Dr. Dineshani Hettiarachchi Sirisena
“Rocking chair moves, dark room,
Blank stare, melancholy doom,
Holding babe, lanky arms,
Tear falling, first do no harm”
Rock forth, rock back,
Losing grip, feeling slack,
Beautiful girl, pudgy cheeks,
Trying to hold close, feeling so weak”
Above is an extract from a poem written by Jenna Hatfield on her PPD journey.
During the postpartum period, about 85% of women experience some type of mood disturbance.
For most, the symptoms are mild and short-lived. However, 10-15% of women develop more significant symptoms of depression or anxiety.
Postpartum psychiatric disorders (PPD) are observed in one to two out of 1,000 childbearing women within two to four weeks following delivery. Hence, it’s not as rare as once assumed.
To shed light to this less-talked-about topic, we spoke to De Soysa Hospital for Women Consultant Obstetrician and Gynaecologist and University of Colombo Faculty of Medicine Senior Lecturer Dr. Mohamed Rishard (MBBS, MD, MRCOG [UK], Dip. in Laparoscopy [France]).
Childbearing is the most complex event in all human experiences.
The postpartum period is a demanding period due to the overwhelming biological, social, and emotional changes a woman goes through; it requires significant personal and interpersonal adaptation, especially in the case of a firstborn.
Mothers are vulnerable to a whole spectrum of general psychiatric disorders soon after delivery.
According to Dr. Rishard, PPD is typically divided into three categories:
(i) Postpartum blues
(ii) Postpartum depression
(iii) Postpartum psychosis
However, they exist along a continuum where “postpartum blues” is the mildest and “postpartum psychosis” the most severe form of postpartum psychiatric illness.
Untreated postpartum depression can have adverse long-term effects for both the mother and the child.
For the mother, the episode can be the precursor of chronic recurrent depression.
For her children, a mother’s ongoing depression can contribute to emotional, cognitive, and interpersonal problems later in life.
Such children may also be prone to sleep disturbances. Hence, Dr. Rishard feels strongly about addressing any form of postpartum mood disturbance early on, as this is an area largely neglected.
Postpartum depression is also a main contributor to maternal suicide rates.
Therefore, nipping the problem in the bud is prudent to avoid such drier circumstances.
The stages of psychosocial adjustments following delivery have been divided into three phases, each lasting for a few days to a week.
Taking-in phase – this is when a new mother is talkative. Physically, she is convalescing from the birth’s experience and may be markedly fatigued.
She is open, receptive, and welcomes assistance from caregivers and family.
Taking-hold phase – this is when the mother strives for independence and becomes an introvert.
She becomes concerned about the resumption of her own bodily functions and about her infant.
Infrequently, she expresses anxiety over her ability to care for her child. Since much of this phase occurs after being discharged from the hospital, caregivers must provide support and reassurance during this time.
Letting-go phase – the mother establishes her maternal role patterns. Although still centred on the infant, her concerns also return to issues beyond her and the infant.
Symptoms and signs
Postpartum blues – 50-85% of women experience postpartum blues during the first few weeks after delivery.
Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth and not necessarily a psychiatric illness.
Rather than feelings of sadness, women with “blues” more commonly report mood lability, tearfulness, anxiety, or irritability.
These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or even a few days, remitting spontaneously within two weeks of delivery.
When to seek medical help?
. Depressed or sad mood
. Tearfulness
. Loss of interest in usual activities
. Feelings of guilt
. Feelings of worthlessness or incompetence
. Fatigue
. Sleep disturbance
. Change in appetite
. Poor concentration
. Suicidal thoughts
What causes postpartum depression?
The postpartum period is characterized by a rapid shift in the hormonal environment.
Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically.
As these steroid hormones modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shifts in the emergence of postpartum mood disorders.
There is a subgroup of women particularly sensitive to the hormonal changes that take place after delivery – they may be at a greater risk of developing PPD.
Risk factors
. Previous episode of PPD
. Depression during pregnancy
. History of depression or bipolar disorder
. Recent stressful life events
. Inadequate social supports
. Marital problem
. Establishing a diagnosis
Your doctor will usually talk with you about your feelings, thoughts, and mental health to distinguish between a short-term case of postpartum baby blues and a more severe form of depression.
Don’t be embarrassed – postpartum depression is common. Share your symptoms with your doctor so that a useful treatment plan can be created for you.
The Edinburgh Postnatal Depression Scale (EPDS) is a tool available online. In Sri Lanka, the EPDS scale is given by midwives in the field to screen women with postpartum depression. This is available in all three languages.
Once the diagnosis of PPD is established, what next?
Psychotherapy – it may help to talk through your concerns with a psychiatrist, psychologist, or other mental health professional.
Through therapy, you can find better ways to cope with your feelings, solve problems, set realistic goals, and respond to situations in a positive way. Sometimes, family or relationship therapy in the form of counselling can also help.
Antidepressants – your doctor may recommend an antidepressant. If you’re breastfeeding, any medication you take will enter your breast milk.
However, most antidepressants can be used during breastfeeding with little risk of side effects for your baby. Your doctor will work with you to weigh the potential risks and benefits of specific antidepressants.(Source: Mayo Clinic)
Mental health, once the most neglected problem in public health, is today considered to be crucial to the overall wellbeing and productivity of individuals, communities, and countries.
Dr. Rishard further emphasised that it is best to seek treatment as soon as possible. If it’s detected late or not at all, the condition may worsen.
If you are currently being treated while you are recovering from postpartum depression, you will probably see an improvement as months go by.
Keep in mind that your symptoms can flare up before a menstrual period due to hormonal fluctuations.
Finally, is it true that it takes a village to raise a child, and community interaction is important not only for a newborn but also for the mother.
During this phase of a new mom’s life, social and family support is crucial as it will help speed up the recovery process, helping her enjoy the fruits of her labour.
As more and more women are now aware of mental wellbeing, it is important to herald such conversations openly to build a strong support network, and staying numb about such issues of paramount social importance should be a thing of the past.
Dr. Mohamed Rishard (MBBS, MD, MRCOG [UK], Dip. in Laparoscopy [France])
About the writer
The writer, Dineshani Hettiarachchi Sirisena, is a family physician with a special interest in rare genetic diseases and regenerative medicine currently working as a lecturer at the Department of Anatomy, Faculty of Medicine, University of Colombo.
