Postpartum Psychological Problems

The period of pregnancy and childbirth results in umpteen changes in the environment of women at several levels: biological, psychological and psychosocial. Pregnancy and the initial transition to motherhood are experienced by several women as stressful.

The hormonal and neurotransmitter environment undergoes several changes which impact the mood state of the person.

There are changes in body image which some women may dislike. She also needs to prepare herself for the responsibility of childcare and this may be in conflict with her other roles especially that of career.

Her relationship with the husband and in-laws may change as the news of arrival of a child may affect the previously existing bonds in several ways. In situations where there is a troublesome relationship between the woman and her husband or the in-laws, the person may be extremely ambivalent about giving birth to a child. 

Postpartum disorders are classified on a continuum ranging from little to severe disturbance and broadly divided into three categories: postpartum blues, postpartum depression and postpartum psychosis.

Postpartum blues

Around 50 to 80% of women experience postpartum blues in the period of first few weeks after the childbirth. It often starts with crying between third to fifth days after childbirth and becomes intense within ten days. Postpartum blues is characterized by frequent changes in mood; the mood may shift from being happy to weepy, anxious and irritable quite rapidly. In a majority of cases, these symptoms disappear within two weeks after childbirth on their own. Though the woman feels disturbed, she can function properly and take care of the child.
As such no treatment is required for postpartum blues but the woman needs to be educated about the condition and its causes. She needs to be reassured that it would remit on its own and that there is nothing to worry about. Constant care and affection from the spouse and other family members is required. However, if these symptoms continue with a high intensity beyond two weeks, a mental health professional should be consulted as this may indicate development of a more serious disorder.

Postpartum depression

When the symptoms of postpartum blues are very intense and disabling and last more than two weeks, the person may be suffering from postpartum depression. The person may feel that she is an incompetent mother and some harm may befall on the baby. She feels sad and unhappy most of the time, gets tired with minimal activity, is tearful and guilty, loses interest in normal day-to-day activities, is unable to take care of the baby, has sleep problems and reduced concentration, feels worthless and hopeless and experiences changes in appetite.

The family members must not criticize or reject the person at this time but provide reassurance and support. During this period, if the mother is extremely depressed other family members should take care of the baby but frequent meetings of the mother and baby should be arranged in the presence of family members otherwise it may adversely impact the future mother-child relationship. Family members should take adequate care of the baby because this troubled time has a potential of negatively impacting the future development of the child. Psychotherapy given by a qualified clinical psychologist or other mental health professionals is very effective in dealing with postpartum depression and in some cases where symptoms are very intense it can be combined with antidepressant medication. The goal of psychotherapy is to alleviate the conflicts that the person is experiencing and develop an insight into them so that she can stop the negative emotions from taking charge of her total personality. With treatment, a majority of patients recover within a year.

Postpartum psychosis

It is the most severe form of postpartum disorders and occurs very rarely. The person is restless and very irritable. She is confused and may have disturbed awareness of the surroundings. Her memory may seem to be impaired. Her self-care, food intake and sleep decline. She appears very slow, disorganized and withdrawn. She may deny that she has given birth to a child. In contrast, in some cases the person may be very hyperactive and energetic, make big plans and display disinhibited and aggressive behavior. She may hear voices (auditory hallucinations) which criticize her for being a bad mother or instruct her to harm herself or the baby. She may experience delusions (false beliefs) that baby is an incarnation of God and people want to harm the baby or that the baby is a devil and must be killed. There is a significant risk that the person may harm herself or the baby and therefore needs to be hospitalized and monitored carefully. The woman suffering from postpartum psychosis needs intensive psychiatric treatment.

Prevention

All women are at a risk of experiencing some degree of psychological upheaval during the postpartum period i.e. the time period following the childbirth. Minor degree of upheaval resolves on its own with time and presence of emotional support from significant others but in some cases where this does not happen women go on to develop clinical disorders. Talk to the person and give her space to express all her thoughts, feelings and anxieties related to pregnancy and childbirth without any criticism. 
Women who have a previous history of suffering from depression, anxiety or other psychological problems are at a greater risk. Experiencing marital problems, recent stress and having an inadequate social support system increases the risk several times.

Therefore, these factors should be kept in mind and if your spouse/daughter/daughter-in-law is exposed to these risk factors it is desirable to monitor her behavior and arrange for professional mental health consultation as soon as you see the first signs of disturbance emerging.