POSTNATAL DEPRESSION

Depression after childbirth, known as postnatal depression is a common problem in modern society affecting between 10% to 40% of young mothers. It may also be referred to as post-partum or puerperal depression and the most important thing for women to realise is that, if it is correctly diagnosed, it can be cured. Postnatal depression may rear its ugly head any time during the first year after the baby"s birth and inflict itself upon the most unsuspecting and unlikely candidates. It is just as likely to occur in women who have spent years in infertility clinics trying desperately to have a baby as it is in those women whose well ordered lives have been interrupted with an unwanted pregnancy.
There are three types of postnatal mood disorders which are distinct in their features and require different treatment. It is helpful to look at the features of these three different types:
The Maternity Blues
This is sometimes called the "post-partum blues" or "third day blues" and is just about as common as " "lovers blues", so much so that some clever guitarist should write a 12-bar blues song to play over the radio to offer solace to these tearful new mothers. Postnatal wards in women"s hospitals are sometimes called the "weeping wards" as at any one time about 50% to 80% of its inpatients will be feeling overly emotional and excessively tearful.
Thankfully, maternity blues don"t last too long and are generally not severe, followed by a spontaneous return to a normal, happy, emotional state about 14 days after childbirth. This transient change in the emotional personality does not require any medication and will pass with support, rest and reassurance.
If the birth has been prolonged or difficult, the new mother is often physically and mentally drained, feeling very anxious that she will not cope with the baby"s needs and this can precipitate anxious and tearful moments as can breastfeeding problems if they are not handled tactfully and patiently.
The nursery and medical staff should take great pains to try and accommodate the wishes of the new mother regarding the way she wants She had seen several doctors who asked her if her menstruation was still regular and as soon as she replied that she menstruated at monthly intervals the verdict was that she could not possibly be suffering with a deficiency of oestrogen and that her symptoms were due to stress. She was given a prescription for sedatives and anti-inflammatory drugs and told to rest more and cease reading women"s magazines. This woman was very angry and was made to feel that she could not cope with the so-called normal phases of life.
A blood test to measure the hormonal levels is a simple and non-invasive procedure and it is also a simple and physiologically appropriate thing to try a course of natural Hormone Replacement Therapy (HRT), for three months at least to see if these pre-menopausal symptoms can be alleviated. Such treatment can be dramatically effective and often avoids the need for sedatives, anti-depressants, painkillers and anti-inflammatory drugs in premenopausal women.
Some women are told not to worry about their hormones until they stop menstruating completely, at which time they can return for HRT. By this stage you may have turned into a little wizened up old prune and even your mother can then pronounce you menopausal!; you won"t need a doctor to make the diagnosis.
to spend the first few postnatal days with her baby as things that may appear tiny and inconsequential to others may seem vitally important to her and her relationship with her husband and baby. Doctors and nurses must realise that a new mother is vulnerable, dependent and often highly emotional, in need of support and sensitivity from those looking after her.
I remember an older mother coming to see me nine months after the birth of her second child, complaining of depression, anxiety and insomnia. She told me that she was haunted by the memory of the suturing of her episiotomy (vaginal cut) immediately after the birth of her baby. Her own obstetrician had been unavailable and his locum doctor had been called in at 3 a.m. to do the stitching. This doctor had complained bitterly about his disturbed sleep and had joked with the nursing staff about his drunken weekend. He had refused to allow the mother to cuddle and breastfeed the baby immediately before he began stitching the vaginal tear which had taken a full forty minutes. This woman found the doctor and staff totally insensitive and had longed for a quiet romantic twenty minutes with her baby immediately after birth. This patient was very angry and resentful and being unable to express this to the doctor she had turned it inside upon herself resulting in depression.
The sudden hormonal withdrawal during the first 24 hours after birth is partly responsible for the third-day blues and may also cause a hormonal migraine, an increase in general aches and pains and, occasionally, in susceptible women, a flair up of arthritis, auto immune disorders or an asthma attack. These physical discomforts require specific treatment as they only add to the feelings of vulnerability and dependency in these early postnatal days.

Puerperal Psychosis
The second type of postnatal mood disorder is called puerperal psychosis and is a severe mental4mbalance that needs urgent medical treatment. This type is vastly different to the common and mild maternity blues and, thankfully, is relatively rare occurring in only two to three per thousand births.
Puerperal psychosis usually has a sudden and dramatic onset, manifesting within the first two to three weeks after childbirth and may occur as early as several hours after birth. It produces a total change in the mental state with the thoughts and emotions becoming jumbled, frenzied, confused and irrational. The helpless victim of this psychosis becomes totally out of touch with reality being tormented and preoccupied with weird thoughts that may cause her to behave in an agitated and paranoid manner. She may be subject to hallucinations of sight and smell, seeing and hearing voices and things that are not present and imagining that she or her baby are in imminent and grave danger. Understandably, she may become disorientated and unable to sleep, eat or care for her child.
Christine, a 31-year-old single mother had had a normal pregnancy and easy vaginal delivery of a healthy baby and all seemed well as I wished her good night after checking her baby. The next morning when I arrived at her bedside, she had become a different person with an agitated and worried look upon her face. She insisted that the nurses had put a spell on her baby that made him susceptible to evil spirits and that her breast milk was poisonous. She wanted to purify the baby by putting him on a fast and giving him a bath in holy water. She asked me to urgently find a priest to exorcise the spirit out of her son with a cross and holy bible. Christine was continuously distracted by loud voices although in reality her ward was quiet and almost empty and she complained that her breast milk smelt rotten and unwholesome.
The nursing staff were unable to restrain or control this large powerful woman and an urgent injection of tranquillising medication was required. It was nine months before Christine was able to care for her baby without constant supervision.
The most dangerous aspect of post-partum psychosis is that a sufferer may have compulsions or obsessions to harm herself or % her baby and suicide and infanticide are not rare in this disorder.
One psychotic woman became so obsessed with the long shape of her baby"s head that she was found trying to hammer it back into a rounder shape. Every year a case of severe puerperal psychosis tragically makes the newspaper headlines and we read that:
"Mother jumped out of hospital window with her baby"
"Mother stabs three children"
"Child suffocated by distraught mother"
"Two children and mother asphyxiated with car exhaust".
These tragedies should not occur and if society, families and professionals were more aware of the early stages of post-partum psychosis, life-saving emergency treatment could be given. It is incredible to think that Governments spend billions of dollars trying to cure AIDS, cancer and heart disease and yet post-partum psychosis which is easier to prevent and cure than these diseases, receives very little funding or attention and these tragedies continue.
Obviously, these women need 24-hour observation in a security hospital environment and major tranquillising drugs. The mother cannot be left alone with the baby under any circumstances even in the safety of a mother and baby unit within the hospital or mother craft centre.
Post-partum psychosis requires powerful tranquillising drugs and when the mother is discharged from hospital care her behaviour and emotional state is still influenced by these drugs so that she is usually slow and unable to care for her baby by herself. Generally, she would take many months to several years for complete recovery, although hormonal therapy with natural progesterone may shorten her illness.
She, or her family, should be instructed to keep a menstrual calendar to check for pre-menstrual deteriorations in her mental state and once she is stable an attempt can be made to reduce her tranquillisers. She may require extra progesterone to control pre-menstrual exacerbations of her psychosis.
Postnatal Depression
This illness falls in between the maternity blues and post-partum psychosis being more severe than the former and less incapacitating and destructive than the latter. Postnatal depression is really a mixed bag of problems that varies in the type of symptoms, their severity and duration. Postnatal depression is very common as 10% to 40% of women are affected. The symptoms of postnatal depression may start any time in the 12 months after birth. Some people do not realise this so postnatal depression may not be recognised for what it is, especially if it begins as long as 6 months after childbirth. Most commonly it lasts for several months but up to one in five Women with postnatal depression are still feeling unwell 12 months after the birth.
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