Dear Doctor,

I’m a new mother, my baby just turned three months but I’m always tired. What’s funny is that I do get some rest as she is not a fussy baby. I get up only twice in the night to feed her. But I seem to always feel tired or worn out. I have a girl who helps me out but this hasn’t changed anything. Is something wrong? ​

​Lucy

Dear Lucy,

Congratulations on the arrival of the addition to the family. It seems you are suffering from post-partum fatigue, that is, undue tiredness after delivery. It can simply be due to the exhaustion following the labour pains of normal delivery. Mental stress related to the care of a new-born, and hormonal and emotional changes after child birth, all contribute to it. Even if you have help to care for the baby and other chores as well, you may still not be mentally free of these tasks, worrying about them and supervising them.  Skipping meals, lack of adequate sleep also cause tiredness.

Excess blood loss during delivery can lead to chronic anaemia, which manifests as early fatigue, vague body ache and in advanced cases breathlessness on exertion. Chronic anaemia can also be due to dietary deficiency. During pregnancy and in the period of breastfeeding after delivery, the requirement of iron and calcium is increased in the body. If this is not fulfilled in the diet, one can develop tiredness, joints and body pain. Early tiredness can also be due to any acute or chronic infection. Hypothyroidism (under functioning of the thyroid gland) can be precipitated or aggravated after child birth. Early fatigue and sense of exhaustion are one of the manifestations of hypothyroidism, along with feeling cold, dryness of skin, decreased appetite, constipation, and etcetera. symptoms.  Some women can develop cardiomyopathy (affection of the heart muscle), during pregnancy or after child birth. This leads to easy exhaustion and breathlessness on any exertion.  Diagnosis and treatment of any of these medical disorders, if present helps to improve the condition.

As such, 40 to 80 per cent new mothers, world over, suffer from depression and tiredness after a child birth. These child birth blues usually pass away in a week or two. However, if this persists after two weeks, the exhaustion and depression are so severe, that the woman is unable to take care of herself and the baby, she is suffering from post-partum depression (PPD). 10 per cent of women globally suffer from post-partum depression, though experts say that the figure of PPD may be higher as many women do not seek medical treatment. It may begin in pregnancy itself, before delivery or occur after delivery.  Easy exhaustion, loss of appetite, not getting sleep in the night or excess daytime somnolence, not feeling interested in any chore, crying for no reason, being unduly irritable,  and etcetera, are some of the problems that occur with post-partum depression.  It occurs due to a combination of hormonal, environmental, emotional and genetic factors.  Treatment consists of counselling and anti-depressant medication.

 Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk