The birth of a baby is supposed to be a time of happiness and joy, but in reality this a period of major upheaval both for physical as well as psycho-social aspect of an individual's life. The hormonal changes in women's body, sleep deprivation and fatigue culminated with new responsibilities and changes in relationship with her own self and her spouse often cause feelings of anxiety, despair, tearfulness and mood swings, which is called postpartum blues. It happens to occur in up to 80% women following child birth. This condition usually tends to abate over a period of a week to 10 days as the couple adjust to the arrival of a new member in the family. But in certain biologically vulnerable population, the mood disturbance may persist and worsen over a period of time leading to depression and anxiety which requires proper assessment and intervention.
The common risk factors for development of depression in postpartum period are linked to socio demographic, obstetric and genetic variables. Increase incidence is seen in women who have a family history of mood disturbance, stressful conditions due to social, interpersonal or financial factors, difficulty in conception or complications during pregnancy or childbirth.
The consequences of postpartum depression are significantly disturbing for the person suffering from it as well as the child and family. In our society, mothers are given special status amounting to reverence, this makes it difficult for women to acknowledge that they are not feeling so great about having a baby. The feelings of guilt and inability to express themselves further worsen the emotional state and she is unable to be comfortable around the child.
In clinical practice, doubts of "how I will handle the child" to "I am a bad person and don't deserve to be a mother" have often been expressed by patients of depression in puerperium. The situation causes disturbance in parent-child bonding which is important for healthy development of babies. Sometimes, women are blamed for feeling sad, anxious and emotional and family support is actually withdrawn with a belief that if she is left alone with the child, she will learn to deal with it herself, which can overwhelm an otherwise poorly coping psychological state causing sense of helplessness and even suicide.
It is thus important to identify and address the issue right at the beginning. Obstetricians have a major role to play in initial screening during pregnancy as vulnerabilities are highly associated with perinatal psychiatric complaints. Patients indirectly talk about their problems to their doctors and paediatricians and need to be heard carefully instead of downplaying every emotional issue as natural outcome of pregnancy.
Psychological counselling can be started in perinatal women with difficult or complicated conception, especially those who have had miscarriages, or several cycles of IVF to conceive or have struggled with depressive tendencies in past. Similarly, single mothers, history of domestic violence and abuse, working women with no social support for child rearing, certain isolating practices in postnatal period and poor physical health impair stress coping abilities causing higher risk of mood symptoms.
The management of postpartum depression requires proper assessment and timely intervention. The stigma associated with psychiatric diagnosis, and family's reluctance to address the issue due to fear of harming the child delays the process. Awareness of mental health issues is thus of paramount importance to identify and deal with it. Safe and effective treatment options are available to treat women with these problems which not only improve outcomes for suffering patients but also for the children by improving mother child bonding which has positive effect on child's physical health and immune system.
About the author: Dr. Jyoti Kapoor Madan is a well renowned Psychiatrist in Delhi- NCR. With over 15 years of experience, Dr. Jyoti had worked as a Psychiatry Consultant, Researcher and Psychotherapist in her tenure with famous hospitals. She is currently a Psychiatrist at Paras Hospital, Gurugram.
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