Mental health

The puerperium is a high risk time for mental illness and it is important that health practitioners routinely enquire into maternal wellbeing. The rate of postnatal depression and anxiety is high-15%, and the postnatal period is also a time for other psychiatric disorders, such as bipolar mood disorder, to flare. Suicide is one of the leading causes of maternal death in New Zealand, so it is important to screen for, diagnose, and treat perinatal mental health disorders promptly. Your textbook contains a good section in Chapter 9 on Mental health following birth and this RANZCOG article also gives a general overview of the common psychiatric conditions during this period. Further links have been included in this section if you are interested in further information. 

The "Baby Blues" 

• Commonly occurs between days 3-5 after birth and is related to hormonal changes 
• Self-limiting 
• Lasts 1-2 weeks and is usually completely gone by day 10 
• Symptoms include: 
• Feeling weepy and flat 
• Emotional lability 
• Feelins of inadequacy 
• Reduced appetite 
• Feeling overwhelmed 
• No intervetion is required other than support, understanding, and helping to relieve anxiety 

Postnatal depression and anxiety 

• Risk factors for postnatal depression and anxiety include: 
• Previous episodes of depression and anxiety 
• Stressful pregnancy or difficult birth 
• Poverty 
• Social isolation and poor social support 
• Family violence and conflict 
• Previous physical, sexual, or emotional abuse 
• Pregnancy loss 
• Perfectionistic or borderline personality traits/disorders 
• Postnatal depression can affect both the mother and the baby- it interferes with bonding and increases the chance of cognitive problems and language delay in the baby 
• We use a special score called the Edinburgh Postnatal Depression Score when assessing for postnatal depression as there are symptoms specific to this disorder and is different from the Kessler Depression Score 
• Anxiety symptoms are often prominent in postnatal depression 
• It is important to treat postnatal depression when it occurs to prevent long-term effects on mother and baby 
• More information can be found here 

PTSD

• Most births are not traumatic, but up to 6% of women may develop symptoms of PTSD after childbirth 
• PTSD can have serious consequences including panic attacks, depression and anxiety, sexual dysfunction, difficulties in attachment and bonding, and family breakdown 
• There may also be consequences for the woman's reproductive future- she may choose not to have any more children, or request a Caesarean birth with her next baby in an attempt to avoid repeating the trauma 
• Counselling and emotional support are very important 
• More information can be found here 

Puerperal psychosis 

• Puerperal psychosis is a rare but "not to be missed" psychiatric emergency, as it can have serious consequences for both the mother and the baby 
• It usually occurs in the first 2-3 weeks postpartum, but can occur later 
• The duration of the ilness is variable 
• Women with pre-existing mental health disorders are at higher risk of puerperal psychosis, especially those with bipolar disorder
• Early symptoms may include insomnia, mood fluctuations, confusion, restlessness, and obsessive concerns about the newborn. Late symptoms can include delusions, mania, disinhibition, hallucinations, extremes of behaviour, disorganised thoughts, and suicidal and infanticidal ideations 
• All women require psychiatric input and may need admission to a specialised "mother and baby" unit for treatment 
• More information can be found here