Psychiatric Illness Post Childbirth
Birth of a child can be a joyous experience to most parents, since at the end of a nine month ordeal, comes out a little breathing wonder giving you the new title “mom and dad”. Like most things in life, post childbirth, a period known as “the postpartum period”, the women’s body begins to heal and rebuild the strength. However child birth could also bring about changes in women’s mental and physical health which in turn may have ripple effects on her interpersonal relationship with her husband, family and friends. The main focus currently is on a number of mental health issues related to childbirth.
During the postpartum period, about 85% of women experience some type of mood disturbance. For most women these disturbances are short-lived and mild. However for a good 10-15% of women develop depression and anxiety post delivery. Postpartum mental health problems are categorised into three main categories, namely:
- Postpartum blues
- Postpartum depression
- Postpartum psychosis
While postpartum blues is the most mildest, postpartum psychosis is the most sever form of postpartum psychiatric problem.
1. Postpartum Blues: This is often called as “baby blues”. about 50-80% of women experience this and is a common phenomenon which begins around the 4th or 5th day after childbirth. This condition is characterised by symptoms such as mood swings, tearfulness, irritability etc. These symptoms may last for a couple of hours or days, which may subside within a week or two. These symptoms most often might not interfere with their daily functioning and caring for the infant. No specific treatment is generally necessary unless it is noticed that, the symptoms are continuing and worsening.
2. Postpartum Depression: It is a condition which is less common than postpartum blues (10-20% of women post childbirth) and begins mostly in a week or two after childbirth. However some women begin to notice symptoms during pregnancy as well. The symptoms of postpartum depression is indistinguishable from depression in general which includes symptoms such as:
- Feeling sad, hopeless, empty, or overwhelmed
- Crying more often than usual or for no apparent reason
- Worrying or feeling overly anxious
- Feeling moody, irritable, or restless
- Oversleeping, or being unable to sleep even when her baby is asleep
- Having trouble concentrating, remembering details, and making decisions
- Experiencing anger or rage
- Losing interest in activities that are usually enjoyable
- Suffering from physical aches and pains, including frequent headaches, stomach problems, and muscle pain
- Eating too little or too much
- Withdrawing from or avoiding friends and family
- Having trouble bonding or forming an emotional attachment with her baby
- Persistently doubting her ability to care for her baby
- Thinking about harming herself or her baby.
-National Institute of Mental Health, USA
In order to diagnose postpartum depression, the symptoms must be present for more than two weeks at a stretch.
Factors that might contribute to postpartum depression are:
Hormonal changes: A drop in the levels of estrogen and progesterone which causes chemical changes in the brain causing mood swings. Along with these lack of rest, sleep and exhaustion can contribute to symptoms of postpartum depression.
Situational risks: Childbirth itself can be rather stressful event contributing to symptoms pf postpartum depression.
Life stressors: Along with stressors of childbirth, the mother who is also experiences other stressors such as hostile family environment, lack of adequate support, strained marriage etc can act as additional factors which could contribute or worsen the depressive symptoms.
The main forms of treatment for postpartum depression are pharmacological (antidepressants) and non-pharmacological (psychotherapy from clinical psychologist or counsellor). Support groups also aid in understanding in dealing with symptoms of postpartum depression. Early identification of symptoms by the physician could reduce the risk of having a full blown postpartum depressive episode. Along with this, adequate family support and nutrition are equally important.
3. Postpartum psychosis: It is the most sever form of postpartum psychiatric problem which occurs in about 1-2/1000 women post childbirth. The symptoms begin with 48 or 72 hours of childbirth. They often experience restlessness, insomnia, depressed or elated mood, erratic behaviour, fixed unchangeable beliefs which centre around the child and experience of hearing voices which no one else can hear instructing the mother to harm herself or the infant. Risk of committing suicide is high in this group of women. Immediate help is required if women experience postpartum psychosis since it is a rather serious condition. Pharmacological treatment is available for postpartum psychosis as well.
It is necessary to be aware of postpartum conditions even though one might experience it, since, “prevention is better than cure” especially with respect to mental health problems.