Postpartum Mental Health Disorders

Postpartum mental disorders are divided into transient mood disturbances, postpartum depression, and puerperal psychosis. They are associated with poverty, labor pain, the newborn's health, an unplanned pregnancy, a high number of pregnancies, and dissatisfaction with the baby's sex, in addition to a hereditary predisposition to mental disorders.

Transient mood disturbances

Transient mood disturbances (the “baby blues”) affect approximately one-half to two-thirds of women who have given birth, particularly on the third and fourth days after childbirth. They are limited to irritability, crying easily, and mood fluctuations between feelings of elation and misery. These disturbances often affect women after their first baby, especially women who previously experienced symptoms of depression and anxiety during the third trimester of pregnancy and those who usually experienced premenstrual tension. The sudden hormonal change shortly after childbirth is believed to play an important role in the development of these symptoms, which usually resolve on their own and require understanding rather than treatment.

Postpartum depression

Moderate depression affects approximately 10–20% of women during the first weeks after childbirth. Its symptoms include fatigue, anxiety, negative feelings toward the newborn, excessive fears, and obsessive symptoms. These symptoms may persist for 2–6 months. Lack of sleep, exhaustion, and difficulty adapting to a new role in life, such as motherhood, reveal a hereditary predisposition to this type of illness. Support from husbands, however, is extremely important in alleviating these symptoms.

Postpartum psychosis

As for puerperal psychosis, or postpartum “madness,” its symptoms resemble those of any other psychotic illness and include hallucinations, delusions, and loss of reason. It results in one of every five hundred women who give birth being admitted to a psychiatric hospital. It is more prevalent in developing countries and usually begins during the second week after childbirth. It is often affective and sometimes schizophrenic. It is essential to assess the mother's psychotic thoughts about her newborn during the illness to ensure that the mother's delusions do not lead her to harm the baby.

For example, a mother with depressive psychosis may believe that the child is gravely ill and will suffer from severe poverty and the hardships of life, leading her to kill her newborn to spare the child from suffering. Schizophrenic delusions may lead a mother to imagine that the child is an evil, demonic creature that brings misfortune, which may also lead her to kill the child in order to save humanity. In both cases, the mother may take her own life immediately after regaining her reason and realizing what she has done. A mother experiencing psychosis must therefore remain under observation and must not be left alone with her child until she has fully recovered from all delusions and depression.

Also read about infanticide after childbirth.

Available types of psychological treatment

Psychotherapy and medication have an effective role in treating these illnesses and preventing their effects on the child's cognitive and emotional development. Unfortunately, many cases of postpartum depression are not detected, causing the illness to become chronic and to be mistakenly regarded as a natural change in a woman's personality after childbirth.

Some mothers and fathers may hesitate to accept medication for fear that breastfeeding will have to stop. Two points should be noted here: despite the importance of breastfeeding, it is not more important than the mother's mental health. If her condition is not treated, it will have devastating effects on the child, particularly because a child at this stage mirrors the mother's condition.

It is also worth noting that electrical stimulation sometimes plays a role in treating mothers who experience postpartum mental disorders, enabling them to resume caring for their children as quickly as possible. With treatment, most of these mothers recover. The illness may recur in approximately 30% of them after future births, so psychiatric follow-up before childbirth is recommended to ensure that their psychological symptoms are controlled before they intensify.

The truth is that families, like our colleagues in obstetrics and gynecology, pediatrics, and family medicine, have the greatest role in detecting mental illnesses in women, whether while examining the women themselves or their newborn children. These doctors can treat mild cases of these illnesses and promptly refer more difficult cases to a psychiatrist.

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