Postpartum Illness

Having a baby is supposed to be a time of great joy and excitement for new mothers. Childbearing is usually marked with celebration, families and the broader community may forget that this can be a stressful time for a mother, perhaps overwhelmed with all the sudden changes. No new mother can fully comprehend the enormous amount of work that is involved in caring for a newborn child until she actually begins to meet the everyday challenges of motherhood.

Childbearing is a special time in a woman’s life—a time of changes, both physical and emotional. During pregnancy, her body changes, her hormones are in flux, and she has to come to terms with the joys and responsibilities of a new life growing inside of her. After childbirth, she still has to deal with her own changes, but now has to take care of her baby’s needs as well.

One moment they may be feeling exhilarated and on top of the world and the next moment feel frustrated, inadequate and totally incapable of meeting the newest challenges that motherhood has delivered to your doorstep. Sometimes, the experience can be so disorganized and exhausting that the woman becomes too sad, anxious or overwhelmed to get back to her normal life.

The Postpartum Period

Postpartum means “after birth” and postpartum illness is a term used to describe a range
of emotional problems that can negatively affect a mother after giving birth. Some women experience postpartum illness right after birth, but it can happen anytime during the first year. During the postpartum period, about 85% of women experience some type of mood disturbance. For most the symptoms are mild and short-lived; however, 10 to 15% of women develop more significant symptoms of depression or anxiety.

Postpartum psychiatric illness is typically divided into three categories:

1) Postpartum blues (“Baby Blues”)
2) Postpartum depression and
3) Postpartum psychosis.

“Baby Blues” — Not Considered a Disorder

This is not considered a disorder since the majority of mothers experience it.
Baby’ or maternity blues are a mild and transitory form of ‘moodiness’ suffered by about 50 to 85% of postpartum women. Often the term “baby blues” is used to describe a short period of mild depression which many women experience after having a baby. It usually starts 1 to 3 days after delivery and can last for several weeks.

Post Partum is characterized by following symptoms:

Lack of Sleep
No Energy
Food Cravings or Loss of Appetite
Anxiety and Excessive Worry
Feeling, “I’m not myself; this isn’t me”
Lack of Confidence
Sadness
Feeling Overwhelmed
Crying more than Usual
Hyperactivity or Excitability
Oversensitivity
Feelings Hurt Easily
Irritability
Lack of Feeling for the Baby

While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes the blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression. If symptoms of depression persist for longer than two weeks, the patient should be evaluated to rule out a more serious mood disorder.

Post partum depression

Post partum depression can develop when the “baby blues” become worse. The depression can develop more slowly and may not be noticeable until several weeks after the baby’s birth. .Estimates of its occurrence range from 3% to 20% of births.PPD typically emerges over the first two to three postpartum months but may occur at any point after delivery.
Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life. Women who experience postpartum depression often describe the following feelings or symptoms:

Headaches, Numbness, Chest pain, Hyperventilation
Tearfulness
Loss of interest in usual activities
Feelings of guilt
Feelings of worthless or incompetence
Extreme fatigue, sluggishness, exhaustion
Feelings of sadness, hopelessness and misery
Difficulty sleeping
Appetite disturbances
Feeling extremely anxious, scared, and panicked for much of the day
Inability to cope with everyday situations
Unrealistic concerns for the baby’s well being
Thoughts of harming oneself or the baby

Postpartum depression is not restricted to women who are giving birth for the first time, either. It is just as likely to affect women who are adopting, and those who have had children before. Moreover, it can occur anytime from right after childbirth, to a few months later.

Postpartum Psychosis

Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.

It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.

Patients with postpartum psychiatric illness are offered a variety of services by Clinicians, Psychologists and Psychiatrists:

Clinical evaluation for postpartum mood and anxiety disorders
Medication management
Consultation regarding breastfeeding and psychotropic medications
Non-pharmacological treatments: cognitive-behavioral therapy, Interpersonal therapy etc.
Referral to support services within the community

The type of treatment selected is based on the severity and type of symptoms present.