 months and 10 weeks old.
For Alison, a mother of two from Dubai, it started when she was about three months pregnant with her second child. "At that point I couldn't work out whether I was depressed or whether it was just the hormones or whether it was issues between my husband and I that we hadn't resolved in terms of managing our son and two full-time jobs," she says. It continued throughout the pregnancy and after the birth. "I was worried that the second time round I wouldn't be able to perform my role as effectively," she says. "This other child came along and he was a stranger to our family, and I felt uncomfortable, and in pain after the birth and that I couldn't give my second baby what I'd given to our first child."
Her son was seven months old before Alison realised what the problem was and sought help. "I went to see a professional a couple of times but she wanted to talk about my childhood and I didn't want to do that," she says. In fact, the turning point came when her husband packed her off on a week's holiday on her own. "I needed to get away from this feeling that all these people were dependent on me," she says, "and I managed to take control of my thoughts a bit." Around the same time, her son turned one. "My mother-in-law was staying and she turned around and said: 'It's really hard and we totally appreciate what you're doing.' It felt like a bit of a sisterhood thing - we're not alone - and that was the moment when it all seemed to dissipate."
For Noura, a mother of two from Abu Dhabi, it was the lack of sleep after the birth of her daughter that triggered her PND. "I think because my body clock was so used to not sleeping that I stopped being able to sleep," she says. "So where the baby was starting to sleep I was not going back to sleep anymore, and because I wasn't sleeping very well I started to get quite hormonal and irrational and argumentative. I was also getting very down."
A family history of depression meant that she was able to recognise the symptoms quite quickly. "I'd never been treated or spoken to anyone about depression before but I was aware that sometimes I go through periods of feeling quite blue and this felt like a worse version of it. I just didn't feel like I could carry on feeling that blue. My husband was of the same opinion and suggested that I go and get help."
Curing her insomnia was the first hurdle, for which she was prescribed sleeping pills. "As soon as I was able to break the pattern of insomnia I started to feel better immediately," she says. "So I don't know if it was so much to do with the medication I was given for depression, although that was great too. It was about getting the insomnia sorted."
Around two years later, after the birth of her son, Noura started taking sleeping pills as soon as she could in order to prevent the same thing from happening. "My doctor said that around 60 per cent of the people who have post-natal depression will develop it again with the next pregnancy," she says. "So to pre-empt that, and knowing I was going to be awake all the time, I decided to start taking the pills again immediately after I stopped breast-feeding. It just meant I could go back to sleep after I had fed the baby, otherwise I wouldn't go back to sleep at all." She has not suffered from post-natal depression this time around.
With the easy availability of home help here, and often extended family members to help share the childcare, does that help keep PND at bay? Dr Rasha Abbas, a psychiatrist at the American Center in Abu Dhabi, thinks not. "Having help might help in terms of treatment because you can have a break or who might take over while you sleep," she says, "but I don't think there is any link between having help and a lack of post-natal depression. Part of the issue is being supported. I think a lot of people with two or three maids at home still don't feel supported."
Getting help early is vital, says Abbas. "If left untreated and if it's very severe, post-natal depression can develop into a psychotic depression where the woman can have delusions and hallucinations," she says. "She could believe that the baby was possessed by the devil or the voices in her head are telling her that she should harm them."
Cases such as the tragedy of the two young children killed in the UK, though very rare, happen everywhere. "It's a worldwide phenomenon," says Abbas, "and not something that's specific to a certain ethnic group or geographical area. The difference is that mental illness is not spoken about very much here. The stigma is much stronger. Families try to keep a lid on things and try to support the person without seeking help because of the stigma. But also women here are expected to get on with it and the family in general doesn't like to accept that someone might be mentally ill or might need help from a professional. That can put a lot of extra pressure on women."
The names of the mothers have been changed in this article