Shaken Baby Syndrome

A large number of child deaths are reported in South Africa each year. A lot of deaths relate to neglect, abuse or murder. Despite this, there's a knowledge gap in relation to understanding the issue....

Amniotic fluid problems

The importance of amniotic fluid Amniotic fluid is essential for pregnancy and foetal development. Amniotic fluid is a watery substances residing inside a casing called the amniotic membrane or sac. ...

Choosing a pre-school

Becoming a parent is a momentous; life-changing event filled with hopes, expectations and naturally some fears. Parents often learn and grow alongside their children, as they face the challenges of pa...

Newborn reflexes

Although newborn babies are physically helpless and vulnerable at birth, they have a number of amazing innate abilities or reflexes. Reflexes are involuntary movements or actions, designed to protect ...

Mastitis

Mastitis is an inflammation of the breast that can lead to infection. The word “mastitis” is derived from the Greek word “mastos” meaning “breasts”, while the suffix “-itis” denotes “inflammation”. Ma...

Pelvic floor exercises

Although your new baby will probably bring you immense emotional satisfaction, physically you may feel uncomfortable and strange in your own skin. After 9 months of pregnancy and hormonal changes, you...

Colic

Babies cry because they need to communicate something and most parents, especially new moms, find it distressing to see or hear an unhappy baby. In time, you will learn to recognize the various causes...

Antenatal Classes

Antenatal classes are informative sessions provided to prepare expecting parents for the birth of their child and the early days of being a parent.Most antenatal classes are run by Midwives and occasi...

Strap-in-the-Future

The Decade of Action for Road Safety 2011-2020 was launched on the 11 May 2011. It is a global declaration of war against road crashes and fatalities. According to Mr Sibusiso Ndebele, MP Minister of ...

  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Baby Blues, Postpartum Depression and Postpartum Psychosis

“When you first have your baby, no matter who much you love them- they are often strange and rather frightening. And your hormones are all over the place. Your emotions go up and down and that kind of emotional roller coaster is very common, if not normal." - Margaret Oates (Perinatal Psychiatrist)

THE POSTPARTUM PERIOD     

During the period following child birth, approximately 85% of women suffer from some type of mood disturbance. It may be useful to conceptualize postpartum psychiatric disorders as existing along a continuum; where postpartum blues is the mildest, most short-lived, postpartum depression or anxiety involves more significant symptoms, and postpartum psychosis is the most severe form of the illness.

Whether you develop baby blues, postnatal depression or postpartum psychosis after giving birth, it is important to understand that it does not mean that you do not love or care for your baby. Furthermore, many women do not realize that they have a psychiatric condition. It is therefore important for partners, family, friends and healthcare professionals to recognize the symptoms of postpartum mood disorders, as early as possible, so that appropriate treatment can be given. Although postpartum psychiatric illness can bring with it feelings of loneliness, fear, hopelessness and distress, be reassured that there are many treatments available. As long as these illnesses are recognized and treated early, they are temporary conditions that you can recover from.

Why is it difficult to admit to or recognize postnatal depression or anxiety?

1) Being a new mom brings with it several changes and some moms may fail to recognize symptoms of depression and anxiety because they are tired, overwhelmed, adjusting to life with a baby, or perhaps thinking that this is what part of being a new parent is all about. It is often difficult for new moms and their families, to distinguish between symptoms of depression and anxiety, and those of motherhood. As new moms, we might be afraid of being seen as complaining or not being able to cope with motherhood. Often we think it can't happen to us. Women who suffer from PND tend to blame themselves instead of realizing that it is a medical condition and not a sign of failure.

2) Due to stigmas surrounding postpartum psychiatric illness, mothers and their families may feel ashamed or embarrassed about the condition. Mothers may blame themselves and be too fearful to admit to negative feelings postnatally, for fear of their children being taken away or as being labelled bad mothers.

3) Each women experiences a unique situation and their own cluster of symptoms- some new mothers are sad and tearful, some feel overwhelmed and irritable, some bond immediately with their infants, while others feel distant, some sleep constantly while others have insomnia. The up-and-down nature of symptoms, may make it difficult to identify a depression or anxiety problem.

BABY BLUES

"The whole nine months of pregnancy I was in this bubble- unreal bubble - And I didn't realize how hard this was going to be and how my life was going to change… Everything felt so difficult…Everything just looked really, really sad"

The "baby blues" are mood swings caused by hormonal changes. One minute you are feeling low and weepy, and the next euphoric. In most cases, baby blues don't last beyond the first week after delivery, but Moms do require much love, affection and support to help get through it. Generally baby blues resolve without any medical assistance and are regarded as a normal adjustment period after giving birth. Approximately 80% of new mothers are likely to experience baby blues. Because the condition is often to be expected and also very common, it is not considered to be an illness. The baby blues do not affect the mother's ability to function and to take care of her child.

Symptoms:

Symptoms usually peak 3-5 days after delivery and last for a few days up to 2 weeks. Baby blues involve a mild and passing state of heightened emotions and can include:

  • Rapidly fluctuating mood
  • Frequent and abrupt tearfulness
  • Feelings of sadness
  • Irritation
  • Sleep difficulties
  • Anxiety

Treatment:

Baby blues are usually mild in severity, self-limiting and spontaneously resolve themselves in the first two weeks postpartum. No specific treatment is required, except for support and reassurance. However, if the symptoms increase in severity or persist for longer than 2 weeks, further screening for postpartum mood disorders is necessary.

POSTNATAL DEPRESSION (PND)

"It’s all upside down and not how you imagine it. I felt I was in a black pit, just falling and I couldn't get out of it. I couldn't function; I didn't function - I didn't want to move."

Some women experience postnatal depression after they have a baby. PND generally develops between 4-6 weeks after childbirth, but in some cases it may not develop for several months. It can range in severity from very mild and transient, to severe and lingering. Postnatal depression is common after the first pregnancy. Women often feel worse first thing in the morning and better as the day progresses. PND is also referred to as postpartum non-psychotic depression. Postpartum depression is no different from depression that can occur any other time in a woman's life.

Although PND is more common in women, the birth of a new baby can be stressful for both parents and men can be affected too. Symptoms may include:

  • Feeling a sense of anti-climax after the birth
  • Feeling unable to cope. Having to be the tower of strength while your partner is feeling low, can be a huge strain
  • Feelings of not giving your partner the support she deserves
  • Finding it difficult to adjust to the major changes and demands made by a new baby

Symptoms of PND:

PND affects women in different ways. Symptoms generally begin soon after birth and last for months, or in severe cases they may last for over a year. The range of symptoms depends on the severity of the depression, and may include;

  • Low self-esteem and lack of confidence
  • Negative thoughts
  • Low mood for long periods of time (2 weeks or more)
  • Irritability
  • Tearfulness
  • Panic attacks or feelings of being trapped in your life
  • Anxiety or heart palpitations
  • Difficulty concentrating or remembering things
  • Lack of motivation
  • Being disinterested in yourself and your new baby
  • Loneliness
  • Feeling guilty, rejected or inadequate as a parent
  • Feeling overwhelmed and unable to cope
  • Constant tiredness, difficulty sleeping or changes in sleeping patterns
  • Physical signs of tension, evident in symptoms such as headaches, stomach pains, or blurred vision
  • Loss of appetite
  • Reduced libido

How does PND affect how I feel about my baby?

  • You may feel guilty that you don't feel the way you're expected to
  • Excessive worries and obsessions about the infant's health and well-being
  • Ambivalent or negative feelings towards the infant
  • Intrusive and unpleasant thoughts or fears about harming the infant
  • You may find it hard to identify what your baby is feeling or what your baby needs
  • From sheer tiredness and desperation, you might feel like hitting or shaking your baby. In spite of having these feelings, most mothers don't act on them. If you feel like this, tell someone. Your GP or midwife will want you to get better and will help you on the road to recovery, so that you can continue to enjoy and care for your baby at home.

Contributory factors:

The exact causes of PND are still unknown and there are several factors that may play a contributory role. It depends on you as a person, your personal circumstances and the way your baby behaves. Research has shown that the following risk factors may make you more susceptible to PND.

1) Physical changes - even a relatively easy birth brings about overwhelming changes for the female body. In addition, the sudden drop in pregnancy hormones has a significant impact on brain chemicals (neurotransmitters). If you've had a particularly difficult birth experience, you could easily feel demoralized or that you have failed in some way. Sheer exhaustion and broken sleep also contribute to depression, especially if you have a very demanding, sleepless baby.

2) Emotional changes - including fatigue, change of identity, not feeling attractive physically or sexually. Adapting to parenthood is daunting. New mothers have to deal with the constant demands of a baby, a different dynamic in the relationship with her partner and the loss of her own independence. This is coupled with a lack of sleep and recovering physically from giving birth.

3) Psychosocial problems - marital conflict or employment loss, inadequate social support from friends and family. New moms may find it difficult to keep up contact with friends and workmates, possibly leading to feelings of isolation and loneliness. Adapting to living on one wage may also be difficult. Other recent stressful life events, daily stressors such as childcare, unintended pregnancy and insurance status have been validated as risk factors.

4) Biological vulnerability - this includes both a family and personal history of mood disorders. Women with a previous history of postpartum depression or psychosis have up to 90% risk of recurrence.

Treatment:

If you feel depressed most of the time after your baby is born and these feelings don't go away, you may have PND. Your GP will be able to determine whether you have the condition and will suggest an appropriate course of treatment. As long as PND is identified and treated, it is a temporary illness that you will recover from. However, if postpartum depression is not completely treated, there are chances of the depression coming back, even after the postpartum period.

Support from friends and family is often crucial in a woman's recovery. Talking to other PND sufferers in a support group or to a trained counsellor, may be particularly helpful. Individual or group psychotherapy (CBT or interpersonal therapy) have shown to be particularly effective. In more severe cases or those in which the condition does not respond to non-pharmacological treatment, your doctor may prescribe anti-depressants or other medications, to bring about a change in mood.

Overcoming postpartum depression:

If you are feeling low, there are a number of things you can do to help yourself.

* Keep in mind that it is common for women to experience some form of depression after delivery. Most mothers find it comforting to talk to friends who have had similar experiences. Local support groups such as the Le Leche League may also offer valuable advice. It is important not to bottle up your feelings, this can make matters worse.

* If any of the risk factors for postnatal depression are identified before or during your pregnancy, attempt to take preventative measures before the postpartum period.

* Be flexible and realistic. Often our preconceived ideas and plans for the ideal childbirth do not come to pass and some disappointments may occur.

* Insist on developing an early bonding relationship with your child and rooming-in, in the hospital. This will allow for any tension-producing problems to be sorted out immediately, and not left to be dealt with at home.

* Avoid extreme fatigue at all costs and get as much rest as possible. Your most important responsibility is to your baby and yourself. Allow others to help you at home, with the housework, dishes and meals. Catnap during the day, and get someone to help you with night feeds if possible.

* Seek help immediately if you begin to experience symptoms of insomnia and loss of appetite.

* Take a few hours a week for "me" time. Go for a walk, in order to clear your mind. A brisk walk in the fresh air can help lift your spirits. Treat yourself to some form of physical activity, even if you have to force yourself initially. Spend time with a friend.

* Make an effort with your appearance. If you look good, you feel good.

* Don't feel compelled to entertain visitors unless you wish to do so. Your only obligations are to your baby, yourself and your husband.

* Seek help from your husband and be specific in telling him what you need.

* Good nutrition is essential. Ensure that you follow a healthy, balanced diet, even if you sometimes have to force yourself to eat. Include plenty of fresh fruit and vegetables, and avoid bingeing on chocolate, sweets and crisps. Eat little and often. Avoid going on a strict diet.

* Severe exhaustion after giving birth may be compounded by a potassium deficiency. Low potassium levels are easily corrected by eating plenty of potassium rich foods, such as bananas or tomatoes.

* Avoid any major upheavals during the postpartum period. Don't start a new job, move house or redecorate.

* It is common to experience aches and pains postnatally, especially if you are depressed. Try to take them in your stride - they will fade over time and improve if you relax.

* Be kind and gentle towards yourself. Don't force yourself to do things you don't want to do or that you may find upsetting. Don't worry if the house is not spotless or if there is a lapse in household tasks. Rather focus on small, undemanding tasks and reward yourself on their completion.

* Drugs should only be used for postpartum depression on the advice of your doctor.

* Believe in recovery. Bear in mind that you will get better, even if it takes some time.

What fathers can do:

As a father, you may feel helpless because like any psychiatric illness, PND may be difficult to understand. Remember that the condition is temporary and treatable, so try be patient. Here are some guidelines on how to help your partner during the postnatal period:

* Talk and listen to your partner. Bear in mind that PND is an illness and be sensitive to your partner’s emotional needs. Don't tell her to pull herself together because she can't and don't assume she'll snap out of it, because she won't. Rather empathize with her feelings. "You must be feeling very tired. I understand". Avoid reactions of anger if she seems tired and irritable.

* Mothers need mothering too. Encourage your partner to rest, eat and drink properly. Compliment your partner frequently. Free your wife from unnecessary tasks that may keep her away from the baby, and that she may find overwhelming during this time. For example, help with the dishes or if a friend asks if you need anything? say 'Yes, please bring supper tonight'.

* Be sensitive to and aware of early signs of exhaustion and depression. Your wife may be unable to ask for help, for fear of being seen as weak or she may cover up her shaky feelings.

* Respect the nesting instinct. Avoid making any major life changes, immediately after childbirth, such as moving house or changing jobs. This can be particularly unsettling at this time because mothers have a strong nesting instinct. To upset the nest, is to upset the mother.

* Encourage your partner to be with the baby as much as she'd like to. Some women need to take things slowly and they will gradually figure out where the baby fits in.

* Spend time with your partner and make sure she's not alone too much.

* Set strict visiting policies with friends and family, even if you follow the same visiting principles as those enforced in the hospital.

* Convey your love to your wife. Although she may know that you love her, express and convey these feelings to. The greatest gift you can give your child is to love his/her mother.

* If you feel that your wife is suffering from PND and is refusing to admit that she may be ill, see your doctor first for advice. He may organize for an informal visit at home.

PND and your relationships:

1) Post natal depression can put a strain on even the most loving relationship and it is common for couples to feel that their relationship has been soured beyond repair. Generally, this is not the case and relationships return to normal, once the depression has lifted. Avoid making any major life decisions while you are suffering from PND.

2) Women suffering from PND generally withdraw from everyone, including their child. It is important to bear in mind that this is a symptom of the condition, and that you are not a 'bad' mother. The bonding relationship between mother and child is an ongoing process. Once the depression lifts, you will once again begin to experience the full range of emotions and start to enjoy your baby.

POSTPARTUM PSYCHOSIS

Can you imagine all of a sudden realizing that you had recovered from an illness that you had no idea you were suffering from, or that it even existed in the medical books in the first place? Postpartum psychosis is the most cruel, twisted joke Mother Nature could ever play, and probably on the list of the world's best-kept secrets from the general public. The miracle of birth - the time in one's life that is supposed to be full of a special, never before experienced kind of joy. Instead, it can turn into something beyond one's worst imaginable nightmare”

Postpartum psychosis is a rare illness, affecting approximately 1 or 2 out of every 1000 deliveries. The onset is usually sudden, occurring within 4 weeks of giving birth. Because psychosis involves delusional thinking and irrational judgement, postpartum psychosis is a medical emergency that requires immediate treatment and careful monitoring by a trained healthcare professional. It is important to bear in mind, that if you do suffer from postpartum psychosis - it is not your fault and you are not to blame. With professional help, postpartum psychosis is a temporary and treatable condition.

Symptoms:

Symptoms of postpartum psychosis can include the following;

  •  Delusions or strange beliefs
  •  Hallucinations - seeing or hearing things that are not there
  •  Feeling very irritated
  •  Hyperactivity
  •  A decreased need for or inability to sleep
  •  Paranoia or suspiciousness, such as feeling everyone is against you
  •  Rapid mood swings
  •  Communication difficulties

There is a 5% infanticide and suicide rate associated with postpartum psychosis. This is because women who experience psychosis are having a break from reality. In their psychotic state, their delusional thinking, that is often religious in nature, makes sense to them. This makes immediate treatment essential. However, not all delusions are destructive nor do they necessarily contain violent commands. Delusions can take many forms and most women who experience postpartum psychosis, do not harm themselves or anyone else. Neglect, rather than infanticide, is a much more common result of psychosis.

Risk factors:

The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.

Treatment:

Puerperal psychosis is regarded as a medical emergency that usually requires inpatient treatment. Acute treatment with anti-psychotic medications is indicated. Since there is a well established relationship between postpartum psychosis and bipolar mood disorder, postpartum psychosis is usually treated as an affective psychosis and a mood stabilizer is indicated. Women with a history of bipolar or postpartum psychosis may benefit from prophylactic treatment with lithium, given either before or within 24 hours of delivery. Breastfeeding may be problematic for women with postpartum psychosis. Firstly, significant disruptions in sleep may make mothers more vulnerable to relapse. Secondly, various mood stabilizers have been associated with toxicity in nursing infants. However, since psychiatric illness has a significant effect on the mother and her child, avoiding or discontinuing medication postnatally, is not always the safest option.

The possible effects of untreated postpartum illness:

Untreated postpartum depression can have a huge impact on the lives of people with the illness, their family and friends, and the baby. Untreated depression can lead to:

  • Marriage problems
  • Family problems
  • Financial difficulties
  • Difficulties finding or persevering with employment
  • Drug and alcohol abuse
  • Anger management problems
  • Difficulties bonding with children
  • Suicide

Conclusion:

Adjusting to life as a mother can be difficult. Many women report, that having a baby is the most significant life-changing event that they will ever experience. Adjusting to this major life change and coping with the daily stress of a new baby can make some women more prone to developing some form of depression postnatally, even if they have never suffered from depression in the past. Whether you develop baby blues, PND or postpartum psychosis, there is effective treatment available and full recovery is possible. In the words of a PND sufferer, "For all of you reading this and who are experiencing this very debilitating illness now, remember you will get better, it is a gradual and timely recovery, but postnatal depression does go and you will live life to the full again."

References:

http://www.nhs.uk/

http://www.tenderbabycare.com/

http://www.beyondblue.org.au/

http://www.ppdsupportpage.com/

http://www.betterhealth.vic.gov.au

http://www.postpartum.net/

http://www.denverpost.com/

http://www.womenshealth.org

http://www.emedicine.medscape.com/

http://www.postnataldepression.com/

http://www.ncpych.ac.uk

Leary, P.M. (1990). Creative Parenting: How to use the concept of attachment parenting to raise children successfully from birth to adolescence. Struik Timmins: Cape Town.

Stoppard, M. (2005). Family Health Guide: The essential home reference guide to a lifetime of good health. Dorling Kindersley: Great Britain.