Women's Mental Health Series: MENTAL HEALTH ISSUES IN POST-PARTUM PERIOD

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The arrival of a newborn is often a source of great joy for both the mother and the family members. However, it also means a lot of adjustment and adaptation to a new and challenging situation, especially for new mothers. Physiological, hormonal and biological changes can increase a woman’s vulnerabilities for mental health issues. 

The awareness around postpartum disorders is gradually improving and many women are opening up about their struggles, still there are many who have to suffer in silence due to several reasons. We must understand that silence is never the answer of any mental health disorder and when neglected, they can impact both mother and the baby, even beyond the post-partum period.

There are several types of mental health disorders in the post-partum period:

1.   Postpartum blues: These are also known as “Baby blues” and are very common, often reported in upto 85% of women. The symptoms are crying spells, irritability, confusion and agitation, which begin within days of delivery, peak by 3-5 day and then resolve by 10 days. Social support and reassurance by family members is sufficient and no active intervention is required. 

2.   Postpartum Depression (PPD): This is most common psychiatric disorder in the post-partum period and is seen in about 10-15% women or upto 1 in 5 women. It usually appears in few weeks to 2-3 months following delivery and in severe, untreated cases may even require hospitalization. 

    The symptoms include pervasive low mood, fatigue, a lack of interest in pleasurable activities, disturbances in sleep and appetite, thoughts of feeling helpless, guilt of not being a good mother, feeling hopeless and suicidal ideations. There can be severe anxiety with relation to baby’s wellbeing and safety. Past history of depression significantly raises the risk of subsequent PPD. 

3.   Postpartum Psychosis (PP): Although rare (1 in 1000 cases), postpartum psychosis is an acute medical emergency and often requires hospitalization for the safety of the mother and the baby. PP begins abruptly often within 2 weeks to 2-3 months following delivery. 

    The symptoms include extreme mood changes, aggressive behaviours, delusions, hallucinations, disorganized behavior. Suicide and infanticide have been reported. Past history of bipolar disorder, postpartum psychosis, family history of psychotic illness significantly increases the risk of PP.

4.   Anxiety Disorders around postpartum period: Anxiety disorders are most often unreported and under-diagnosed but nonetheless quite prevalent. Many mothers worry excessively about their child’s safety, fear of cot death and may repetitively check child’s breathing to the point of neglecting one’s own sleep and overall health. Obsessive thoughts about the child’s safety may manifest as repetitive, intrusive thoughts or even images and may lead to repetitive checking, washing or other compulsive behaviours.

5.   Postpartum Post traumatic stress disorder (PTSD): Sometimes, following a traumatic birth experience, women may develop post traumatic stress disorder characterized by flashbacks (in this case, the experience around delivery), nightmares, hyperarousal symptoms like irritability, hyper-vigilance, sleep disturbances, avoidance of triggers associated with the event, panic attacks and feeling of numbness and detachment. There may be persistent fear of pregnancy.

 

Management

It is essential that all mothers are screened for mental health issues after delivery. As many may develop after weeks or months of delivery, repeated screening is often required. Once we have ruled out medical causes, treatment includes providing education to mothers and family members regarding these disorders, reassurance and social support. Psychotherapy like Interpersonal Therapy, Group Therapy is often beneficial. For more severe cases, medications are available which are started by psychiatrists or perinatal mental health experts. Concerns regarding breastfeeding can be allayed after discussing the risks and benefits.

Most psychiatric disorders in the post-partum period have a good outcome if diagnosed early and given proper treatment. This not only helps both the mother and the child bonding but can also prevent relapses in future pregnancies. Health care professionals should screen mothers for postpartum mental health disorders regularly and refer them to psychiatrists or mental health professionals for further assessment and management. Families/partners must be involved in the treatment process and they must be given psychoeducation and reassurance and support if needed. We must always remember that a healthy mother is must for a healthy baby and healthy family.

 

Dr. Suhasini Das, MD, FIPS

 

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