Vijai P. Sharma, Ph.D
As the case of Andrea Yates is "heard" in the court of the public media, the health of the motherhood is under close scrutiny. Questions and concerns abound but answers are hard to come by. So, let's look at what we know about mood disorders during pregnancy and after the birth of a baby.
There are three discrete conditions that deserve to be differentiated from one another: 1. The "Baby blues" 2. Post-Partum Depression and 3. Post-Partum Psychosis.
According to the Post-Partum International report, five to eight out of ten mothers may experience mild baby blues lasting a few weeks, typically a couple of weeks. Symptoms often involve weepiness, irritability, poor sleep, nightmares, nervousness or mood swings. Other symptoms may include lowered self-confidence, feeling overwhelmed or feeling something to the effect, "I'm not myself; this isn't me."
But, only one out of ten mothers may experience "Post-Partum depression." Post-partum depression may include despair and hopelessness, tearfulness, feelings of inadequacy, guilt, anxiety, irritability, insomnia, fatigue, lack of energy, non-restorative sleep, food cravings or loss of appetite, impaired concentration, memory problems or loss of normal interests. Some may even experience suicidal thoughts.
Such depression, instead of weeks, may last for months. It is a clinical depression and needs prompt treatment.
In about one thousand cases, the mother of a newborn might experience Post-partum psychosis. Onset of the psychotic disorder is severe and quick, usually within the first couple of months. Post-partum psychosis is mainly characterized by delusions and/or hallucinations. The term "delusions" refers to false beliefs, which others would regard as baseless or absurd, but the person suffering them believes them to be true. The term, "hallucination" refers to seeing or hearing things that do not exist in reality.
Other symptoms of Post-partum psychosis may include hyperactivity, rapid speech, mania, inability to stop an activity or just frantically excessive energy. Suspiciousness, irrational statements or a preoccupation with trivia, which are totally out-of-character for the mother, may also be observed.
Post-partum psychosis is a serious problem and needs immediate professional attention. Unfortunately, there is limited public awareness about psychotic disorders and need for prompt treatment. It is estimated that only two out of ten mothers suffering from psychotic symptoms actually seek treatment.
Some post-partum symptoms may be specifically directed towards the baby such as the fear of harming the baby; lack of interest and or interaction to the baby, excessive concern for, lack of feeling or no feelings for the baby.
In an extreme form of a psychotic disorder, particularly the one with bizarre delusions, a mother may believe that her baby is evil, such as being a child of, or an incarnation of Satan himself. She may believe that she herself is possessed by the Devil. This is extremely rare. Years ago, when I worked in a state mental institution, I saw only two such cases. Fortunately, they were hospitalized early on and received proper care and supervision.
Some women may have an underlying Obsessive-Compulsive Disorder (OCD), which may surface or become exaggerated after the birth of a baby. Due to their OCD, they may be obsessed with the fear that they might harm their baby. Their compulsive behaviors and rituals may increase. However, they are not confused regarding what is real and unreal. They do not have delusions about their own identity or that of their baby; they simply worry too much about the possible harm they might cause to their baby.
There are stressors may increase the chances of developing a post-partum disorder: previous history of a mental disorder such as depression, anxiety disorder, panic attacks or trauma; high level of conflict and stress in the marriage or family; Caesarian birth or other birth complications, feelings of inadequacy as a mother; mixed feelings regarding pregnancy and the role as a working woman and housebound mother; lack of family and social support. Additionally, the mother's weight after the birth of the baby might become a self-esteem issue.
There is a greater incidence of post-partum depression at the birth of the first child. If a mother suffers from post-partum depression at the birth of the first baby, there is a greater likelihood of her experiencing a mood disorder following subsequent births, compared to mothers who had no such difficulty the first time. If a mother has a history of emotional difficulties, she is more vulnerable to post-partum problems compared to mothers who don't have such a history.
If the depression doesn't go away in a couple of weeks, a mental health consultation should be arranged. If clinical depression continues without relief for a long time, it may have a negative effect on the physical and emotional health of the mother and the baby. Post-partum psychosis may have even more serious consequences.
Attributing post-partum disorders to the "flooding" of hormones and other chemical imbalances related to the pregnancy and birth might obscure the significance of psychosocial factors. Birth of the baby and a woman's entry into motherhood are family and community concerns. Many societies have rituals and ceremonies that celebrate and honor a mother and focus on supporting her and paying attention to her needs. Such attention and support is hard to come by in a relocated family living in a "bedroom community".
Are the emotional needs of a mother being met? Is her marriage stable and strong? Are extended families of both partners supportive? Is the work environment supportive of the needs of the working parents? Social and family support is vital to the health and happiness of the parents and their newborn child.
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Copyright 2002, Mind Publications
Dr. Vijai Sharma
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