Childbirth is one of several important life events. Psychiatric disorders that occur after childbirth are usually divided into three categories: Sadness, depression and psychosis. It is important to note, however, that all three conditions are, along the same lines, manifestations of a psychiatric spectrum of varying severity.
The depressive state can range from a normal state of baby blues to a colorful and rapid-onset psychotic depression.
The Sadness of Motherhood
It occurs in about half of mothers after childbirth. It is a condition characterized by emotional volatility and crying in the first 7-10 days after birth, with a rapid onset and rapid disappearance. The duration is usually between a few hours and a few days. Although many hormonal and sociodemographic studies have been conducted, no significant results have been obtained.
Postpartum sadness is thought to be a continuation of the tension and restlessness experienced before delivery. Two important risk factors have been proposed for this.
-First time pregnancy,
-The patient has a history of premenstrual syndrome (premenstrual tension syndrome).
In general, this is considered normal and only patience and confidence-building approaches are recommended.
Depression
Depression occurs in 16 percent of mothers within one year following the first birth. Studies have suggested that cognitive predisposition, marital tension and dissatisfaction experienced during pregnancy, and undesirable life events are important factors in this regard, while expectations and concerns about child care have not been reported to be decisive.
The greatest risk factor for postpartum depression is the presence of a history of depression. Hannah and colleagues, who have conducted many studies on this subject, found that low birth weight, cesarean delivery, a more difficult delivery than expected and bottle feeding were associated with high rates of depression. Other risk factors include out-of-wedlock birth, stillbirth and family history of the disease.
Symptoms of the disease are consistent with typical symptoms of depression. The patient complains of crying, unhappiness, sadness, grief, reluctance, sleep and appetite irregularities.
Depression in the mother also has significant effects on the baby. It has been found that depressed mothers have decreased maternal skills, weakened responsibilities towards their babies, look at their babies’ faces for a shorter time during feeding and show less positive attitudes. It is thought that infants also show cognitive and emotional weakness and passivity in such a situation, and therefore the infant’s behavior exacerbates the mother’s depressed affect and perception of herself as inadequate in mothering.
Postparum Psychosis
Often depression and accompanying delusions (hallucinations) are characterized by the mother having thoughts of harming the baby and/or herself. Some mothers may act out such thoughts, with quite dramatic consequences. Therefore, such thoughts should be especially carefully monitored.
The incidence of postparum psychosis is 1-2 per 1000 births. Almost half of the women with this disorder have a family history of psychiatric illness (especially mood disorders such as depression and mania). Although it is mainly a female disorder, fathers can also be affected in rare cases. In these rare cases, the father may have feelings and thoughts that he may have switched places with the child and that he has to compete with the child for the mother’s love and attention.
A small proportion of postparum psychosis may be caused by a general medical condition such as infection, intoxication due to drugs used during labor (scopolamine, meperidine, etc.) or excessive blood loss. It is also thought that sudden changes in hormones (estrogen and progesterone) after childbirth may be a factor. However, treatments with these hormones are ineffective.
The fact that it is often seen following the first birth suggests that only psychosocial mechanisms of action are involved and that postparum psychosis may be related to recent stressful experiences.
Most prominently among these,
-the presence of emotional conflicts in the mother related to the motherhood experience,
-feeling trapped in an unhappy marriage because of childbirth,
-involuntary conception,
-excessive fear of childbirth,
-marital problems during pregnancy.
Symptoms of postpartum psychosis begin within 8 weeks after delivery. Specifically, the patient complains of fatigue, insomnia and inability to listen, and there may be periods of crying and emotional volatility. This may be followed by disorganization, confusion and incoherence in thoughts and speech, illogical statements, skepticism, and unwarranted obsessions about the baby’s health. Delusions (unrealistic thoughts and beliefs) occur in almost half of all patients and hallucinations (unrealistic perceptions in the form of sounds, sights or smells) in a quarter. Complaints of inability to move, stand and walk can be observed frequently.
The patient may have feelings of not liking the baby, not wanting to take care of the baby, harming the baby, herself or both. The content of the delusions is mostly the thought that the baby was born dead or disabled. The patient may deny that she gave birth or even claim that she is unmarried or a virgin. He/she may also talk about evil being done to him/her, conspiracies, being controlled and manipulated by someone. Hallucinations are of a similar nature and may include hearing voices telling the patient to harm the baby or herself.
A few days before the noisy and dramatic presentation of the illness, there are usually initial symptoms of insomnia, inability to rest, emotional volatility, nervousness and mild cognitive impairment (forgetting, confusing and confusing dates, places and people). When psychosis occurs, one should be especially careful about the harm that the patient may cause to herself or the baby. Studies have shown that 5 percent of patients kill themselves and 4 percent kill their babies.
An episode of postpartum psychosis is considered as an episode of mood disorder. Mood disorders are episodic disorders, so patients who have had an episode of postpartum psychosis may have another episode in the first or second year after delivery. There is also a high likelihood of relapse in other deliveries.
The biggest difficulty in the treatment of postpartum psychosis is that the mother cannot be given medication because she is breastfeeding. However, in a significant proportion of patients, depending on the severity of the illness and the harmfulness of the patient, breastfeeding should be stopped and medication should be considered. Patients at risk of suicide may need to be hospitalized to prevent such an attempt. If the mother is willing, contact with the baby usually works well. However, possible harmful thoughts and actions should still be considered and necessary precautions should be taken. Psychotherapy is absolutely necessary after the acute psychotic episode has subsided. Good and close environmental support is of great importance in these patients. The patient’s compliance before the illness and having a supportive family structure are effective in the success of the treatment. Studies show that treatment is highly successful in patients with postpartum psychosis.