Introduction

Conception and birth are passages from one phase of life to another. It may bring about crisis leading to disequilibrium. With favorable conditions it can lead to personal growth but some women may develop problems.

Psychiatric disorders related to childbirth(postpartum)can be divided into 3 main categories:

• Postpartum blues
• Postpartum depression
• Postpartum psychosis

Postpartum blues

• It is the mildest form and may occur in 25-85% of women. It usually begins in the first few days following childbirth and peaks on the fifth day and commonly resolves within 2 weeks.

Postpartum depression

• It occurs in 10-20% of women and begins in the first month of childbirth. Most episodes resolve spontaneously within 3-6 months but in severe cases may persist up to 2 years

Postpartum psychosis

• It is a rare condition that occurs in every 500 – 1000 births. It has a rapid onset and usually occurs within the first few days to 2 to 3 weeks postpartum but the risk remains high for several months

Signs and symptom

Postpartum blues

• Mild depression and mood lability (mood change)
• Tearfulness
• Irritability
• Nervousness
• Poor concentration
• Diminished appetite and sleep

Postpartum depression

• Depressed mood
• Decreased energy/ inability to function
• Social withdrawal
• Complaints of lack of social support
• Misinterpretation of baby’s cues
• Problems with concentration and memory

Postpartum psychosis

• Sleep & appetite disturbances
• Agitation
• Suicidal and homicidal thoughts
• Bizarre feelings and behaviors
• Psychotic symptoms e.g. hearing voices when there is no one around (hallucinations or having false belief(delusions)

Complication

Children of mothers with postpartum disorders may develop emotional and behavioral difficulties and also learning problems. In addition in extreme cases they may be in danger of being harmed by their ill mothers

Treatment

Postpartum blues

• Education regarding the disorder is essential. The mother will need support from family members and also assistance in reducing psychological stressors. Symptoms must be monitored in case they worsen in which case they need to be seen by a doctor

Postpartum depression

• Education, reassurance and support is important especially from the family members. Supportive psychotherapy and cognitive therapy may be useful and in some cases medication is given. In more severe cases hospitalization may be needed. In these cases visits between mother and baby are encouraged

Postpartum psychosis

• Hospitalization may be necessary. Medication will be started to control the symptoms and in serious cases, electroconvulsive therapy can be given. Family members should receive education about the problem.

Prevention

Early detection of women who are at risk is important so that treatment can be started as early as possible. Women who have higher risk include those with previous history of depression or postpartum disorder, family history of psychiatric disorders , unplanned pregnancies and marital disharmony

Rehabilitation

Postpartum depression (Depression)
Postpartum psychosis (Schizophrenia)

Support group

www.postpartum.net

Reference

Postpartum Depression Fact Sheet: National Women’s Health Information Centre.(www.4woman.gov)
American Association of Family Physicians (www.aafp.org)