A child’s birth is supposed to be a joyful, special time for parents. After months and sometimes years of waiting, mother and father finally get to meet the little person they’ve been anxiously expecting. With a new life and growing family, possibility is everywhere.
For some mothers though, this joyful time can become a nightmare as they sink into depression, anxiety or even psychosis.
Postpartum illness is something most people are aware of, but it is still often spoken of in hushed tones and disbelief. Although many don’t want to think about it, postpartum illness affects between 15 and 20 per cent of all mothers. Of these, 15 per cent experience symptoms to such severity that they attempt suicide.
In fact, the time directly after childbirth is the period of peak prevalence for psychiatric illness in women.
Most postpartum illness is caused by the massive hormonal changes occurring in the new mother’s body. Estrogen, progesterone and other hormones produced during pregnancy are quickly lost with the birth and this triggers changes in the key neurotransmitters involved in many psychiatric illnesses.
Along with the hormonal changes, the addition of a new child is a significant life stressor that can also negatively affect a woman’s mental health in the same way a new job, marriage or major move can.
Several kinds of postpartum illness exist with varying levels of seriousness. The least severe is known as the baby blues. This is not considered a disorder though, because most women will experience it to some extent. Mild symptoms of sadness, anxiety, weepiness, lack of concentration, mood instability and dependency are common.
Full blown depression and/or anxiety affect the largest number of women who experience a postpartum illness. Usually, symptoms begin gradually and it can begin at any time from the onset of pregnancy to within the first year of the child’s life.
Symptoms of postpartum depression or anxiety are the same as symptoms of these illnesses at other points during life. Some specific symptoms related to the postpartum period can include discomfort around the baby or a lack of feeling toward the baby.
Three to five per cent of women will develop obsessive compulsive disorder in the post partum period and 10 per cent will experience panic disorder.
Some risk factors for the more common depression and anxiety disorders include previous postpartum illness, depression or anxiety during pregnancy, personal or family history of depression or anxiety, social isolation or mood changes while taking the birth control pill or fertility medication.
One or two women in a thousand will experience the much more severe postpartum psychosis. This usually occurs in the first few days after the baby is born and symptoms can include hearing voices or seeing disturbing and unreal images.
Women with postpartum psychosis will often hear voices telling them to harm their baby or they may see many visions of themselves hurting their baby. These are usually very upsetting to the new mother and there is a five per cent suicide rate among women who develop psychotic symptoms. There is also a four per cent infanticide rate in this group.
Unfortunately, because of the societal expectation that mothers be unfailingly happy after the birth of their children, the stigma of mental illness is high for postpartum women. As a result, it is not surprising that many women keep negative feelings a secret.
Screening questionnaires and doctor interviews during the prenatal period can help to identify those at risk and ensure that support systems are in place before a crisis develops.
Counseling, medication and social support are all important factors in treating postpartum illness.
It is vitally important for women experiencing postpartum illness to seek help. Not only will support and treatment help mothers, but will also help to keep children safe and happy. Untreated maternal depression can have a profound negative effect on family relationships and the healthy development of children.
Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.