Postpartum Depression

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Postpartum depression, also called 'postpartum blues' or 'baby blues', is a condition in which a woman has moderate to severe clinical depression after childbirth. It usually occurs 3-4 days after delivery of the baby but can occur at any time upto one year after childbirth.

It is natural for many new mothers to have mood swings after delivery, feeling joyful one minute and depressed the next. Feelings of anxiety, irritation, tearfulness, and restlessness are common in the week or two after pregnancy. These feelings are known as the 'postpartum blues' or 'baby blues', and often go away by the end of the second week of delivery without the need for treatment.

But some women may experience a deep and ongoing depression which lasts much longer and can get worse instead of better as time goes by. This is clinical depression and needs treatment for a complete recovery.

The incidence of postpartum depression is believed to range between 10-20%. Women who have had postpartum depression in previous deliveries have a 50% more chance of developing it again.

It is suspected that most of the women who suffer from postpartum depression have an underlying subclinical depression which flares up due to the pressures and stresses of a normal pregnancy.

Women who complain during the pregnancy that the baby is unwanted or that she is having marital problems should be carefully watched during the postpartum period. She is likely to develop depression to a greater or lesser extent after chidbirth.

Types of Postpartum Depression

Although the terms 'postpartum blues' and 'postpartum depression' are used interchangeably for the same condition, researchers describe them as different conditions. There are three types of postpartum depression.

  • Postpartum Blues: This is a minor depression which occurs in the first two weeks after childbirth, is associated with mild mood swings, anxiety and stress and clears up spontaneously. It needs no treatment.

  • Postpartum Depression: This is a form of depression which is severe enough to interfere with a woman's daily activities. She may not only suffer from unexplained fears and anxiety but may be unable to look after herself or the baby. This form of depression needs to be treated for a recovery.

  • Postpartum Psychosis: This is a very rare disorder, occurring in approximately 1 to 2 out of every 1000 deliveries. The symptoms include extreme confusion, fatigue, agitation, hallucinations, delusions, illogical thoughts, insomnia, refusing to eat, extreme feelings of anxiety, agitation, rapid speech, delirium or mania as also suicidal or homicidal thoughts. This condition needs immediate treatment and the baby should be removed form the mother until she recovers.

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Risk Factors of Postpartum Depression

  • Hormonal Imbalance: Hormonal imbalance after childbirth is believed to be the main cause. But very often there are associated problems like prolonged labour or difficult childbirth which triggers off postpartum depression.

  • Prolonged or difficult labour: A prolonged and difficult labour leads to severe exhaustion in the woman. At this stage, if she is further burdened with the task of having to care for a newborn all alone, she is likely to get depressed.

  • Severe eclampsia: Pre-eclamptic toxemia (PET) can cause edema (collection of fluid) in the brain. The women may be confused about herself and the baby and be severely depressed.

  • Postpartum complications: Postpartum Complications like infections, breast engorgement, breast abscess can cause severe postpartum depression or postpartum blues.

  • Chronic Fatigue: Fatigue is common with loss of sleep immediately after the delivery.

  • Previous Psychological Problems: Women who have had previous psychological problems like depression, panic attacks, anxiety, bipolar disorders are more at risk for developing postpartum depression.

  • Sudden let down of the excitement felt during pregnancy and labor.

  • Fears of not being able to care for the baby. Lack of a support network can also push a woman into depression.

  • Anxiety of becoming unattractive to the spouse or a difficult relationship with the husband or other family members.

Signs and Symptoms of Postpartum Depression

  • Baby blues which do not fade after 2 weeks.
  • Depression which gradually increases in time.
  • Feelings of sadness, guilt, doubt or helplessness, especially about the baby.
  • Anxiety or panic attacks.
  • Trouble carrying out daily activities in the house.
  • Headache, not controlled by medicines.
  • Insomnia -inability to sleep- or other sleep disorders.
  • Delusions /confusions about herself or the baby. Inability to care for herself or the baby.
  • Refusal of food. Refusal to talk to other people. Becoming gradually less communicative.
  • Manic depression - becoming completely cut off from her surroundings, people around her and the baby and losing complete interest in anything.
  • Fears of harming the baby.
  • Tendency to suicidal thoughts or self harm.

Management / Treatment of Postpartum Depression

  • Good Nursing care to make the woman as physically comfortable as possible. A breast pump to express out the breast milk and prevent breast engorgement and breast abscess, clean vaginal pads and a regular washing and bathing routine will do much to make the patient feel comfortable.

  • Maintenance of good nutrition.

  • Care of the bowels especially by managing constipation.

  • Relieving the patient of some of the care of the baby. A nurse or a relative can look after the baby, while allowing the woman to breastfeed and handle the baby from the time to time.

  • Sedative, anti-psychotic and anti-depressant drugs- Anti-depressants should be prescribed as soon as the woman shows mild signs of depression.This will help to bring the depression under control before it deteriorates further.

  • Careful watch over the patient for any signs of tendency to commit suicide.

  • Separating the baby from the mother in cases of manic depression and if there is a fear of infanticide.

  • Enlisting the help of a local support group is usually beneficial.

Most women with postpartum depression usually recover completely with proper care and treatment.

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