Dr Sekela Gad-Briggs
A Nigerian expert in women’s health and mental well-being has spoken about about postpartum disorders. Dr Sekela Gad-Briggs is a general practitioner at the National Health Service, England, with interest in women’s health and mental well-being. She tells Fidelis Chidi Blog about postpartum disorders.
What is postpartum?
Postpartum refers to a period of time
following childbirth. It is commonly defined as six weeks after birth.
However, in the case of postpartum depression, this can be diagnosed up
to 12 months following childbirth.
What are postpartum disorders?
Postpartum disorders are mental health disorders which can affect women following childbirth.
Are they different from postpartum psychiatric illness, baby blues or depression?
Baby blues are intense mood swings
caused by high hormonal changes occurring during and after childbirth,
and they affect approximately 80 per cent of mothers. It is not
considered a psychiatric illness. Women may feel a huge mix of emotions
from joy, love and pride to worry, sadness and frustration. The baby
blues are usually mild symptoms and pass within 10 to 14 days. If
symptoms persist more than a couple of weeks, then this could be a sign
of something more serious like a postpartum disorder (postpartum
psychiatric illness).
What are the different types of the postpartum disorder?
There are postpartum depression, postpartum psychosis (puerperal psychosis) and postpartum obsessive compulsive disorder.
Are there major causes?
There is no single cause, but certain
women may be at an increased risk of developing a postpartum disorder.
Possible causal factors include previous psychiatric history such as
depression, bipolar disorder, or schizophrenia; previous postnatal
depression, family history of psychiatric problems, and unwanted or
unplanned pregnancy. Others are complications in pregnancy or
childbirth, having a baby with health problems or special needs,
multiple birth (twins or triplets), difficulty breastfeeding,
relationship problems with spouse or partner, stressful events in the
preceding 12 months, e.g. pregnancy complications, job loss, illness,
financial problems, and weak support system, e.g. lack of good friends
or family support.
Is postpartum disorder genetic?
If the mother has family members who
have suffered from postpartum disorder, she is at a slightly higher risk
of developing it, but it is not guaranteed that she will have it.
There is no single inherited gene known to cause postpartum disorder.
However, women with a first-degree relative with postpartum psychosis or
bipolar disorder are at a higher risk of psychosis.
At what time does postpartum disorder occur?
Postpartum disorders normally present
within the first six to eight weeks after childbirth. But they may be
diagnosed up to 12 months after birth.
How is it diagnosed?
Screening for mood disorders should
begin during the pregnancy period so that any signs and symptoms are
picked up early. Patients at risk of postpartum psychosis should have
specialist care during pregnancy and be seen by a psychiatrist.
Diagnosis after childbirth requires assessment of the mother’s mood,
with depression scales commonly used to score the woman’s symptoms, and
an assessment of the mother’s feelings for and attachment with the
baby. Various healthcare workers who may come into contact with the
mother and baby after birth, such as doctors, nurses, midwives and
health visitors are able to perform such assessments.
What are the signs and symptoms that show that a woman is suffering from a postpartum disorder?
The signs include postpartum depression
or PPD. PPD usually presents in the first one to two months following
childbirth. However, the mother may have noticed the onset of milder
symptoms of depression during late pregnancy. The symptoms of PPD are
much the same as symptoms of depression occurring at other times during a
woman’s life and they include sad mood, tearfulness, loss of energy or
fatigue, loss of interest in things normally enjoyed, and withdrawal
from family and friends
They also include change in appetite,
feeling of worthlessness or guilt that they are not a good mother, sleep
disturbance, poor concentration, suicidal thoughts, anxiety and panic
attacks, and constant negative thoughts.
Postpartum psychosis is the most severe
form of postpartum disorder. It has a sudden severe onset with symptoms
starting as early as 48 hours after delivery, with the majority of
women showing symptoms within the first two weeks. The symptoms include
confusion and disorientation, trouble sleeping, hallucinations (voices
instructing the mother to harm herself or her child) and delusions
(thoughts or beliefs that are highly unlikely to be true).
What are the complications?
In postpartum psychosis, there is a
significant risk of the mother taking the infant’s life, or her own. She
may act on the suggestions of the voices she hears instructing her to
cause harm.
What are the various treatment options?
Treatment for postpartum depression or
OCD can usually take place at home with medication such as
antidepressants, and psychological therapy (counselling). For more
serious postpartum depression cases, or women with postpartum psychosis,
most women need to be treated in hospital, ideally in a specialist
unit for mothers and babies or in a general psychiatric unit.
The mother may be advised to take
prescribed medication such as antidepressants to resolve symptoms of
depression; antipsychotics to help with symptoms such as hallucinations
and abnormal thoughts; and mood stabilisers to stabilise the mood
swings and prevent symptoms returning. Psychological or
electroconvulsive therapies may be recommended. Electroconvulsive
therapy is very rarely used, but may be tried if a woman has severe
depression or psychosis that has not responded to other forms of
treatment. Most women with postpartum disorder make a full recovery if
they receive the right treatment.
Is postpartum disorder common among certain age groups?
Postpartum disorders can affect any age
group. However, studies have shown that both very young mothers and
older mothers above the age of 40 years show a slightly higher risk of
having a postpartum disorder.
Is it more prevalent among Africans?
Postpartum depression affects
approximately 10 to 15 per cent of mothers every year in the UK and the
US. However, there are much higher rates reported in developing
countries. Postpartum psychosis is much less common, affecting one or
two in every 1,000 women after childbirth. Due to limited research, it
is hard to say whether postpartum disorders are more prevalent amongst
Africans. However, it has been shown that African women are less likely
to seek help for symptoms of emotional distress and try to cope with
things alone. This may lead to them being diagnosed late and with more
severe symptoms by the time they present.
Recently, a young Nigerian woman
was reported to have killed her baby by drowning her in a bucket
before reporting herself to the police. She claimed the baby cost her
the chance to go to university and that she felt no remorse after
murdering her baby. Can this be linked to postpartum disorder?
This is a very extreme and sad case. The
medical details are not known and therefore I can only speculate. It
is very likely that this young mother was suffering with postpartum
psychosis causing depression, despair, abnormal thoughts and possibly
hallucinations and hearing voices telling her to cause harm to her
child. Severe psychosis can cause lack of insight, where the person does
not even recognise that they are unwell, and they have no control over
their actions. Those around them may not recognise that they are in a
dangerous situation. It appears she may have had a lack of social and
financial support which may have further worsened the situation. The
father of the child did not want to be involved and the young woman
stated that she had wished to abort the pregnancy but her father
refused. Both she and her sister, whom she lived with, had no financial
income. It was reported by the sister that their late mother had a
history of mental health problems.
How should such a case be handled?
This case is very difficult and complex.
In addition to the legal enquiry, it is very important that a full
mental health assessment of the young woman is conducted to get her the
necessary treatment for any psychiatric disorder.
How can families help their loved ones suffering from postpartum disorder?
Relatives can help their loved one
recover by taking time to listen, being calm and supportive, and helping
with errands and chores. They can also help with childcare so that the
mother can have a break to rest and sleep. They should not have too
many visitors at one time but should keep the home environment calm and
quiet.
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